Family-Centered Early Intervention Deaf/Hard of Hearing (FCEI-DHH): Structure Principles

Abstract

This article is the seventh in a series of eight articles that comprise a special issue on family-centered early intervention for children who are deaf or hard of hearing and their families, or FCEI-DHH. This article, Structure Principles, is the third of three articles (preceded by Foundation Principles and Support Principles) that describe the 10 FCEI-DHH Principles. The Structure Principles include 4 Principles (Principle 7, Principle 8, Principle 9, and Principle 10) that highlight (a) the importance of trained and effective Early Intervention (EI) Providers, (b) the need for FCEI-DHH teams to work collaboratively to support families, (c) the considerations for tracking children’s progress through developmental assessment, and (d) the essential role of progress monitoring to continuously improve systems.

Full text

Received: December 29, 2023. Revised: August 10, 2023. Accepted: August 11, 2023
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Journal of Deaf Studies and Deaf Education, 2024, 29, SI86–SI104
https://doi.org/10.1093/deafed/enad040
Empirical Manuscript
Family-Centered Early Intervention Deaf/Hard of
Hearing (FCEI-DHH): Structure Principles
Amy Szarkowski 1,2,Elaine Gale 3, Mary Pat Moeller 4,Trudy Smith 5,Bianca C. Birdsey 6, Sheila T.F. Moodie 7,
Gwen Carr 8, Arlene Stredler-Brown9,Christine Yoshinaga-Itano 10,FCEI-DHH International Consensus Panel‡,
Daniel Holzinger 11 ,12
1The Institute, Children’s Center for Communication/Beverly School for the Deaf, Beverly, MA, United States
2Institute for Community Inclusion, University of Massachusetts Boston, Boston, MA, United States
3School of Education, Deaf and Hard-of-Hearing Program, Hunter College, City University of New York, New York, NY, United States
4Center for Childhood Deafness, Language & Learning, Boys Town National Research Hospital, Omaha, NE, United States
5NextSense Institute, Sydney, NSW, Australia
6Global Coalition of Parents of Children Who Are Deaf or Hard of Hearing (GPODHH), Durban, South Africa
7Health Sciences, School of Communication Sciences & Disorders, Western University, London, ON, Canada
8Early Hearing Detection and Intervention and Family Centered Practice, London, United Kingdom
9Colorado Early Hearing Detection and Intervention Program, Colorado Department of Human Services, Denver, CO, United States
10Institute for Cognitive Sciences, University of Colorado Boulder, Boulder, CO, United States
11Institute of Neurology of Senses and Language, Hospital of St. John of God, Linz,Austria
12Research Institute for Developmental Medicine, Johannes Kepler University, Linz, Austria
Corresponding author: The Institute, Children’s Center for Communication/Beverly School for the Deaf, 6 Echo Ave., Beverly, MA, 01915, United States.
Email: amyszarkowski@cccbsd.org and Institute for Community Inclusion, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA, 02125,
United States. Email: amy.szarkowski@umb.edu
‡See Supplementary Material
Abstract
This article is the seventh in a series of eight articles that comprise a special issue on family-centered early intervention for children
who are deaf or hard of hearing and their families, or FCEI-DHH.This article, Structure Principles,is the third of three articles (preceded by
Foundation Principles and Support Principles) that describe the 10 FCEI-DHH Principles. The Structure Principles include 4 Principles (Principle
7,Principle 8,Principle 9,andPrinciple 10) that highlight (a) the importance of trained and effective Early Intervention (EI) Providers, (b)
the need for FCEI-DHH teams to work collaboratively to support families,(c) the considerations for tracking children’s progress through
developmental assessment, and (d) the essential role of progress monitoring to continuously improve systems.
Collectively, the Foundation Principles,Support Principles, and Struc-
ture Principles comprise the 10 FCEI-DHH Principles, describing
family-centered early intervention (FCEI), which aims to improve
the lives and the outcomes of children who are deaf or hard
of hearing (DHH) and their families. The Structure Principles
emphasize the knowledge, skills, and expectations of EI Providers
as well as mechanisms that contribute to effective monitoring
and meaningful provision of supports from FCEI-DHH programs/
services and systems.
The 10 FCEI-DHH Principles are revised and expanded from
an earlier version (Moeller et al., 2013) by multidisciplinary col-
laborators and an international consensus panel (See Moeller,
et al., 2024, Introduction,andMoodie et al., 2024, Methods, this
issue, for details about contributors and processes of arriving at
the current 10 FCEI-DHH Principles). Throughout this article, the
abbreviation DHH is used inclusively to address all children who
are DHH, including children who are deaf or hard of hearing with
disabilities (see Moodie et al., 2024, Methods,andMoeller et al.,
2024, Introduction, both this issue, for description of consensus
panel perspectives on DHH+).
Principle 7
Trained FCEI-DHH Providers: Dispositions
and competencies
Early intervention (EI) Providers must possess certain disposi-
tions to effectively support families such as kindness, empathy,
and commitment to their work. EI Providers trained to work in
FCEI-DHH possess competency in their own discipline, in the
provision of general early intervention, and in providing DHH-
specific supports. Collaboration with families and with other
professionals, both within and outside the EI team, is valued.
Trained FCEI-DHH EI Providers deliver effective, professional,
equitable, and inclusive FCEI-DHH supports to optimize child
and family outcomes.
Dispositions
Some aspects of being an effective EI Provider are difficult to
quantify and measure. Beyond the technical expertise that is
necessary (described under competencies), skilled EI Providers
also hold certain dispositions that allow them to truly connect
with others and make an impact with their work. Necessary
dispositions of impactful EI Providers include (a) integrity (such
as acting ethically and respectfully with families and colleagues);
(b) responsiveness (adjusting to and meeting the diverse needs
and abilities of children and families); (c) deliberation (the ability
to reflect critically on one’s work and the assumptions that one
holds that inform how work is conducted); and (d) recognition of the
value of one’s professional work (Molla & Nolan, 2019). In working
with young children, having emotional capital (the ability to engage
reflexively about emotions being experienced by oneself and by
the child or family) is also important (Andrew, 2015). Empathy,
emotional insight, and resilience or tenacity are aspects of
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Journal of Deaf Studies and Deaf Education, 2024, Vol. 29, No. SI |SI87
emotional capital, also known as practical wisdom. EI Providers
value family-centeredness and include family members as active
partners in the provision of services to their children (Dalmau
et al., 2017;Sass-Lehrer et al., 2016).
Competencies
Skilled EI Providers should possess and continually work toward
improving their competencies across several areas. EI Providers
require broad knowledge in their field of study, knowledge about
child development, skill in working with families and young chil-
dren, and particular knowledge about supporting children who
are DHH and their families.
Discipline-specific competency
The EI Providers in FCEI-DHH have a variety of professional back-
grounds (see Principle 8 for information about the composition of
FCEI-DHH teams). Training requirements for EI Providers and the
specific work of EI Providers vary by regions and cultures as well
as by area(s) of expertise. Specific education, training, or licensing
is required to work as an EI Provider in some contexts, and EI
Providers are considered “qualified” if they meet the training and
licensing requirements. Even if not required, EI Providers complete
relevant training programs and obtain the necessary degrees,
certificates, or licenses to become skilled in their specif ic profes-
sion. In some contexts, hiring trained EI Providers with discipline-
specific expertise may be difficult and on-the-job training may be
necessary to assist EI Providers to develop discipline-specific com-
petency. Professional development, supervision, and mentoring by
knowledgeable and skilled professionals can further enhance EI
Providers’ skills to support children and families through FCEI-
DHH (Joint Committee on Infant Hearing [JCIH] et al., 2013;King
et al., 2009).
EI-specific competency
Working with young children in collaboration with families
requires knowledge and skills beyond discipline-specific skills
and competencies. Possessing EI-specific competency involves
knowledge and skills across several core areas including (a)
early childhood development; (b) family-centered engagement;
(c) strengths- and relationship-based approaches; (d) cultural and
linguistic responsiveness; (e) planning EI sessions and program-
s/services, coordination, and collaboration; (f) program/service
and system quality assessment; (g) professionalism; and (i)
critical reflection (Hiebert-Murphy et al., 2017;Inbar-Furst et al.,
2020;Sukkar, 2017;Sukkar et al., 2017). Trained EI Providers
should draw upon the strengths of the families, individuals
with vested interests, communities, and leaders within their
cultural contexts (see Szarkowski & Moeller et al., 2024, Cultural
& Global Implications, this issue). They deliver accurate and
effective FCEI-DHH supports to children and families, being
respectful of family cultural beliefs and values (see Szarkowski
& Moeller et al., 2024, Cultural & Global Implications, this
issue, for cultural considerations in guiding families to foster
their children’s development). Effective EI Providers engage in
ongoing learning and continuing education, individualize the
work they do to match the strengths and needs of each family,
and adjust how they work informed by knowledge related to FCEI-
DHH practices, supports, and technology changes (Sass-Lehrer
et al., 2016). They must practice ethically, ensuring that their
work with families aligns with the ethical guidelines of their
respective professions and with regional or national ethics
that govern the provision of EI supports in their area (Coufal
& Woods, 2018;JCIH, 2019). Skilled EI Providers also maintain
professionalism including timeliness with tasks and accuracy in
record-keeping (Able et al., 2017). They critically examine and
reflect on their own emotional responses, attitudes, values, and
thought processes related to FCEI and acknowledge and strive to
minimize their bias and its impact on their work (Harris et al.,
2021;seeSzarkowski & Moeller, et al., 2024, Support Principles,
Principle 6, this issue for a discussion of bias). Trained EI Providers
recognize their strengths and limitations in applying their
discipline-specific knowledge to FCEI (e.g., Szarkowski & Moeller
et al., 2024, Support Principles, this issue, for family- and child-
specific domains of support). Critical self-reflection inf luences
the relationships that EI Providers have with families and other
members of the FCEI team and is linked to EI Providers’ improved
self-knowledge as well as self-regulation as professionals
(Inbar-Furst et al., 2020).
