An Innovative Rehabilitation Model
for Working with Bilingual Families
Assessment to Intervention
Learning Objectives
• Discuss issues, challenges and opportunities
relevant to this population
• Identify resources and methods that can facilitate
effective bilingual assessment and intervention
• Understand current intervention models and
their outcomes
Who are we talking about?
Linguistically Diverse Populations
Simultaneous bilinguals
Sequential bilinguals
Fluency in one language with significant
exposure to another
Use of more than one dialect
Limited English Proficient
Opportunities
Selena - Spanish
Selena English
Opportunities
Issues/Challenges
Issues
Population of Children with Hearing Loss
Other
languages
Low SES
Other
Challenges
• Lack of bilingual teachers, therapists and
interpreters
• Lack of sufficient immersion in two languages
• Inadequate language base
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Previous country infrastructure
Late intervention
Parents paralyzed by grief
Family support and motivation level
Challenges
• Co-occurring disorders
• Poor Memory
• Personality of the child and parents
• Low Parent Participation/Resources
Opportunities
Considering literature on children
without hearing loss
Why Support the Home Language?
Children with typical hearing
• There is no scientific reason to believe that children
can not develop more than one language early in
life (Genesee, 2008)
• Strengthening the home language can facilitate
development of the second language. (Kohnert, et al, 2005)
• Therapy studies on bilingual children with language
impairment yield equal results as monolingual
children with language impairment (Gutierrez-Clellen et al,
2008)
Challenges
Variability in Programming
Educational Programs
Sequential Educational Outcomes
(Collier & Thomas, 2004; Garcia & Jensen, 2006)
Program
Description
Result
Subtractive
English language learners
are immersed in English
only. Some are provided
ESL support (teachers
trained to provide special
comprehensible input) for
three years or more and
then are integrated into allEnglish instruction
Students show less
progress in math and
reading, limited
conversational English,
little academic progress,
rarely catch up, many
forget hm. Lang. & drop
out of high school. Many
are below the 50th
percentile in English
reading tests
Additive One-way
Two-way
Content instruction is given
in both the target and
majority language for four
to six years. In some
programs, Majority
language is introduced in
second grade or later
Equal achievement in both
languages and equal
achievement in the
majority language as maj.lang. speaking peers.
Outperform ESL subtractive
programs. >50%ile in
reading
Children with Hearing Loss
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•
Waltzman, Robbins, Green & Cohen, 2003
Guiberson, 2005
•
Thomas, El Kashlan & Zwolan, 2008
•
Rhoades, Perusse, Douglas, Zarate, 2008
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Douglas, 2011
•
Douglas, Cantu, Kirby, & Zarate, 2011
•
Teschendorf et al. (2011)
•
Yim, 2011
•
Douglas and Bunta, 2013
•
Lund and Schuele, 2014
•
Guiberson and Sindell, 2014
•
Douglas, Bunta, Dickson, Cantu, Wickesberg and Gifford, (in press)
Major Opportunities
Bunta and Douglas, 2013
There were no statistically significant
differences between the language age
scores of children with varying levels of
parental education (F(3, 32) = .50 at p = 0.69
with a relatively small effect size of 0.045.
Appropriate intervention has the potential to
overcome maternal education effects.
Opportunities
Auditory-Verbal Education!
Assessment
Start with Fair Assessment
Assessment Model
Recommendation
Test Results
analysis
Assessment
Administration
Assessment
Discovery
Selection
Development
Discovery
Current and Developing Resources
Initial Considerations
(Douglas, 2011)
Simultaneous
Two or more
languages
before 2 or 3
Process
Sequential
Another language
After 3
Family
Monolingual Other
Language
Language other than the
majority is spoken at home
and in the neighborhood
Bilingual
Both the majority and
Minority languages are
Spoken at home and in
The neighborhood
Discovery - Initial Procedures
1. Case History
2. Caregiver Interview
3. Linguistic Profile Review
4. Age indices calculation
5. Determine Language of assessment
Assessment Selection
Assessment Selection
Determine Language of Assessment
• Consider the Law
• Consider Linguistic Proficiencies
BICS and CALP
Assessment Selection
1. Formal vs. Informal language assessment ??
2. Low-incidence languages ??
3. Bilingual children ??
4. Assessments for Children with suspected Language
Impairment ??
5. Articulation Assessment ??
Formal vs. Informal Assessment
Formal Assessment
• Use of Standardized Assessment
• Language exposure, use, and proficiency in
both languages
• View with caution
• List strengths and weaknesses
Informal Assessment Procedure
• Speech and Language sampling
• Dynamic assessment/stimulability probing
– Processing dependent measures
• Structured observation
• Narrative assessment
Low-Incidence Languages
Formal or Informal?
Bilingual Children
Formal or Informal Assessment?
Bilingual
L1
L2
Children with Language
Impairment
Formal or Informal?
