FAMILY CHARACTERISTICS, STATE PROGRAM EFFECTIVENESS, AND REPORT OF INADEQUATE CARE AMONG FAMILIES OF YOUNG CHILDREN WITH HEARING LOSS

Approximately 1.6 per 1,000 newborns in the U.S. are born with hearing loss. Congenital hearing loss poses a risk to their speech, language, cognitive, and social-emotional development. Early detection and intervention can improve outcomes. Every state has an Early Hearing Detection and Intervention program (EHDI) to promote and track screening, audiological assessments and linkage to early intervention. However, a large percentage of children are “lost to system (LTS),” meaning that they did not receive recommended care or that it was not reported. This study used data from the 2009-2010 National Survey of Children with Special Health Care Needs and data from the 2011 EHDI Hearing Screening and Follow-Up Survey to examine how 1) family characteristics; 2) EHDI program effectiveness, as determined by LTS percentages; and 3) the family conditions of education and poverty are related to parental report of inadequate care. The sample comprised 684 children between the ages of 0 and 5 years with hearing loss. The results indicated that living in states with less effective EHDI programs was associated with an increased likelihood of not receiving early intervention services (EIS) and of reporting poor family-centered communication. Sibling classification was associated with both receipt of EIS and report of unmet need. Single mothers were less likely to report increased difficulties accessing care. Poor and less educated families, assessed separately, who lived in states with less effective EHDI programs, were more likely to report non-receipt of EIS and less likely to report unmet need as compared to similar families living in states with more effective programs. Poor families living in states with less effective programs were more likely to report less coordinated care than were poor families living in states with more effective programs. This study supports the conclusion that both family characteristics and the effectiveness of state programs affect quality of care outcomes. It appears that less effective state programs affect disadvantaged families’ service receipt report more than that of advantaged families. These findings are important because they may provide insights into the development of targeted efforts to improve the system of care for children with hearing loss.

TEACHERS’ ATTITUDES TOWARD INCLUSION OF CHILDREN WITH DISABILITIES IN RURAL EL SALVADOR

The attitude of school teachers toward inclusion of children with disabilities is an important factor in the successful implementation of a national inclusion program. With the universal pressure to provide education for all and international recognition of the importance of meeting the needs of diverse populations, inclusive education has become important to governments around the world. El Salvador’s Ministry of Education seeks to establish inclusion as an integral part of their struggle to meet the needs of children across the country, but this is a difficult process, especially for a country with limited resources which still struggles to meet international expectations of educational access and quality. Teacher attitude is an important factor in the success of inclusion programs and can be investigated in relation to various factors which may affect teachers’ classroom practice. While these factors have been investigated in multiple countries, there is a need for more knowledge of the present situation in developing countries and especially in schools across the rural areas of El Salvador to meet the needs of the diverse learners in that country. My research was a mixed methods case study of the rural schools of one municipality, using a published survey and interviews with teachers to investigate their attitudes regarding inclusion. This research was the first investigation of teachers’ attitudes toward inclusion in rural El Salvador and explored the needs and challenges which exist in creating inclusive schools across this country. The findings of this study revealed the following important themes. Some children with disabilities are not in school and those with mild disabilities are not always getting needed services. Teachers agreed with the philosophy of inclusion, but believed that some children with disabilities would receive a better education in special schools. They were not concerned about classroom management. Teachers desired more training on disability and inclusion. They believed that a lack of resources, including materials and personnel, was a major barrier to inclusion. Teachers’ attitudes were consistent regardless of family and professional experience with disability or amount of inclusion training. They were concerned about the role of family support for children with disabilities.