Family-Centered Early Intervention for Deaf and Hard-of-Hearing Children (and Their Families!)

The Issue

Since passage of the Walsh Act calling for universal newborn hearing screening, it has become clear that best practices in supporting children who are deaf/hard of hearing (DHH) have centered families in this process. Part C of the Individuals with Disabilities in Education Act (IDEA) is the federal legislation that guides early intervention (EI) programs to serve children birth through 36 months. Consensus documents, such as those put forth by the Joint Committee on Infant Hearing (JCIH, see below), provide guidelines for professionals who work with caregivers as central members of intervention teams.

Those of us who have had the privilege of working with caregivers as the primary learner aren’t just motivated by the law. Instead, providers experience the joy of seeing a caregiver recognize their own strengths, facilitate positive communication interactions with their child, and celebrate their child’s successes as they reach early communication milestones. This work is humbling and challenging. Family centered early intervention (FCEI) providers recognize child and caregiver strengths and build upon them. FCEI providers are problem-solvers who collaborate with caregivers and other professionals to offer ideas, explore, and experiment with those approaches that can support learning and development. FCEI providers recognize that coaching builds caregiver capacity, increases confidence and competence to achieve their desired outcomes. When EI programs support families of children who are DHH by providing resources and support, culture is honored and celebrated, family influence is recognized, and capacity is built.

What we know

EI programs aim to support parents of young children who are DHH. Guiding principles of many programs purport a strengths-based approach honoring family culture and caregiver’s capacity to help children learn and grow. So, what do we know?
  • The earlier children are identified and connected with support services, the greater developmental outcomes they realize. Parental involvement predicts language, reading, and social-emotional outcomes. Promoting communicative interactions between caregiver and child is a key priority to optimize outcomes. Shared caregiver child interactions lead to shared communication and language development. These communication habits then influence a child’s pattern of interaction with others.
  • EI is effective and supported by research on early brain development. By enriching environments and caregiver child interactions early, intervention becomes a developmental rather than remedial approach.
  • Good intentions aren’t enough. Professionals need specific knowledge and skills to provide FCEI.
  • FCEI is efficient and has lasting benefits. Adults who spend the most time with young children have the greatest influence. FCEI empowers the child’s entire communication network, including siblings, grandparents, and babysitters.
  • Intervention can happen anywhere. Often these services are provided in the family’s natural environment (living room, backyard, daycare, etc.) but successful FCEI and coaching can also happen in clinics and therapy rooms.

What we don’t know

  • We don’t know how much is enough. The frequency and intensity of FCEI sessions are wide-ranging in practice. Some families meet with their FCEI coach on a weekly basis, for an hour at a time. Others meet less often (2x/month, 1x/month).  We don’t (yet) have clear empirical evidence on the right number or spacing of sessions. The optimum is likely highly individualized and not dependent solely on hearing level or communication modality. Instead, family needs and priorities ought to inform the frequency and intensity of sessions.
  • We don’t know how to do it all. Working within a family system, professionals may learn of or observe an unmet need that they themselves don’t have the knowledge/skills to support. Thus there is a clear need for collaboration, interprofessional practice, and referrals.
  • We don’t fully understand the efficacy of FCEI when offered through distance technology. While important research is underway comparing face-to-face family-centered practice with tele-intervention, it isn’t yet clear whether one platform better supports families. There is likely a time and place for both.


For practitioners –

  •  Develop relationships to support caregiver emotional health. Trust, respect and rapport go a long way.
  •  Assess family needs to engage caregivers in joint planning, prioritizing what families really want/need.
  •  Share expertise, give information, and connect families to resources (consider child development, hearing levels, play, speech and/or language acquisition, etc).
  •  Engage parents in participatory practices. Capitalize on routines and activities and suggest embellishments (i.e., strategies and techniques) to support child development.
  •  Reflect, reflect, reflect. What went well? What didn’t? What will you do differently next time?

For families –
Keep up the good work. You are your child’s most important and best teacher conversation partner. Your child is lucky to have you as their biggest fan. We professionals are lucky to serve you.

Posted on July 6, 2018 by
Jenna Voss
Fontbonne University
jvoss {at}


Further reading

Hintermair, M., Sarimski, K., & Lang, M. (2017). Preliminary evidence assessing social–emotional competenci it’s great. Es in deaf and hard of hearing infants and toddlers using a new parent questionnaire. Journal of Deaf Studies and Deaf Education, 22, 143. view details

Ingber, S., & Dromi, E. (2010). Actual Versus Desired Family-Centered Practice in Early Intervention for Children With Hearing Loss. Journal of Deaf Studies and Deaf Education, 15, 59. view details

Moeller, M. P., Carr, G., Seaver, L., Stredler-Brown, A., & Holzinger, D. (2013). Best practices in family-centered early intervention for children who are deaf or hard of hearing: An international consensus statement. Journal of Deaf Studies and Deaf Education, 18, 429. view details

Yoshinaga-Itano, C. (2003). From screening to early identification and intervention: Discovering predictors to successful outcomes for children with significant hearing loss. Journal of Deaf Studies and Deaf Education, 8, 1. view details