DHH-specific competency
In addition to discipline- and EI-specific competencies, trained EI
Providers working within FCEI-DHH programs should also possess
DHH-specific competency (JCIH, 2013). Along with understanding
family-centered approaches to EI, additional core knowledge and
skills are also required. Core areas include (a) provision of socially,
culturally, and linguistically responsive supports including under-
standing of DHH cultures and communities (see Szarkowski &
Moeller et al., 2024, Cultural & Global Implications, this issue, for
more information about adapting FCEI-DHH for global audiences);
(b) language acquisition and communication development; (c)
technologies to support communication; (d) factors influencing
infant and toddler development; (e) screening, evaluation, and
assessment (along with interpreting and sharing of assessment
results); (f) planning and implementation of services; (g) collab-
oration and interdisciplinary models and practices; and (h) pro-
fessional and ethical behavior (see JCIH et al., 2013 for Knowledge
and Skills tables; Sass-Lehrer et al., 2016).
It is vital that EI Providers understand the specific needs of chil-
dren who are DHH across language, communication, and other
developmental domains (JCIH, 2019). Particularly for EI Providers
who are emerging professionals or those without substantial
experience or skills in supporting families and children who are
DHH, there is a need for guidance, mentoring, and supervision
from professionals with expertise in this area. All EI Providers
require opportunities for DHH-specific professional development
to enhance their skills and knowledge and to stay up-to-date with
current, evidence-informed FCEI-DHH. In addition to possessing
disciplinary-, EI-, and DHH-specific competencies, it is essential
that EI Providers embrace the values that are central to FCEI-DHH
(JCIH et al., 2013;Sass-Lehrer et al., 2016;seeMoeller & Szarkowski
et al., 2024, Guiding Values, this issue, for information about the
five values upon which FCEI-DHH programs/services and systems
should be based).
Competency offered by individuals who are DHH
DHH individuals who utilize various communication and
language approaches, as well as have diverse backgrounds and
knowledge, can offer experience-based insights. For example,
expertise offered by individuals who are DHH can support families
in making decisions to facilitate their children’s development
(Chang, 2017;Hyde et al., 2010). Adults who are DHH often serve
in vital roles with families that range from providing direct EI
support to mentoring and fostering family learning and well-
being (Cawthon et al., 2016;Gale, 2020;Gale et al., 2021;Hamilton
& Clark, 2020;Hintermair, 2008;Hoskin et al., 2023;Jackson,
2011;alsoseeMoeller & Szarkowski et al., 2024, Guiding Values,
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SI88 |FCEI-DHH: Structure Principles Szarkowski et al.
Tab l e 1. Recommendations for ensuring that EI Providers are well trained, knowledgeable and skilled (Principle 7).
Principle 7 Trained FCEI-DHH Providers: Dispositions and competencies
EI Providers actions in response to family-identified needs and
concerns
Family activities & outcomes that may be experienced when EI
Providers are responsive to family needs and concerns
1. Explain to families, in response to their questions, the roles and
competencies of all members of the FCEI-DHH team; explain the value
of having a team of diverse professionals available for the child and
family
1. Ask about the ways that each team member can support the
family; engage in discussions with FCEI-DHH team members to
learn about their roles and competencies
2. Possess and maintain knowledge and skills in relevant discipline(s)
through training and education (where available), as well as through
supervision, to develop discipline-specific skills
2. Receive FCEI-DHH from EI Providers who are skilled in their
relevant discipline(s)
3. Possess and continue to improve upon EI-specific competencies 3. Recognize the value of and advocate for EI Providers who meet the
competency guidelines for EI provision (or are actively in the
process of gaining the necessary knowledge/skills)
4. Possess and continue to improve upon DHH-specific competencies 4. Recognize the value of and advocate for EI Providers who meet the
DHH-specific competency guidelines (or are actively in the process
of gaining the necessary knowledge/skills)
5. Possess and demonstrate understanding of early child development to
contextualize the support provided to families
5. Develop additional insights in collaboration with EI Providers
about their child’s abilities, skills, and growth in the context of
overall child development
6. Build knowledge about the rationale for providing family-centered
supports; gain understanding of the FCEI-DHH Principles and strategies
for doing family-centered work; engage in family-centered support
6. Engage in FCEI-DHH
7. Support and collaborate with families in developing skills to advocate
for trained EI Providers in FCEI-DHH programs
7. Recognize the value of and advocate for EI Providers having the
training and requisite skills to match their child and family needs;
engage with programs/systems to express concerns if expectations
are unmet
8. Share information about own knowledge, skills, and lived experiences
with others on the FCEI-DHH team; work collectively to ensure that the
competencies needed to support the family are available among team
members; recognize when needed competency is not present among
team members and connect families with other specialists
8. Understand EI Provider knowledge and skills requirements and
request additional support from professionals outside the existing
FCEI-DHH team if current team members do not possess
necessary competencies; follow-through with referrals to other EI
Providers or other professionals as indicated based on the unique
needs of their child
9. Gain understanding of the value of including on the FCEI-DHH team
individuals who have acquired the necessary competencies for
engaging in FCEI-DHH and who possess relevant lived experience,
including family leaders and DHH adults
9. Gain understanding of the value of having EI Providers with
necessary FCEI-DHH competencies and the value of inclusion of
individuals who possess relevant lived experience, including
family leaders and DHH adults
10. Demonstrate and maintain professionalism in work with families and
among the FCEI-DHH team (e.g., timeliness, consistency, accuracy,
follow-through); engage in discussions with families about expectations
related to professionalism
10. Recognize the value of and advocate for professionalism in
interactions with EI Providers; share with EI Providers the family’s
expectations related to professionalism; engage in discussions
with EI Providers and/or programs or systems if expectations for
professionalism are not met
11. Engage in critical self-reflection with an aim toward ongoing
improvement in the EI Provider role and in one’s discipline-specific
profession
11. Engage in discussion with EI Providers about their family’s
experience in FCEI-DHH to further support their ability to reflect
on their practice
12. Share knowledge about EI-specific competencies with family leaders
and individuals who are DHH to build supports; gain knowledge from
family leaders and a diversity of DHH adults to obtain valuable insights
from their lived experiences to build own competencies
13. Seek and receive guidance and supervision to continue to build
discipline-specific, EI-specific, and DHH-specific competencies
14. Connect with regional, national, or international organizations to locate
and establish relationships with peer guides or supervisors
15. Follow the codes of ethics of one’s specific professional organization in
implementing FCEI-DHH
16. Seek opportunities for professional development training to supplement
existing professional knowledge
17. Utilize ethical practice, best available evidence, and knowledge gained
through professional experience to support families
Program/service and system processes
1. Recruit and hire EI Providers with discipline-specific knowledge and skills who can help to foster child and family outcomes
2. When individuals with discipline-specific knowledge and skills are not available, train and supervise individuals who possess the appropriate
values to support the FCEI-DHH Principles (e.g., professionals who value diversity and the cultural experiences of families or who are eager to
partner with families and other professionals to support children who are DHH)
Continued.
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Tab l e 1. Continued.
Program/service and system processes
3. Establish hiring practices that foster a diverse, highly trained, and knowledgeable professional workforce
4. Develop or maintain mechanisms for ensuring EI Providers gain or possess EI-specific expertise
5. Develop training mechanisms to ensure that EI Providers can work effectively with families and children who are DHH
6. Hire and maintain a workforce of EI Providers with DHH-specific competencies (including, but not limited to, serving as competent and f luent
language models in the language(s) used by the family and child)
7. Hire, train, and compensate family leaders and DHH adults and ensure that they possess needed competencies to serve as trained and
knowledgeable EI Providers
8. Create mechanisms for team development between EI Providers who are DHH and EI Providers who are hearing to improve or ensure cultural
understanding and enhance communication as well as interactional skills among all EI Providers
9. Implement evidence-informed competency standards (disciplinary-, EI-, and DHH-specific) for all EI Providers
10. Establish and maintain on-going professional development to foster EI Providers’ discipline-, EI-, and DHH-specific competencies
11. Support EI Providers to work flexibly and consider the unique strengths, values, cultures, and needs of each child and family
Family activities and outcomes listed in the right-hand column are not intended as a “test” of family skills, but rather a description of the abilities and
outcomes that may result when EI Providers are effectively supporting families through FCEI-DHH. Even if actions in the Table are aspirational, progress
toward their implementation and/or adaptation is encouraged to meet the needs of families of children who are DHH and the aims of FCEI-DHH. In any of the
family outcomes or behaviors that involve engaging in services, it is essential to respect that families have the right to participate in ways that are most
comfortable for them and to accept or decline what is offered.
this issue, for description of the value of including individuals
with lived experience on FCEI-DHH teams; see Szarkowski &
Moeller et al., 2024, Cultural & Global Implications, this issue,
for information about cultural aspects of being DHH).
In FCEI-DHH, simply “being DHH” does not necessarily indicate
that an individual possesses other competencies necessary for
being a skilled EI Provider; knowledge about FCEI competencies is
also required. Trained individuals who are DHH bring unique lived
experience perspectives to EI, as well as expertise that is valuable
to both families and other hearing or DHH colleagues (Cawthon
et al., 2016;Rogers & Young, 2011). Trained DHH individuals
serving on FCEI teams should be compensated for their work and
their expertise. Leaders who are DHH should be involved in the
development of the vision of EI programs and integrated into FCEI-
DHH programs/services and systems.
Competency offered by family members of children who are
DHH
In some contexts, trained family members of children who are
DHH who have gained knowledge and skills related to FCEI-
DHH serve as EI Providers. Family members are associated with
family-to-family support programs, which may form part of FCEI-
DHH teams. As defined by Hands & Voices (a family-to-family
support network), trained family leaders are “ ...parents who have
experiential knowledge and who gain skills necessary to function
in meaningful leadership roles and present a ‘parent voice’ to
help strengthen families, work in active, equal partnerships with
others to create and inf luence effective programs, and contribute
to the vision and implementation of the systems that are created
for families.” (For information on Hands & Voices, see Table 5
on FCEI-DHH resources to support the Structure Principles).
