1.Inclusion of children with Hearing Loss into the classroom Sheeba Khan821745502Lisa McCaie Centennial College Progress

2. Lily Lily is a 4-year old child with severe hearingimpairment who has just joined my preschool room.Till this point in her life, she has always been cared forby her maternal grandparents, so this is her first timein a child care setting. Lilys parents are new to Toronto and ask about theservices in the area. They speak some English butprimarily Cantonese. Lily has 2 siblings > a 6-year oldbrother and a 6-month old sister. 3. Lilys needs and the needs of herfamily: Lily has a severe hearing Lilys parents primarily speakimpairment. Cantonese, and very little Lily has previously only been English.looked after by her Lilys family has just recentlygrandparents, so she will need to moved to Toronto.adjust to the child care Lily has 2 other siblings so herenvironment.parents have their hands full. Lily may experience some The family may have to teachtrouble communicating withLily sign language, and mayother children in her class.need to learn it themselves too.The family may fear that theirother children may or may nothave hearing loss also, and mayor may not have been diagnosedyet. 4. Hearing Impairment Hearing Impairment is a broad term that includes both deaf and hard of hearing. The term deaf is used to describe a person who has an intense hearing loss which cannot benefit from any intensification of sounds. Hard of hearing is the term used for people who may experience mild to severe hearing loss; these are people who may benefit from amplification. The International Symbol of Access for Hearing Impairment. 5. Main Types of Hearing Loss1. Conductive Hearing Loss: caused by diseases or obstructions in the outer or middle ear that usually affect all frequencies of hearing. A hearing aid generally helps a person with a conductive hearing loss.2. Sensorineural Hearing Loss: results from damage to the inner ear. This loss can range from mild to profound and often affects certain frequencies more than others. Sounds are often distorted, even with a hearing aid. 6. Statistics According to the Hearing Foundation of Canada website, Astudy in the Journal of the American Medical Associationreported that nearly 15% of school-aged children had hearingdeficits at low and high frequencies (Niskar et al, 2004). The VOICE for Hearing Impaired Children website also statesthat many children continue suffering hearing loss through theirschool years. More than 2,000 children are born with a hearing loss inCanada every year, making it one of our countrys most commonbirth defects for which screening is available. Approximately sixin every thousand babies born in Canada have some degree ofhearing loss, including profound deafness (The HearingFoundation of Canada). 7. CausesSome known causes of Hearing Impairment are: A family history of hearing loss. Frequent and/or recurring ear infections as an infant or toddler. Some antibiotics and chemotherapy treatments that may have hearing loss asone of the side effects. Meningitis, Measles and CMV (Cytomegalovirus) Infection. Some syndromes and disabilities have also been associated with causinghearing loss, such as Down Syndrome, Pervasive Develeopment Disorder,Autism, Alport Syndrome and Crouzon syndrome. 8. Other Risk FactorsChildren may also be tested for a hearingimpairment if they experienced any ofthe following: If the child was born premature and/orweighed less than 2 lbs at birth. Required ventilation assistance for morethan 10 days right after birth. Scored very low on the Apgar Test atbirth. Experienced severe jaundice after birth. If the mother had experienced certainillnesses like German Measles(Rubella)during pregnancy 9. Not all children with Hearing Loss look and act the same;some children may look and behave just as any othernormal child.One of the most common myths about Hearing Impairment is that individualswho are hearing impaired are easily identifiable, either by their use of sign language,clearly visible hearing aids or by their inability to hear speech and sounds. However, not all children and adults experiencing severe hearing loss look thesame. Especially with early intervention and the right adaptations, they may be just likeany other person out there. The following video demonstrates just how normal childrenwith even a severe hearing loss may look and act like:Is This Child Really Deaf? 10. Infant Screening in Hospitals Infant Screening The Hearing Association ofCanada has been working since 2002 to providefree hearing screening for babies born in all theCanadian provinces. Without screening, theaverage age of identification of hearing loss hashistorically been between 2 to 3 years of age,making it difficult for many children to catch upwith communication and social skills (TheHearing Association of Canada). Early detectionis the most beneficial, so this program allows forimmediate identification of hearing loss soonafter delivery of the baby, the test is fairly simpleand non-invasive. 11. Signs & Symptoms of a HearingImpairment in Children The child may experience frequent ear infections. The child may be delayed in their language development. The child may find it difficult to identify or locate certain sounds. The child may watch TV at a really high volume. The child may have behavioural issues, displaying inattentiveness and disruptive behaviour. The childs speech may sound different or not speak clearly. The childs vocabulary may consist many words that are often missing endings. 12. Impact on ChildHearing Impairment can cause 4 major impacts on the child: It may cause a delay in communication skills (speech and languagedevelopment). As a result, this language deficit would cause learning problems and pooracademic achievement. Social isolation and poor self-concept may also be caused by a lack ofcommunication skills and poor social. 