Managing the Mainstream By Pamela Talbot
The following is an article published in The Auricle by Auditory-Verbal International, Volume 9 Number 4, Summer 1997. The Author has kindly given her permission for me to place her article on this page.
By Pamela Talbot M.Ed, CCC-SLP, C.E.D.
Mainstreaming is a process that extends far beyond the decision to place a child in a classroom with normal hearing peers. It requires continuous monitoring and creative problem solving to ensure the child with hearing loss is learning to his or her full potential.
This is quite different from the "sink or swim" philosophy. The mainstream is not appropriate for all children. Certainly, if the child is in over her head and "sinking," something must be done. In some cases, a different placement may be warranted. However, it is unfortunate when a district jumps to that conclusion at the first indication that the child can't "swim" on his own. An experienced and strong educational team will evaluate the situation and attempt to find ways to teach the child to swim before ordering them out of the pool.
Inexperienced teams can be just as effective in developing creative strategies if they are given adequate information about the nature of the child's hearing loss, strengths and weaknesses, and appropriate expectations.
The following text is intended as a framework to organize some of the concepts of mainstreaming into three areas. Viewing the issues one area at a time can prevent or alleviate the feeling of being overwhelmed.
The three areas include the environment, the child, and the team.
The Learning Environment consists of the acoustics, physical layout of the classroom, dynamics and degree of structure and the teacher's teaching style. For the child who relies on residual hearing, a poor acoustic environment is the biggest obstacle to learning. It is also the most controllable.
The typical classroom falls short of the +10 to +20 signal-to-noise ratio a person with hearing impairment needs to process speech at an intelligible level. In fact, the typical classroom averages +4 signal-to-noise ratio, which doesn't even provide an adequate signal for a normal hearing child to hear at an intelligible level. Personal FM systems and sound field FM systems are helpful to increase the ratio. However, starting with a quieter environment will result in more favorable ratios.
Professional sound treatment is the most effective way to assess and adapt a room. If finances do not allow for formal modifications the team must develop creative ways to improve the conditions. Whoever thought of the idea to insert the legs of each chair and table into old tennis balls to reduce chair scraping was certainly "on the ball." Other ideas have included decorating with fabric crafts that the children have made, putting cork boards on the walls, dividing the room into smaller areas and making curtains. In general, any adaptation that reduces the hard shiny surfaces will lower the echo effect and improve conditions.
Even in the best acoustic conditions the child with hearing loss is starting at a disadvantage. Therefore the teacher needs to be aware of strategies to enhance speech reading. Simple ideas such as not speaking as the teacher turns to write on the board or standing away from the window, need to be communicated to the teacher to build awareness.
The more orientation the child has to the topics of the class lessons the more efficient he/she will be at filling in any missing sounds or words in order to gain comprehension. The teacher can clearly define transitions from one topic to the next, write new vocabulary and key concepts on the board, and provide an abundance of visual and contextual cues to assist the child. The team can obtain lesson plans and materials from the teacher and preteach vocabulary and basic concepts. When this preview occurs the child can focus his attention on listening during the class with less breakdowns due to unfamiliar terminology.
The Child with significant hearing loss is likely to start school with speech and language gaps. Many of the gaps or weaknesses are easily identified when the team becomes familiar with the child.
The child with hearing loss has to work harder than the other students to receive information. Figuring out words that they have misperceived and concentrating for long periods is exhausting. Auditory fatigue is an issue that requires recognition and compassion. It may be helpful for the child to have the privilege of "down time" in a quiet place when they feel overloaded or when the teacher notices they are having difficulty maintaining focus. General reduction of the "auditory clutter" of background music or general noise is helpful.
Reducing the length of instructions, pausing frequently during long monologues and scheduling quiet tasks in between activities with high listening demands are also strategies the teacher may integrate.
Group discussions are particularly difficult for the student with hearing loss. If an FM system is being used the microphone should be passed to the speaker whenever possible. It is especially helpful for the teacher to call on children by name and point to children when calling on them so the child with hearing loss can reduce the time it takes to locate the speaker. The teacher can also draw attention to changes in the topic and rephrase what the other students say.
Reduced distance hearing presents several problems. First, and most obvious, there will be difficulty hearing students speaking from a distance. This has the potential to isolate the child from others.
The next issue is less noticeable because it extends beyond the context of here and now. That is the cumulative effect of reduced distance hearing on the child's communication skills. Children with severe to profound hearing losses often don't have access to incidental learning which comes from overhearing others around them. This contributes to vocabulary gaps particularly related to slang, expressions and fads of discussion. A large part of conversational maturity and clarification strategies is based on unwritten rules of communication, which most children absorb without being taught. The child with hearing loss is at risk for gaps or immature skills in these areas.
Poor confidence has the potential to sway any competent student away from success. The child with hearing loss may be particularly sensitive or self-conscious of their skills as they develop awareness of areas that are more difficult for them than their peers. The last thing a child with poor confidence needs is to be singled out in front of the class for issues related to their weakness. Teacher statements such as "John can't hear because it's too noisy in here" or "Say it loud enough for John to hear you" are constant reminders to John that hearing is harder for him. It would be better for the teacher to make listening a class issue rather than as a reference to the one child's needs. Teacher statements such as "It's hard to hear someone from far away, please move closer," or "It is hard to listen when it is this noisy," or "Everyone should be looking at the person speaking" put the focus on the issue rather than the child.
Poor confidence as a listener may result in a number of behavioral patterns such as: monopolizing the conversational turns; lack of risk-taking for fear of being wrong; avoidance of difficult situations; or lack of attention. Children with hearing loss may also become so accustomed to missing information or not being understood, so they don't recognize the need to take responsibility to clarify when there is a breakdown. Often the child is unaware that everyone experiences communication breakdowns and that these clarification strategies are universal. The child may become skilled at appearing to comprehend with very convincing head nods even when he/she did not understand the message. It takes a lot of confidence and encouragement to speak up to request clarification. It is important for the teacher to specifically give permission to the child to ask questions and to remind the child throughout the year.
The Team typically consists of the parents, the teacher, a speech-language pathologist, a teacher of the hearing impaired and a consulting audiologist. Other team members may include a psychologist, a tutor or other specialists if additional problems are an issue. The degree of parent involvement varies depending on the desire of the parents and the philosophy of the educational team. The parents must communicate their desire to become involved. The two most common problem areas in team management occur when the role of each team member is not clearly defined and when there is poor coordination and communication between the members. These issues should be addressed at the beginning of the school year.
The classroom teacher may not know how the specialists can support her needs in relation to teaching the child. It is strongly advised that the specialists observe the child in class periodically to help the teacher make any necessary modifications and to assess the child's ability to function in different conditions. The classroom teacher cannot be expected to teach the curriculum by herself. The child with hearing loss often requires a great deal of repetition with several examples and rephrasing with explanations to master the work. The team can work to preteach and expand the topics of the curriculum to enhance language experiences. The team must communicate closely to keep ahead of concepts to be discussed in the class lessons and to monitor the child's mastery of the work. A notebook that circulates between all team members is useful, but it does not take away the need for full team meetings. The frequency of team meetings should be discussed at the beginning of the school year.
This degree of team teaching and coordination may be a new concept to districts that have not had the challenge of mainstreaming a severely-to-profoundly hearing impaired student. Once the team understands the child's specific needs, then creative management can begin. Although there are numerous books on the subject, there is no "right way" to achieve success. There is no harm in experimenting with new ideas if the team is carefully monitoring the child's progress and willing to make changes whenever necessary.