1 MR. BOSSO: HELLO, EVERYONE COULD WE GET YOUR ATTENTION, PLEASE. IF WE COULD HAVE EVERYONE KIND OF NUDGE EACH OTHER WE'RE A BIT BEHIND SCHEDULE ALREADY AND WE NEED TO GET MOVING WITH THE PROGRAM. SO IF YOU COULD PLEASE SETTLE AT YOUR TABLES. WE HAVE THE FORTUNE HERE TO HAVE CHRISTINE YOSHINAGA-ITANO HERE TODAY WITH US. KIND OF FUNNY, I DON'T EVEN FEEL LIKE I NEED TO INTRODUCE HER BECAUSE SHE'S SO WELL KNOWN ALL OVER THE COUNTRY FOR HER WORK THAT I'M SURE MANY OF US WERE TALKING LAST NIGHT THAT, YOU KNOW, WE ARE CONSTANTLY LOOKING ON GOOGLE ON THE WEB FOR RESEARCH AND TO HER FOR EARLY INTERVENTION FOR EARLY IDENTIFICATION FOR NEWBORNS. SO SHE'S A WONDERFUL SUPPORT FOR AND ADVOCATE FOR OUR PROFESSION. WE'RE HERE FOR HER TO SHARE SOME OF HER OBSERVATIONS AND SOME OF THE WORK THAT'S HAPPENING OUT IN OUR FIELD AND WHAT'S REALLY SUCCESSFUL OUT IN THE FIELD. AND THE LESSONS THAT WE'VE 2 LEARNED FROM HER AND THEN LOOKING AT THE PROGRAMS. SO WITHOUT MUCH ADO, HERE WE ARE WITH CHRISTINE YOSHINAGA-ITANO. DR. YOSHINAGA-ITANO: IS THIS WORKING? FROM THE FLOOR: YES. DR. YOSHINAGA-ITANO: I REALLY STRUGGLED WITH WHAT TO ACTUALLY PRESENT HERE. AND SO THERE ARE SOME SLIDES THAT ARE -- YOU DON'T HAVE. AND WHEN THEY PUT THE POWERPOINT UP ON THE WEBSITE, YOU WILL HAVE IT. BUT AFTER SOME OF THE QUESTIONS FROM ACTUALLY THE SUMMIT, THERE WERE LOTS OF QUESTIONS ABOUT COCHLEAR IMPLANTS AND AUDITORY VERBAGE. SO I PUT SOME OF THEM IN LATER, BUT THE THEY WON'T BE IN YOUR HANDOUT AND I APOLOGIZE FOR THAT. ALL OF YOU PROBABLY KNOW, BECAUSE YOU HAVE HAD CONNECTION WITH YOUR EHDI, EARLY HEARING DETECTION AND INTERVENTION COMMITTEES IN YOUR STATE THAT THERE HAS ACTUALLY BEEN SOME SIGNIFICANT PROGRESS IN TERMS OF SCREENING OF NEWBORNS. SO LAST YEAR AND THE YEAR BEFORE WE'VE BEEN 3 REPORTING THAT 92 TO 95 PERCENT OF ALL THE BABIES BORN IN THE UNITED STATES, THERE ARE FOUR MILLION BABIES BORN EVERY YEAR, ARE BEING SCREENED FOR HEARING WITHIN ONE MONTH AFTER THEIR BIRTH. MOST OF THEM BEFORE HOSPITAL DISCHARGE. THAT'S A GOOD THING. BUT THERE ARE SOME REALLY BIG PROBLEMS THAT HAVE EMERGED SINCE THAT TIME. WE KNOW THAT THE INCIDENTS OF HEARING LOSS, THAT THE PROGRAMS THAT HAVE DONE A GOOD JOB IN SCREENING AND FOLLOW-THROUGH, THAT WE SHOULD BE IDENTIFYING BETWEEN TWO TO THREE CHILDREN PER THOUSAND BIRTHS WITH CONGENITAL HEARING LOSS. AND THAT RANGES FROM PROFOUND DEAFNESS ALL THE WAY TO UNILATERAL HEARING LOSS THAT CAN BE MILD OR BORDERLINE. NOW, HERE'S THE PROBLEM. WE ONLY HAVE DATA THAT SAYS WE'RE IDENTIFYING ONE OUT OF EVERY THOUSAND BABIES. AND THESE ARE WHAT THE STATES ARE REPORTING TO THE CENTER FOR DISEASE CONTROL. SO WHAT THAT MEANS IS THAT WE ARE LOSING 4 OVER 50 PERCENT OF THE BABIES THAT ARE SCREENED AT THE NEWBORN PERIOD. AND THIS IS ONLY THE BEGINNING OF THE LOSS; OKAY? SO THIS IS THE FOLLOW THROUGH TO DIAGNOSIS OF HEARING LOSS. PART OF THE PROBLEM IS THE DATA MANAGEMENT. BUT IT'S NOT THE WHOLE PROBLEM. THE HOSPITALS TRACKING SYSTEMS CAN'T TRACK INDIVIDUAL BABIES IN SOME OF THE STATES. AND THAT'S A PROBLEM. AND WHAT THEY'RE REPORTING IS THE TOTAL NUMBER SCREENED, THE TOTAL NUMBER REFERRED, AND THE TOTAL NUMBER THAT PASSED. WE'RE HAVING PROBLEMS ALL OVER THE UNITED STATES WITH PHYSICIANS NOT AGGRESSIVELY INFORMING THEIR FAMILIES THAT THEY NEED TO RETURN FOR FOLLOW THROUGH. AND SOME OF THE PROBLEM IS BECAUSE THE SCREENING PROGRAMS AREN'T HIGH QUALITY ENOUGH. THEY'RE REFERRING SO MANY BABIES, THAT MANY OF THE BABIES REALLY HAVE NORMAL HEARING AND THEY DON'T NEED EXTENSIVE TESTING. BUT THE PROTOCOLS ARE NOT BEING -- THEY DON'T 5 HAVE THE FIDELITY THAT WE WOULD LIKE THEM TO HAVE. WE HAVE A BIG PROBLEM IN DIAGNOSING THE HEARING LOSS. BECAUSE IN MANY OF YOUR STATES, THERE AREN'T CENTERS OF EXCELLENCE THAT HAVE STRONG PEDIATRIC AUDIOLOGISTS. AND SO THEY'RE GOING ALL OVER THE STATE TO PEOPLE WHO REALLY DON'T HAVE THE EXPERTISE TO DIAGNOSE THE HEARING LOSS IN THE INFANT PERIOD. AND SO EITHER THEY'RE DOING INAPPROPRIATE DIAGNOSTIC EVALUATIONS OR THEY'RE NOT ACTUALLY GETTING APPOINTMENTS IN THE RIGHT PLACE. AND THEN, IF YOU HAVE A STATE AND YOU HAVE -- I DON'T KNOW, MAYBE SEVERAL DOZEN DIFFERENT PEOPLE OR EVEN AS MANY AS 50 DIFFERENT SITES THAT ARE DIAGNOSING DEAFNESS AND HEARING LOSS, THEY'RE NOT REPORTING THAT DATA TO THE STATE DEPARTMENT. SO WE DON'T KNOW WHETHER THE BABIES ACTUALLY CAME BACK OR NOT. THE OTHER PROBLEM IS THAT EVEN WHEN WE -- EVEN WHEN THE AUDIOLOGIST IDENTIFIES DEAFNESS AND HEARING LOSS, 6 THEY DON'T KNOW WHO TO REFER THE BABIES TO. SO THEY'RE NOT GETTING INTO EARLY INTERVENTION. SO PART OF THE PROBLEM IS THAT THERE'S MANY, MANY DIFFERENT PROFESSIONALS THAT INTERACT WITH THESE FAMILIES FROM THE BIRTHING PERIOD. AND THEY DO NOT UNDERSTAND THE URGENCY. THEY THINK WE HAVE PLENTY OF TIME AND THAT THERE'S NO PROBLEM WITH FAMILIES GETTING LOST IN THE SYSTEM FOR -- ACTUALLY, MANY OF THE STATES ARE REPORTING THAT IT COULD BE 12 TO 18 MONTHS AFTER THE REFERRAL FROM THE HOSPITAL SCREENING BEFORE THEY EVER END UP IN A DEAFNESS SPECIFIC INTERVENTION PROGRAM. SO THIS IS A HUGE PROBLEM. WE ARE CURRENTLY IDENTIFYING ONLY, ACCORDING TO THE CENTER FOR DISEASE CONTROL, 3,528 BABIES WITH HEARING LOSS IN THE INFANT PERIOD. WE SHOULD BE IDENTIFYING, MINIMALLY, 8,000, RIGHT, AND PROBABLY MORE LIKE 12,000 PER YEAR. SO WE HAVE A LOT OF WORK TO DO. OF THE 3,528 BABIES THAT WERE BORN IN 2006, ONLY HALF OF THOSE BABIES WERE 7 ACTUALLY IDENTIFIED BEFORE THREE MONTHS OF AGE. WHICH MEANS THAT THEY'RE LATE IDENTIFIED. SO EVEN THE ONES THAT WE KNOW ABOUT ARE NOT GETTING IDENTIFIED FAST ENOUGH FOR US TO DO EARLY INTERVENTION. NOW, FROM THE BABIES THAT WE HAVE BEEN ABLE TO IDENTIFY, AND THIS -- ACTUALLY, WE'VE BEEN TALKING TO THE UNITED KINGDOM, SEVERAL OF THE PROGRAMS THAT ARE ABLE TO ACTUALLY COLLECT DATA WHERE THEY ACTUALLY ARE GETTING THE BABIES, THIS IS WHAT IT LOOKS LIKE. FROM ALL THE BABIES THAT WE'RE IDENTIFIED, ABOUT 30 TO 40 PERCENT OF THEM HAVE A UNILATERAL HEARING LOSS. NOW, IN THE PAST, AUDIOLOGISTS WOULD SEND THOSE BABIES AWAY AND SAY OKAY; YOU HAVE ONE NORMAL EAR AND YOU HAVE ONE EAR WITH A HEARING LOSS, AND THEY JUST GAVE COUNSELING AND THEY DIDN'T GIVE ANY TREATMENT. THE PROBLEM IS THAT THOSE UNILATERAL HEARING LOSSES ARE AT VERY HIGH RISK FOR BILATERAL LOSS WITHIN THE FIRST YEAR OF LIFE. 8 AND SO WE'RE SEEING ABOUT 20 PERCENT, ONE OUT OF EVERY FIVE -- AND OUR DATA IS NOT ACTUALLY AS GOOD AS IT COULD BE, SO IT COULD BE MORE THAN THAT. BUT ONE OUT OF EVERY FIVE WITHIN THE FIRST TWO TO THREE YEARS, MOST OF IT IN THE FIRST YEAR, ARE BECOMING BILATERAL HEARING LOSS. SO IF THEY'RE NOT FOLLOWED, WE LOSE THOSE BABIES TOO. OF THE BILATERAL HEARING LOSS CHILDREN, WE HAVE ABOUT 30 PERCENT OF THEM THAT ARE MILD AND MODERATE, WE HAVE 30 PERCENT OF THEM THAT ARE MODERATE SEVERE SEVERE, AND WE HAVE 30 PERCENT OF THEM THAT WE WOULD HAVE CLASSIFIED BY AUDIOGRAM, WHICH WE KNOW IS NOT A GOOD WAY TO CLASSIFY THEM, AS DEAF. TEN PERCENT OF THAT POPULATION IS PROFOUND. AND ACCORDING TO CRITERIA FOR COCHLEAR IMPLANT, ONLY TEN PERCENT ARE EVEN CANDIDATES FOR CONSIDERATION. OF THAT AMOUNT OF OUR SEVERE TO PROFOUND CATEGORIES, FIVE PERCENT OF THOSE FAMILIES ARE DEAF DEAF IN THE REPORTS THAT WE HAVE. 9 NOW, AGAIN, YOU HAVE TO REMEMBER THAT WE DON'T HAVE GOOD DATA COLLECTION. SO SOME OF THESE NUMBERS COULD BE LOW FROM WHAT YOU MIGHT KNOW FROM THE STATES THAT YOU'RE WORKING IN. WE CURRENTLY HAVE ABSOLUTELY NO DATA, EXCEPT FOR FOR IN INDIVIDUAL STATES, ABOUT WHETHER OR NOT CHILDREN THAT ARE RECOMMENDED FOR AMPLIFICATION ACTUALLY GET THEIR AMPLIFICATION AND THE AGES AT WHICH THEY GET AMPLIFICATION. BUT WE KNOW THERE'S AN EVEN BIGGER PROBLEM THAN THAT AND THAT IS THAT AUDIOLOGISTS EVERYWHERE IN THE UNITED STATES ARE WAITING UNTIL THEY GET THE AMPLIFICATION BEFORE THEY REFER TO EARLY