13. Impact on Family When a family receives news of a childs disability or special need, the parentssometimes feel denial, guilt, anger or shock initially. As they start to slowly accept the news and work towards aiding and assistingtheir child in any way possible by making adaptations in their home, securingresources and financial assistance, etc. they may feel stress, fatigue andpossibly even helplessness. Slowly, they will need to make the necessary changes in their homeenvironment and in their lifestyle to accommodate the child with the specialneed. In the case of Hearing Impairment, ongoing hearing tests and screening,meeting with doctors, specialists and resource aids, speech therapy, etc. issomething the family can expect in their long-term future. 14. Doctors In Lilys case, if her hearing impairment hadnt been diagnosed at birth, then the doctorwould have been the first professional to be contacted when a hearing loss wassuspected. The signs and symptoms have been discussed earlier that would raise concernand require a hearing test to be performed. At the familys request, a family doctor or apaediatrician would send the child to an audiologist for the hearing test or screening. Theprimary care physician may also provide a referral to a doctor who specializes in medicalgenetics, to find out if your childs hearing loss may be hereditary. That may help youdetermine if a similar hearing loss could occur in your other children 15. Doctors Because Lilys parents have recently moved to Toronto, they would need to finda family doctor or a paediatrician in the area. According to an article in TheHuffington Post, the doctor shortage that we had experienced a few years agoin Toronto has been resolved. Presently, we may have an influx of doctors inCanada, some of whom may remain jobless for a while due to the saturation inthat field over the past 5 years. When looking to find a new doctor, here are some tips that are beneficial touse: 1. Ask your last doctor for recommendations. 2. Ask your family and friends for referrals or recommendations. 3. Search locally for Medical Centres in the area. 4. Go to a Walk-In Clinic. 5. Use the CPSO (College of Physicians and Surgeons of Ontario) Doctor Searchonline. 16. Audiologists Once a Doctor feels it necessary, he will refer the patient to an Audiologist for Hearing Screening. The audiologist is the health professional that would run the necessary tests in order to determine if there is a partial hearing loss, mild to severe hearing impairment or profound hearing loss and also the type of hearing loss. This is done by performing a series of behavioural and objective tests. The audiologist also is trained to fit hearing aids and to help you gradually adjust to the aids. This usually requires periodic followups to observe changes and progress in hearing abilities. The audiologist may also refer you to an ENT (Ear Nose Throat) doctor for futher screening. Because Lily has already been identified as having a severe case of Hearing Impairment, she would have seen an audiologist already and will need to find a new audiologist in Toronto for future follow-ups to monitor her hearing. 17. Some hearing tests performed byAudiologists: Auditory Brainstem Response (ABR) Test - a test that checks thebrains response to sound; the person being tested can be sound asleepduring the test, they do not need to be awake and active. Otoacoustic Emissions (OAE) - a test that checks the inner earsresponses to sound. The person does not need to be awake during thistest. Behavioral Audiometry Evaluation this test allows the audiologistto assess how a person responds to sound overall by testing thefunctions of all parts of the ear. The person being tested must be awakeand actively responding to sounds heard during the test in order tohave accurate results. 18. ENT (Ear Nose Throat) Doctor orOtolaryngologist After the initial screening is performed by an audiologist, the child will be referred to anotolaryngologist, who will then determine if there are any underlying issues that may be(atleast partially)causing the hearing loss. The ENT Doctor will also be the one to verify if the problem can be treated medically orsurgically and then will provide such treatment. X-Rays, CT-Scans, MRI scans, etc. maybe required in order to further assess what type of hearing loss is present. After theassessment, simple treatments could be suggested ( like placing eardrum ventilationtubes) or other surgical procedures may be required (Cochlear Implants). The doctoralso provides clearance for hearing aid fitting, after determining if no other interventionis indicated. If it is determined that your child needs a cochlear implant, theotolaryngologist, along with the audiologist, will carry out further tests andexaminations, and will carry out the implant surgery (Role of ENT Doctor). 19. Early Intervention Specialist A professional with an education backgroud, the Early Intervention Specialist would assist in finding community resources, defining family members roles through the management of the hearing impairment and addressing concerns about future educational placement. 20. Speech and Language Pathologist The Speech and Language Pathologist (SLP) is aprofessional who predicts what kind of an impact thechilds hearing loss will have on his languagedevelopment. She will also monitor his progress anddetermine if the child needs to be referred back tothe audiologist or otolaryngologist. It is also theSLPs job to assist the child to learn proper speechproduction. If the parents pursue oral communication for thechild, the an Auditory-Verbal Therapist may need tostep in to direct the family towards additionalmedical or audiological treatments. The AVP alsoteaches the family appropriate speech/language,auditory, and cognitive developmental milestonesyou may expect for a child with hearing loss (Role ofSpeech and Language Pathologist). 