Trained family leaders should be afforded opportunities for
leadership development, such as training in sharing one’s own
story in ways that do not result in other families feeling that
they must make similar decisions to those made by the family
leader, supporting families from a variety of backgrounds, and
leadership opportunities, such as serving on FCEI-DHH advisory
boards (Hands & Voices, 2021). Both family members and family
leaders play vital and beneficial roles in FCEI-DHH (Eleweke et al.,
2008;Fitzpatrick et al., 2008;Henderson et al., 2014,2016;Jackson,
2011;Jamieson et al., 2011;Poon & Zaidman-Zait, 2014). The vital
roles that family members and family leaders hold should be
recognized, compensated, and integrated in FCEI-DHH programs/
services and systems (see Moeller & Szarkowski et al., 2024,
Guiding Values, this issue, for a description of the value of includ-
ing family members and family leaders on FCEI-DHH teams).
Family members who want or choose to be leaders need to
understand how the experiences they have had with their child
can influence their perspectives, biases, and support of other
families (Davenport et al., 2020).Trained family leaders and family
members should be involved in developing the vision for and
implementation of FCEI-DHH; they should also be integrated
into FCEI-DHH systems. Family leaders, both deaf and hearing,
often lead the establishment of family-to-family support groups
and collaborations across groups (i.e., GPODHH, Hands & Voices).
Family-to-family support may include direct support, education,
information, technical assistance, and referral (see Table 5 for
resources to support the Structure Principles of FCEI-DHH).
Recommendations for Principle 7
Table 1 provides recommendations related to Principle 7 regarding
the need for trained, skilled, and knowledgeable EI Providers,
including expected competencies and values. The table includes
(a) recommendations for EI Provider actions in response to family
questions or requests, (b) family activities and outcomes that may
result when effective FCEI-DHH supports are provided, (c) and
program/service and system processes that are needed to ensure
that EI Providers are trained and knowledgeable. For this Princi-
ple and all remaining Principles (8–10), recommendations for EI
Providers and families are placed side-by-side with the intention
of conveying the “give-and-take” of effective family–EI Provider
collaborations and are not intended to depict a provider-driven
process (Dunst & Espe-Sherwindt, 2016;Moeller & Mixan, 2016).
Principle 8
Teamwork among professionals:
Composition, collaboration, and
responsibilities of teams
FCEI-DHH teams include a variety of skilled EI Providers and
other professionals who contribute their complementary skills,
expertise, and resources. FCEI-DHH teams should work collabo-
ratively toward mutually agreed-upon goals to support positive
child and family outcomes. Collaborative FCEI-DHH teams
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SI90 |FCEI-DHH: Structure Principles Szarkowski et al.
build trust as they exchange skills, knowledge, and understand-
ings. FCEI-DHH supports that are provided by a collaborative
team should be accessible, continuous, family-centered, cul-
turally inclusive, and compassionate (Woodruff & Lutz, 2020).
Composition of teams
Family members play a vital role as members of their child’s
FCEI-DHH team. Families’ needs, wants, strengths, and values
are central to determining which FCEI-DHH supports are offered
and how the family can implement and benefit from those sup-
ports. The relationship between family members and EI Providers
is critical to promoting positive outcomes for the child who is
DHH and the family; the essential elements of family–EI Provider
partnerships are described in Principle 2 (see Moeller et al., 2024,
Foundation Principles, this issue, for a discussion of family–EI
Provider partnerships). Principle 8 focuses on the professionals who
comprise FCEI-DHH teams, their specialized areas of expertise,
and collaborative efforts. The composition of collaborative teams
will vary (see the box describing Specialists and their roles on
FCEI-DHH teams) and should be individualized to the needs of
the family and the child (JCIH et al., 2013).
Specialists and their roles on FCEI-DHH teams as EI
Providers, consultants, and/or mentors
(JCIH et al., 2013)
•Teachers of the deaf and hard of hearing: Offer knowl-
edge about child development and strategies to promote
learning for children who are DHH
•Speech-language pathologists: Provide assessments
and supports related to the development of language,
speech, and pragmatic communication skills
•Individuals who are DHH: Provide DHH adult-to-family
connections and leadership of DHH adult-to-family
support programs
•Family members and family leaders: Provide family-
to-family support and leadership of family-to-family
support programs
•Case managers and service coordinators: Aid families
in scheduling, navigating, and following up with appoint-
ments with a variety of professionals; help families
connect with FCEI-DHH supports
•Pediatric audiologists: Quantify the child’s hearing
levels over time, fit and monitor hearing aids, and
program and monitor cochlear implants; may provide
habilitative supports
•Otolaryngologists: Provide medical management and
treatment; may provide cochlear implant or bone-
anchored hearing aid surgeries
Additional specialists depending on needs of child and
family
•Sign language specialists: Support the family in learn-
ing and using sign language
•Interpreters (spoken and sign language): Provide lan-
guage access for the family in situations where the
professionals and families do not share a common lan-
guage; provide insights about the culture and language
of the family to the team
•Therapists (occupational and physical): Provide support
for fine and gross motor development and adaptive
behaviors
•Mental health professionals (psychologists, counselors,
psychiatrists): Provide support for family adjustment
and well-being
•Developmental professionals (early childhood profes-
sionals with expertise in deaf/blind, autism spectrum
disorders or other disabilities, developmental delay,
and/or emotional/behavioral issues): Support the team
in adjusting interventions for children who are DHH with
disabilities (or DHH+)
•Community health workers: Provide help to families in
reducing unmet needs and connecting to health sys-
tems; typically, are from same community as the family
•Medical specialists (primary care providers [PCPs], neu-
rologists, pediatricians): Provide medical care and iden-
tification and treatment of illness and disabilities
In this next section, the roles of three professionals who may
serve on FCEI-DHH teams are further explained: community
health workers, interpreters, and indigenous or bilingual patient
navigators. They are highlighted below because they often
represent local or indigenous groups and serve globally in roles of
helping families access supports.
Community health workers
FCEI-DHH teams often include community health workers who
can increase the sustainability and credibility of the services
(Scott et al., 2018). Inclusion of community health workers on
FCEI-DHH teams is a way to expand the skills of the team to
address specific needs of the child and family. Community health
workers are often from the same community or area as the
families they support, and they may receive on-the-job training to
address particular health-related needs. They help reduce unmet
needs of families in areas where access to necessary supports
are limited or inconsistent (Folz & Ali, 2018). Community health
workers are often a bridge between families or communities
and formal health systems. Community health workers typically
function to support communities in the roles of (a) service extender
by bringing services to people or bringing people to the health
system; (b) cultural broker by mediating between the culture(s)
of the family and the culture(s) of the systems (this involves
sharing information about the cultural context that influences
care); or (c) social change agent by addressing social determinants
of health in the contexts in which families reside (Schaaf et al.,
2020). Social change agents can encourage actions that address
social problems in positive and inclusive ways. Not all cultural
brokers are community health workers. Cultural brokers support
families whose cultural or linguistic backgrounds differ from
those of FCEI-DHH team members and other professionals. In
some contexts, community health workers and cultural brokers
are involved in the provision of FCEI supports, which may serve as
a model for other FCEI-DHH systems around the globe.
Interpreters
For some families, collaborative teams will partner with spoken
or signed language interpreters from diverse backgrounds to pro-
mote understanding of the languages being used. Interpreters
share contextual or cultural information that benefits both the
family and the team. Maintaining confidentiality of individuals
and families for whom they interpret is of utmost importance
(and it is an aspect of professional ethics interpreters are expected
to follow). Sharing information about the families’ culture with
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professionals can be quite useful. Interpreters’ familiarity with
social life, family dynamics, and cultural structure are helpful
in establishing and maintaining rapport with families (Acar &
Blasco, 2018). Acar and Blasco (2018) contend that “ ... collabo-
ration with interpreters may increase general cross-linguist and
cultural sensitivity and improve access to available resources for
all the parties involved” (p. 174).
Patient navigators
The term “patient” does not resonate with many professionals
involved in FCEI-DHH. However, there are professionals whose
roles include the term “patient” that may be helpful to families
who are engaged with FCEI-DHH, including indigenous patient
navigators and bilingual patient navigators. Indigenous patient
navigators are individuals who guide indigenous individuals or
families to connect with appropriate providers with the aim of
mitigating barriers to accessing health and social care (Rankin
et al., 2022). In some contexts, Indigenous patient navigators
are lay persons from the indigenous community, while in other
contexts, they are professionals. Indigenous patient navigators
perform many different tasks ranging from assisting families with
completing paperwork to arranging transportation for a family to
explaining indigenous cultural rituals to professionals when those
rituals may influence an indigenous family’s ability to engage
(Rankin et al., 2022). Bilingual patient navigators assist families
with making health-related information and appointments more
accessible when the language(s) of the family and the language(s)
of the professionals differ (Crezee & Roat, 2019).
Collaboration approaches and models
Collaborative models for teamwork discussed in this section
include coproduction, medical home, and case coordination.
These models may take the form of multidisciplinary, interdis-
ciplinary, transdisciplinary, and/or interprofessional approaches.
Varied approaches to collaboration ref lect the different roles
of team members, their specialized expertise, and the extent
to which they work together. For example, multidisciplinary
approaches include professionals from varied disciplines who
contribute by addressing needs through their respective distinct
disciplinary lenses. Interdisciplinary approaches involve sharing
information across disciplines in a way that informs each
other’s work. Transdisciplinary approaches are characterized by
the sharing of roles across professional boundaries to maximize
collaboration (Gehlert et al., 2010). Interprofessional approaches
include collaboration of varied professionals in the planning
and implementation of supports (Coufal & Woods, 2018;
King et al., 2009). Cultural inf luences and the status of the
FCEI-DHH program/service and system (e.g., whether they are
emerging or well established, or whether they are functioning
separately or as a part of a larger system of care) will influence
how teams collaborate (see Szarkowski & Moeller et al., 2024,
Cultural & Global Implications, this issue, for information about
how culture(s) influence the composition of FCEI teams and the
provision of service). It is essential that team members coordinate
their efforts across professional boundaries to ensure that family
supports are optimized (Coufal & Woods, 2018).