INTERVENTION. NOW THAT IS AN ABSOLUTE -- THAT IS AGAINST ALL OF OUR BEST PRACTICE DOCUMENTS ON WHAT THEY SHOULD BE DOING. FROM THE IDENTIFICATION OF HEARING LOSS WITHIN 48 HOURS OF WHETHER OR NOT THEY HAVE HEARING AIDS OR NOT, THEY SHOULD BE REFERRING TO THE EARLY INTERVENTION PROGRAM. THAT, I CAN TELL YOU, IS ONLY 10 OCCURRING IN A FEW STATES THROUGHOUT THE UNITED STATES. SO HERE'S WHERE IT GETS EVEN WORSE; RIGHT? OF THE 1,700 THAT WE HAVE DIAGNOSED BEFORE THREE MONTHS OF AGE, ONLY 46 PERCENT ARE ENROLLED IN AN EARLY INTERVENTION PROGRAM BEFORE SIX MONTHS. AND WE CAN'T EVEN TELL YOU THAT THE INTERVENTION PROGRAM THAT THEY'RE ENROLLED IN IS A DEAFNESS SPECIFIC SYSTEM. AND I CAN ACTUALLY TELL YOU THAT THAT IS PROBABLY NOT HAPPENING. AND IT'S PROBABLY ONLY A SMALL PERCENTAGE OF THE 46 PERCENT THAT ARE ACTUALLY BEING ENROLLED IN A DEAFNESS SPECIFIC SYSTEM. SO ACCORDING TO OUR DATA, WE HAVE 782 INFANTS IN THE UNITED STATES ENROLLED IN EARLY INTERVENTION BEFORE SIX MONTHS OF AGE. WE KNOW FROM OUR OWN DATA IN COLORADO THAT OVER A HUNDRED OF THEM COME FROM THE STATE OF COLORADO. I THINK ABOUT 600 COME FROM THE STATE OF CALIFORNIA. AND EITHER PEOPLE AREN'T REPORTING OR THEY'RE NOT GETTING TO 11 EARLY INTERVENTION. SO IF IT WEREN'T FOR CALIFORNIA, WE PROBABLY WOULD HAVE NO REPORTING AT ALL OF WHO GETS INTO INTERVENTION BY SIX MONTHS OF AGE. AND I CAN TELL YOU WHAT SOME OF THE PROBLEMS ARE. I REALLY WOULD LIKE YOU TO BECOME FAMILIAR WITH THE JOINT COMMITTEE ON INFANT CARING 2007 STATEMENT. THANK HEAVENS FOR CEAED'S REPRESENTATION ON THAT COMMITTEE. BETH BENEDICT AND BOBBY SKOGGINS HELPED ME PUSH FORWARD SOME THINGS ON THAT DOCUMENT THAT I CAN TELL YOU IF IT WERE LEFT UP TO THE OTOLARYNGOLOGISTS, THE PEDIATRICIANS, THE AUDIOLOGISTS AND THE SPEECH LANGUAGE PATHOLOGISTS, YOU WOULDN'T HAVE ANYTHING OF THESE THINGS ON THERE. IT SAYS IN THE DOCUMENT THAT BEST PRACTICE IS THAT EARLY INTERVENTION SHOULD BE PROVIDED BY SPECIALISTS IN DEAFNESS AND HEARING LOSS. THAT'S NOT HAPPENING. ALMOST ALL OF THE EARLY INTERVENTION SERVICES PROVIDED FOR THESE BABIES IS 12 BEING PROVIDED BY SPEECH LANGUAGE PATHOLOGISTS. AND I CAN PROBABLY TELL YOU THAT THE VAST PROPORTION OF THOSE SPEECH LANGUAGE PATHOLOGISTS HAVE NO SIGN LANGUAGE ABILITY WHATSOEVER. THEY ALSO DON'T HAVE A WHOLE LOT OF EXPERIENCE EVEN WITH ORAL DEAF AND HARD OF HEARING BABIES. BECAUSE THEY HAVE NOT -- THEY'RE GENERALISTS. THEY HAVE NOT SPECIALIZED IN DEAF AND HARD OF HEARING SERVICES. SOME OF THE BABIES -- AND ACTUALLY IT'S PROBABLY A HUGE PORTION, ALMOST EQUAL TO THE SPEECH LANGUAGE, ARE GOING INTO EARLY CHILDHOOD SPECIAL ED SERVICES PART C. AND THESE ARE INDIVIDUALS WHO HAVE NEVER HAD A COURSE EVEN ON DEAFNESS OR HEARING LOSS. THEY HAVE NEVER SEEN AN AUDIOLOGICAL REPORT. THEY HAVE MAYBE NEVER EVEN MET A DEAF OR HARD OF HEARING PERSON, AND THEY HAVE NO KNOWLEDGE WHATSOEVER. THEY'RE THE FIRST CONTACT. THAT'S WHAT'S HAPPENING THROUGHOUT THE UNITED STATES. VERY, VERY FEW AS YOU HEARD 13 YESTERDAY OF THE SERVICES ARE ACTUALLY BEING PROVIDED BY EARLY INTERVENTION PROVIDERS WHO ARE DEAF OR HARD OF HEARING. AND EVEN FEWER ARE BEING PROVIDED BY ANY EARLY INTERVENTION PROVIDERS FROM ANY ETHNIC RACIAL GROUP THAT IS NOT CAUCASIAN. AND AS YOU KNOW, THE ENROLLMENTS OF OUR SPANISH SPEAKING POPULATION AND AFRICAN AMERICAN POPULATION AND IN SOME PARTS OF THE UNITED STATES NATIVE AMERICAN POPULATION ARE VERY VERY LARGE POPULATION. IF YOU WANT TO GET TRUST RELATIONSHIPS WITH THOSE FAMILIES, IT'S NOT GOING TO HAPPEN UNLESS YOU HAVE A CULTURALLY COMPETENT PERSON GOING INTO THEIR HOME. SO THE BIGGEST PROBLEM THAT WE HAVE IS THAT WITH THOSE FAMILIES, THEY'RE BEING IDENTIFIED IN COLORADO EARLY, BUT WE CAN'T GET THEM INTO INTERVENTION UNTIL AFTER SIX MONTHS OF AGE. THE URGENCY ISSUE FOR THEM IS NOT THE SAME AS IT IS FOR OTHER FAMILIES. WE'RE GETTING BETTER, BUT ONLY IF WE USE INDIVIDUALS WHO ARE TRAINED FROM THE ETHNIC 14 COMMUNITIES THAT THEY'RE COMING FROM. SO WHO ARE WE NOT -- I MEAN, WE'RE LOSING ALL OF THESE BABIES IN A LOT OF PLACES. THE UNILATERAL HEARING LOSS POPULATION GETS LOST A LOT AND NOT REPORTED. THE BORDERLINE MILD HEARING LOSS KIDS GET LOST. THIS IS ANOTHER PROBLEM, BECAUSE WE ALSO KNOW THAT 20 PERCENT OF THE KIDS THAT WE FOLLOW GET WORSE IN THEIR HEARING, FROM THE NEWBORN PERIOD IN THE FIRST THREE YEARS OF LIFE. WHICH MEANS THAT THEY MAY START OUT WITH MILD HEARING LOSS, AND BY 12 MONTHS THEY MAY HAVE A SEVERE TO PRONOUNCED HEARING LOSS. SO JUST BECAUSE THEY'RE MILD HEARING LOSS AT BIRTH DOESN'T MEAN THAT THEY'RE NOT GOING TO BE ENROLLED IN OUR DEAFNESS SPECIFIC PROGRAMS WITHIN A VERY, VERY SHORT PERIOD OF TIME. WE HAVE SOME CHILDREN THAT HAVE WHAT WE CALL AN AUDITORY NEURAL HEARING LOSS, MEANING THEY CAN HEAR BUT THEIR NEURAL PATHWAYS ARE NOT SUFFICIENT FOR UNDERSTANDING LANGUAGE. AND THESE ARE CHILDREN WHOSE VISUAL SYSTEMS AND 15 COMMUNICATION HAVE BEEN VERY, VERY HIGHLY SUCCESSFUL. HEARING AIDS HAVE NOT BEEN VERY SUCCESSFUL WITH THESE CHILDREN. IT CAN HELP, BUT THEY'RE NOT WHAT WE WOULD CALL SUCCESSFUL. BUT EVEN COUNTING ALL OF THOSE POPULATIONS, THAT DOESN'T -- THAT DOESN'T REPRESENT 50 PERCENT OF THE CHILDREN THAT WE ARE NOW LOSING. SO WE KNOW ALSO THAT THE KIND OF SERVICES THAT THEY'RE GETTING IS THEY'RE GOING INTO THE PART C SYSTEM. AND I KNOW I'VE TALKED TO A LOT OF REPRESENTATIVES ACROSS THE STATES FOR THE DEAF AND BLIND. AND MANY OF YOU ARE TELLING ME THAT THERE'S A 12 TO 18-MONTH LAG BETWEEN THE TIME THAT THEY'RE IDENTIFIED AND YOU ACTUALLY GET THEM. BECAUSE THEY'RE IN GENERIC COUNSELING SERVICES. NOW, WE DO KNOW FROM THE RESEARCH THAT THE THING THAT HELPS GRIEVING THE MOST FOR PARENTS IS INFORMATION AND DATA. THE PART C COORDINATORS, UNLESS IT'S A DEAFNESS SPECIFIC PART C SYSTEM, 16 CAN'T POSSIBLY PROVIDE THAT INFORMATION FOR PARENTS. IT'S IMPOSSIBLE BECAUSE THEY JUST DON'T KNOW -- THEY DON'T HAVE THAT DATA. 7.7 PERCENT ARE NON PART C. NOW, I'M THINKING THAT THOSE ARE OUR DEAFNESS SPECIFIC PROGRAMS. PRESUMABLY, THE REMAINDER OF THOSE THAT ARE NOT REPORTED IN EITHER OF THOSE TWO CATEGORIES ARE GOING TO PRIVATE SERVICES. AND MANY OF THOSE FAMILIES ARE NOT EVEN GETTING THE INFORMATION THAT PUBLIC SERVICES ARE AVAILABLE AND THAT THEY'RE AVAILABLE FOR FREE TO MANY OF THESE FAMILIES. SO THIS IS A HUGE PROBLEM. WE'RE GOING TO START -- HOPEFULLY WE WILL COLLECT DATA TO FIND OUT HOW MANY OF THESE PART C SYSTEMS ACTUALLY HAVE SOME DEAFNESS SPECIFIC -- A COMPONENT OF THEIR PART C PROGRAM. AND YOU MAY KNOW THAT. YOU MAY BE WORKING WITH YOUR PART C SYSTEMS IN YOUR STATES, BUT IT'S A HUGE PROBLEM. SO THIS IS WHAT THE STATE IS NOW FROM SCREENING. FOR EVERY HUNDRED DEAF 17 AND HARD OF HEARING NEWBORNS, ONLY 50 OF THEM WILL BE IDENTIFIED BEFORE -- WELL, ACTUALLY, ONLY 50 OF THEM WILL BE IDENTIFIED, PERIOD. OF THESE 50 KIDS, ONLY HALF OF THEM ARE GOING TO BE IDENTIFIED BEFORE THREE MONTHS OF AGE. AND OF THE 50, 32 OF THEM WILL BE REFERRED TO EARLY INTERVENTION, BUT ONLY 15 OF THEM WILL ACTUALLY START BEFORE SIX MONTHS OF AGE. NOW, OUR ENTIRE SCREENING EFFORT IS GOING TO COMPLETELY FAIL IF WE CAN'T IMPROVE THESE STATISTICS. BECAUSE BASICALLY, WE'RE ENDING UP WITH ALMOST OVER 80 PERCENT OF THE BABIES ARE NOT GETTING EARLY INTERVENTION. I DON'T HAVE TO TELL YOU THAT THE IDENTIFICATION AND THE SCREENING ARE ONLY THE FIRST STEP. THEY'RE REALLY NOT THAT IMPORTANT IF WE CAN'T GET THEM TO APPROPRIATE INTERVENTION. I ALSO KNOW THAT MANY OF YOU HAVE HAD GREAT FRUSTRATIONS WORKING WITH YOUR EHDI COMMITTEES, AND I AM PLEADING WITH YOU NOT TO GIVE UP. I KNOW HOW 18 FRUSTRATING SOME OF THOSE MEETINGS CAN BE AND EVEN DEMEANING BECAUSE OF THE LACK OF KNOWLEDGE PEOPLE HAVE ABOUT DEAFNESS. BUT IF YOU DON'T STAY AT THIS TABLE, WE'RE NEVER GOING TO IMPROVE THESE STATISTICS. AND THEN ALL OF THE MONEY AND ALL