Identifying Language Impairment:
Assessment Tasks Sensitive to
Language Impairment
• Non-word repetition performance
• Sentence repetition tasks
• Spontaneous Language Samples
– Looking for low TTR and MSL, agrammatic language
• Structured Probes
– Dynamically – Test – Teach - Retest
Quantifying Informal Language
Assessment
Ex. The boy watched the boy eat. The boy eat
again. The boy smiles.
Type-Token Ratio (TTR): A ratio of the number
of different words compared to the total
number of words used. TTR above is 6:13
Mean Sentence Length (MSL): The mean
number of words per sentence. MLS above is 4.
Articulation Assessment
Articulation Assessment
• Formal and informal
• Complete assessment in both languages
• Consider each phonological system
Informal Articulation Assessment
(Taelman, Durieux, & Gillis, 2010)
• Phonological Mean Length of Utterance
– PMLU
• Proportion of Whole-Word Proximity
– PWP
PMLU
• Choose 25 age-appropriate words. Assign one
point for each consonant and vowel in the
word.
• Each correctly produced consonant is assigned
an additional point.
• Ex. The child’s production of /pun/ of “spoon”
is 5 points out of 7 possible points
PWP
• The ratio between the PMLU for the target
words in the sample and the child’s PMLU for
the same sample.
• Calculate the PMLU for each word in the list.
Obtain a total.
• Ex. PMLU for “spoon” is 7. A child’s response
of /pun/ is 5. The PWP is (5:7) or .71
Assessment Administration
Assessment Administration
1. Bilingual Therapist
2. Ancillary Examiner
3. Interpreter
Test Result Analysis
Interpretation Considerations
• Law
• Integration of Issues
• Potential to Benefit from Services
• Determining Progress/Amount of Services
The Law
IDEA 2004
IDEA 2004
Distinction between
impairment and difference
• Diagnosis of an impairment cannot be made due
to Limited English Proficiency
• Diagnosis of an impairment cannot be made
based on a single measure
• Diagnosis requires a variety of assessment tools
and strategies
Integrating Certain Issues
Integrating Certain Issues
Hearing
Impairment
Language
Learning
Bilingual
Issues
e.g. Vocabulary Assessment
Spanish
• Elephante
• leche
English
• Elephant
• cup
Score?
• 4?
• 3?
e.g. Language assessment
Comprehension vs. Expression
Comprehension
Tense Markers
Easier to hear:
regular or irregular verbs?
English
Spanish
Expression
May hear one language and respond in the other
Easier to hear?
Singular or Plurals
e.g. Bilingual Issues
e.g. Speech Assessment
Sounds of
L1 +
Sounds of
L2 =
Accented
Speech
Tun/sun
Walk/walked
(rolled R) run/run
Uh uh/banana/platana
Not
Articulation
Impairment
Potential to Benefit
from
Services
Considering Simultaneous vs. Sequential Development
Factors Supporting Bilingual Learning
Early identification and fitting
Immediate, early intervention
Early implantation
Excellent speech perception; access to soft conv. speech
Absence of additional disabilities
Intact anchor language
Good parent involvement
Familial motivation for multi-language learning
Exposure to rich and complex language models IN BOTH
LANGUAGES
• Opportunities to practice each language meaningfully
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Possible Concerns for Bilingual Learning
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Late age of identification/intervention
Late age of CI with limited auditory development pre-CI
Poor detection and speech perception skills
Presence of more than one disability
Evidence of a struggle to acquire an anchor language
Clinical red flags for slow auditory progress post CI
Lack of family commitment for multi-language
learning.
Determining Progress
Determining Amount of Service
Determining Progress/Amount of Services
50
45
40
35
30
Spanish Language Age
English Language Age
25
Intervention Age
20
15
10
5
0
Child 1
Child 2
Child 3
Child 4
Child 5
Assessment
Video Tape Examples
Hi or Low Modifiability?
Dynamic Assessment:
Fast Mapping
Intervention
One Language
Or
Two?
Environments
and
Outcomes
INTERVENTION CONSIDERATIONS
Service Provision Decisions
Bilingual Children
(Douglas, 2011)
Simultaneous
Two or more
languages
before 2 or 3
Process
Sequential
Another language
After 3
Family
Monolingual Other
Language
Language other than the
majority is spoken at home
and in the neighborhood
Bilingual
Both the majority and
Minority languages are
Spoken at home and in
The neighborhood
Designing Intervention
Bilingual
Child with
HL
Audiology
(Moog & Stein, 2008)
(Genesee, 2008)
Maj. Lang.
Min. Lang.