Coproduction
Collaboration may take the form of coproduction, which means
involving those who directly benefit from a service in contributing
to the service delivery at all stages (Bovaird & Loeffler, 2013).
Individuals and families with lived experience (e.g., families
with children who are DHH and DHH adults) are included in
coproduction processes. Some organizations solidify that relation-
ship through the development of coproduction charters (Brandsen
& Honingh, 2018). In coproduction, all participants are equal part-
ners in commissioning, designing, delivering, and assessing public
services and outcomes (Loeffler, 2021). While co-production
may be considered novel in some areas around the globe,
in the U.K., for example, coproduction charters are common.
Supported by national organizations and entities, such as the
National Health Service, these charters form agreements between
providers and families/individuals with lived experience (for an
overview of coproduction charters, see Bovaird & Loeff ler, 2013).
Medical home
A second model of collaborative teamwork is the medical home.A
medical home is an approach to providing primary care that fos-
ters coordination of services and teamwork among professionals
and families. A medical home is not a physical location; rather,
it is a mechanism for the organization and provision of health-
related care (Woodruff & Lutz, 2020). In many places around the
globe, medical and family-based supports are aligned with health
care systems. There are differing perspectives about the role of
a “medical home,” given that many of the supports families of
children who are DHH receive are educational and developmental
in nature. However, the concept of coordinating and organizing
specialized supports has value as a model and applies beyond
medical services.
Case coordination
Case coordinators, case managers, or service coordinators help
guide families to access supports. Case coordination and case
management may be especially helpful in supporting children
who are DHH with disabilities or have complex needs (Asarnow
et al., 2017). Case management involves a professional who can
guide a family to identify resources in the area where they reside,
while care coordination aims to ensure that appointments with
the various professionals supporting the child and family are
as streamlined as possible. Service coordinators often work with
families to identify needs and help families navigate various
systems and providers (JCIH et al., 2013).
While case management, care coordination, and service
coordination can be helpful to many families, these approaches
may provide even greater assistance to families with limited
resources. Case coordinators serve as (a) an assistant to acquire
information, (b) a peer guide or supervisor to assist with
navigating systems, and (c) a supportive individual who under-
stands the need for flexibility in arranging appointments to be
able to address the needs of the whole family. For example,
flexible scheduling may be needed such as arranging to see
families at times that do not interfere with family members’
work schedule or other commitments (Swafford et al., 2015).
When care is coordinated (e.g., across various FCEI-DHH services
and/or other organizations involved), children who are DHH may
be more likely to be monitored following 1–3–6 JCIH guidelines
(see Moeller et al., 2024, Foundation Principles, Principle 1, this
issue, for information on 1–3–6 guidelines) and to receive timely
supports (Stewart & Bentley, 2019). Access to coordination and
management of supports varies across the globe.
Responsibilities of teams
Members of the collaborative team (see Recommended collabora-
tive practices for teams) are responsible for effectively communi-
cating with each other and with families. Effective communica-
tion is needed to ensure and enhance understanding as well as to
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SI92 |FCEI-DHH: Structure Principles Szarkowski et al.
facilitate problem-solving. Team members often need to discuss
alternatives, formulate plans of actions, facilitate agreements,
and coordinate implementation of the agreed-upon decisions
with families (Raver & Childress, 2015).
Individual team member responsibilities
Individual team members are responsible for gaining and main-
taining the appropriate skills and competencies to be effective
in their work (see Principle 7 for information on general, EI-,
and DHH-specific competencies). In addition to the expertise,
skills, and mutual respect offered by individual members of the
team, working effectively with families of children who are DHH
also requires teams to connect, collaborate, and communicate
regularly (Alduhaim et al., 2021).
As team members seek to collaborate across professional dis-
ciplines on behalf of families, several competencies are essen-
tial. The following guidelines offer direction for professionals
as they work to integrate their efforts with other team mem-
bers. Four core competencies are described in an update to the
Core Competencies for Interprofessional Collaborative Practice
(Interprofessional Education Collaborative, 2016) and are summa-
rized by Coufal and Woods (2018). Paraphrased here, they include
(a) work with other professionals while maintaining a climate of
mutual respect and shared values; (b) use knowledge of one’s own
role and other professionals’ roles to appropriately address family
needs and goals; (c) communicate with others (families, profes-
sionals, and communities) in responsive and responsible ways
to support teamwork and outcomes; and (d) apply relationship-
building skills to perform effectively in various team roles. Mem-
bers of FCEI teams are also expected to deliver culturally and
linguistically responsive family-centered supports.
Collective responsibilities of the collaborative team
It is the responsibility of the collaborative team to provide high-
quality supports and interventions that are comprehensive and
coordinated, focused on quality, safety, and the specific needs
of each family (Asarnow et al., 2017). Members of collaborative
teams are also responsible for ensuring that the supports and
interventions provided are accessible to the family (e.g., trans-
portation is available), consistently available or offered by pro-
fessionals, culturally responsive, and delivered with compassion
(Woodruff & Lutz, 2020). Notably, although collaboration among
team members is strongly endorsed, few empirical studies have
examined collaboration in early intervention (Bricker et al., 2022).
Bricker and colleagues (2022) proposed a framework for enhanc-
ing collaboration to promote both research and integrated ser-
vices for families. See the Recommended collaborative practices
for teams highlighted in the box below.
Recommended collaborative practices for teams
(Bricker et al., 2022)
•Communicate effectively—convey positive attitudes,
discuss alternatives, and compromise regarding joint
action plans
•Share information, resources, and skills—strive to
enhance team functioning and receive information in
the spirit of learning and improving
•Engage in joint planning—cooperate in developing a
unified plan and be accountable for joint decisions
•Compromise—consider alternative options and make
appropriate adjustments
•Model—demonstrate or provide examples to support
team members
•Acknowledge—offer feedback and appreciation
Establishing mechanisms to promote team members’ ability to
perform the types of tasks described in the Recommended collab-
orative practices for team is essential. For example, mechanisms
and times can be established for meeting with others, sharing
information, and providing guidance to other team members, if
appropriate.
Recommendations for Principle 8
Table 2 provides recommendations for Principle 8, which focuses
on the need for collaborative teamwork among professionals
serving children who are DHH and their families. Recommen-
dations are provided that relate to the composition of teams,
responsibilities of team members, and approaches to team coor-
dination. Consistent with the behaviors recommended across
the other Principles, Table 2 includes recommendations for EI
Provider actions,anticipated family activities and outcomes when
effective FCEI-DHH supports are offered, and program/services
and system processes to address the Structure Principles.
Principle 9
Developmental assessment: Purpose,
approaches, skilled assessors, and
interventions
Family-centered assessments consider the strengths, resources,
priorities, and concerns of the family, along with the interven-
tions and supports that are necessary to enhance the child’s
development and optimize family outcomes. FCEI-DHH recog-
nizes that families, in general, are experts on their child and
that family engagement is vital to the assessment process. The
goal is for family members to be involved on FCEI-DHH teams.
The professionals involved may differ depending on child and
family needs.
Purpose of assessment
Early and consistent developmental assessment that informs
early intervention for young children is important (Smythe
et al., 2021;WHO, 2020). Assessments should be conducted in
settings that are natural and comfortable for the child and family.
Assessments should be comprehensive and measure the child’s
abilities across multiple developmental domains, including
cognitive, physical, social–emotional, adaptive, motor, and
linguistic and communicative domains. For children who are
DHH, assessment and monitoring of auditory and visual skill
development are critical, as these can have important impli-
cations for how children learn and access their environments.
Changes in vision or hearing levels will influence the child’s
care such as acquiring glasses or adjusting the communication
approaches used by the child and family. For children who
are DHH, assessment of linguistic and communicative abilities
should include receptive language, expressive language, and
social-pragmatic communication abilities (Szarkowski et al., 2020;
Toe et al., 2020). Notably, assessment of linguistic and com-
municative abilities includes understanding and use of signed
and/or spoken aspects of language (e.g., phonology, vocabulary,
and understanding of phrases and narratives).
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Tab l e 2 . Recommendations about collaborative teamwork, including team composition, responsibilities of team members, and the
value of coordination of efforts (Principle 8).