OF THE EFFORT AND THE FUTURE OF THE KIDS WHO ARE DEAF AND HARD OF HEARING, WE'RE JUST NOT GOING TO SUCCEED IN DOING WHAT WE KNOW WE CAN DO. WE'VE GOT TO GET BETTER DATA MANAGEMENT. SO IF YOU ARE NOT REPORTING TO THE STATE EHDI SYSTEM, YOU NEED TO REPORT. BECAUSE IT'S ONLY WITH DATA THAT WE'RE GOING TO BE ABLE TO FORCE THE SYSTEM TO CHANGE. AND THE PART THAT I WANT YOU TO FOCUS ON IN YOUR STATES, PLEASE, IS THAT THE JOINT COMMITTEE ON INFANT HEARING RECOMMENDED A SINGLE POINT OF ENTRY AS BEST PRACTICE. AND LET ME EXPLAIN TO YOU WHAT BEST PRACTICE IN A MEDICAL SYSTEM IS. IT'S A STANDARD OF CARE PROTOCOL THAT WAS APPROVED BY OTOLARYNGOLOGY, PEDIATRICS, DEAF EDUCATION, AUDIOLOGY, 19 SPEECH LANGUAGE PATHOLOGY AS WHAT SHOULD HAPPEN. THERE SHOULD BE A POINT OF ENTRY IN WHICH ALL OF THE REFERRALS ARE MADE TO ENSURE THAT THE CHILDREN GET INTO -- AND IN THE JOINT COMMITTEE DOCUMENT IT SAYS -- DEAFNESS SPECIFIC SERVICES. SO WE ARE NOT LOOKING FOR GENERIC EARLY CHILDHOOD SERVICES. WE WANT EXPERTS AT THE VERY BEGINNING TO BE INTERACTING WITH THESE FAMILIES. YOU ALREADY KNOW THIS. WHY ARE WE EVEN BOTHERING? BECAUSE IT'S GREATER PROBABILITY OF GOOD LANGUAGE DEVELOPMENT, GOOD SOCIAL/EMOTIONAL DEVELOPMENT AND GOOD AUDITORY SKILL AND SPEECH DEVELOPMENT. SO NOW, THE PROGRAMS THAT ARE WORKING -- ACTUALLY, THERE ARE DIFFERENT MODELS. LIKE IN CALIFORNIA, IT'S NOT GOING THROUGH THE STATE SCHOOL FOR THE DEAF AND BLIND. THEY HAVE A DEAF AND HARD OF HEARING COORDINATOR AT THE STATE DEPARTMENT OF EDUCATION. A LOT OF THE OTHER STATES, AND THERE ARE ONLY A FEW OF THEM THAT HAVE A SINGLE POINT OF 20 ENTRY, IT IS GOING THROUGH THEIR STATE SCHOOL FOR THE DEAF AND BLIND. FOR INSTANCE, IN COLORADO, OUR SINGLE POINT OF ENTRY IS THE STATE SCHOOL FOR THE DEAF AND BLIND, AND WE HAVE 300 BABIES FROM BIRTH THROUGH THREE ENROLLED IN THE STATE SCHOOL FOR THE DEAF AND BLIND. NOW, THEY'RE NOT ON-SITE BECAUSE ALL OF OUR SERVICES ARE IN THE HOME. BUT IT'S ALL COORDINATED AND REPORTED THROUGH THE STATE SCHOOL TO THE STATE DEPARTMENT OF HEALTH. IF WE DON'T HAVE A SYSTEM LIKE THIS, WE'RE GOING TO LOSE THE DATA. AND WE'RE PROBABLY NOT JUST LOSING THE DATA, WE'RE LOSING THE BABIES. IT'S REALLY IMPORTANT FOR YOU TO FOCUS ON THE FACT THAT THE ONLY THING THAT'S BEEN ENDORSED IS A DEAFNESS AND HEARING LOSS SPECIFIC SYSTEM, NOT A GENERIC SYSTEM. BECAUSE REMEMBER THAT ALL THE SPECIAL ED IS GOING NONCATEGORICAL. SO FOR US TO BE ABLE TO GET THIS APPROVED BY EVERY PROFESSIONAL ORGANIZATION IS REALLY A KU. BUT I 21 THINK THEY DIDN'T UNDERSTAND IT. BECAUSE I THINK IF THEY DID UNDERSTAND IT, WE MIGHT HAVE HAD MORE FIGHTS ABOUT IT. BUT THEY DON'T UNDERSTAND THE EDUCATIONAL SYSTEM. THERE ARE TWO PUBLIC DOCUMENTS THAT ARE SUPPORTING THIS, AND WE'RE HOPING FOR EVEN MORE DOCUMENTS THAT -- BUT THE JOINT COMMITTEE ON INFANT HEARING IS WHAT YOUR EHDI SYSTEMS ARE USING AS THE BEST PRACTICE DOCUMENT. SO THE WAY IT WORKS IN COLORADO IS THAT WE HAVE -- COLORADO CREATED THIS SINGLE POINT OF ENTRY WHICH IS CALLED THE COLORADO HEARING COORDINATOR. THEY ARE EMPLOYEES OF THE COLORADO STATE SCHOOL FOR THE DEAF AND BLIND. THEY ARE THE FIRST CONTACT. AND WE -- UNLIKE CALIFORNIA THAT HAS ONE PERSON, WE HAVE ACTUALLY ONE PERSON IN EVERY REGION. THIS PERSON CONTACTS THE FAMILY WITHIN 48 HOURS OF THE DIAGNOSIS. AND THEY PROVIDE THE BEGINNING OF EARLY INTERVENTION SERVICES WHICH AMOUNTS TO ABOUT TEN HOURS OF CONTACT. AND DURING 22 THAT TIME, THEY'RE GIVING THE RESOURCES OF THE STATE AND THE BASIC INFORMATION FOR THE FAMILIES TO BEGIN MAKING THE DECISIONS ON WHICH PROGRAM THEY WANT TO ENROLL IN. I WILL TELL YOU THAT BECAUSE THE STATE SCHOOL PROGRAM, THE CHIP PROGRAM, IS A FREE SERVICE, THAT 90 PERCENT OF THE FAMILIES DO GO THROUGH THAT SYSTEM. NOW, THEY MAY ADD TO IT SOME OF THE PRIVATE SERVICES, BUT ALMOST ALL OF THE FAMILIES ARE ENROLLED IN OUR PROGRAM. WE STRUGGLE TO INCREASE DIVERSITY. WE HAVE FIVE DEAF AND HARD OF HEARING EARLY INTERVENTION PROVIDERS. AND WE HAVE AN INCREASING NUMBER OF SPANISH SPEAKING AND SPANISH-LATINO PROVIDERS. I DON'T THINK WE HAVE ANY AMERICAN INDIAN PROVIDERS AT THE CURRENT TIME. WE ALSO HAVE A GUIDE BY YOUR SIDE, AND THE PARENTS ARE ALSO PUSHING THE DEAFNESS SPECIFIC SERVICES. AND THAT ACTUALLY IS AN AGENDA OF THE HANDS AND VOICES CHAPTERS. AND SO IF THEY'RE NOT PUSHING IT IN YOUR STATE, THEY SHOULD BE 23 PUSHING IT. BECAUSE WE NEED EVERYBODY WHO'S INVOLVED IN THE SYSTEM TO BE CONSISTENT ON THE MESSAGES THAT WE PROVIDE. WE'RE NOW ACTUALLY THE ONLY STATE THAT CAN GO FROM SCREENING TO OUTCOME. SO WE HAVE -- WE'RE SCREENING 95 PERCENT OF OUR POPULATION. WE HAVE AN 80 PERCENT FOLLOW THROUGH, MEANING THAT THEY ARE DIAGNOSED BY THREE MONTHS OF AGE. SO THE AVERAGE IN OUR STATE IS FROM FOUR TO SIX WEEKS. AND INTERVENTION HAPPENS WITHIN 48 HOURS AFTER THE DIAGNOSIS. WE ARE ENROLLING 80 PERCENT OF OUR INFANTS BEFORE SIX MONTHS. MOST OF THEM ARE ENROLLED AT ABOUT SIX TO EIGHT WEEKS. AND SOME OF THEM CHOOSE NOT TO, PARTICULARLY SOME OF THE PARENTS WITH UNILATERAL HEARING LOSS. WE DOCUMENT THE DEVELOPMENTAL OUTCOMES, AND WE HAVE -- YOU'VE READ SOME OF THE ARTICLES THAT I THINK I'VE PRESENTED BEFORE THAT THE CHILDREN WITH NORMAL COGNITIVE, EARLY IDENTIFICATION, 24 DEAFNESS SPECIFIC SERVICES FROM THE BEGINNING ARE MAINTAINING AGE APPROPRIATE AND COGNITIVELY APPROPRIATE DEVELOPMENT. IT'S STILL NOT AT THE MEAN OF NORMAL HEARING CHILDREN. BUT IT IS ABOVE THE LEVEL OF QUALIFICATIONS FOR SPECIAL ED BY LANGUAGE. WHAT WE'RE GOING TO START ASKING PROGRAMS TO DO, BECAUSE THEY HAVE NOT BEEN DOING THIS BEFORE, IS TO TELL US THE AGE OF ENROLLMENT INTO THEIR EARLY INTERVENTION PROGRAM AND WHAT KIND OF PROGRAM THE BABIES ARE ENROLLED IN. BUT I'M TELLING YOU THAT MOST STATES CAN'T DO THIS. THEY DON'T KNOW THE PROFESSIONAL EXPERTISE OF THE PROVIDERS. MOST OF THEM CAN'T TELL ME THE QUANTITY OR THE FREQUENCY OF SERVICE. AND ALMOST NONE OF THEM CAN TELL ME WHAT THE DEVELOPMENTAL OUTCOMES OF THE BABIES ARE. SO THESE ARE -- SOME OF YOU ASKED ME CAN I PROVE THAT THIS PARTICULAR SINGLE ASPECT CREATES GOOD OUTCOMES? WELL, I CAN'T. I CAN TELL YOU WHAT OUR PROGRAM 25 IS IN COLORADO AND THAT WE HAVE SUCCESSFUL OUTCOMES. AND THESE ARE THE COMPONENTS OF THE PROGRAM. WE HAVE A DEAFNESS SPECIFIC PROGRAM. WE DO OUR DEVELOPMENTAL OUTCOME REPORTING. WE HAVE PARENT-TO-PARENT SUPPORT. AND THIS IS ALSO IN THE JCIH DOCUMENT. I CAN TELL YOU THERE ARE VERY VERY FEW STATES THAT HAVE IT. DEAF ROLE MODEL AND MENTORSHIP STATE SYSTEM WIDE SERVICES. AND I DON'T KNOW IF I WERE TO ASK IN THIS ROOM HOW MANY IN YOUR STATE HAVE A DEAF ROLE MODEL MENTORSHIP PROGRAM STATE WIDE THAT IS GUARANTEED FOR ALL EARLY IDENTIFIED CHILDREN IN THE STATE RATHER THAN UNILATERAL DEAFNESS, THERE ARE PROBABLY NOT MANY OF YOU. YOU HAVE TO FIGHT FOR THIS, BECAUSE I CAN'T BE THIS THERE IN EVERY ONE OF YOUR STATES TO FIGHT FOR IT. BUT IT SHOULD BE BE COMING. THE EXPERTISE COMES FROM THE STATE SCHOOLS FOR THE DEAF AND BLIND. IF ARE THEY'RE NOT INVITING YOU, YOU NEED TO PUSH YOUR WAY IN. BECAUSE WE ALSO HAVE IN THE JCIH 26 DOCUMENT THAT ALL DECISION MAKING FOR EDHI SHOULD HAVE REPRESENTATION FROM DEAF AND HARD OF HEARING COMMITTEES. ALL OF OUR SIGN LANGUAGE -- AND ACTUALLY, THIS WAS A BIG BATTLE IN OUR STATE. ALL OF OUR SIGN LANGUAGE INSTRUCTION IS DONE WITH DEAF AND SOME HARD OF HEARING NATIVE AND FLUENT SIGN LANGUAGE INSTRUCTORS. WE DO HAVE SOME CODAS, BUT THAT'S A MINORITY. NOW, WHEN I SAY THIS WAS A BATTLE, I DON'T KNOW IF YOU'D BE SURPRISED NOW WE'VE HAD THIS FOR A LONG TIME. BUT THE PEOPLE WHO OPPOSED IT THE MOST WERE OUR DEAF EDUCATORS AND HEARING DEAF EDUCATORS. BECAUSE THEY DIDN'T THINK WE NEEDED TO HAVE DEAF FLUENT NATIVE SIGNERS. AND WE USE THE LINGUISTIC THEORY WHICH SAYS IF YOU'RE GOING TO INTRODUCE CHILDREN TO LANGUAGE, YOU NEED TO HAVE AN