21. Youtube Video Early Intervention for Hearing Loss in Children This YouTube Video allows us to see how successful Early Intervention would be for children who experience hearing loss. 22. Technologies that can help Most children with mild or severe hearing impairment have some hearing; this is calledresidual hearing. Based the parents preference, certain technological options can beused to utilize this residual hearing to the best of its ability. Technology options are: Hearing aids these assist in amplifying the sounds a child can hear so they soundlouder. These come in many styles, but usually for young children, behind-the-ear stylesare recommended for their growing ears. Hearing aids help babies hear sounds better sothey have a greater chance of developing their language skills. Cochlear implants a cochlear implant is recommended when hearing aid is not enough,mostly in children with severe to profound hearing loss. Cochlear implants do not makesounds larger; instead, they send sound signals directly to the hearing nerve. A surgery isrequired to place some part of a cochlear implant inside the ear, while the other parts areworn outside of the ear post-surgery. The sound signal is carried from the outer parts tothe inner parts of the cochlear implant. Bone-anchored hearing aids used when children have either a conductive, mixed orunilateral hearing loss, these aids are also recommended for children who cannototherwise wear in the ear and behind the ear hearing aids. 23. Other Assistive Devices FM System a Frequency Modulation device that allows a personwith hearing loss to hear in background noise. It is sometimes usedwith a hearing aid. Closed Captioning usually displayed at the bottom of a TVscreen, captioning shows conversation spoken within a program (TVshow, Movie, etc.) Text messaging using Text messaging on the phone instead of anaudio phone call. 24. Other Assistive Devices (continued...) Flashing and vibrating Audio loop systemsalarms these alarm clocks this is an audiocome with a vibrator that is Telephone amplifiers these frequency loopplaced under a mattress or are portable plug-in devicesInfrared listeningthat amplify the volume of system that allowspillow; it vibrates when thedevices - an infrared incoming calls up to 100% on hearing aid wearers alarm goes off on the clock.listening device is a corded home or business to hear more clearlyFlashing lights also alert thesmall, plastic object phones. Price ranges from $35- by converting person that the alarm is going(shaped like a allows a $110, depending on the type of electromagnetic field off. Price ranges from $50-person to listen to the device and capabilities. signals into sound. $140.audio description in thetheater. It works byconverting an invisiblebeam of infrared lightinto sound that playsinto headphones or earbuds. 25. Medical Treatments The Hearing Loss Clinic states that Only about 10% ofhearing losses are helped by surgery or other medicaltreatment 90% of hearing losses can be treated with the use ofhearing instruments 26. Medical/Surgical Procedures In most cases of conductive hearing loss (occurring in the outeror middle ear), medications or surgery can assist with improvinga childs hearing. Hearing loss caused by a chronic ear infection occurs when fluidbuilds up behind the ear drum in the middle ear. If this doesntclear up with medication, a simple surgery can be performed toplace a tiny tube in the eardrum to drain the fluid out. Conductive hearing loss due to a part of the ear formingincorrectly while the baby was growing in the womb can beimproved or corrected with surgery. An Otolaryngologist willusually determine the steps to take in correcting this issue. Surgery is required for cochlear implants and bone-anchoredhearing aid as well! 27. Physical environment Labelling System1.Signs for Direction (names and pictures on- shelves for toys, cubbies, writing and art material holders, etc.)1.Allergy Board pictures of children with pictures of items they are allergic to.2.Bigger, darker labels than normal so everything is clear and simple for Lily to understand and refer to.3.DAISY a Digital Accessible Information System, these books contain both sound and text.4.Closed Captioning When showing the children an informative video, whether it is part of my own plannedcurriculum or whether we have a guest visitor showing a video to the children, we make make sure to have closedcaptioning so that its easier for Lily to follow along. 28. Physical Environment Promote more learning through a variety of materialsincorporated into many different curriculum areas.ASL Number Puzzle ASL Alphabet Peg PuzzleFirst Signs Match UpSigns Flash CardsKeep Quiet Sign LanguageCubes GameI love you Floor PuzzleSign Language Vocabulary Cards Fingerspelling BlocksSign Language Bingo 29. Changes in Teaching StrategiesRoutines/Transitions I will make sure that routines should be clearly defined with same expectations as for other children, but allow more time for Lily. I will have to make sure I follow through on expectations from Lily. I will create a labelled chart of daily routines (pictures and words) I will allow a little more time for transitions from one activity to another, especially when going from high activity to low activity & vice versa, and from indoor to outdoor & vice versa. I will learn sign language by signing up for classes, so that I can communicate with Lily a little better. While I wait for my classes to start, I will search for some basic ASL training videos on YouTube to teach myself and Lily some simple gestures for common terms and words. Since Lily has never been in a child care setting (she was looked after by her grandparents), I will have to give her some time to adjust to our routines and adapt to the set schedules. 