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Project ASPIRE:Understanding and Addressing Disparities in Pediatric Hearing Loss
Dana Suskind, MDProfessor, Otolaryngology - Head and Neck Surgery & PediatricsDirector, Pediatric Cochlear Implant ProgramUniversity of Chicago Medicine
Sally Tannenbaum, M.Ed., Cert. LSLS, DTHUniversity of Chicago Medicine
CONFLICT OF INTEREST
• We have no relevant financial relationships with the manufacturers of any of the commercial products and/or providers of commercial services discussed in this CME activity.
• We do not intend to discuss any unapproved/investigative use of a commercial product/device in my presentation.
OUTLINE
• Impact of poverty on child development and educational attainment
• 30 million word gap: foundational impact on early language development
• Closing the gap: the Thirty Million Words Project
• SES disparities in children with hearing loss
• Project ASPIRE: addressing the disparity
CHILDREN BORN INTO POVERTY
• Income inequality has never been greater in this country
• Children are profoundly impacted: 16.1 million children live in poverty
• An additional 16.3 million children are living just above the federal poverty line
(Addy, Engelhardt, & Skinner, 2013)
CHILDREN BORN INTO POVERTY:THE STATS
• Racial and ethnic minorities are disproportionately affected
• Children under 18 living in low-income families in the United States in 2011:
• 11 million (65%) of Latino children
• 6.5 million (65%) of African-American children
• .4 million (63%) of American Indian children
• 12.1 million (31%) of white children
• 1 million (32%) Asian children
(Addy, Engelhardt, & Skinner, 2013)
What does this really mean for a child?
It’s more than just income.
Poverty impacts every aspect of a child’s life.
A LIFE OF POVERTY OFTEN MEANS:
• Limited access to
• health care
• quality education
• healthy food
• safe play and exercise
• Living in more violent and economically depressed neighborhoods
• Precarious or unstable housing
These factors culminate in significant levels of stress that profoundly impact both parents and children.
(Wadsworth & Rienks, 2012)
TOXIC STRESS
• Extreme or prolonged stress can become ‘toxic’ for children and derail healthy development
• ‘Toxic stress’ can negatively impact neural connections in the learning and reasoning parts of the brain
• When experienced in early life, this has long-term consequences on a child’s learning, behavior, and physical and mental health
(Center on the Developing Child, 201; Toxic Stress: the Facts, 2012)
IMPACT ON HEALTH
• Impoverished children at greater risk for:
• Poor physical health
• Chronic health conditions
• Behavioral and emotional problems
(Hughes & Simpson, 1995; Morgan, 2009)
EDUCATIONAL ATTAINMENT
• Only 48% of low-SES children are school-ready by age 5
• 80% or more of African-American and Latino public school students can’t read or do math at grade level in 4th, 8th, and 12th grades
.
(Isaacs, 2012; The state of America’s children, 2011)
EDUCATIONAL ATTAINMENT
• Dropout rate of low-SES children was 5 times greater than higher-SES children in 2009
• Even the highest-scoring low-SES children are much less likely to finish college than their higher-SES counterparts
(Chapman, Laird, Ifill, & Kewal Ramani, 2011; Roy, J, 2005)
This educational attainment gap emerges early in children’s lives.
Clearly, many factors contribute to this gap over a child’s lifetime.
But more and more research indicates that the first few years have the biggest and most lasting impact.
At the root of this achievement gap is a disparity in children’s early language environments:
how and how much parents talk with their children.
THIRTY MILLION WORD GAP
• Hart + Risley:
• High-SES children: 45 million words by age 3
• Low-SES children: 13 million words by age 3
• This 30 million word gap profoundly impacts children’s vocabularies, test scores, and IQs
(Hart & Risley, 1995)
DISPARITIES IN EARLY LANGUAGE ENVIRONMENTS
• Both quantitative and qualitative
• Inequities in parents’ language input include:
• significantly less talk and gesture
• shorter and less complex phrases
• less use of open-ended questions
• greater use of directives
(Hammer, Tomblin, Zhang, & Weiss, 2001; Hoff & Tian, 2005; Huttenlocher, Haight, Selzer, & Lyons, 1991; Reilly et al., 2010; Rowe,
2008; Rowe & Goldin-Meadow, 2009; Hoff, 2012)
DISPARITIES IN EARLY LANGUAGE ENVIRONMENTS
• Decreased parental language input leads to significant disparities in children’s development of:
• vocabulary
• grammar
• narrative skills
• Early literacy skills
• Processing speed
• Disparities in language skills are seen from infancy through high school, and the gap widens with age
(Hoff, 2012; Fernald, Marchman, & Weisleder 2012; Hoff, 2005; Huttenlocher, Waterfall, Vasilyeva, Vevea, Hedges, 2010)
This results in children starting school much less prepared to learn.