EXPERT FLUENT SYSTEM FROM THE VERY BEGINNING. AND SO WE HAD A DEAF COORDINATE AT THE SCHOOL FOR THE DEAF AND BLIND. SHE IS, I THINK, FOURTH GENERATION DEAF. SHE DID ALL THE HIRING AND FIRING. AND SHE 27 ALSO DEVELOPED MOST OF THE SIGN LANGUAGE CURRICULUM TO TEACH THE SIGN LANGUAGE INSTRUCTORS HOW TO WORK IN THE HOME WITH THESE BABIES. AND SHE WAS FIERCE. ACTUALLY, SHE ACTUALLY FIRED ONE YEAR THE PRESIDENT OF THE COLORADO ASSOCIATION FOR THE DEAF BECAUSE HE COULDN'T LEARN HOW TO WORK WITH BABIES AND TALK WITH BABIES. AND SHE DIDN'T FEEL LIKE, IN TERMS OF THE INSTRUCTION, PART -- HE WAS OBVIOUSLY FLUENT; RIGHT. BECAUSE THE REQUIREMENTS WERE THAT THEY HAD TO BE GOOD TEACHERS AND BE INTERACTIVE AND NO MATTER HOW SHE WORKED WITH HIM SHE FELT LIKE HE WASN'T MAKING ENOUGH PROGRESS. AND THEY ENDED UP WITH GREAT -- HE ACTUALLY AGREED THAT HE WASN'T A TEACHER, SO THAT WASN'T GOING TO WORK OUT. BUT I THINK WE MAY BE THE ONLY STATE IN THE NATION THAT ALL OF OUR SIGN LANGUAGE AND INSTRUCTION IS DONE IN THIS MANNER FOR ALL OF OUR FAMILIES. AND I DON'T KNOW WHETHER THAT'S -- I JUST DON'T KNOW WHAT'S BEING DONE IN OTHER 28 STATES. IT REQUIRED OUR SYSTEM TO HIRE AND CREATE JOBS FOR DEAF AND HARD OF HEARING INSTRUCTORS AND MENTORS AND ROLE MODELS. AND WE CAN HARDLY KEEP UP WITH THE DEMAND. I WOULD SAY 80 PERCENT OF ALL OF OUR FAMILIES ASK FOR A DEAF SIGN LANGUAGE INSTRUCTOR. A LOT OF THEM ARE NOT GOOD AT THEIR SIGN LANGUAGE. OUR DEAF -- HARD OF HEARING -- OR SIGN LANGUAGE INSTRUCTORS ACTUALLY EVEN WHEN THEY CAN SPEAK FLUENTLY, THEY GO INTO THE HOME WITHOUT AN INTERPRETER. THEY MAKE THIS DECISION. THEY ALSO DECIDED THAT THEY WOULD NOT TALK EVER TO THE FAMILY. AND THAT'S ACTUALLY BEEN REALLY REALLY GOOD. BECAUSE IF THE FAMILY THINKS THEY HAVE ANY SPEECH AT ALL, THEN THEY DON'T LEARN SIGN LANGUAGE AS FAST. SO THEY GO INTO THE HOME AND START THE COMMUNICATION, AND THEY'RE ONE OF THE FIRST VISITORS INTO THE HOME WHICH IS A REALLY WONDERFULL THING. THAT'S WHY WE HAVE MOST OF OUR COCHLEAR IMPLANT BABIES HAVE HAD SIGN 29 LANGUAGE INSTRUCTION FROM A DEAF PERSON. BY THE TIME THEY GET AN IMPLANT AT 12 MONTHS, THEY UNDERSTAND COMMENTS, QUESTIONS, EXPLANATION, COMMANDS. THEY'RE UNDERSTANDING SIMPLE PHRASES, THEY UNDERSTAND LITERACY, THEY HAVE VOCABULARY THEY UNDERSTAND. SO BY THE TIME THEY HAVE AN IMPLANT, THEY HAVE A LANGUAGE BASE. AND THAT'S ACTUALLY WHAT WE'RE LOOKING FOR. SO I WANT TO MOVE FROM THERE BECAUSE I WANTED YOU TO UNDERSTAND WHAT OUR BEGINNING SIGN LANGUAGE WAS SO THAT YOU CAN UNDERSTAND WHAT OUR COCHLEAR IMPLANT RESULTS ARE. I HAVE PUBLISHED THIS THOUGH NOT AS MUCH AS I'M SURE YOU WOULD HAVE LIKED. PART OF IT IS BECAUSE I HAVE A DOCTORATE STUDENT WORKING AND THEY'RE NOT VERY FAST. BUT BASICALLY THIS HAS BEEN PRESENTATIONS ON SPEECH PIGGY-BACKING ONTO SIGN LANGUAGE IN THE COCHLEAR IMPLANT POPULATION OR A FAST MAPPING FROM SIGN TO SPEECH. AND I WOULD SAY 30 THAT WE VERY RARELY -- ACTUALLY IN THE STATE OF COLORADO HAVE ANY OF OUR COCHLEAR IMPLANT BABIES THAT ARE NOT SIGNING. IN FACT, THE REASON I CAN'T COMPARE A STUDY IN OUR STATE IS THAT I CAN'T FIND BABIES THAT AREN'T GETTING SIGN LANGUAGE INSTRUCTION FROM A DEAF SIGN LANGUAGE INSTRUCTOR. SO I DON'T HAVE A GOOD ORAL -- I MEAN, AUDITORY VERBAL ONLY. AND OUR AUDITORY VERBAL THERAPISTS WORK WITH OUR DEAF SIGN LANGUAGE INSTRUCTORS IN THE FAMILY. NOW, THEY HAVE BEEN CRITICIZED BY AUDITORY VERBAL -- IN FACT, THEY HAVE EVEN TRIED TO TAKE AWAY THEIR CERTIFICATION. SO THEY HAVE HAD TO SAY THAT THEY ARE AUDITORY VERBAL THERAPISTS, THEY'RE NOT DOING AUDITORY VERBAL THERAPY BECAUSE AUDITORY VERBAL THERAPY HAS TO BE DONE WITHOUT SIGN LANGUAGE, BUT THEY'RE DOING AUDITORY SKILLS DEVELOPMENT WITH THESE CHILDREN, AND THEY'RE ALSO USING SIGN LANGUAGE. SO THAT'S HOW WE GOT AROUND IT. THIS WILL BE ON THE WEBSITE, BUT 31 THIS IS THE PRIMARY PUBLICATION WITHIN IN THE MARK AND SPENCER CHAPTER. THESE CHILDREN HAD TO PRE-IMPLANT TO BE IN THIS STUDY HAD TO SIGN 50 PERCENT OF THE TIME PRE-IMPLANT. AND I ALSO WANT TO SAY WHEN WE TALK ABOUT SIGN LANGUAGE, SOME OF THESE PARENTS ARE NOT GOOD SIGN LANGUAGE USERS, EVEN THOUGH THEY'VE HAD A REALLY GOOD INSTRUCTOR. THEY'RE PRETTY GOOD -- THE BEGINNING OF ALL THE CURRICULUM, MOST PARENTS WILL SAY WE'RE USING SIGN LANGUAGE BUT WE'RE GOING TO USE IT IN ENGLISH WORD ORDER. THAT'S WHAT THEY ALL SAY. AND THEY'RE VERY GOOD AT VOCABULARY LEARNING. THEIR DEAF INSTRUCTORS REALLY WORK ON THE PHONOLOGICAL FEATURES OF THE LANGUAGE, SO THEY USE FACIAL EXPRESS, BODY LANGUAGE AND HOW TO USE SPACE. AND THEY WORK ON BASIC PRAGMATICS OF THE LANGUAGE. SO THEY GET THAT REGARDLESS OF WHAT THEY SAY THAT THEY'RE GOING TO END UP USING WITH THE LANGUAGE. SO I NOW HAVE PROBABLY OVER 50 OF THESE BABIES. THEY ALL SHOW THE SAME 32 THING. THIS ONE, WE ONLY PUT IN THE STUDY KIDS WHO DIDN'T HAVE ADDITIONAL DISABILITY. AND WE'RE DOING VIDEOTAPES. SO ALL OF THE INFORMATION IS COMING OUT OF VIDEOTAPES WITH PARENT-CHILD INTERACTION. AND REMEMBER -- IF I DID IT WITH THE DEAF SIGN LANGUAGE INSTRUCTOR, WE WOULD GET A MUCH DIFFERENT INTERACTION THAN WITH THE HEARING PARENT. SO BASICALLY THESE -- THIS IS THE MEAN OF ALL OF OUR KIDS WHO WERE USING SIGN LANGUAGE AND GOT A COCHLEAR IMPLANT. THIS INCLUDES -- ACTUALLY, AT THIS POINT IN TIME, HALF OF THESE KIDS WERE LATE IDENTIFIED AND HALF OF THEM WERE EARLY IDENTIFIED. THE FIRST ONE IS HOW MUCH SPOKEN LANGUAGE THEY HAD PRE-IMPLANT. SO YOU CAN SEE IT'S WAY DOWN BY THE ZERO PERCENT; ONE OR TWO PERCENT. THEN THE SECOND ONE IS FIVE MONTHS POST-COCHLEAR IMPLANT, SIX TO 11 MONTHS POST. SO BY 36 MONTHS POST, A HUNDRED PERCENT OF OUR CHILDREN HAD COMPLETELY CHANGED, HAD COMPLETELY 33 MAPPED THEIR SIGN LANGUAGE -- THEIR SIGN LANGUAGE ONTO ORAL SPEECH. THIS IS THE FASTEST -- AN EXAMPLE OF THE -- SO IN EVERY GRAPH YOU'RE GOING TO SEE THAT MIDDLE GRAPH. AND THE -- OUR FASTEST CHILD WAS CHILD A. SO YOU CAN SEE THAT WITH ZERO PRE-IMPLANT AND BY FIVE MONTHS POST-IMPLANT, 80 PERCENT OF EVERY EVERYTHING THAT THE CHILD SAID IN THE LANGUAGE SAMPLE WAS IN ORAL SPEECH WITH THEIR HEARING PARENT. THE SLOWEST CHILD THAT WE HAD WAS WE WERE 11 MONTHS POST-COCHLEAR IMPLANT, THERE WAS NO ORAL SPEECH. BY -- AND I DIDN'T GET ALL OF THE ASSESSMENTS IN BETWEEN. BUT BY 30 MONTHS THE CHILD WAS NOW USING 60 PERCENT OF THEIR LANGUAGE WAS IN ORAL SPEECH. IT COULD HAVE BEEN USED WITH SIGN LANGUAGE. BUT TO BE REALLY HONEST, MOST OF OUR KIDS DON'T -- THEY EITHER USE SIGN LANGUAGE ONLY OR SPEECH ONLY BUT THEY'RE NOT USING SIGN AND SPEECH MOST OF THE TIME. I'M NOT GOING TO GO OVER ALL OF 34 THESE JUST BECAUSE OF TIME, BUT YOU CAN READ THESE WHEN THEY GO ON THE WEBSITE. WHAT YOU'LL SEE IS THE MEAN OF THE GROUP, AND THEN THERE WILL BE ONE CHILD. AND YOU'LL SEE THIS CHILD ZE WHO HAD COCHLEAR IMPLANT AT 13 MONTHS, EARLY IDENTIFIED, SO STARTED SERVICE BETWEEN SIX TO 18 WEEKS -- I MEAN SIX TO EIGHT WEEKS OF AGE. SO THE SIGN LANGUAGE INSTRUCTOR WAS IN HER HOME PROBABLY BY THREE MONTHS. SO BY THE TIME THIS CHILD HAD AN IMPLANT, HE HAD HAD TEN MONTHS OF IN-HOME EXPERIENCE WITH A DEAF SIGN LANGUAGE INSTRUCTOR. BY ELEVEN MONTHS -- SIX TO ELEVEN MONTHS POST-COCHLEAR IMPLANT, 50 PERCENT OF THEIR LANGUAGE SAMPLE WITH THEIR PARENT WAS ORAL, AND BY 18 MONTHS POST-COCHLEAR IMPLANT, A HUNDRED PERCENT. NOW, YOU HAVE TO REMEMBER THAT THAT DOESN'T MEAN THAT THEY DROPPED THE SIGN LANGUAGE. IT JUST MEANS THAT THE PARENT WAS SPEAKING ONLY TO THE CHILD IN THE VIDEOTAPE AND THE CHILD WAS SPEAKING BACK. 35 IN RETROSPECT, I WISH I HAD HAD A VIDEOTAPE -- ANOTHER VIDEOTAPE WITH THE DEAF SIGN LANGUAGE INSTRUCTOR INTERACTING THE BABY, AND WE DON'T HAVE THAT. BECAUSE THE BABIES DID HAVE GOOD SIGN LANGUAGE. SO THIS IS ANOTHER CHILD COCHLEAR IMPLANT. AT 18 MONTHS, EARLY IDENTIFIED, PRE-IMPLANT NOTHING, FIVE MONTHS LATER 90 PERCENT. WE