Principle 8 Collaborative teamwork among professionals: Composition, responsibilities, and coordination of teams
EI Provider actions in response to family-identified needs and
concerns
Family activities & outcomes that may be experienced when EI
Providers are responsive to family needs and concerns
1. Share information with families in response to their questions about
the roles and responsibilities of all members of the collaborative team
1. Gain understanding about how each member of the collaborative
team will contribute to supporting their child and family outcomes
2. Share information about FCEI-DHH systems with all partners working
with the collaborative team
2. Gain understanding about how FCEI-DHH systems operate, including
collaborative practices, and inclusion of partners working with the
collaborative team
3. Ensure that the appropriate professionals are members of the
collaborative team to meet the identified support needs of the child
and family
3. Share information about the support needs of their child and family
to aid in determining the appropriate professionals to serve on the
FCEI-DHH collaborative team
4. Partner with relevant professionals outside of FCEI-DHH in response
to family-identified needs to promote positive child and family
outcomes
4. Engage with professional partners to promote positive child and
family outcomes
5. Work with members of the collaborative team to streamline, integrate,
and ensure consistency of information shared with families
5. Engage with professionals to ensure information is provided in
succinct, accessible formats; use that information to benefit their
child and family; engage in discussions with the collaborative team to
address any concerns related to information shared by team members
6. Identify, implement, and adhere to policies for communicating among
team members and families; communicate in a timely, professional,
and positive manner
6. Expect timely communication from FCEI-DHH collaborative team;
engage in reciprocal communications in a timely and positive manner
7. Offer to connect families with care coordination or case management
supports, if available
7. Engage with care coordination or case management supports
8. Offer families the opportunity to invite relevant, supportive
individuals to planning and/or intervention sessions with members of
the FCEI-DHH team
8. Invite supportive individuals (e.g., advocates, other families with
shared experiences, trusted friends) to be present during planning
and/or intervention sessions with the collaborative team if additional
support is desired
9. Gain and share knowledge with families in response to their questions
about the benefits and roles of professionals who partner with
collaborative teams (e.g., family-to-family support, DHH
adult-to-family support, interpreters, cultural brokers, community
health workers) and partner with these professionals
9. Gain understanding about the benefits and roles of professionals who
partner with collaborative teams (e.g., family-to-family support, DHH
adult-to-family support, interpreters, cultural brokers, community
health workers); evaluate the information received in light of family
values, strengths, needs, and goals
10. Gain and implement skills in working with others who hold views that
differ from one’s own
11. Gain and improve abilities to employ seven essential skills for
collaboration in teams (i.e., communicating, sharing, joint planning,
contributing, compromising, modeling, and acknowledging; Bricker et
al., 2022)
Program/service and system processes
1. Develop policies that ensure that collaborative teamwork is a foundational component of FCEI-DHH models
2. Provide ongoing training for EI Providers to gain knowledge about working effectively as members of a collaborative team and to gain skills in
effective collaboration
3. Develop, implement, or utilize protocols to ensure collaborative practices are employed
4. Support decisions made by families in combination with EI Providers and all members of the FCEI-DHH team when changes in service provision
are requested by the family and team; adjust the composition of members on collaborative teams to meet the support needs of specific families
and as the children’s and families’ needs change over time
5. Establish mechanisms that promote EI Providers’ ability to partner with organizations or individuals to address family needs (e.g., system-wide
mechanisms for referring to family-to-family support and DHH adult-to family support, mechanisms to facilitate collaboration with organizations
that employ community health workers or cultural brokers, and ways to engage professionals who can support child and family goals yet are not
formal members of FCEI-DHH teams)
6. Develop, maintain, or improve access to coordinated supports
7. Provide training to EI Providers to better understand and meet the unique needs of families with children who DHH through collaborative
teamwork
8. Develop, implement, and monitor mechanisms to ensure that child and family data are respected and protected, both across members of the
collaborative team and between the collaborative team and its partners
9. Implement well-integrated systems of care, with particular attention given to development of infrastructure and collaborative practices
Family activities and outcomes listed in the right-hand column are not intended as a “test” of family skills, but rather a description of the abilities and
outcomes that may result when EI Providers are effectively supporting families through FCEI-DHH. Even if actions in the Table are aspirational, progress
toward their implementation and/or adaptation is encouraged to meet the needs of families of children who are DHH and the aims of FCEI-DHH. In any of the
family outcomes or behaviors that involve engaging in services, it is essential to respect that families have the right to participate in ways that are most
comfortable for them and to accept or decline what is offered.
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SI94 |FCEI-DHH: Structure Principles Szarkowski et al.
Developmental assessment of a child serves many purposes
including (a) determining whether a child is showing typical
development or demonstrates a developmental delay, (b) identi-
fying a specific disability, (c) documenting developmental growth
trends, (d) informing selection and implementation of early
intervention goals and strategies, (e) measuring the effectiveness
of early intervention strategies, (f) providing information about
whether a change in strategies might be required, (g) exploring
“what works” for the child and building on those approaches,
and/or (h) helping families recognize developmental processes
(Bellman et al., 2013;JCIH, 2019;Yoshinaga-Itano, 2014). A
combination of assessment tools should be used regularly and
systematically to capture the developmental progress of a young
child who is DHH and address a variety of assessment purposes.
EI Providers should communicate with families to ensure that the
purposes of planned assessments are clear.
Goal setting
Clear identification of child and family outcomes is essential to
FCEI. Goal setting can serve as a “road map” or guide that helps
to ensure that all members of the team are working together to
achieve similar outcomes for the child and family. Clear goals,
for the child and for the family, help to ensure that interven-
tions and supports are functional and yield positive outcomes
(García-Grau et al., 2022). Individualized assessment of child and
family needs and strengths should lead to the co-creation of goals
by members of the FCEI-DHH team including the family.
Goals should be measurable and include timelines and crite-
ria for generalization of skills (García-Grau et al., 2022). Family
goals, whether directly related to the child or more generally
focused on family-identified needs, help to ensure that goals
are meaningful and contextualized. Although DHH-specific goal-
setting tools may not be widely utilized in FCEI-DHH, goal-setting
tools have been used successfully in EI for other populations and
show promise for supporting family and EI Provider collaboration
toward common goals (Jones et al., 2019;Rizk et al., 2023).
Tracking
When monitoring progress, both assessment and tracking are use-
ful in understanding gains and improvements made by a child.
Informal approaches are often used to track progress toward
intervention goals, helping families and EI Providers see trends in
how a child is doing in a particular area of development over time.
For example, this may involve a tracking sheet with “tally marks”
indicating the number of times the child demonstrated an emerg-
ing targeted skill. Periodic assessments aim to formally document
functioning at a given point in time; they typically yield informa-
tion that contributes to understanding a child’s development.
Approaches to assessment
Developmental assessments may include (a) family-report mea-
sures (formal examples include checklists or questionnaires; less
formally, caregivers may report the frequency with which a child
demonstrates a particular skill); (b) norm-referenced/standardized
assessments (these provide information about whether a child’s
development is “on par for their age” or whether there are gaps
in the child’s abilities that require intervention); (c) criterion-
referenced assessments/developmental benchmarks (allow for compar-
ison of a child’s abilities against established developmental trajec-
tories for particular skills and can chart a child’s progress toward
developmental milestones, even when progress is incremental);
and (d) informal assessments (e.g., interviews with caregivers,
observations of family–child interactions, observations of the
child performing a daily routine, observations and descriptions
of play-based interactions, and language sampling; Bagnato
et al., 2010;Szarkowski & Hutchinson, 2016). There are several
approaches to assessments that can be used in FCEI-DHH, as
described below.
Team-based
Team-based developmental assessments involve professionals
from multiple disciplines. Interdisciplinary collaboration refers
to multiple professionals from different disciplines such as a
teacher of the deaf, an audiologist, a DHH professional, and a
physical therapist working together with families in the interest of
delivering high-quality supports. Assessments are most effective
when professionals are working collaboratively with families
to obtain the most authentic information (Coufal & Woods,
2018). A team-based assessment approach is appropriate in FCEI-
DHH and is endorsed by the JCIH (JCIH et al., 2013). FCEI-DHH
systems should strive to ensure that appropriate developmental
assessments and monitoring are integral to their programs.
Appropriate developmental assessments are necessary to ensure
that FCEI-DHH maintain high standards for children who are
DHH. Appropriate developmental assessment tools to be used
in FCEI programs/services may be difficult to locate across the
globe. Workforce capacity, materials, and resources to provide
developmental assessments varies around the globe, and the rec-
ommendations offered here will be aspirational in some places.
Authentic assessment
One “informal assessment” approach is “authentic assessment,”
which is considered developmentally appropriate practice with
young children. Authentic assessment is the process of under-
standing a young child’s competencies or abilities through obser-
vation of the child’s actions and interactions in familiar places,
with a variety of familiar people, at various times during the day
(Bagnato et al., 2010,2014;Guralnick & Bruder, 2019). Authentic
assessments capture the abilities that a child demonstrates in
real-world contexts including in their family, community, and
cultural contexts (Lee et al., 2015). Authentic assessments are an
alternative to conventional, structured testing methods that are
often not well suited for young children. EI Providers describe
authentic assessment tools as more useful than conventional
tests for garnering relevant information about a child’s function-
ing (Lee et al., 2015). FCEI-DHH recognizes the value of authentic
assessments and encourages incorporation of this approach in the
assessment of young children who are DHH.
Family assessments
Family assessments support EI Providers’ understanding of family
values and priorities, strengths, and needs as well as the extent
to which families desire and are able to engage with the EI team
(Bailey et al., 2006). Family assessments serve an integral role
in planning and individualizing interventions. Taking a variety
of forms, family assessments often including informal strate-
gies such as interviews, observations, and questionnaires (Bailey
et al., 2012). Keilty and colleagues (2022) examined a collabora-
tive approach to assessment and planning that used naturalistic
observations and discussions to gain understanding of families’
strategies to promote their children’s learning and their thoughts
about why those strategies were used. Observing natural, daily
interactions between the child and family reveals families’ exist-
ing strategies (strengths) that could be acknowledged and built
upon. Discussions about the observations validated “the impor-
tance of professionals understanding their family strengths and
further cementing the family as the primary promoter of their
child’s learning” (Keilty et al., 2022, p. 408).
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One evidence-informed example of a family assessment that is
widely used in EI is the routine-based interview (RBI; McWilliam,
2016;McWilliam et al., 2009). The RBI is designed to facilitate
family discussion of their views about child and family func-
tioning in the context of daily routines. The information obtained
through the RBI is used for collaborative goal setting and has been
found to lead to functional goals that align with families’ priorities
(García-Grau et al., 2022). EI Providers have reported that the RBI is
helpful in designing family-centered interventions contextualized
in daily family life (Hughes-Scholes et al., 2019). The RBI has been
found to be useful in conducting family assessments and has
been applied in international contexts (McWilliam et al., 2020;
Pereira et al., 2022).