30. Changes in Teaching StrategiesAdaptive Play Materials Adaptations help children to develop independence, interact with their peersand manipulate materials(ConnectABILITY) The 4 strategies used in making these adaptations are:1.Stabilize secure materials onto a surface underneath2.Enlarge add small pieces or materials to make a toy accessible3.Enhance when parts of a toy are used differently to make it more accessible4.Simplify reduce the number of steps, remove the number of pieces or replace the number of materialsIn Lilys case, I would especially use the enhancing technique to add bright/bold colours, add pictures to any toys that have just words on them and make writing appear larger.I would also use the simplifying technique in the beginning, when she is just starting to use certain new toys or play certain new games with us, that she might be experiencing for the first time at our centre. 31. American Sign Language American Sign Language (ASL) is acomplete, complex language that employssigns made by moving the handscombined with facial expressions andpostures of the body. It is the primarylanguage of many North Americans whoare deaf and is one of severalcommunication options used by peoplewho are deaf or hard-of-hearing(National Institute on Deafness andOther Communication Disorders). Although not all forms of sign languagefrom different parts of the world is exactlythe same, many words and terms aresimilar and correspond with each other,making it easier for people who are deafor hearing impaired to communicate withothers. I will encourage Lily to learn some signlanguage (if she doesnt already know it)and I will use this form of communicationin class regularly. 32. Teaching New Skills and Routines Because Lily has a severe hearing impairment, it will be very importantfor me to modify my strategies in the classroom with her, especiallywhen trying to teach a new skill. One of the things I plan on teachingher if she doesnt already know it, is sign language. I would use thetechnique of Prompting and Fading to accomplish this. Types of Prompts are Physical, Modeling, Gestural, Visual, andPositional Prompts. Normally, with any child who has a special need, I would use all thetypes of prompts in that specific order, with full and partial promptingat each step. But with Lily, if she does not have any hearing at all, thenthe verbal instructions that are a part of the Modeling and GesturalPrompts will have to be modified so that Im either using only gestureswith her, or if she has already learned to read well, then I can writedown the words that I would have used while Modeling or Gesturing. 33. Using Visuals With Lily, I would use some other tools besides classroomlabels, to help her learn routines. First/Then Board I would use a First/Then Board withLily to teach her the sequence of events in our routines. Itwill also assist with skill-building when I need Lily to do anactivity she doesnt enjoy very much by showing her that amore-preferred activity will follow. Choice Board During some parts of the day (eg: free play,outdoor playtime, etc.), an individual choice board canallow Lily to make her own choices of what materials/toysshe wants to play with. In the beginning, I will include anon-preferred activity choice on the board to teach her tomake choices, then I will only include the activities sheenjoys. 34. Offer support for Self-esteem andMotivation I will make sure Lily has many opportunities to work with me one-on-one or in small groups withother children in order to learn through a variety of interactions and social situations. I will offer her a variety of open ended materials and developmentally appropriate experiences so shecan be challenged and create her own learning. Some other things I will constantly check and implement as strategies for successful integration are: 1. Philosophy children are more or less the same, and we should all work together as a team. 2. Observation look longer and deeper at what Lily can and cant do, and especially remain observantof her non-verbal behaviour and interactions with others. 3. Physical Presence even if Im not standing right beside Lily, I should position myself in such a wayat all times that I can see her and get to her quickly should the circumstance arise that she needs me. 4. Modeling I will learn to use sign language and use it consistently so I can effectively model to herthe behaviour I want her to learn. 5. Choices - since Lily has a hearing impairment, she will need a little more time to understand whatneeds to be done (rather than just being able to hear instructions and follow them quickly); I willhave to be patient in allowing her time to follow instructions and also in making her own choices. 6. Praise and Encouragement because of Lilys situation, I would use more non-verbal gestures like apat on the back, high-5, wink and nod. I will also have to use precise facial expressions a bit morethan I would with other children in the room. 7. Active Listening I would have to be extra attentive to Lily when she approaches me for help or needssomething. During times of high activity (playing outdoors, getting ready to head home, etc.) Iwould need to keep my eye on Lily and the children around her to read her non-verbal behaviour andreact appropriately. 35. The child as a part of the largergroup of children I will create awareness of Lilys Hearing Impairment by talking to thechildren about this. I will use storybooks, a short video or two aboutHearing Loss, and other resources to teach the children about thisspecial need. Then I will allow them time to formulate and ask anyquestions they have so I can provide them a complete understanding ofLilys situation and ensure empathy from them. I will, of course, go tothe library to research appropriate books on hearing loss, search foryoutube videos and look for any other resources to use with thechildren. Then I will also use Social Stories to teach the children about acceptingothers, sharing and caring, etc. so they can learn what is appropriateand not when they are interacting with Lily every day. A social story isa tool for teaching social skills to children. In this case, the social storywill be used to prepare the children for the new event of having a childwith a hearing impairment in our classroom; it will teach them positivebehaviour. 