ACTUALLY HAVE SOME OF THE BEST ORAL RESULTS OF ANY COCHLEAR IMPLANT BABIES IN THE NATION. WHICH, ACTUALLY, MOST OF THE COCHLEAR IMPLANT STUDIES WON'T COMPARE THEIR DATA WITH OUR DATA BECAUSE OF THAT. I'M JUST GOING TO SHOW ONE MORE. THIS CHILD ACTUALLY MAPPED ON OVER 600 SIGN LANGUAGE WORDS WITHIN SIX MONTHS AND HAD AN INTELLIGIBLE SPOKEN WORD. AND WE'RE SEEING THAT ACTUALLY HAPPEN MORE AND MORE. THEN WHAT HAPPENS IS THE VOCABULARY KEEPS GROWING, BUT THE SIGN VOCABULARY IS DIFFERENT THAN THE ORAL VOCABULARY SO 36 WE HAVE TO KEEP TRACK OF BOTH. WHILE THEY'RE LEARNING THIS, THE SIGN LANGUAGE THEY CAN DO LOTS OF LITERACY ACTIVITY BECAUSE THEIR AUDITORY SKILLS AREN'T SUFFICIENT. EVEN THOUGH THEY HAVE SPOKEN WORDS, THEY DON'T HAVE AUDITORY MEMORY, THEY DON'T HAVE AUDITORY COMPREHENSION OF ENGLISH SYNTAX. SO WE CAN DO LOTS OF LITERARY AND THINGS IN SIGN LANGUAGE THAT WE CAN'T DO IN AUDITORY VERBAL. AND JUST TO SHOW YOU -- THIS IS AN AUDITORY VERBAL CHILD WHO ACTUALLY HAD NORMAL CHILD PRE-COCHLEAR IMPLANT. SO WE DO HAVE SOME OF THOSE, BUT I DON'T HAVE VERY MANY OTHERS THAT ARE ORAL ONLY. AND THIS CHILD SHOWS EXACTLY THE SAME PROFILE AS OUR SIGNING CHILDREN. THERE'S JUST NO DIFFERENCE. AND THIS CHILD ACTUALLY HAD LANGUAGE AND HEARING BEFORE THE CHILD LOST THE HEARING WITH MENINGITIS. SO BASICALLY WHAT OUR STUDIES ARE SHOWING IS THAT 50 PERCENT OF THE CHILDREN USE SPOKEN -- NO, I HAVE THAT 37 WRONG. ON AVERAGE, SO THAT IS 50 PERCENT, THE CHILDREN USE SPOKEN LANGUAGE 50 PERCENT OF THE TIME WITH THEIR HEARING PARENTS AFTER ONLY SIX TO 12 MONTHS OF IMPLANT USE. AND THEY USE SPOKEN LANGUAGE 80 PERCENT OF THE TIME WITH THEIR HEARING PARENT, AFTER 18 TO 24 MONTHS OF IMPLANT USE. ALL OF THE COLORADO COCHLEAR IMPLANT SURGEONS DO SUPPORT THE USE OF SIGN LANGUAGE PRE AND POST-IMPLANTATION. AND WE USED TO HAVE IMPLANT SURGEONS THAT WOULD SAY WE WON'T IMPLANT YOU IF YOU SIGN. AND IF I IMPLANT YOU YOU MUST STOP SIGNING. BUT THAT DOESN'T HAPPEN ANYMORE BECAUSE THE KIDS ARE SO SUCCESSFUL, THE BIGGEST SUCCESSES THEY'VE EVER HAD ARE FROM THE CHILDREN WHO ARE SIGNING. NOW, SOME OF YOU ASKED ME IS THIS BETTER THAN THE ORAL SUCCESSES? AND IT'S NOT BETTER THAN THE ORAL SUCCESSES, BUT THE DIFFERENCE IS THAT IN THE BIG NIH STUDY, THE ONLY PREDICTOR OF SUCCESS 38 WAS SOCIOECONOMIC STATUS. SO IN OTHER WORDS, IF YOU HAD MONEY AND YOU HAD A COCHLEAR IMPLANT, YOU WERE GOING TO BE SUCCESSFUL. THE DIFFERENCE IN OUR STUDY IS THIS IS OUR ENTIRE POPULATION. SOME OF THESE FAMILIES HAVE A SIXTH-GRADE EDUCATION AND THEIR CHILDREN ARE STILL SUCCESSFUL. WE DON'T WANT A PROGRAM THAT ISN'T GOING TO BE SUCCESSFUL WITH EVERYBODY. I MEAN, I CAN'T JUST TAKE 30 PERCENT OF THE POPULATION AND SAY THIS IS THE PROGRAM WE'RE OFFERING. SO MOST OF THE TIME WHEN I PRESENTED THIS I JUST REALIZED THAT I PRESENT IT EVERY YEAR TO THE COCHLEAR IMPLANT SURGEONS. SOME OF THEM BELIEVE IT AND SOME OF THEM DON'T. I PRESENT AT AUDIOLOGY AND SPEECH LANGUAGE PATHOLOGY PLACES, BUT I ACTUALLY HAVE ONLY DONE IT A FEW TIMES WITH PEOPLE IN THIS AUDIENCE BECAUSE I FIGURED YOU WERE THE CHOIR. BUT NOW WHAT I REALIZE FROM YESTERDAY IS THAT YOU NEED SOME AMMUNITION WHEN YOU GO OUT THERE. SO I APOLOGIZE NOT HAVING 39 SPENT A LITTLE MORE TIME WITH THIS PARTICULAR GROUP. BUT I WAS SO BUSY TRYING TO GET THE OTHER PEOPLE TO TRY THE LISTEN THAT I DIDN'T -- I FAILED TO GIVE YOU WHAT YOU NEEDED, IN TERMS OF BEING ABLE TO TALK TO THEM. WHAT'S HAPPENING WITH IMPLANTATION IS THAT THE AGE OF IMPLANTATION IS DROPPING. MOST OF YOUR BABIES ARE GOING TO BE IMPLANTED BETWEEN 12 AND 15 MONTHS OF AGE. MANY OF THEM NOW ARE GETTING BILATERAL IMPLANTS. THE SPEECH AND AUDITORY DEVELOPMENT OF THESE BABIES IS ACTUALLY EVEN FASTER THAN SOME OF THE KIDS THAT I SHOWED YOU IN THOSE GRAPHS. BUT ONE OF THE THINGS -- AND I STILL -- I HAVE TO LOOK AT THIS. WHAT REALLY IS BOTHERING ME A LITTLE BIT IS THAT WE ARE IMPLANTING EARLIER, THEIR AUDITORY AND SPEECH SKILLS ARE BETTER, BUT THE VOCABULARY SKILLS OF THE KIDS WHO HAVE SIGN LANGUAGE IS ACTUALLY HIGHER FROM THE DATA THAT WE'RE SHOWING. BUT SEE, I DON'T HAVE CONTROL OVER -- WHEN THE MEDICAL SYSTEM CHANGES, 40 THE WHOLE POPULATION STARTS TO CHANGE AND THEN TO TRY TO GET THE COMPARATIVE DATA. BUT SOME OF THE KIDS THAT WERE 20 MONTHS OF AGE WHEN THEY GOT THEIR IMPLANT, THEY HAD A LOT OF LANGUAGE. AND THEY'RE FAST MAPPING INTO ORAL SPEECH ACTUALLY LOOKS -- THEIR ORAL LANGUAGE AT THE SAME AGE LOOKS BETTER THAN THE KIDS THAT WERE 12 MONTHS WHEN THEY WERE IMPLANTED, BECAUSE THEY HAD FEWER SIGNS, ACTUALLY, AT 12 MONTHS. SO THEN WHAT HAPPENED IS THE PARENT SKILL WAS ALSO POORER. SO WHAT HAPPENS IS THAT 50 PERCENT OF OUR FAMILIES ARE CONTINUING WITH SIGN LANGUAGE INSTRUCTION, BUT 50 PERCENT OF THEM ARE NOT. AND THERE'S NOT A WHOLE LOT I CAN DO ABOUT THAT. A LOT OF THEM ARE COMING BACK TO IT AFTERWARDS WHEN THEY FIND THAT THEIR KIDS CAN'T KEEP UP WITH THE -- EVEN THE PRESCHOOL ACTIVITIES WHERE THEY'RE DOING REALLY MORE ABSTRACT STORY TELLING. AND THEIR CHILDREN CAN'T ANSWER ANY OF THE QUESTIONS BECAUSE THEY DON'T UNDERSTAND 41 THE LANGUAGE IN THE AUDITORY MODE. THEY CAN UNDERSTAND IT IN THE SIGNING MODE, BUT THEY CAN'T UNDERSTAND IT IN THE ORAL MODE. BUT UNFORTUNATELY, THAT TAKES A SOPHISTICATION OF KNOWLEDGE THAT IS HARD FOR MANY OF THESE PARENTS. BECAUSE THEY'RE SO THRILLED THAT THEIR KIDS ARE NOW SPEAKING AND, MANY OF THEM, THAT'S WHAT THEIR GOAL IS. SO TRYING TO KEEP THAT INTENSIVE PROGRAMMING IN THE PRESCHOOL YEARS, TO ME, IS REALLY AN IMPORTANT PART. I HAVEN'T QUITE FIGURED OUT HOW TO DO THAT EVEN IN OUR OWN STATE. SO IF YOU COULD HELP OUT, THAT WOULD BE GREAT. LET ME -- THE OTHER -- SWITCHING TOPICS NOW TO A DIFFERENT TOPIC, THIS IS ON THE QUESTION OF DO THE EFFECTS FROM THE FIRST THREE YEARS, ARE THEY LASTING? AND NOW I ACTUALLY HAVE A THOUSAND BABIES ON MY DATABASE. THESE ARE 244 BABIES, BECAUSE THEY HAVE THREE TEST TIMES FROM THE INFANT PERIOD ALL THE WAY UP TO THE PRESCHOOL PERIOD OF TIME. SOMETIMES THIS SEEMS STUPID TO DO 42 QUESTIONS ON THINGS THAT WE ALREADY KNOW THE ANSWERS FOR, BUT THE MEDICAL PROFESSION DOESN'T -- WON'T ACCEPT EVIDENCE-BASED THINGS UNLESS WE DO IT IN A CERTAIN WAY. SO I DON'T BELIEVE THAT SCREENING HAS ANYTHING -- I MEAN, THE ONLY THING THAT SCREENING DOES IS IT GIVES US AN OPPORTUNITY TO GET EARLY INTERVENTION STARTED EARLIER. BUT SCREENING, IN AND OF ITSELF, DOESN'T DO ANYTHING. PHYSICIANS THINK THAT THIS IS THE CURE ALL. SO THE REASON THAT IT'S DONE THIS WAY IS FOR THE PHYSICIANS. WE HAVE THREE BIRTH COHEARTS: THE KIDS THAT WERE BORN BEFORE UNIVERSAL NEWBORN HEARING SCREENING, IN OUR STATE THAT WOULD BE BEFORE 1992; THE KIDS THAT WERE BORN WHILE WE WERE TRYING TO ESTABLISH THAT, THAT WOULD BE BETWEEN 1992 AND THROUGH 1998; AND THEN THE KIDS THAT WERE BORN AFTER EVERY HOSPITAL IN THE STATE WAS SCREENING HEARING LOSS, AND THAT WOULD BE AFTER 1999. BUT AS YOU KNOW, WHICH PHYSICIANS AND AUDIOLOGISTS AND SPEECH LANGUAGE 43 PATHOLOGISTS DON'T ALWAYS UNDERSTAND, IS THAT WE HAVE A VERY DIVERSE POPULATION. AND ANYTHING THAT YOU SAY ABOUT ANY COMPONENT OF THE POPULATION WILL BE UNTRUE FOR A DIFFERENT SUBGROUP OF THE POPULATION. SO -- AND MOST PEOPLE WHO DO RESEARCH DON'T DO A POPULATION. THEY PICK ONLY THE KIDS THAT ARE AT THE TOP. SO WE HAVE LOTS AND LOTS OF DATA ABOUT THE KIDS THAT ARE SUCCESSFUL. AND THE KIDS THAT YOU SERVE, BECAUSE YOU'RE GETTING A LOT OF THE KIDS THAT NOBODY ELSE WANTS TO SERVE OR HAVE DROPPED OUT OF THE SYSTEM OR THEY'VE FAILED IN THE SYSTEM THAT WITH THE LOWER EFFORT OR THEY GO TO THE SCHOOLS FOR THE DEAF AND BLIND, THERE'S ALMOST NO RESEARCH ON THESE CHILDREN. AND OBVIOUSLY THAT'S WHERE WE NEED OUR RESEARCH TO BE. SO THIS IS BASICALLY WHAT THESE PLOTS LOOK LIKE. I'M NOT GOING TO GO OVER IT. BUT THE LINE THERE IS THE AVERAGE FUNCTIONING FOR