Skilled assessors
In FCEI-DHH, assessments need to be conducted by professionals
with knowledge, skills, and experience in assessment of children
who are DHH and their families including (a) knowledge of infant,
toddler, and child development and implications of being DHH;
(b) appreciation of the many factors influencing development,
including culture; (c) trained observational skills; (d) ability to
contextualize and aptly describe observations; (e) capacity to
succinctly and compassionately convey findings; (f) understand-
ing of family systems (including environmental and personal
factors) and sensitivity in working with families; (g) ability to
understand and be understood by the child, having competence
in the language(s) (signed and/or spoken) used by the child;
and (h) knowledge of and familiarity with specific assessment
tools and ability to select appropriate assessments for each child
(Szarkowski & Hutchinson, 2016). Developmental assessments
of children who are DHH need to be socially, culturally, and
linguistically responsive to the strengths and needs of the family
(JCIH, 2019). Professionals who conduct assessments should be
capable of sharing feedback about the testing to advance families’
understanding of overall child development (Postal & Armstrong,
2013). Given the lack of specialized expertise in conducting assess-
ments with children who are DHH and their families around
the globe, supervision and training of EI Providers and teams
to develop assessment skills is necessary for most FCEI-DHH
programs/services and systems.
Selection of assessment tools
Skilled assessors in FCEI-DHH will recognize that care must be
taken in utilizing instruments normed exclusively on samples of
children who are DHH. Although such norm-referenced assess-
ment measures can provide useful information, results can be
misinterpreted if the implications of being DHH are not under-
stood. When assessments are designed for children with typical
hearing yet are used with children who are DHH, the results
might lead to misunderstandings. For example, the instructions
might require the child to respond to sounds or to follow complex
instructions to be able to perform tasks, and not doing so leads
to lower scores. When a child who is DHH does not respond or
follow instructions, performance may ref lect their reduced hear-
ing rather than their language or cognitive abilities. An unskilled
assessor could mistakenly assume that the lower score reflects
reduced skills.
Some tests normed specifically on groups of children who
are DHH do not have strong psychometric properties (Allen &
Morere, 2022;Visser et al., 2012). The range of performance in
selected groups of children who are DHH is often wide, which
can affect what it means to be “in the average range for a child
who is DHH.” Scoring within the “average range” compared to
norms for children who are DHH may not reflect performance
that is consistent with the child’s potential. Interpretation of test
results could lead to underestimating a child’s skills and not
recognizing a child’s true strengths or overestimating a child’s
ability. Overestimation may result i n overlooking needs that could
be addressed through intervention.
Skilled assessors recognize that multiple domains of function-
ing are associated with positive development in early childhood.
Development across the domains is asynchronous, yet interde-
pendent (Darling-Churchill & Lippman, 2016); that is, children
will not develop uniformly across all developmental domains and
gains in one area will influence development in other areas. It is
important that FCEI teams attend to all domains of development
to ensure that children are gaining necessary skills. Assessment
of specific developmental domains can also be influenced by
child progress in different areas. For example, assessment of a
child’s social–emotional skills can be influenced by the child’s
language and communication abilities, since many assessments
rely on a child’s ability to use language to show understanding
(Darling-Churchill & Lippman, 2016). When children are DHH and
have a disability, it is essential that assessors are cognizant of
the ways that a child’s disability might influence performance on
assessment tasks. For example, motor challenges can inf luence
a child’s ability to do puzzles or sequence objects, which are
tasks that are intended to capture a child’s cognitive abilities.
Skilled assessors will consider the many aspects of developmental
assessment and use caution in the selection of assessment tools
(see Moeller & Szarkowski et al., 2024, Guiding Values, this issue,
for information about the developmental domains that should
be considered in developmental assessment). Assessment of lan-
guage in children who are DHH warrants further attention.
Assessment of language(s)
Skilled assessors conducting language assessments should be
fluent in the language(s) they are assessing (whether signed
or spoken), experienced and knowledgeable about conducting
assessments with children who are DHH, and able to interpret
the testing results (Szarkowski & Hutchinson, 2016). Specific skills
are needed when assessing the language abilities of children who
are DHH who utilize sign language as their primary language.
Assessors who are fluent in sign language(s) and experienced in
assessing children who are DHH are needed in such contexts.
Trained DHH professionals may be particularly well suited to
conduct such assessments and/or to contribute to the team’s
understanding of a child’s emerging language development.
Assessments should be conducted in the languages used by the
children and families who are bilingual or multilingual, whether
in signed languages, spoken languages, or signed and spoken
languages. When language assessments are not available in the
child’s language, whether because the test itself is not available in
the child’s primary or preferred language or because the assessor
is not fluent in the language of the test, use of language-specific
assessment tools will not document a child’s true abilities. When
the language(s) of the child and family differ from those of the
assessors, it may be necessary to include an interpreter. However,
extreme caution is necessary to ensure that assessment tools
are used appropriately, and interpretation of results accurately
capture the child’s abilities (for example, see Frisbie et al., 2021,
for a discussion of issues related to assessment of signed and
spoken languages; see Pizzo & Chilvers, 2019, for considerations in
assessment of children who are DHH; and see Acar & Blasco, 2018,
for guidelines in working with interpreters in EI). It is generally not
advised to assess language development through an interpreter
(Acar & Blasco, 2018).
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Even when it is inappropriate to directly assess language abili-
ties because assessment tools are not available in the language(s)
used by the child, informal procedures for understanding how a
child communicates can offer valuable information to the family
and the team. Comprehensive assessment is still needed to assess
other developmental domains (e.g., motor, non-verbal cognitive
abilities). In such cases, it is necessary to utilize tools that have
minimal language burdens to ensure that assessment results
capture the child’s true abilities and are not compromised by
difficulties in comprehending the demands of the task. Results
from assessments of a child’s functioning across developmen-
tal domains can be used to guide the selection of needed sup-
ports. Additional skills may be needed for professionals assess-
ing the communicative abilities of children who are DHH and
have disabilities. For example, professionals may need knowledge
and skills in assessing and understanding the development of
communication abilities for children who use augmentative and
alternative communication (AAC) and other means to support
communication (Neild et al., 2023).
Interventions
Assessments in EI should inform the EI supports that families
receive (Guralnick & Bruder, 2019). EI goals and strategies are
altered over time in response to changes in child or family
strengths or needs or because the anticipated progress is not
being made using the existing strategies. Periodic assessment
is necessary to address changes in child and family needs, to
incorporate new evidence-informed approaches and to document
progress as children grow and develop new abilities (JCIH, 2019;
Szarkowski & Hutchinson, 2016).
It is essential for FCEI-DHH teams to understand and docu-
ment whether children who are DHH are attaining developmen-
tal milestones. Ongoing monitoring involves tracking milestones
in the areas of language and communication, cognitive, social–
emotional, physical, motor, auditory/visual, and adaptive devel-
opment. While differences in developmental trajectories exist
among children who are DHH (Ching et al., 2018;Niparko et al.,
2010;Tomblin et al., 2015), the aim of FCEI-DHH programs should
be to support families in facilitating each child’s development up
to that individual child’s full potential.
Recommendations for Principle 9
Table 3 provides recommendations for Principle 9, involving the
importance of ongoing developmental assessments of outcomes
for children and families. The recommendations relate to con-
ducting comprehensive and purposeful assessments by appropri-
ately skilled assessors, managing language(s) used, and utilizing
results from assessments to inform intervention planning. As
in other Principles, Table 3 incorporates recommendations for EI
Provider actions, family activities and outcomes, and program/ser-
vices and system processes.
Principle 10
Progress monitoring: Relevance,
effectiveness, and tracking DHH
programs/services and systems outcomes
Progress monitoring is an important element of ensuring
accountability and effectiveness of implementation of supports
across families and across FCEI-DHH programs/services and
systems.
FCEI-DHH benefits from the inclusion of structural components
that allow for efficiency in serving children who are DHH and their
families as well as opportunities for monitoring and improvement
of supports provided. Progress monitoring involves the develop-
ment and use of measures to track results and outcomes.In FCEI-
DHH, progress monitoring is needed to track the effectiveness of
supports provided across families, as well as to track outcomes
across programs/services and systems.
Relevance: Cultural and contextual
To be successful, both the supports and interventions provided
by FCEI-DHH programs/services and systems must be developed
and/or adapted within their local, regional, and national contexts
and inclusive of and respectful toward the cultures therein.
Monitoring of cultural and contextual relevance is a foundational
component of progress monitoring at all levels of FCEI-DHH (see
Szarkowski & Moeller et al., 2024, Cultural & Global Implications,
this issue, for more discussion of these topics).
While increased global understanding of “what works” in FCEI-
DHH is needed (see Szarkowski et al., 2024, Call to Action, this
issue, for knowledge gaps in the provision of FCEI-DHH that need
to be addressed), it is also true that specific indicators for mea-
suring progress will vary widely depending on context. Regular
monitoring of child and family outcomes associated with FCEI-
DHH can help to ensure that high-quality interventions are being
implemented. Progress monitoring at program/service and sys-
tems level can ensure that FCEI-DHH supports promote positive
child and family outcomes and hold central all 10 FCEI-DHH
Principles (JCIH, 2019;JCIH et al., 2013;seeMoeller et al., 2024,
Foundation Principles, this issue, for information on Principles 1
and 2; see Szarkowski & Moeller et al., 2024, Support Principles,
this issue, for information on Principles 3–6).
Effectiveness of interventions for children and
families
There is a need to develop or implement effective measures
designed to track the accessibility and quality of interventions
and supports. The goal of tracking is to inform the expansion and
improvement of programs/services and systems (Daelmans et al.,
2015). Emphasis on quality of supports is a critical dimension in
any monitoring system. Access to programs/services as well as
the quality of supports families receive are vitally important in
facilitating meaningful and positive outcomes for children and
families (Britto et al., 2011). Monitoring the quality of interven-
tions and supports and ensuring that they are accessible and
equitable among the families receiving them is essential.