36. Collaborative Planning, Staff Training and Communicating withParents of Child with Special Needs I will research many different sources in order to learn more about Hearing Impairmentsand what more I can do for Lily in my classroom. I will also research resources to helpLilys parents in their situation. I will set aside some time on a weekly basis, and as required by Lilys parents, to connectwith them about Lilys learning and development progress. We will collaborate and plantowards her future. Regular charts and a Home/School Communication Book will becreated in order to track issues, concerns, accomplishments and overall progress. I will also try to learn some Chinese, or initially have an interpreter present for my weeklymeetings with Lilys parents, since they dont speak English too well. I will also refer tothem some ESL classes if they wish to find out how to learn more English or get fluent inthe language. Materials will be added to our classroom to promote diversity and add to Lilys sense ofbelonging while she is in our classroom (Books on Chinese culture, Dolls to match herlooks a little more, Photographs of Chinese Traditions, Paintings, etc.) Using our Identifying Skills to Teach handout from Week 6, I will follow the stepsclosely to first choose a single area or skill I want to teach, break it down into smallersteps, build Lilys confidence and motivate her through reinforcement, keep track of theprogress and invite other teachers and Lilys parents to join in teaching the skill as well. 37. Communicating with Lilys Parents The first thing I will do is to speak with Lilys parents and identify whather situation is like, in detail. If this requires an interpreter, I willcontact one through the Agency Supervisor, so that we cancommunicate properly without any obstructions. I will find out what type of Hearing Loss Lily has and at what herhistory has been like. Of most concern will be whether or not Lily hasbeen fitted with any hearing aids or implants or if shes undergone anysurgery to correct her impairment. I will also check with her parentswhether or not Lily uses any technology or assistive devices to help herin everyday activities and communications. Then I will ask if they usesign language to communicate with her. The answers to thesequestions will help me get a holistic idea of Lilys situation and willhelp me in planning for her more effeciently. Then, together, we will decide on a joint approach to assist Lily in herlearning and development at home and at daycare. 38. Providing Support/Resources Family Support Services For Lilys parents, whether they have just recently foundout about Lilys hearing loss or have been aware of this for along time, they would still need a lot of support. Parents of children with recently identified hearing losscan seek different kinds of support. Support is anythingthat helps a family and may include advice, information,having the chance to get to know other parents that have achild with hearing loss, locating a deaf mentor, findingchildcare or transportation, giving parents time forpersonal relaxation or just a supportive listener(FamilySupport Services). 39. Doctor The doctor is who makes the initial diagnosis and then makesthe referral for diagnosis and links the parents to other resourcesfor support. Lily has already been diagnosed as hearing impairedso in this case, the doctor would be needed for the otherassistance rather than the diagnosis. Because Lilys parents have just recently moved to Toronto, theywould need to find a doctor for her. This can be done using anonline database of doctors, called The College of Physicians andSurgeons of Ontario. This online search is free of charge, servesall residents of the province of Ontario and does not require areferral. Any person can go online and search the database byplugging in some key information about what type of doctor youwant, whether you would like to request a female or male doctorspecifically, what language is primarily spoken, what area youprefer the doctors office to be located in, etc. 40. Audiology at Rouge Valley Health System(Centenary Site) Audiologists screen patients for hearing loss by running tests and assessments. They also provide interventionsupports for children who have hearing loss.Audiology at Rouge Valley Health System Centenaryhttp://www.rougevalley.ca/rehabilitation2867 Ellesmere RdScarborough, OntarioM1E 4B9416-281-7266Fax: 416-281-7224audiologists@centen.on.caThe Audiology department at the Centenary Hospital in Toronto provides all audiology services: audiological evaluation,hearing aid prescription, aural rehabilitation, central auditory screening, auditory brainstem response assessments andinfant auditory brainstem response. Their children screening services are top notch- all tests are play based. One testutilizes peg boards (the child should add a peg to the board each time a short sound is played in his ear. The results arerecorded to see, on average, how many times he was successful in hearing the sound and placing the peg on the board).Another test requires the child to sit on a chair in the middle of the sound room, and then a short sound is played atshort intervals to see if the child acknowledges the sound. These sounds vary in pitch, allowing the audiologist toassess and record the range of hearing for the child in both ears individually. These are some of the tests used onpreschoolers and school age children. Services are available in French, Cantonese and Mandarin, which is benefical toLilys parents who speak Cantonese primarily and only a little English. The clinic is child-friendly, welcoming thepatients siblings to also play with other toys provided for the purpose of keeping them occupied and happy so parentsare less stressed.Fee Covered by OHIPReferral usually referred by a doctor, but services can also be arranged independently.Availability some waiting period, usually 6 months to a year, depending on the diagnosis and age of child. 