LATE IDENTIFIED AND EARLY IDENTIFIED CHILDREN. EVERYTHING ABOVE THE LINE IS AT AGE 44 LEVEL AND A LITTLE BIT BELOW THE LINE. SO THERE'S A COMPONENT BELOW THE LINE AND I CAN'T -- LET'S SEE. I DON'T HAVE THE -- I CAN'T QUITE FIGURE THIS OUT. SO PROBABLY ABOUT HERE ON UP, THOSE ARE ALL LOW AVERAGE. AND THEN BELOW THAT ARE ALL KIDS THAT WOULD HAVE BEEN STAFFED BY SPECIAL ED FOR LANGUAGE THAT IS SIGNIFICANTLY BELOW NORMAL. BUT WHAT IT MEANS IS THAT, ACTUALLY, A GOOD PORTION OF THESE CHILDREN IN OUR STATE, 75 TO 80 PERCENT OF THEM, ARE WITHIN THE NORMAL RANGE. THEY'RE NOT EXACTLY AT AGE LEVEL, BUT THEY'RE NOT SO DELAYED THAT THEY WOULD BE STAFFED INTO SPECIAL EDUCATION. SO THIS JUST SHOWS YOU THE GROWTH CURVE. THE DOTTED LINE IS NORMAL. THE RED LINE ARE THE KIDS THAT WERE BORN AFTER UNIVERSAL NEWBORN HEARING SCREENING. SO WE STILL HAVE A LOT OF WORK TO DO. THEY'RE NOT QUITE ON THE AVERAGE OF NORMAL DEVELOPMENT, BUT THEY'RE WITHIN THE NORMAL RANGE. THEY'RE IN THE LOW AVERAGE RANGE. AND 45 THE BLUE LINE ARE THE KIDS THAT WERE BORN BEFORE UNIVERSAL NEWBORN HEARING SCREENING WAS ESTABLISHED. THEY'RE WAY FAR AWAY FROM ANYTHING WITHIN THE RANGE OF NORMAL DEVELOPMENT. THIS PROBABLY YOU JUST CAN READ IT, BUT IT JUST TELLS YOU WHAT THE PROGRESS OF SCREENING WAS IN OUR STATE. HERE WE DIVIDED IT OUT EVEN MORE. AND THAT IS THE BLUE LINE AS THERE WERE NO EARLY IDENTIFIED CHILDREN THROUGH UNIVERSAL NEWBORN SCREENING. THE RED LINE IS ABOUT HALF OF THE KIDS WERE IDENTIFIED EARLY. AND THE GREEN LINE IS NOW ALL OF THE KIDS ARE IDENTIFIED, EXCEPT FOR OUR SPANISH SPEAKING CHILDREN FROM NONENGLISH SPEAKING HOMES. THOSE CHILDREN ARE IDENTIFIED, BUT THEY'RE NOT STARTING INTERVENTION QUICK ENOUGH. SO BASICALLY WHAT WE'VE DONE IS JUST REPLICATED ALL THE WAY THROUGH AGE SEVEN THAT IF WE GIVE DEAFNESS SPECIFIC SERVICES, THESE KIDS STAY ON -- THEY'RE NOT LOSING -- THEY ACTUALLY ARE LOSING A LITTLE BIT OF GROUND. THEY'RE GETTING A 46 LITTLE BIT WORSE AS THEY GET OLDER. AND I'M PERSONALLY CONVINCED IT'S BECAUSE THEY LOSE SERVICES IN THE PRESCHOOL YEARS. WE DON'T MAINTAIN THE LEVEL OF QUALITY SERVICE IN PRESCHOOL AS WE DID IN THE INFANT PROGRAM. AND THAT'S BECAUSE OUR CHILDREN GO FROM PART C TO PART B. AND PART B FOR PRESCHOOL IS REALLY VERY, VERY VARIED DEPENDING UPON WHERE YOU LIVE IN OUR STATE. NOW, ALL OF YOU KNOW THIS STATISTIC -- WELL, ACTUALLY, 40 PERCENT OF ALL OF BABIES ARE MULTIPLY DISABLED. WHAT SEEMS TO BE DIFFERENT IS THAT THEY ARE MORE MULTIPLY DISABLED. IN OTHER WORDS, THE SEVERITY OF THEIR PROBLEMS IS GREATER. SO THEY MAY STILL BE 40 PERCENT OF THE POPULATION, BUT THEIR COGNITIVE NEUROLOGICAL ISSUES AND THE MULTIPLICITY OF THEIR SECONDARY PROBLEMS ARE GREATER THAN I -- THIRTY YEARS AGO. SO WE MIGHT HAVE BEEN SAYING THERE WAS 30 TO 40 PERCENT THIRTY YEARS AGO, BUT THESE KIDS ARE MUCH MORE INVOLVED THAN BEFORE. MANY MANY OF THEM HAVE 47 COGNITIVE DISABILITIES, AND MANY OF THEM WERE BORN IN THE INTENSIVE CARE UNITS. THESE ARE BABIES THAT WERE PREMATURE, WEIGHED VERY FEW POUNDS AT BIRTH AND HAVE MANY ISSUES, DEAFNESS BEING ONE OF THEM. NOW, IN THE PAST, MANY OF THOSE KIDS WOULD HAVE BEEN -- THEY WOULD HAVE SAID DEAFNESS IS NOT THE PRIMARY DISABILITY. BUT DEAFNESS IS THE REASON THAT THEY DON'T DEVELOP COMMUNICATION. AND SO IF THEIR COGNITIVE -- WHAT HAPPENS IF WE DON'T SEE THEM AS THE PRIMARY PROVIDER, WE DON'T GET THEIR COMMUNICATION LEVEL TO THEIR COGNITIVE LEVEL. SO THEY'RE DELAYED BECAUSE THEIR COGNITION IS DELAYED. BUT IF THEY GET DEAFNESS SPECIFIC SERVICES, THEY GET COMMUNICATION. IF THEY DON'T, THEY DON'T GET COMMUNICATION. THEY MIGHT GET LOVE AND CARE, BUT THEY'RE NOT GETTING ANY WORDS OR THEY'RE NOT GETTING ANY LANGUAGE OR COGNITIVE DEVELOPMENT TO HELP THEM COMMUNICATE. BASICALLY WHAT WE KNOW NOW IS THAT 48 THIS WHOLE GROUP OF LOW COGNITIVE KIDS ARE FUNCTIONING AT HALF OF THE LEVEL OF KIDS WITH NORMAL COGNITIVE. THAT'S ALL THIS GRAPH IS SHOWING. SO THE SLOPE IS .39 GROWTH VERSUS THE GROWTH CURVE OF .69. THE GRAPHS DON'T TAKE INTO ACCOUNT YET AGE OF IDENTIFICATION OR DEGREE OF HEARING LOSS. WE'RE STILL WORKING ON THAT. BUT IT JUST GIVES YOU AN IDEA OF HOW IT'S VERY COMPLICATED TO ACTUALLY DO THIS DATA CRUNCHING. BECAUSE EVERY TIME YOU FIND AN ANSWER YOU HAVE TO ADD SOMETHING ELSE IN TO REFINE IT JUST THAT ONE MORE BIT. DEGREE OF HEARING LOSS FOR CHILDREN WITH LOW COGNITION, AND THAT'S WHAT ALL THESE GRAPHS ARE SHOWING YOU, ACTUALLY MAKES ALMOST NO DIFFERENCE WHATSOEVER. NOW, WHETHER THAT'S BECAUSE THEY'RE NOT GETTING GOOD SERVICES, I HAVE NO IDEA. BUT DEGREE OF HEARING LOSS PREDICTS JUST ABOUT NOTHING FOR OUR LOW COGNITIVE CHILDREN. IN OTHER WORDS, IF YOU HAVE A LOW COGNITIVE MILD HEARING LOSS AND A LOW COGNITIVE WITH PROFOUND HEARING 49 LOSS, THEY'RE GOING TO TURN OUT ABOUT THE SAME IN TERMS OF THEIR LANGUAGE SKILLS. THERE IS AN EFFECT WE'RE NOW FINDING WITH THE NORMAL COGNITIVE GROUP. BUT IT'S MILD HEARING LOSS VERSUS EVERYTHING ELSE. THE MILD HEARING LOSS WITH GOOD INTERVENTION ARE ACTUALLY STAYING RIGHT AT PRETTY CLOSE TO THE NORMAL -- TO THE MEAN OF NORMALLY HEARING CHILDREN. AND THEY SHOULD BE. WE IDENTIFIED THEM AT SIX TO EIGHT WEEKS, AND THEY HEAR PRETTY NORMAL WITH THEIR AMPLIFICATION. SO THEY SHOULD BE RIGHT ON PAR WITH THE REST. ALL OF THE REST FROM MODERATE ON DOWN LOOK ALMOST THE SAME. SO WHEN PEOPLE SAY HARD OF HEARING SHOULD GET DIFFERENT SERVICES OR HARD OF HEARING AREN'T THAT MUCH DIFFERENT, WHAT WE'VE FOUND IS ACTUALLY THE HARD OF HEARING AND THE DEAF SHARE MUCH MORE CHARACTERISTICS THAN THE HARD OF HEARING SHARE WITH NORMAL HEARING. AND, YOU KNOW, UNFORTUNATELY, OUR 50 FIELD HAS SEPARATED THOSE OUT. AND WE'VE SEPARATED THOSE OUT BECAUSE OF MEDICAL DEFINITIONS. AND THAT'S PROBABLY A DETRIMENT TO WHAT WE'RE TRYING TO DO NOW. BUT PEOPLE WHO HAVE KNOWLEDGE ABOUT DEAFNESS AND HEARING SHOULD BE THE PEOPLE WHO SERVE THESE CHILDREN, WHETHER THEY HAVE UNILATERAL LOSS OR PROFOUND LOSS. AND ALL OF OUR DATA ON SUCCESS SAYS THAT THESE ARE THE PROVIDERS THAT ARE PROVIDING THAT. THIS -- YOU DON'T NEED TO LOOK AT THESE. THESE JUST SHOW YOU THE DIFFERENCE BETWEEN COGNITIVELY NORMAL AND COGNITIVELY IMPAIRED BY DEGREE OF HEARING LOSS. I'M HOPING THAT WITHIN THE NEXT YEAR WE'LL BE ABLE TO DIVIDE IT OUT SO THAT I CAN ACTUALLY SAY WITH CHILDREN WITH THIS KIND OF COGNITIVE DISABILITY AND THESE DEGREES OF HEARING LOSS, THIS IS WHAT YOU'RE GOING TO SEE. THE GROWTH CURVES ARE LIKE THIS. WITH CHILDREN THAT ARE NORMAL OR ABOVE NORMAL THIS IS WHAT YOU'RE GOING TO SEE. AND WE ARE DIVIDING IT OUT BY DEGREE OF 51 HEARING LOSS, EVEN THOUGH I'M SURE THAT IN THE END WHEN I TAKE THE EARLY IDENTIFIED AND LATE IDENTIFIED THAT THE DEGREE OF HEARING LOSS FOR MODERATE TO PROFOUND WILL ACTUALLY SHOW JUST ABOUT NOTHING, THAT THEY'RE ALL GOING TO LOOK VERY, VERY SIMILAR. THIS JUST SHOWS YOU HOW VERY SIMILAR THEY ARE, ACTUALLY. I AM WORRIED THAT THE LANGUAGE QUOTIENTS DECREASE WITH AGE, BUT THAT'S BECAUSE LANGUAGE GETS HARDER AS CHILDREN GET OLDER. WHICH IS ALSO THE REASON THAT MOST OF OUR PARENTS ARE DOING THIS SIGN LANGUAGE INSTRUCTION FROM THE VERY BEGINNING. BECAUSE EVEN WITH THE COCHLEAR IMPLANTS WITH THEIR KIDS ARE GOING TO BE CURED FOR THEIR AUDITOR SPEECH DEVELOPMENT WHAT WE'RE SAYING TO THEM IS OKAY, IF YOU GET THE IMPLANT AT 12 MONTHS, IT'S GOING TO TAKE YOUR CHILD AT LEAST 12 MONTHS TO JUST GET THE DISCRIMINATION. THEY'LL GET IT WITH GOOD THERAPY. BUT WHILE THEY'RE DOING THAT, THEY'RE NOT GOING TO BE LEARNING 52 MUCH VOCABULARY. BETWEEN 12 MONTHS AND 24 MONTHS OF AGE, YOUR CHILDREN HAVE TO LEARN 300 VOCABULARY WORDS JUST TO SAY ON PAR WITH NORMAL. AND WITHIN A HALF A YEAR LATER, THEY SHOULD HAVE 600 TO A THOUSAND WORDS. BY THE TIME THEY GET TO KINDERGARTEN, WE WANT THEM TO HAVE 3,000 TO 5,000 WORDS. AND YOU'RE NOT GOING TO BE ABLE TO DO THIS