Evaluations of effectiveness of FCEI-DHH supports in promot-
ing child and family outcomes should include examination of the
outcomes of different subgroups in the population of children
who are DHH to ensure that their differentiated needs are being
met in comprehensive ways. This monitoring may include (a) chil-
dren with unilateral hearing difference and children with bilateral
hearing difference; (b) children who are DHH and children who
are DHH+; (c) children who are distinct in audiologic status (e.g.,
those who could be classified audiologically as hard of hearing
compared with those who are deaf); or (d) children with caregivers
and family members who are themselves DHH. It may also be
useful to consider child and family outcomes for families who are
linguistic/cultural minorities in a given culture, who utilize spo-
ken language(s), visual language(s), or a combination of visual and
spoken language(s), or for families with various socio-economic
resources. Additional subgroups could be relevant in different
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Journal of Deaf Studies and Deaf Education, 2024, Vol. 29, No. SI |SI97
Tab l e 3. Recommendations related to ongoing developmental monitoring and assessments (Principle 9).
Principle 9 Developmental assessment: Purpose, approaches, skilled assessors, and interventions
EI Provider actions in response to family-identified needs and
concerns
Family activities & outcomes activities & outcomes that may be
experienced when EI Providers are responsive to family needs and
concerns
1. Partner with families to assess developmental outcomes of children,
routinely and authentically, across developmental domains
1. Partner with EI Providers in assessment to provide information about
and understand their child’s progress and developmental outcomes
across domains
2. Communicate with families about assessment information in ways
that optimize understanding, including utilizing materials in
alternative formats or languages to ensure accessibility
2. Broaden understanding about assessments from EI Providers through
means that are accessible to family members
3. Share assessment information with families in a professional
manner, compatible with their needs (using language that is familiar,
providing information visually, etc.); provide opportunities for
families to ask questions about the assessment process and the
results
3. Expect to be provided with assessment information in a professional
and transparent way that makes the results and their implications
clear; ask questions of EI Providers to increase understanding of their
child’s developmental outcomes and trajectory
4. Collaborate with families, other EI Providers, and other professionals
involved in supporting families to utilize assessment data; use
assessment results to inform whether changes to interventions may
be needed (e.g., increases in amount of intervention, changes to
chosen communication approaches)
4. Share observations and engage in ongoing assessment with EI
Providers and other professionals to increase understanding of what
works well/does not work well for their child
5. Describe for families the importance of observations of children
across contexts and the value of family input in the assessment
process
5. Develop or increase current skills in observing and reliably reporting
their child’s progress to enable active participation in the ongoing
assessment process
6. Collaborate with families to interpret developmental assessment
results (including how the child presents in family contexts);
facilitate discussions that guide intervention planning
6. Gain understanding about the implications of the outcomes of the
assessments for their child’s developmental profile and usefulness in
intervention planning
7. Promote family skills in requesting the needed
supports/interventions informed by assessment findings
7. Gain and refine skills in requesting needed supports/interventions for
their child and family identified through the assessment process
8. Partner with families and FCEI-DHH team members (and
collaborators, if applicable) to adapt assessments, when necessary, to
better capture the true abilities of all children who are DHH
8. Offer guidance to EI Providers about the adaptations needed to allow
their child’s competencies to be observed
9. Seek family input regarding children’s progress toward goals and the
success of the interventions in promoting outcomes; validate
family’s attempts to promote child’s development
9. Share information with EI Providers about their child’s progress
toward goals and the successes/drawbacks of interventions supports
10. Assist families in understanding children’s current and next steps in
their developmental trajectory to bolster those abilities through their
interactions and work with families to set goals based on this
information
10. Recognize current and next steps in the developmental milestones
that are a focus of their child’s intervention to incorporate strategies
to bolster their abilities throughout the day and to set goals for the
child and family
11. Utilize authentic assessment approaches alongside formal
procedures to generate comprehensive understanding of children’s
development and abilities in different contexts
11. Collaborate with EI Providers in finding authentic ways to understand
their child’s abilities in different contexts
12. Adapt the approaches or strategies used to support children’s
development, informed by results of assessments, to optimize child
outcomes
12. Collaborate with EI Providers to adapt supports so they can be used in
daily interactions with their child
13. Collaborate with trained, competent professionals who are DHH in
the assessment process, when available, as they may be able to
provide unique insights on visual communication strategies as well
as children’s language use and communicative attempts, and family
behaviors (e.g., family-child interaction, social–emotional
development, visual strategy use)
13. Consider the value of including professionals who are DHH in
assessment and the unique insights they can provide
14. Work with the family to access additional expertise when challenges
are suspected, identified, or “diagnosed” that are outside the scope of
FCEI-DHH
14. Engage with specialists beyond the FCEI team as needed; gain
understanding of the specialist’s role and the information that they
provide
15. Gain knowledge and maintain current understanding of
evidence-informed approaches for assessment and service provision
for families and children who are DHH
16. Use standardized measures, when available, that have been
normed/validated for the language(s) in use, whether spoken or
signed, when available and if appropriate to the child
17. Participate in professional development opportunities to build or
broaden expertise in conducting assessments with children who are
DHH, including authentic assessment approaches
Continued
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SI98 |FCEI-DHH: Structure Principles Szarkowski et al.
Tab l e 3. Continued.
Program/service and system processes
1. Train EI Providers to foster families’ abilities to observe their child’s abilities across contexts
2. Organize and offer guidance and support for families to gain assessment-related observational skills and gain understanding about the role and
value of developmental assessment
3. Support ongoing consultation, training, and educational opportunities for EI Providers (including professionals who are DHH, who may be
particularly useful in providing insights about language and communication development, social-emotional development, and visual strategy use)
to improve their skills in conducting developmental assessments of children who are DHH
4. Ensure that EI Providers have access to appropriate assessment materials and necessary tools to accurately and adequately assess functioning
and developmental progress of children who are DHH and their families
5. Provide training and supervision to EI Providers on implementing evidence-informed assessment processes for children who are DHH and their
families
6. Develop or implement mechanisms to ensure that EI Providers are regularly monitoring child and family outcomes and using that information to
guide interventions
7. Establish and utilize protocols for families and EI Providers to adjust interventions when desired outcomes of interventions and supports are not
being achieved as expected
8. Establish and maintain mechanisms for accessing input from specialists outside of the FCEI-DHH team and for sharing information from
FCEI-DHH teams with other specialists who are supporting families
9. Evaluate EI Providers’ ability to conduct developmental assessments; provide feedback to guide improvement of assessment skills
10. Provide supervision and mentoring opportunities for EI Providers to improve their ability to conduct appropriate and meaningful assessments
11. Seek advice from family leaders and DHH leaders about issues that should be considered in assessing child and family outcomes
Family activities and outcomes listed in the right-hand column are not intended as a “test” of family skills, but rather a description of the abilities and
outcomes that may result when EI Providers are effectively supporting families through FCEI-DHH. Even if actions in the Table are aspirational, progress
toward their implementation and/or adaptation is encouraged to meet the needs of families of children who are DHH and the aims of FCEI-DHH. In any of the
following family outcomes or behaviors that involve engaging in services, it is essential to respect that families have the right to participate in ways that are
most comfortable for them and to accept or decline what is offered.
regions, to ensure that consideration is given to the unique needs
of marginalized groups (see Szarkowski & Moeller et al., 2024,
Cultural & Global Implications, this issue, for considerations on
FCEI-DHH support provision across the globe).
Tracking FCEI-DHH outcomes
FCEI-DHH systems need to document, track, and monitor
outcomes across EI Provider, program/service, and systems levels,
as well as to continually strive to improve those outcomes.
Effective progress monitoring and tracking of outcomes in
FCEI-DHH include several components and recurring steps
(see the box, “Ensuring effective progress monitoring”). FCEI-
DHH programs/services and systems should implement current
standards of evidence-informed family-centered approaches
(Adams et al., 2013;Division for Early Childhood, 2014;Dunst,
2017).
Development, implementation, and monitoring of FCEI-DHH
should address factors at the systems level including local,
regional, and national systemic factors (Yoshikawa et al., 2018).
At the local level, programs may be tasked with recruiting EI
Providers, providing training (e.g., on topics such as child devel-
opment and working with family systems), or ensuring that other
specialists are available to support family and child needs that are
outside the scope of FCEI-DHH. Monitoring the effectiveness of
these strategies is needed. Regionally, collaborating across organi-
zations and establishing connections between local and national
entities can help to monitor and ensure the robust delivery of
interventions. Regional entities should provide guidance on the
recommended knowledge and skills needed by EI Providers along
with training and supervision. National legislation, nationwide
strategic plans, and participation in policy development by
organizations like JCIH in the United States and invested
parties with expertise in FCEI-DHH are critical to implementing
evidence-informed interventions and monitoring intervention
effectiveness.
Ensuring effective progress monitoring
(Chacón-Moscoso et al., 2021;Mertens & Wilson, 2018)
1. Ensure that benchmarks (i.e., indicators of progress
or achievement) against which EI Providers,
programs/services, and systems are assessed are
clear and appropriate to the culture and context for
which they are intended
2. Establish who and what will be monitored (e.g., people,
practices, environment, policies, comprehensiveness of
services)
3. Determine types of monitoring tools (e.g., fidelity check-
lists, observations, surveys, interviews)
4. Determine the frequency of monitoring
5. Determine how accountability will be maintained and
the consequences for not doing so
6. Embed continual or ongoing periodic quality improve-
ment mechanisms
7. Incorporate family feedback regarding perceived effec-
tiveness of supports provided
8. Incorporate feedback from other professionals outside
of the FCEI-DHH team including those who refer fami-
lies for supports or exchange information with the team
9. Ensure sustainability of monitoring processes
10. Plan for dissemination of the results of progress mon-
itoring to professionals on the FCEI-DHH team and
leaders of FCEI programs/services and systems
11. Determine the data collection systems that will be used
for monitoring purposes
12. Ensure that data collection procedures are followed
with fidelity
13. Use analysis of FCEI-DHH-related information to
inform and refine processes
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Journal of Deaf Studies and Deaf Education, 2024, Vol. 29, No. SI |SI99
Tab l e 4. Recommendations related to program/service and system-level monitoring of outcomes and effectiveness (Principle 10).