• The multifactorial nature of poverty and its impact on children’s development is certainly staggering
• But the profound impact of parents’ language upon development and children’s ultimate trajectories gives us hope
Parents have the power to use their words to grow their children’s brains
• Could we target the SES-achievement gap through an educational program that partners with parents to enrich children’s early language environments?
So we asked:
THE THIRTY MILLION WORDS PROJECT
• 12-week parent-directed behavioral intervention to equip parents with skills to enrich their children’s language environments
THE THIRTY MILLION WORDS PROJECT
What does this have to do with children with hearing loss?
• The disparities noted among typically developing children are compounded in children with hearing loss
• Early language environments have a profound impact on the outcomes of children with hearing loss
TARGETING THE DISPARITY: PROJECT ASPIRE
• Parent-directed program designed to enrich the early language environments of children ages 0-4 with hearing loss
• Listening and spoken language curriculum
• Designed for underserved families but applicable for all
• Provided in addition to Early Intervention
• Now funded: Dept. Education IES
GUIDING PHILOSOPHY
• Parents are children’s first and most important teachers
• Enriching a child’s early language environment occurs through promoting parent-child interactions that have been linked to positive child outcomes
• This does NOT require changing cultural practices and values or idiomatic speech
GOALS
• Equip parents with knowledge of their child’s brain and language development
• Increase parents’ belief that their words have the power to “build their child’s brain” and positively impact their educational outcome
• Increase parents’ language input to enrich their child’s early language environment
CURRICULUM: MORE THAN JUST “TALK”
• Early language strategies include:• child-directed speech• positioning• joint attention• follow the child’s lead• turn taking• wait time and expectant look• routines & repetition• self talk & parallel talk• description and expansion• give choices & open-ended questions• labeling - take the “it” out of your vocabulary • book sharing• eliminate background noise• decreasing TV and technology time
INTERVENTION ELEMENTS
• Coaching method• One-on-one Home Visiting model
• Educational modules• Behavioral strategies
• Video modeling
• Quantitative Linguistic Feedback
• Goal setting
PROJECT ASPIRE
• Parents are partners
• 10 weekly computer-based modules
• Integrate practical strategies for increasing parent talk and turn taking into routines and everyday activities
• Discussion-based, motivational, non-judgment
• Video of parent-child interaction illustrates real-life applications
• Animation takes scientific concepts and makes them user friendly
BEHAVIOR STRATEGIES: VIDEO MODELING
• Interventionist and parent practice new skills on video
• Review and discuss using coaching method
• Gives parents immediate concrete feedback on implementing strategies
BEHAVIOR STRATEGIES: QUANTITATIVE LINGUISTIC FEEDBACK
• LENA’s automated technology grants an unprecedented window into a child’s natural language environment
• Records 10-16 hours• Measures
• adult words• conversational turns• child vocalizations• TV time
(Automatic language assessment in three easy steps, 2011).
BEHAVIOR STRATEGIES: QUANTITATIVE LINGUISTIC FEEDBACK
• Tool for:
• awareness of language input
• feedback
• motivation
• goal setting
(Automatic language assessment in three easy steps, 2011).
PILOT STUDY
• Currently ongoing
• 32 families in Chicagoland area
• Quasi-experimental study
• 3-months post-intervention follow up
PROJECT ASPIRE: NEXT STEPS
• Longitudinal, multi-institutional study
• Identify potential partners to make curriculum accessible nationwide
• ASPIRE Espanol
• Adapt for Telemedicine
• Comprehensive professional learning
• Web-based Community of Practice for ASPIRE Interventionists
IT TAKES A VILLAGE
• Kristin Leffel
• Beth Suskind
• Eileen Graf
• Sally Tannenbaum
• Michelle Havlik
• Lyra Repplinger
• Lia Ferro
• Mary Ellen Nevins
• Marc Hernandez
• Teresa Caraway
• Ereni Katsaggelos
• Jean Desjardin
• Christina Perigoe
I would like to thank Project ASPIRE’s many collaborators:
REFERENCES• Addy, S., Engelhardt, W., & Skinner, C. (2013, January). Basic facts about low-income children. Retrieved from http://www.nccp.org/publications/pub_1074.html#3.
• Automatic language assessment in three easy steps. (2011). Retrieved from http://www.lenafoundation.org/ProSystem/Overview.aspx
• Center on the Developing Child, Harvard University (Producer). (2011). Toxic stress derails healthy development [Online video series]. Retrieved from http://developingchild.harvard.edu/resources/multimedia/videos/three_core_concepts/toxic_stress/.
• Chapman, C., Laird, J., Ifill, N., & Kewal Ramani, A. (2011, October). Trends in high school dropout and completion rates in the United States: 1972-2009. Retrieved from http://nces.ed.gov/pubs2012/2012006.pdf.
• Evans, G. W., Gonnella, C., Marcynyszyn, L. A., Gentile, L., Salpekar, N.. (2005). The role of chaos in poverty and children's socioemotional adjustment. Psychological Science, 16 (7).
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