ORALLY. BECAUSE YOUR KIDS ARE TRYING TO LEARN THE DISCRIMINATION, THE MEMORY, NOT ONLY THE VOCABULARY, BUT THE SENTENCE STRUCTURE. WE KNOW WE CAN DO THAT IF WE HAVE BOTH INSTRUCTION AUDITORY AND SIGN LANGUAGE. SO OUR EARLY IDENTIFIED KIDS AT -- WITH NORMAL COGNITION AT 18 MONTHS ARE RIGHT AT THE MEAN OF NORMAL; 99 INSTEAD OF A HUNDRED. THEY'RE LOSING A LITTLE BIT BY 36 MONTHS. THEY'RE 87. BUT THAT'S PRETTY CLOSE. THEY'RE STILL LOW AVERAGE. BUT I'M WORRIED ABOUT THAT THEY LOSE EVEN MORE FROM THE THREE TO FIVE PERIOD. SO OUR GOAL IN THE STATE OF COLORADO IS TO NOT SEE THAT SLIGHT DECREASE. EVEN THOUGH THEY STAY WITHIN 53 THE NORMAL RANGE, THEY GET MORE AND MORE AT RISK FOR DROPPING INTO THE DELAYED -- THE SIGNIFICANTLY DELAYED RANGE AS THEY AGE. WHAT I WANT TO GET TO IS THE SCHOOL AGE STUFF. SO LET ME JUST SPEND A LITTLE BIT OF TIME ON OUR SCHOOL AGE DATA, BECAUSE WE ACTUALLY HAVE BEEN COLLECTING DATA IN THE STATE OF COLORADO ON OUR ENTIRE POPULATION FOR THE LAST PROBABLY TWENTY YEARS. TRYING TO COMPARE DEAF AND HARD OF HEARING CHILDREN WITH THE NORMALLY HEARING MAINSTREAM POPULATION IS A PROBLEM. BECAUSE IT ISN'T UNTIL UNIVERSAL NEWBORN HEARING SCREENING THAT WE COULD EVEN GIVE THE TEST TO MOST OF THE KIDS AND THEY WOULDN'T FALL SO FAR BELOW THE NORM THAT THEY WEREN'T EVEN SCORING ON THE TEST. NOW OUR KIDS CAN TAKE THE REGULAR ED TEST. SO WE ARE ABLE TO COMPARE THEM. ONLY ONE PERCENT OF OUR POPULATION ACTUALLY ARE ON THE ALTERNATIVE MODE WHICH REALLY HAS BEEN GREAT FOR US. 54 WE HAVE THE NO CHILD LEFT BEHIND TEST. IT'S CALLED CSAP, COLORADO ASSESSMENT PROGRAM. AND IT'S BEING GIVEN TO ALL OF OUR DEAF AND HARD OF HEARING KIDS FROM THIRD GRADE THROUGH 12TH GRADE. SO WHAT WE SEE FROM THIS IS WE STARTED BEING ABLE TO COLLECT THIS DATA IN 2001. SO IF YOU LOOK AT THE FIRST BAR WHICH IS UNSATISFACTORY, 40 PERCENT OF THE KIDS WERE UNSATISFACTORY IN 2001. BY 2005 WE HAD IMPROVED BY ALMOST TEN PERCENT. WHICH MEANS THAT WE BUMPED ALL OF THOSE KIDS THAT WERE UNSATISFACTORY EITHER INTO PARTIALLY PROFICIENT OR PROFICIENT. NOW, THE PARTIALLY PROFICIENT OR PROFICIENT ARE KIDS THAT ARE FUNCTIONING WITHIN THE NORMAL RANGE. BUT OBVIOUSLY OUR STATE DEPARTMENT OF EDUCATION WANTS EVERYBODY TO BE IN EITHER PROFICIENT OR ADVANCED. SO 80 PERCENT OF OUR KIDS ARE FUNCTIONING WITHIN THE RANGE OF THE NORMAL CLASSROOM WHICH IS REALLY PRETTY PHENOMENAL. AND AS TIME GOODS ON, WE HAVE MORE AND MORE KIDS IN THE ADVANCED 55 GROUP. NOW, I CAN TELL YOU WHAT OUR BIGGEST PROBLEM IS. OUR BIGGEST PROBLEM IS THAT THE MORE SUCCESSFUL WE ARE WITH ANY OF OUR KIDS, THEY GET PLACED OUT OF SPECIAL ED INTO 504. AND ONCE THEY GO INTO 504, OUR STATE DEPARTMENT OF EDUCATION SAYS THAT THEY'RE NO LONGER DEAF, EVEN WHEN THEY'RE PROFOUNDLY DEAF. SO THEY PLACED THEM IN THE CONTROL GROUP WHICH IS THE NORMALLY HEARING GROUP. SO WHAT IT DOES IS -- SEE, WE WOULD ACTUALLY BE BETTER IF THEY DIDN'T TAKE ALL THE KIDS THAT WERE IN 504 AND PUT THEM IN THE CONTROL GROUP. BECAUSE THEY DON'T LET US KEEP -- THE ONLY WAY WE'RE GOING TO BE ABLE TO FOLLOW THESE KIDS IS IF WE KNOW WHAT THEY WERE LIKE AT BIRTH AND WE CAN FOLLOW THEM INDIVIDUALLY ALL THE WAY UP THROUGH 12TH GRADE. BECAUSE EVERY TIME YOU'RE REALLY SUCCESSFUL AND THE KIDS ARE FUNCTIONING AT AGE LEVEL OR IN GIFTED PROGRAMS, THEY'RE GOING TO TAKE THOSE KIDS AWAY FROM YOU. YOU'RE NO LONGER GOING TO BE ABLE TO CLAIM THEM AS 56 DEAF AND HARD OF HEARING, EVEN WHEN WITHOUT THE COCHLEAR IMPLANT TURNED, ON THEY'RE COMPLETELY DEAF. THEY CAN HEAR NOTHING. WE HAVE TO FIX THIS. BECAUSE OTHERWISE THE KIDS THAT WE'RE GOING TO BE LEFT WITH ARE THE MULTIPLY DISABLED, THE LATE IDENTIFIED AND THE NONENGLISH SPEAKING KIDS. AND IT'S GOING TO LOOK LIKE WE'RE DOING NOTHING, WHEN WE'VE ACTUALLY BEEN ENORMOUSLY SUCCESSFUL. SO BASICALLY WHAT WE'VE BEEN ABLE TO SHOW BECAUSE NOW WE HAVE A WHOLE POPULATION OF CHILDREN THAT HAVE BEEN EARLY IDENTIFIED, WE ACTUALLY -- THE THIRD GRADE CLASS IS THE FIRST CLASS FOR THIS TESTING THAT ACTUALLY EVERY ONE OF THOSE BABIES WENT THROUGH UNIVERSAL NEWBORN HEARING PROGRAM IF THEY WERE BORN IN THE STATE OF COLORADO. THE REST OF THEM FROM FOURTH GRADE TO 12TH GRADE SOME OF THEM DID AND SOME OF THEM DIDN'T. BUT WHAT WE'RE SHOWING ACCORDING TO THE NORMAL HEARING NORMS IS THAT LESS THAN 20 PERCENT OF OUR 57 CHILDREN ARE MAKING LESS THAN A YEAR'S GAIN. AND 81 PERCENT OF OUR CHILDREN ARE MAKING A YEAR'S GAIN OR GREATER ON THEIR READING, WRITING, AND MATH. SO THESE KIDS ARE REALLY -- NOW, IF THEY'RE DELAYED, THEY'RE STILL GOING TO BE DELAYED. BUT THEY'RE MAKING A YEAR'S GROWTH. THIS IS THE WRITING. ONLY TEN PERCENT ARE MAKING LESS THAN A YEAR'S GROWTH. 55 PERCENT ARE MAKING A YEAR'S GROWTH IN WRITING. 30 PERCENT ARE MAKING GREATER THAN A YEAR'S GROWTH. AND WE HAD A REALLY WEIRD THING HAPPEN THAT OUR DEAF AND HARD OF HEARING KIDS WERE DOING BETTER ON THE WRITING THAN OUR NORMALLY HEARING CONTROLS. AND THAT'S BECAUSE THEY NO LONGER TEACH ANY ENGLISH LANGUAGE STRUCTURE IN THE REGULAR ED CLASSROOMS. AND SO THE KIDS WRITING IN THE NORMALLY HEARING KIDS WRITING WAS JUST AWFUL IN THE CONTROL GROUP. AND THEY HAD -- THEY ENDED UP IN OUR STATE DOING LOTS AND LOTS OF IN-SERVICE AND CHANGING THE WAY THEY 58 PROGRAM BECAUSE IT WAS PRETTY BAD. AND THEN THE MATH SCORES, LESS THAN TEN PERCENT ARE MAKING LESS THAN A YEAR'S GROWTH. AND THERE'S ACTUALLY OVER 90 PERCENT OF OUR KIDS ARE MAKING A YEAR'S GROWTH OR GREATER IN OUR MATH SKILLS. AND THIS INCLUDES ALL THE CENTER BASED, THE STATE SCHOOL FOR THE DEAF, AND ALL THE MAINSTREAM PROGRAMS. SO IF YOU HAVE EARLY IDENTIFICATION AND YOU GET APPROPRIATE DEAFNESS SPECIFIC SERVICES FOR THESE KIDS, REGARDLESS OF WHERE THEIR PROGRAM WHETHER THEY'RE IN THE MAINSTREAM, THE STATE SCHOOL FOR THE DEAF AND BLIND OR THE CENTER BASED PROGRAM, THESE KIDS CAN BE PRETTY COMPARABLE TO THEIR HEARING KIDS. NOW THE BEST THING, AND THE THING THAT -- THIS IS THE ONLY DATA THAT I HAVE ON THIS. AND THE REASON THAT IT'S THE ONLY DATA THAT I HAVE IS BECAUSE IN THE STATE OF COLORADO, EARLY IDENTIFICATION IS EQUIVALENT TO EARLY INTERVENTION REPORTS. THAT'S NOT TRUE 59 IN YOUR STATES. SO IF I WERE STUDYING YOUR STATES, I COULD PROBABLY DIVIDE IT OUT. BUT BECAUSE WE HAVE KIDS IN THE THIRD GRADE THROUGH TWELFTH GRADE IN THE STUDY WHO EITHER WERE IN THE BEGINNING PART OF SCREENING OR WERE NOT SCREENED AT ALL, WE HAVE KIDS THAT WERE EARLY IDENTIFIED BUT DIDN'T PARTICIPATE IN EARLY INTERVENTION. SO IT TURNS OUT THAT THE MOST POWERFUL PREDICTOR FOR DEAF AND HARD OF HEARING KIDS, SCHOOL AGE, THIRD GRADE THROUGH TWELVE GRADES, FOR SUCCESSFUL OUTCOMES IS WHETHER THEY PARTICIPATED IN AN EARLY INTERVENTION PROGRAM THAT WAS DEAFNESS SPECIFIC, NOT EARLY IDENTIFICATION. THE SECOND ONE, ACTUALLY, IS WHETHER THEY PARTICIPATE IN EXTRACURRICULAR ACTIVITIES. IT'S ONLY THE THIRD ONE THAT IS AGE IDENTIFICATION OF HEARING LOSS. SPOKEN LANGUAGE IS IN THERE BECAUSE THERE IS SOME OVERLAP WITH SOME OF THE EXTRACURRICULAR ACTIVITIES WHEN THEY'RE 60 IN THE MAINSTREAM. BUT THERE'S NOT THAT MUCH PREDICTED VALUE FOR EITHER THE SPOKEN LANGUAGE OR FOR THE DEGREE OF HEARING. AND A LOT OF THAT DEGREE OF HEARING LOSS IS TAKEN UP BY THE UNILATERAL -- NO, ACTUALLY, IT'S TAKEN UP BY THE MILD HEARING LOSS POPULATION. AS IN ALL OF THE CSAP RESULTS FOR THE REGULAR CLASSROOM AND OUR DEAFNESS SPECIFIC SERVICES, CHILDREN WHO ARE ON FREE AND REDUCED LUNCH, IT'S A DETRIMENT TO THEIR ACADEMIC PERFORMANCE. AND THAT'S TRUE, UNFORTUNATELY, ACROSS ALL OF OUR SERVICES. WE HAVE A PROGRAM IN COLORADO THAT ACTUALLY FOR SCHOOL PLACEMENT, IS STANDARD ACROSS THE STATE. WE CALL IT THE COLORADO INDIVIDUAL PERFORMANCE PROFILE. EVERY SCHOOL DISTRICT IN THE STATE USES IT FOR PROGRAMMING. AND BASICALLY, IT'S BASED ON THE FACT THAT THE CHILDRENS LANGUAGE LEVELS SHOULD BE COMMENSURATE WITH THEIR