Principle 10 Progress monitoring: Relevance, effectiveness, and tracking FCEI-DHH program/service and system outcomes
EI Provider actions in response to family-identified needs and
concerns
Family activities & outcomes that may be experienced when EI
Providers are responsive to family needs and concerns
1. Gain knowledge of the identified, measurable benchmarks for delivery
of FCEI-DHH for families (at the programs/services and systems level)
1. Become familiar with identified, measurable benchmarks that guide
intervention for the child and family
2. Seek and receive mentoring and/or supervision designed to assess
whether FCEI-DHH program/service or system benchmarks are
attained and implemented regularly; adjust practices as needed in
response to input
2. Collaborate and engage with EI Providers and provide feedback about
the extent to which benchmarks for the family are attained, are
working for the family, and are contributing to/resulting in desired
outcomes
3. Seek and receive training on implementation of progress monitoring;
implement selected progress monitoring approaches with fidelity and
consistency
3. Gain understanding about the purposes of system-wide monitoring
that are designed to ensure that processes result in the intended
outcomes for children and families
4. Provide information for families about the roles of various EI Providers
and their involvement in program monitoring; provide information
about DHH adults and family leaders involved in supporting the
family (whether they are members of the FCEI-DHH team or
partnering with the team); ensure that families understand that data
are aggregated and that privacy is protected
4. Increase understanding of the roles of EI Providers, mentors,
supervisors, and others, and their involvement in program
monitoring; know about family rights to quality services; know that
family privacy is protected in system-wide monitoring
Program/service and system processes
1. Investigate international guidelines for implementation and monitoring of early intervention and FCEI-DHH program/service and system
outcomes
2. Incorporate cultural considerations in implementation of supports and monitoring of progress and outcomes
3. Partner with organizations and leaders at local, regional, and national levels, leveraging existing relationships and building new networks to
implement FCEI-DHH supports and monitor for quality
4. Develop measurable benchmarks for tracking the components of FCEI-DHH offered by EI Providers, programs/services, and systems
5. Develop and implement data collection processes that identify (a) who will provide input, (b) how benchmarks will be measured, (c) how
professionals will be trained for accurate data collection, (d) how data will be gathered and summarized, and (e) what actions will result from the
findings
6. Develop and implement evidence-informed mechanisms for data collection that support the identification of what is and what is not working at the
level of EI Providers, programs/services and systems
7. Develop and implement an infrastructure to support system-wide data collection, including input from professionals across systems (including, as
relevant, mentors, supervisors, trainers, administrative personnel, and data collection managers)
8. Develop and implement a systematic process of quality improvement across program/service and system levels including (a) assessment, (b) data
collection, (c) analysis, and (d) summarization; utilize quality improvement data to continuously strengthen FCEI-DHH interventions and supports
9. Interpret findings of system-wide assessment to inform the need to alter assessment mechanisms and/or supports
10. Develop and implement measures to monitor how family leaders and family members are infused or included in FCEI-DHH programs/services or
systems, the quality of the supports offered by family leaders, and the impact of their involvement on families receiving FCEI-DHH supports
11. Develop and implement measures to monitor how DHH adults are infused or included in FCEI-DHH programs/services or systems, the quality of
the supports offered by DHH adults, and the impact of their involvement on families receiving FCEI-DHH supports
12. Implement ongoing progress monitoring processes, informed by feedback from families and others who interact with FCEI-DHH systems, to
ensure that supports provided, and changes implemented in provision of FCEI-DHH are contributing to or resulting in the intended changes to the
program/service or system
13. Create opportunities for EI Providers to connect with other EI Providers, including training and mentoring to ensure accurate data collection and
monitoring
14. Report, publish, and disseminate de-identified, summarized information about EI Provider outcomes and program/service and system outcomes,
as well as aggregated child and family outcomes, with the aim of continually improving FCEI-DHH
15. Develop plans to address when benchmarks are not met (with the inclusion of relevant invested parties including family leaders, DHH and hearing
professionals, and Deaf community members)
16. Design and implement formal and informal monitoring systems for system-wide quality improvement that are informed by key invested parties
(e.g., EI Providers, family members and family leaders, DHH adults and DHH leaders, researchers and professionals with expertise related to
supporting children who are DHH and their families, cultural brokers, etc.)
17. Develop mechanisms to receive and resolve concerns or complaints from relevant invested parties about EI Providers, DHH adult-to-family and
family-to-family supports, and program/service or system provision of FCEI-DHH interventions or supports
18. Develop and implement mechanisms to promote inclusion and diversity, including training of EI Providers, within delivery of interventions
provided by programs/services and systems
In any of the family outcomes or behaviors that involve engaging in services, it is essential to respect that families have the right to participate in ways that
are most comfortable for them and to accept or decline what is offered. Family activities and outcomes listed in the right-hand column are not intended as a
“test” of family skills, but rather a description of the abilities and outcomes that may result when EI Providers are effectively supporting families through
FCEI-DHH. Even if actions in the Table are aspirational, progress toward their implementation and/or adaptation is encouraged to meet the needs of families
of children who are DHH and the aims of FCEI-DHH.
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Recurring steps in tracking, monitoring, and documenting
outcomes
(Buzhardt et al., 2010;Raspa et al., 2010;Yoshinaga-Itano,
2014)
1. Implement current standards of evidence-informed
interventions and/or “best practices” in delivery of
FCEI-DHH
2. Monitor and track EI Provider outcomes (e.g., access
system supports with families, collaborate with other
professionals in the system)
3. Assess the effectiveness of child- and family-specific
interventions or supports and monitor impact on child
and family outcomes
4. Assess the effectiveness of implementation of
FCEI-DHH programs/services and systems, and hold
programs/services and systems accountable for
outcomes
5. Identify what is and what is not working with the inter-
ventions and supports provided
6. Identify what is and what is not working with the
ways programs/services and systems are organized and
operated
7. Implement quality improvement mechanisms and
hold programs/services and systems accountable for
outcomes
8. Implement and follow the FCEI-DHH Principles in this
special issue
Across all programs/services and systems, there is a need
to establish benchmarks and data collection processes, as well
as develop and implement mechanisms to review FCEI-DHH
outcomes (JCIH, 2019). Analysis of outcomes and reporting of
findings will allow programs/services and systems to learn from
each other and make continual improvements (see Szarkowski et
al., 2024, Call to Action, this issue, for information about progress
monitoring–related needs).
Recommendations for Principle 10
Table 4 includes recommendations for Principle 10 related to
progress monitoring by program/services and systems. The
recommendations relate to the need to ensure that FCEI-DHH
services and supports are culturally relevant, and ensure regular
monitoring of effectiveness, so that programs are accountable
and invest in quality improvement. As in other Principles, Tab l e 4
incorporates recommendations for EI Provider actions, family
activities and outcomes, and program/services and system
processes.
Family-centered early intervention
resources: Structure Principles
The resources in Table 5 are examples of helpful websites and
other online materials that support the application of the FCEI-
DHH Structure Principles. The resources include a range of
options that reflect the myriad demographics and global perspec-
tives of the FCEI-DHH international community. The resources are
intended to be used as a starting point and may be adapted or used
alongside materials currently available. Readers are encouraged
to identify the resources that best fit their local context.
Acknowledgments
The authors are grateful to Bahar Rafinejad-Farahani for her
generous contribution of time and expertise in managing and
formatting references. We appreciate the guidance of Dr. Marilyn
Sass-Lehrer, the special issue editor, whose capable direction and
invaluable wisdom enhanced the work. We express thanks for
the helpful guidance from the anonymous reviewers whose input
strengthened this article. Finally, we acknowledge the efforts our
Tab l e 5. FCEI-DHH resources that are relevant to implementation of the Structure Principles.
Structure resources Description of resource and internet link
Australian Children’s Education and Care
Quality Authority
Australian standards for early childhood education and care that provide guidance about education
programs, health and safety, physical environments, and collaborative partnerships with parents.
Link: https://www.acecqa.gov.au/nqf/national-quality-standard
British Sign Language (BSL) Toolkit British Sign Language (BSL) Toolkit is a resource for practitioners working with users of BSL. This
resource provides advice about understanding sign language, Deaf culture and identity, and
strategies to use in practice.
Link: https://education.gov.scot/resources/bsl-toolkit- for-practitioners
Early Hearing Detection and Intervention
Action Center (EHDI)
North American guide to establishing and maintaining EHDI Data Systems.
Link: https://www.cdc.gov/ncbddd/hearingloss/guidancemanual/index.html
Hands and Voices North American organization that provides support for families including recommendations for
establishing Family-to-Family Support Programs: Guidelines for Addressing the Needs of Families
who have children who are Dead/Hard of Hearing (D/HH).
Link: https://handsandvoices.org/fl3/fl3-docs/Fam- Fam-support- guidelines-8-30-2018.pdf
JCIH 2013 Supplement to the JCIH 2007 Position
Statement: Principles and Guidelines for Early
Intervention After Confirmation That a Child Is
DHH
North American resource that provides guidelines for early hearing detection and intervention
programs to support the provision of early intervention and benchmarks for monitoring progress.
Link: https://publications.aap.org/pediatrics/article/131/4/e1324/31903/Supplement-to-the-
JCIH-2007- Position- Statement?autologincheck=redirected
National Deaf Children’s Society The National Deaf Children’s Society operates in the U.K., England, Scotland, Wales, and Northern
Ireland. Their resource provides guidance to teachers of the DHH and other professionals to conduct
specialist assessments with children who are DHH.
Link: https://www.ndcs.org.uk/information-and-support/professionals/assessments/
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Journal of Deaf Studies and Deaf Education, 2024, Vol. 29, No. SI |SI101
colleagues who assisted us in gathering resources for FCEI-DHH
implementation.
Supplementary data
Supplementary material is available at Journal of Deaf Studies and
Deaf Education.
Conflicts of interest
None declared.
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