Barriers to and Facilitators of Early Hearing Detection and Intervention in the United States: A Systematic Review.

OBJECTIVES: Early hearing detection and intervention (EHDI) is guided by the 1-3-6 approach: screening by one month, diagnosis by 3 mo, and early intervention (EI) enrollment by 6 mo. Although screening rates remain high, successful diagnosis and EI-enrollment lag in comparison. The aim of this systematic review is to critically examine and synthesize the barriers to and facilitators of EHDI that exist for families, as they navigate the journey of congenital hearing loss diagnosis and management in the United States. Understanding barriers across each and all stages is necessary for EHDI stakeholders to develop and test novel approaches which will effectively reduce barriers to early hearing healthcare. DESIGN: A systematic literature search was completed in May and August 2021 for empirical articles focusing on screening, diagnosis, and EI of children with hearing loss. Two independent reviewers completed title and abstract screening, full-text review, data extraction, and quality assessments with a third independent reviewer establishing consensus at each stage. Data synthesis was completed using the Framework Analysis approach to categorize articles into EHDI journey timepoints and individual/family-level factors versus system-level factors. RESULTS: Sixty-two studies were included in the narrative synthesis. Results revealed that both individual/family-level (e.g., economic stability, medical status of the infant including middle ear involvement) and system-level barriers (e.g., system-service capacity, provider knowledge, and program quality) hinder timely diagnosis and EI for congenital hearing loss. Specific social determinants of health were noted as barriers to effective EHDI; however, system-level facilitators such as care coordination, colocation of services, and family support programs have been shown to mitigate the negative impact of those sociodemographic factors. CONCLUSIONS: Many barriers exist for families to obtain appropriate and timely EHDI for their children, but system-level changes could facilitate the process and contribute to long-term outcomes improvement. Limitations of this study include limited generalizability due to the heterogeneity of EHDI programs and an inability to ascertain factor interactions.

Single-Case Design Research on Early Literacy Skills of Learners Who Are d/Deaf and Hard of Hearing.

A systematic review explored the evidence base of literacy intervention studies that examined the early years of schooling (preschool through first grade) of participants who were d/Deaf or hard of hearing (d/Dhh). Specific inclusion criteria were used to select single-case design (SCD) studies published in peer-reviewed journals between 2004 and 2017. Fourteen studies met the criteria. Studies were evaluated according to the quality indicators for evidence-based research, individually and across studies (Horner et al., 2005; Institute for Educational Sciences, 2017; Kratochwill et al., 2013). Five of the 14 studies were categorized as "Meets Standards Without Reservations"; 7 as "Meets Standards With Reservations"; and 2 as "Does Not Meet Standards." None met the established criteria for an evidence base. Recommendations for future research are provided, with specific studies highlighted for replication to build evidence-based practices using SCD in the field of educating students who are d/Dhh.

Effects of Reading Racetracks on Sight Word Acquisition for Deaf Kindergarteners.

This study examined the effects of a reading racetrack game on acquisition, maintenance, and generalization of sight words for four kindergarten students who are deaf. The game consisted of placing sight words around a racetrack board and prompting the participant to read the words. A multiple probe design across word sets demonstrated a functional relation between the intervention and the participants' acquisition of vocabulary to 100% mastery on at least three consecutive sessions for each participant. Three out of four participants maintained most of the sight words acquired for 2-4 weeks after intervention and generalized reading the words to another presentation format.

Effects of Behavioral Skills Training on Teacher Implementation of a Reading Racetrack Intervention.

This study examined the effects of behavioral skills training (BST) on teachers' implementation fidelity of a reading racetrack (a board game designed to increase sight word fluency) with elementary students identified as struggling readers. BST, an alternative to traditional professional development, is a performance-based protocol incorporating instruction, modeling, rehearsal, and feedback. A multiple probe design across teacher-student dyads demonstrated that BST was functionally related to the teachers' implementation of a reading racetrack with 100% fidelity on at least three consecutive sessions. Additionally, students met mastery criteria for sight word acquisition and demonstrated maintenance at least one to two weeks post intervention.

Effects of a Picture Racetrack Game on the Expressive Vocabulary of Deaf Preschoolers.

This study examined the effects of a picture racetrack game on the acquisition, maintenance, and generalization of picture labeling for 2 preschool students who are deaf. The game consisted of placing photographs representing individualized target vocabulary around a racetrack board and prompting the participant to sign each photo. A multiple baseline design across picture sets demonstrated that playing the picture racetrack game was functionally related to acquisition of vocabulary to 100% mastery on at least 3 consecutive sessions for each participant. Additionally, both participants maintained most of the vocabulary they acquired for at least 4 weeks after intervention, and they generalized picture labeling to a different presentation mode (i.e., a photo album).