41. Octolaryngology at Sunnybrook Hospital Otolaryngology is a medical specialty concerned withillness or injury of the ear, nose, and throat (ENT), as wellas medical and surgical treatments for diseases of the earand skull base (Octolaryngology at Sunnybrook).Octolaryngology at Sunnybrook Hospitalhttp://sunnybrook.ca/content/?page=Dept_ENT_HomeSunnybrook Health Sciences Centre 2075 Bayview Avenue, Suite M1 102 Toronto, ON M4N 3M5 Tel: (416) 480-4138 Fax: (416) 480-5761 The Octolaryngology department is located in the Sunnybrook Health Sciences Centre building and provides many medical and surgical treatments sought by people suffering from a hearing loss. Services provided are Audiology, Cochlear Implant Program, Dizziness Clinic and Vestibular Lab, Head and Neck Oncology Clinic, and the Hearing Aid Centre. A referral is required from a doctor or audiologist; forms are provided online.Fee covered by OHIP partially/Insurance or Full payment of costs and servicesReferral made through a doctor or an audiologist. Forms are provided on the website.Availability usally about 6-9 months for an appointment 42. InterpreterMCIS Language Services An Interpreter translates the message from onelanguage to another after each person speaks in aconversation.MCIS Language Serviceshttp://mcislanguages.com/789 Don Mills RdSuite 608North York, OntarioM3C 1T5 MCIS Language Services is an online website providing Oral Interpretation Services, Translation and Transcription, and Social Intitiatives in over 200 languages. Requests can be made online 24/7 for an in-person interpreter, or for a scheduled phone/video interpreter.Fee unable to find accurate fee unless a form for interpreter services is filled out and submitted.Referral no referral requiredAvailability phone and Video interpretation services are available immediately upon request, but if an in-person interpreter is reqired, it takes about 24 hours is the suggested waiting period. 43. Speech and Language TherapistToronto Preschool Speech and Language Services Speech and Language Therapists work with a child toassist in the development of the childs verbal andnon-verbal communication, language and also theirswallowing and feeding skills.Toronto Preschool Speech and Language ServicesPreschool Speech and Language ProgramToronto Public Health416-338-8255 (voice)416-338-0025 (TTY)tpsls@toronto.caToronto Preschool Speech and Language Services provides an excellent program for children who may require a wide range ofservices or assessments due to delays in language or speech development. Services are free, do not require OHIP coverage, andare provided for all ages from birth till entry into senior kindergarten. Services provided include assessment of childrenslanguage development, speech and language workshops for children and their families, therapy in groups or individually ifneeded, and a transitional plan for the child when he is ready to start kindergarten.Fee No cost to the family.Referral No referral required. Parents, Caregivers, Nurseries, etc. can call the agency directly.Availability Appointments are given in a timely manner; at the most, 1 month wait. 44. Bibliography1. Definition of Hearing Impairment. Industry Canada Website. Retrieved on March 10, 2013 from http://www.apt.gc.ca/wat/wb14200e.asp?did=5.2. Image. International Symbol of Access for Hearing Impairment. Deafness Forum of Australia. Retrieved on March 3, 2013 from http://www.deafnessforum.org.au/index.php?q=accessible-accomodation.3. Image. Girl Doing Sign Language. Retrieved on March 29, 2013 from http://www.google.ca/imgres?q=hearing+impairment&hl=en&biw=1365&bih=596&tbm=isch&tbnid=5Yd2sDS2TVbr1 M:&imgrefurl=http://www.cdc.gov/ncbddd/kids/hearing.html&docid=iZgcoiPBcA_H9M&imgurl=http://www.cdc.gov /ncbddd/kids/images/sign-language-kid- kq.jpg&w=298&h=243&ei=35NVUcfvLcX5qwHYooC4DQ&zoom=1&iact=hc&vpx=310&vpy=264&dur=328&hovh=194&h ovw=238&tx=146&ty=125&page=1&tbnh=140&tbnw=172&start=0&ndsp=21&ved=1t:429,r:9,s:0,i:133.4. Main Types of Hearing Loss. Kentuckys Office for the Americans with Disabilities Act. Retrieved on March 2, 2013 from http://ada.ky.gov/hearing_imp_def.htm.5. Image. Main Types of Hearing Loss. Green Business and Lifestyle Blog. Conductive Hearing Loss in Newborn. http://www.google.ca/imgres?q=conductive+hearing+loss&hl=en&sa=X&biw=1365&bih=596&tbm=isch&tbnid=EC3m mj5CFSfc0M:&imgrefurl=http://www.greenbizletter.com/conductive-hearing-loss-in- newborn/&docid=eirbIxE7zD59DM&imgurl=http://greenbizletter.com/wp- content/uploads/2012/03/hearing_types.jpg&w=375&h=285&ei=YJZVUbv9BMfyqQHi2oGYCg&zoom=1&iact=hc&vpx= 291&vpy=110&dur=3073&hovh=196&hovw=258&tx=150&ty=131&page=1&tbnh=142&tbnw=187&start=0&ndsp=21&ved=1t: 429,r:2,s:0,i:102 . 45. 6Statistic About Hearing Deficits. Hearing Foundation of Canada Retrieved on March 29, 2013 from http://www.thfc.ca/cms/en/KeyStatistics/KeyStatistics.aspx?menuid=877Statistic about Hearing Impairment in Children. VOICE for Hearing Impaired Children. Retrieved on March 3, 2013 from http://www.voicefordeafkids.com/education.asp8YouTube Video. Early Intervention for Hearing Loss in Children. Retrieved on March 2, 2013 from http://www.youtube.com/watch?v=-3jmo14zZDoOnline Website. Causes. MedicineNet.com. Retrieved on March 9, 2013 from http://www.medicinenet.com/detecting_hearing_loss_in_children/page2.htm10 Image. Antibiotics. Retrieved on March 29, 2013 from http://www.google.ca/imgres?q=antibiotics&hl=en&biw=1365&bih=596&tbm=isch&tbnid=ojPSlZnsDTPleM:&imgrefu rl=http://www.nlm.nih.gov/medlineplus/antibiotics.html&docid=Nv4T5g13CXIgHM&imgurl=http://www.nlm.nih.go v/medlineplus/images/pills.jpg&w=230&h=181&ei=IC1WUcObPOaFywGg2YHgDQ&zoom=1&iact=hc&vpx=209&vpy=1 88&dur=1950&hovh=144&hovw=184&tx=118&ty=100&page=1&tbnh=142&tbnw=181&start=0&ndsp=21&ved=1t:429,r:1,s:0, i:15113 Image. Ear Infection. Retrieved on March 29, 2013 from http://averastorycenter.org/wp-content/uploads/2012/11/Eich- ear-infections-photo.jpg14 Image. Autism Awareness. Retrieved on March 29, 2013 from http://www.topnews.in/health/diseases/autism15 Image. Apgar Test Score. Retrieved on March 12, 2013 from http://www.umm.edu/pregnancy/000129.htm9Youtube Video. Is This Child Really Deaf? Retrieved on March 28, 2013 from http://www.youtube.com/watch?v=P5xVJJU2Bgo10 Image. Sign Language and Child. Retrieved on March 3, 2013 from http://www.google.ca/imgres?q=deaf+children&hl=en&sa=X&biw=1365&bih=596&tbm=isch&tbnid=uZniB2EvqZaSJM: &imgrefurl=http://kidsbookclub.tescomagazine.com/parents-zone/helping-your-deaf-child-learn-to- read.html&docid=_uj4Z997mXNBhM&imgurl=http://kidsbookclub.tescomagazine.com/Media/images/deaf-child- blog-hero-47314aa6-3b48-454e-ba64-9e53f9a13e4a-0- 580x295.jpg&w=580&h=295&ei=Cq9VUZfFMoq6qgGtrYHwAw&zoom=1&iact=hc&vpx=872&vpy=142&dur=3198&hovh =160&hovw=315&tx=135&ty=99&page=1&tbnh=138&tbnw=269&start=0&ndsp=20&ved=1t:429,r:5,s:0,i:97 46. 