COGNITIVE LEVELS. AND IF THEY'RE NOT, THEN THE LEVEL OF SERVICE PROVIDED INTENSIFIES 61 DEPENDING UPON THE DEGREE OF DELAY. AND FROM OUR DATA, IT LOOKS LIKE THE SPECIAL ED TEAMS ARE MAKING GOOD DECISIONS. BECAUSE NO MATTER WHERE THEY'RE PLACED, NO MATTER -- THEY'RE MAKING THE SAME DEGREE OF GROWTH. SO IF THEY'RE IN THE RESIDENTIAL SCHOOL, THAT'S GOOD BECAUSE THEY NEED THAT LEVEL OF SERVICE BECAUSE THEY'RE MAKING GOOD GROWTH. AND IF THEY'RE IN THE CENTER BASED PROGRAM WITH PARTIAL SELF-CONTAINED PARTIAL MAINSTREAMING, THEY ARE MAKING THE RIGHT DECISION BECAUSE THEY'RE MAKING GOOD GROWTH. AND THAT'S THE WAY WE NEED SOME OF THAT. NOW, IT'S NOT JUST COLORADO THAT ACTUALLY CAN SHOW THESE RESULTS. WE'VE BEEN DOING SOME WESTERN STATES PROGRAMMING. AND ACTUALLY, THE WESTERN STATES ARE ALL VERY, VERY SIMILAR TO COLORADO. THEY HAVE A STATE-WIDE EARLY INTERVENTION PROGRAM. ARIZONA, UTAH, NEW MEXICO, WYOMING NOT SO MUCH, IDAHO, AND I'M PROBABLY FORGETTING ONE OF THE WESTERN STATES. THE BIGGEST PROBLEM IS 62 THE OTHER WESTERN STATES AREN'T GETTING THE REFERRALS. THEY HAVE A STATE-WIDE SYSTEM, BUT THEY'RE NOT GETTING THE REFERRALS FROM THE SCREENING PROGRAM. SO THEY'RE NOT GETTING AS MANY OF THE BABIES. BUT FROM THE BABIES THAT THEY'RE GETTING, WE'VE BEEN ASSESSING THEIR DEVELOPMENT WITH THE SAME INSTRUMENT. AND THEY'RE GETTING IDENTICAL RESULTS TO COLORADO. AND ALL OF THEIR SERVICES STATEWIDE, I THINK, ARE ALL THROUGH THE STATE SCHOOL FOR THE DEAF AND BLIND. IS THAT RIGHT, MARY? I THINK ALL OF US HAVE STATEWIDE SERVICES EARLY INTERVENTION STATEWIDE, AND THEY'RE ALL MANAGED THROUGH STATE SCHOOL. SO WHEN WE HAVE THAT, WE'RE ALL SHOWING EXACTLY THE SAME RESULTS. WYOMING DOESN'T BECAUSE I DON'T WYOMING DOESN'T HAVE ANY KIDS BASICALLY. THEY ONLY HAVE LIKE 9,000 BIRTHS PER YEAR. NOW, WE DID A SCHOOL AGE STUDY WITH ARIZONA. WE HAVE 150 KIDS. AND THE AVERAGE PERFORMANCE ACADEMICALLY OF THESE KIDS -- THESE ARE MAINSTREAM KIDS 63 WITH ONE STANDARD DEVIATION OF THEIR HEARING PEERS. BUT THE MAINSTREAM KIDS, IF THEY'RE THEIR ON IEPS, ARE GETTING DEAFNESS SPECIFIC SERVICES. SO WE'RE SIMILAR WITH ARIZONA ACROSS THE BOARD. THESE ARE JUST SOME OF THE EFFECTS THAT YOU WOULD GUESS WOULD BE THE FACTORS THAT WOULD AFFECT WHETHER OR NOT THEY'RE GOING TO BE SUCCESSFUL. SO THERE ARE MORE SLIDES IN THERE, BUT I JUST WANTED TO GIVE YOU THE GIST OF WHAT OUR RESEARCH IS SHOWING. AND AT THIS POINT IF ANY OF YOU HAVE ANY QUESTIONS, I THINK I'D LIKE TO.... MR. BOSSO: WE HAVE FIVE MINUTES LEFT FOR QUESTIONS, THEN WE'LL HAVE TO MOVE ALONG AND GO TO LUNCH. AND THEN WE'LL GET EVERYTHING READY FOR THE 12:30. SO IF YOU HAVE ANY QUESTIONS, THEN DR. LAUREEN SIMMS WILL DO THEM. BUT IF YOU HAVE ANY QUESTIONS, PLEASE ADDRESS THEM. FROM THE FLOOR: ON THE SUMMARY OF CSAP OUTCOMES, STRONG EFFECTS OF OUTCOMES PRIORITIZE AND THEN EARLY 64 INTERVENTION, SO THERE'S NOT A MENTION ABOUT SIGN LANGUAGE. BUT DO WE ASSUME THERE THAT THEY GOT DEAF SPECIFIC INTERVENTION AND THAT SIGN LANGUAGE WAS A COMPONENT OF THOSE CHILDREN'S PROGRAMS? DR. YOSHINAGA-ITANO: WELL, I CAN ONLY TELL YOU THAT I DON'T KNOW AS MUCH ABOUT ARIZONA, BUT THEY'RE HERE SO THEY CAN TELL YOU. IN COLORADO, 80 PERCENT OF THOSE CHILDREN GOT A DEAF SIGN LANGUAGE INSTRUCTOR AND WERE EARLY IDENTIFIED AND EARLY INTERVENTION WITHIN THE FIRST SIX MONTHS OF LIFE. I THINK ARIZONA, IF THEY GET THEIR KIDS -- I'M NOT SURE ACTUALLY. I THINK THEY'RE PRETTY SIMILAR. FROM THE FLOOR: VERY SIMILAR. DR. YOSHINAGA-ITANO: YOU HAVE A DEAF MENTOR PROGRAM. I MEAN, WE HAVE VERY, VERY SIMILAR CHARACTERISTICS. FROM THE FLOOR: THANK YOU. FROM THE FLOOR: I JUST GOT AN E-MAIL LAST NIGHT FROM HOME IN UTAH AND 65 THEY WERE SAYING THAT THEY WERE GOING TO PUT THE IMPLANT TEAM WANTS TO GET TOGETHER BECAUSE THEY'VE GOT RESEARCH FROM SEATTLE SAYING THAT WE ARE ONLY GOING TO IMPLANT BABIES WHO HAVE IT COMMITTED TO OR THOSE FAMILIES HAVE COMMITTED TO AN AUDITORY ORAL APPROACH. DO YOU HAVE SOME RESEARCH THAT I CAN SITE SAYING THAT THE OPPOSITE IS ALSO TRUE? OR ARE THERE OTHER STUDIES? DR. YOSHINAGA-ITANO: I DON'T THINK THAT STUDY -- I THINK THE STUDY IS NOT FROM SEATTLE. BECAUSE THE SEATTLE CHILDREN'S HOSPITAL, I THINK, HAS A LOT OF COCHLEAR IMPLANT CHILDREN THAT ARE IN SIGN LANGUAGE PROGRAMS. BUT BEING IN A SIGN LANGUAGE PROGRAM AND GETTING SIGN LANGUAGE INSTRUCTION IN THE HOME BY A DEAF FLUENT SIGNER, I MEAN THEY MAY NOT BE EQUIVALENT KINDS OF THINGS. BUT THERE IS A STUDY THAT HAS ACTUALLY NOT BEEN PUBLISHED. I THINK THEY'RE WRITING A BOOK ON IT. THERE'S A STUDY THAT'S OUT THERE NOW THAT WAS A 66 STUDY OF ORAL -- MOSTLY AUDITORY VERBAL PROGRAMS AND WHAT THEY CALLED SIGN SUPPORTED SPEECH. NOW, I DON'T KNOW IF YOU WOULD CHARACTERIZE YOUR PROGRAM AS SIGN SUPPORTED SPEECH, BUT COLORADO DIDN'T HAVE ANY PARTICIPANTS IN THAT STUDY BECAUSE WE DON'T HAVE ANY PROGRAMS THAT WE COULD CHARACTERIZE AS SIGN SUPPORTIVE SPEECH. THEY CAME OUT WITH THE RESULTS THAT THERE WAS NO DIFFERENCE IN THE SPEECH OUTCOMES OF THE CHILDREN THAT WERE IN SIGN SUPPORTED SPEECH AND ORALISM. BUT THE RESEARCHER CONCLUDED AS A RESULT OF NO SIGNIFICANT FINDINGS THAT, THEREFORE, NO FAMILY SHOULD USE SIGN LANGUAGE BECAUSE THERE'S NO DIFFERENCE. YOU HAVE TO REMEMBER THESE ARE NOT POPULATION STUDIES. THEY TOOK PROGRAMS ALL OVER THE UNITED STATES, AND THEY HAND PICKED FROM EACH PROGRAM. SO THERE ARE MAYBE THREE OR FOUR KIDS FROM EACH PROGRAM, FROM MOSTLY PRIVATE. I WOULD SAY THAT THERE PROBABLY WAS NO PUBLIC PROGRAM THAT WAS IN THE STUDY. THAT'S 67 THE OTHER PROBLEM. THEN THEY LOOKED AT THE LATE IDENTIFIED KIDS AND THEY SAID THEIR LATE IDENTIFIED KIDS CATCH UP. NOW IT'S TRUE SOME LATE IDENTIFIED KIDS DO CATCH UP. BUT WE CAN LOOK AT ALL THE HISTORICAL LITERATURE, MOST OF THE KIDS DON'T CATCH UP. AND THE WAY TO CATCH UP IS BY HAVING HIGHER COGNITIVE AND HAVING HIGHER SOCIOECONOMIC KIDS. AND YOU GET MORE SERVICES. SO WE KNOW THEY CATCH UP. BUT THE RESEARCHER MADE THE INFERENCE FROM THAT DATA THAT IF YOU'RE LATE IDENTIFIED -- OH, NO, THERE WAS ONE OTHER FINDING. THE LIGHT IDENTIFIED KIDS THAT USED SIGN LANGUAGE DID POORER IN THEIR SPEECH DEVELOPMENT THAN THE LIGHT IDENTIFIED KIDS WHO WERE ORAL ONLY. BUT IT GIVES NO PREVIOUS HISTORY. THEY TOOK THESE KIDS, ENROLLED IN THE PROGRAM. THEY DIDN'T SAY WHAT THEIR LANGUAGE WAS LIKE WHEN THEY ENROLLED IN THE PROGRAM OR HOW LONG THEY'D BEEN IN THE PROGRAM. SO THE RESEARCHER MADE THE CONCLUSION THAT, THEREFORE, LATE 68 IDENTIFIED CHILDREN WHO WANT TO TALK SHOULD NEVER HAVE SIGN LANGUAGE. SO THAT'S THE STUDY THAT YOU'RE GOING TO BE HEARING ABOUT ALL OVER THE UNITED STATES. BUT I CAN TELL YOU RIGHT NOW THAT IT HAS NOT BEEN PUBLISHED. AND I THINK IT HASN'T BEEN PUBLISHED BECAUSE IT HAS SOME BASIC ISSUES WITH THE DESIGN OF THE STUDY. NOW, IT PROBABLY WILL BE PUBLISHED. BECAUSE IF YOU KEEP AT IT, YOU'RE GOING TO GET IT PUBLISHED SOMEWHERE. BUT YOU'RE GOING TO HAVE TO KNOW ABOUT THIS STUDY, BECAUSE THE ORALISTS ARE GOING TO BRING THIS UP ALL THE TIME. SO WHO WAS THE RESEARCH? SUSAN NICHE IT WAS A BIG NIH STUDY ON SPEECH. AND SUSAN WAS IN UTAH. SO I THINK IT'S THE UTAH STUDY. I DON'T THINK IT'S THE SEATTLE, WASHINGTON STUDY. BECAUSE PEOPLE IN SEATTLE, WASHINGTON ARE MUCH MORE PRO THE USE OF SIGN LANGUAGE. DR. NAPARCO HAS MANY, MANY CHILDREN SIGNING PLUS HAVE A COCHLEAR IMPLANT IN THE BALTIMORE, MARYLAND AREA. IN 69 MASSACHUSETTS AT THE CHILDREN'S HOSPITAL, ALMOST ALL OF THEIR CHILDREN GETTING COCHLEAR IMPLANTS ARE ALSO SIGNING. BECAUSE THERE'S A LOT OF SUPPORT. SO THERE ARE POCKETS THROUGHOUT THE UNITED STATES IN WHICH THEY ARE -- THEY HAVE PROGRAMS THAT ARE VERY, VERY SUCCESSFUL WITH CHILDREN WHO SIGN. MR. BOSSO: I'M GOING TO HAVE TO CUT OFF QUESTIONS AT THIS POINT. WE REALLY NEED TO KIND OF MOVE ON TO LUNCH. SO I WOULD ASK YOU TO JOIN ME IN REALLY THANKING CHRIS.