10 Infant Screening in Hospitals. The Hearing Association of Canada. Retrieved on March 12, 2013 from http://www.thfc.ca/cms/en/NewbornHearingScreening.aspx11 Image. Infant Hearing Test. Retrieved on March 12, 2013 from http://health.allrefer.com/health/hearing-loss-infants- hearing-test.html12 Online Website. The Hearing Foundation of Canada. Retrieved on March 12, 2013 from http://www.thfc.ca/cms/en/NewbornHearingScreening.aspx13 Signs & Symptoms of a Hearing Impairment in Children. Retrieved on March 12, 2013 from http://www.thfc.ca/cms/en/NewbornHearingScreening.aspx14 Image. Child Ear Infection. Retrieved on March 12, 2013 from http://frenchtribune.com/teneur/1316436-ear- infections-linked-high-number-hearing-loss-cases15 Online Website. Impacts of Hearing Loss on the Child. The American Speech Language Hearing Association. Retrieved on March 12, 2013 from http://www.asha.org/public/hearing/disorders/effects.htm16 Online Website. Impact of Hearing Impairment on the family. American Academy of Otolarygology. Retrieved on March 15, 2013 from http://www.entnet.org/HealthInformation/childHearingLoss.cfm17 Online Web Article. Web MD. Help for Parents of Children with Hearing Loss. Retrieved on March 30, 2013 from http://www.webmd.com/parenting/help-for-parents-hearing-impaired-children18 Image. Doctor with Child. Retrieved on March 30, 2013 from http://www.cbc.ca/news/pointofview/2011/01/doctor- shortage-have-you-had-trouble-accessing-a-doctor.html.19 Online News Report. The Huffington Post. Number of Doctors at an All Time High in Canada. Retrieved on March 30, 2013 from http://toronto.about.com/od/health/ht/findadoctor.htm20 Online Article. About.Com Toronto. Retrieved on March 30, 2013 from http://toronto.about.com/od/health/ht/findadoctor.htm 47. 10 Image. Child Ear Infection. Retrieved on March 12, 2013 from http://frenchtribune.com/teneur/1316436-ear-infections-linked- high-number-hearing-loss-cases11 Online Website. Impacts of Hearing Loss on the Child. The American Speech Language Hearing Association. Retrieved on March 12, 2013 from http://www.asha.org/public/hearing/disorders/effects.htm12 Online Website. Impact of Hearing Impairment on the family. American Academy of Otolarygology. Retrieved on March 15, 2013 from http://www.entnet.org/HealthInformation/childHearingLoss.cfm13 Online Web Article. Web MD. Help for Parents of Children with Hearing Loss. Retrieved on March 30, 2013 from http://www.webmd.com/parenting/help-for-parents-hearing-impaired-children14 Image. Doctor with Child. Retrieved on March 30, 2013 from http://www.cbc.ca/news/pointofview/2011/01/doctor-shortage- have-you-had-trouble-accessing-a-doctor.html.15 Online News Report. The Huffington Post. Number of Doctors at an All Time High in Canada. Retrieved on March 30, 2013 from http://toronto.about.com/od/health/ht/findadoctor.htm16 Online Article. About.Com Toronto. Retrieved on March 30, 2013 from http://toronto.about.com/od/health/ht/findadoctor.htm17 Online Website. Role of Audiologists. Retrieved on March 30, 2013 from http://www.entnet.org/HealthInformation/childHearingLoss.cfm18 Image. Audiologist. Retrieved on March 21, 2013 from http://www.hearingdevicetips.com/tips-to-find-a-good-audiologist..19 Online Website. Centers for Disease Control and Prevention. Retrieved on March 18, 2013 from http://www.cdc.gov/ncbddd/hearingloss/screening.html20 Online Website. American Academy of Otolaryngology. Retrieved on March 30, 2013 from http://www.entnet.org/HealthInformation/childHearingLoss.cfm.21 Image. ENT. Retrieved on March 15, 2013 from https://www.google.ca/search?q=ent+doctor&hl=en&safe=off&source=lnms&tbm=isch&sa=X&ei=yG1XUdj1B4e1qgHKvYDoAQ& ved=0CAcQ_AUoAQ&biw=1280&bih=929#hl=en&safe=off&tbm=isch&sa=1&q=ear+nose+throat&oq=ear+nose+throat&gs_l=img .3..0l6j0i24l4.5054.26379.6.28432.21.14.2.5.6.0.635.2041.8j4j0j1j0j1.14.0...0.0...1c.1.7.img.Nb52LFzXCSw&bav=on.2,or.r_qf.&bvm=bv .44442042,d.aWM&fp=93555186d4e829f5&biw=1280&bih=929&imgrc=WWUQ1ZrZzJQe_M%3A%3BZBZyIVELHA9aMM%3Bhtt p%253A%252F%252Fwww.kudzu.com%252Fcontent%252Fincludes_kudzu%252Fcategory%252Fear-nose-and- throat.jpg%3Bhttp%253A%252F%252Fwww.kudzu.com%252FcategoryMain.jsp%253FN%253D2058%3B574%3B255.22 Online Website. Role of the Early Intervention Specialist. Retrieved on March 13, 2013 from http://www.entnet.org/HealthInformation/childHearingLoss.cfm 48. 10 Image. Early Intervention Specialist. Retrieved on March 13, 2013 from https://carmenwiki.osu.edu/display/hdfs361sp20119489/Early+Intervention+Specialist11 Online Website. Role of Speech and Language Pathologist. American Academy of Otolaryngology. Retrieved on March 15, 2013 from http://www.entnet.org/HealthInformation/childHearingLoss.cfm12 Image. Speech and Language Pathologist. Retrieved on March 15, 2013 from http://www.mysomeday.com/lulu/someday/Career/be-a- Speech-Language-Pathologist13 Online Website. Devices that help with hearing loss. Centers for Disease Control and Prevention. Retrieved on March 18, 2013 from http://www.cdc.gov/ncbddd/hearingloss/treatment.html14 Online Website. Telephone Amplifiers. Harris Communications. Retrieved on March 31, 2013 from http://www.harriscomm.com/catalog/default.php?cPath=47_16715 Image. Hearing Loss Clinic. Retrieved on March 15, 2013 from http://www.hearingloss.ca/testimonials/16 Online Website. Medical/Surgical Procedures. Centers for Disease Control and Prevention. Retrieved on March 18, 2013 from http://www.cdc.gov/ncbddd/hearingloss/treatment.html17 Online Website. Family Support Services. Centers for Disease Control and Prevention. Retrieved on March 18, 2013 from http://www.cdc.gov/ncbddd/hearingloss/treatment.html18 Image. Phone Amplifier. Retrieved on March 31, 2013 from http://www.assistireland.ie/eng/Products_Directory/Deaf_and_Hard_of_Hearing/Telephones/Portable_Amplifiers/Plug- in_Telephone_Amplifier.html19 Online Website. Flashing and Vibrating Alarms. 4 Alarm Clocks. Retrieved on March 31, 2013 from http://www.4alarmclocks.com/vialcl.html20 Image. Flashing & Vibrating Alarm Clock. Retrieved on March 31, 2013 from http://www.ebay.com/itm/Clarity-Wireless-Alarm-Clock- Flashing-Light-Lamp-Visual-Vibrating-Deaf-Alert-Sys-/40043605658221 Online Website. Audio Loop Systems. Ampetronic. Retrieved on March 31, 2013 from http://www.ampetronic.com/Home22 Image. Audio Induction Loop. Suffolk. Retrieved on March 31, 2013 from http://www.shss.org.uk/inductionloopsystem.html 49. 10 Online Article. Infrared Listening Devices. Arts and Visually Impaired Audiences. Retrieved on March 31, 2013 from http://www.artsvia.org/newsArticle.cfm?aId=3911 Image. Infrared Listening Device. Retrieved on March 30, 2013 from http://www.audiolinks.com/tek9/tek9.asp?pg=products&specific=jpdoomrnq12 Online Website. The Hearing Loss Clinic. Retrieved on March 12, 2013 from http://www.hearingloss.ca/hearing-loss-statistics- demographics/13 McCaie, Lisa. Centennial College. Inclusion of Children with Special Needs. Class Handout. Adaptive Learning Environments. Week 414 Image. Labelled Bins for Materials. Retrieved on March 31, 2013 from http://www.kindergartenkindergarten.com/2010/09/my- kindergarten-classroom.html15 Image. Labelled areas. Retrieved on March 29, 2013 from http://crisscrossapplesauce.typepad.com/.a/6a00e55111563088340134872fea70970c-pi16 Image. Manipulatives. Retrieved on March 15, 2013 from http://crisscrossapplesauce.typepad.com/.a/6a00e55111563088340133f40f3251970b-pi17 Image. Math area. Retrieved on March 15, 2013 from http://crisscrossapplesauce.typepad.com/.a/6a00e55111563088340133f40f31bb970b-pi18 Image. Reading area. Retrieved on March 15, 2013 from http://crisscrossapplesauce.typepad.com/.a/6a00e55111563088340134872fea70970c-pi19 Image. Shapes Chart. Retrieved on March 16, 2013 from http://www.guruparents.com/shapes-chart.html#.UVmWCdxzbcsImage. Daily Routine Chart. Retrieved on March 16, 2013 from http://psjhomedaycare.com/2.htmlImage. Sign Language Charts and Book. Retrieved on March 16, 2013 from http://mommypowers.us/wp- content/uploads/2011/08/DSC06540.jpgImage. ASL Chart. Retrieved on March 16, 2013 from http://my.opera.com/tdjmd1/albums/showpic.dml?album=9277802&picture=128398402 50. Online WebSite. Assistive Products for Deaf and Hard of Hearing. Harris Communications. Retrievedon March 22, 2013 from http://www.harriscomm.com/ Image. Sign Language Vocabulary Cards. Retrieved on March 22, 2013 fromhttp://www.harriscomm.com/index.php/basic-signing-vocabulary-cards-set-b.html#.Uvmgsdxzbcs Image. I Love You Floor Puzzle. Retrieved on March 22, 2013 fromhttp://www.harriscomm.com/index.php/american-sign-language-ily-8inch-wooden-puzzle.html#.UVmhCtxzbcs Image. Finerspelling Blocks. Retrieved on March 22, 2013 fromhttp://www.harriscomm.com/index.php/fingerspelling-sign-language-blocks.html#.UVmmMNxzbcs Image. ASL ABC Peg Puzzle. Retrieved on March 22, 2013 fromhttp://www.harriscomm.com/index.php/alphabet-sign-language-peg-puzzle.html#.UVmhXNxzbcs Image. ASL Number Puzzle. Retrieved on March 22, 2013 fromhttp://www.harriscomm.com/index.php/asl-sign-language-numbers-puzzle.html#.UVmh0Nxzbcs Image. Signs Flash Cards. Retrieved on March 22, 2013 fromhttp://www.harriscomm.com/index.php/more-signs-sign-language-flashcards.html#.UVmiGNxzbcs Image. Keep Quiet Sign Language Cubes Game. Retrieved on March 22, 2013 fromhttp://www.harriscomm.com/index.php/keep-quiet-sign-language-cubes-game.html#.Uvmistxzbcs Image. Sign Language Bingo. Retrieved on March 22, 2013 fromhttp://www.harriscomm.com/index.php/sign-language-bingo-game.html#.UVmi8txzbcs Image. First Signs Match Up. Retrieved on March 22, 2013 fromhttp://www.harriscomm.com/index.php/match-up-puzzles-first-signs.html#.UVmjPdxzbcs McCaie, Lisa. Centennial College. Inclusion of Children with Special Needs. Class Handout.Identifying Skills to Teach. Week 6 51. Online Website. Family Support Services. Centers for Disease Control and Prevention. Retrieved on March 18, 2013 fromhttp://www.cdc.gov/ncbddd/hearingloss/treatment.html McCaie, Lisa. Centennial College. Inclusion of Children with Special Needs. Class Powerpoint. Week 9The College of Physicians and Surgeons of Ontario. Online Database. Retrieved on April 1, 2013 fromhttp://www.cpso.on.ca/docsearch/ McCaie, Lisa. Centennial College. Inclusion of Children with Special Needs. Class Powerpoint. Week 9. slide 9 Rouge Valley Health System Centenary. Learning Disabilities Resource Community. Retrieved on April 1, 2013 fromhttp://www.ldrc.ca/community/directory/?id=131 Audiology at Rouge Valley Centenary. Retrieved on April 1, 2013 from http://www.rougevalley.ca/rehabilitation Patient Services. Octolaryngology at Sunnybrook Hospital. Retrieved on April 1, 2013 fromhttp://sunnybrook.ca/content/?page=Dept_ENT_Prog Octolaryngology at Sunnybrook Hospital. Welcome. Retrieved on April 1, 2013 fromhttp://sunnybrook.ca/content/?page=Dept_ENT_Home Interpreter Services. MCIS Language Services. Retrieved on April 1, 2013 from http://mcislanguages.com/interpretation/ McCaie, Lisa. Centennial College. Inclusion of Children with Special Needs. Class Powerpoint. Week 9. slide 12 Toronto Preschool Speech and Language Services. Preschool Speech and Language Program. Retrieved on April 1, 2013 fromhttp://www.tpsls.on.ca/psl/services.htm