Intervention
Intervention
Language of Intervention Decisions
Family
Language Use
Dominant
Language
Language
Environments
Language of
Intervention
Gonzalez et al, 2008
Language of Intervention Decisions
(Gonzalez et al; 2005; Kohnert & Derr, 2004)
Clear
Dominance
No Clear Dominance
Bilingual Dominance
Dominant
Language
Home
Language
Both
Languages
Simultaneous Bilingualism
Intervention Models
(Gonzalez et al, 2005; Douglas, 2011)
Bilingual
Support Model
Coordinated
Service Model
Integrated
Bilingual model
These may operate on a continuum
Combination of
bilingual
support and
coordinated
models
Develop L1 for
3-4 years.
(or more)
Second
First
Begin L2 &
cont. with
L1 training
Enlist the
Family &/or
Tutor
Third
Sequential Bilingual Process
Provide
Coordinated
Services
90/10
50/50
Dual
Language
Programs
80/20
70/30
Kohnert & Derr, 2004
Designing Bilingual Language Intervention
Develop a listening function in the home language
Immerse in the other language as soon as possible
Bilingual Model
Focus on structures that are similar between languages
Spanish
English
NOUN + NOUN
NOUN + NOUN
Papa Oso
Papa Bear
SVPP
SVPP
El gato esta dormiendo en la
mesa
The cat is sleeping on
the table
Explicitly focus on differences between languages
Cross Linguistic Model
NOUN + ADJECTIVE
ADJECTIVE + NOUN
Carro azul
Blue car
REFLEXIVE PRONOUNS
REFLEXIVE PRONOUNS
Ella se la comio
She ate it herself
Facilitating Intervention Plans
Bilingual – Majority and
Minority Language
Speaking Families
Monolingual Minority
Language Speaking
Families
Home
Mutual strategizing for
home intervention –
(minority lang. use @ hm.)
Minority language is
spoken at home and in the
neighborhood
Therapy
Individual therapy in the
majority language with
active parent participation
– parent uses the
strategies in the minority
language at home.
Individual therapy is
provided in the minority
language (with bilingual
therapist/assistant or
monolingual therapist and
an interpreter).
School
Maj. language immersion
Maj. language immersion
through an auditory-oral or through an auditory-oral
mainstream preschool.
preschool program.
Extra-curricular
Parent may enroll the child Parent may enroll the child
in additional, individualized in additional,
minority language training. individualized majority
language training.
IT TAKES A VILLAGE!
Service
Continuum
Models
Video Tape Examples
Service Models
Bilingual Support Model
Preproduction Phase
Coordinate Service Model
Ind. Therapy
Home
Spanish
Spanish
1/week with Parent
Child
Pre-K Class
English
5/week
Small Group
English 3/day, 5/week
+
Bilateral – sev-profound HI,
corrected to mild with CI.
Bimodal- CI + HA
Implant activated at 19 months
Appropriate intervention started
at 40 months
Sporadic attendance in school
and therapy
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Intervention
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Jacqueline
Background
Monolingual Spanish-speakingonly home and neighborhood –
ind. Tx in Spanish
Auditory-oral preschool for
English Immersion
Video Tape Segments
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Demonstrating Coordinated and
Integrated Models
Final slide - Conversational
Language Activity – Target “ya” in
Spanish then “already” in English.
Both in SVO Sentences.
Final Video is taken at 4 years of
intervention
Techniques
Notice how the 2nd therapist has fun while using:
•Explicit instruction to transfer language,
• modeling, imitation
•Scaffolding/shaping, and
•Repetition to develop automaticity
+
Coordinated Service Model
1 yr after baseline
Early Production Phase
Coordinated Service Model
Speech Emergence Phase
Integrated Model
Year 3 or 4
Intermediate Fluency Phase
Combination
Model
Advanced Fluency Phase
Facilitating Beginner
Sequential Bilingualism:
What it may look like
1. English example
2. Word Repetition
3. Parent Training
No Bilingual Staff?
No Problem!
There are ways to
COMPENSATE!
McConkey Robbins (2007)Loud & Clear! Issue 1
Adv. Bionics Corp.
Douglas, 2011 HearSAY Issue 7 MED-EL
Ways to Compensate for Staff Shortages
Bilingual Families
Monolingual-other
Language Families
Tag Team Approach
Tag Team Approach
Parent-Centered
Use of Interpreters/
Integrated Model
Bilingual Resources
Refer to a Language
Teacher
Refer to a Language
Teacher
You don’t have to know the language. Just know what to do.
Tag Team Approach
• Clinician demonstrates in English and interacts in
English with the child.
• The parent follows suit in the home language and
interacts with the child in the home language.
• Clinician Observes and Provides Positive Feedback
You don’t have to know the language. Just know what to do.
Parent Centered Integrated Model
Douglas, 2011
• Therapist and parent mutually plan a home
language and majority language approach with
the family.
• Therapist conducts sessions with the family in the
majority language with a focus on listening and
speaking strategies (much like beginning sequential learning, or i.e.
resource Talk around the Clock)
• Therapist inventories words the child learns in
the home language and “integrates” them into
therapy sessions for transfer to the majority
language.
Parent-Centered
Integrated Model
Douglas, 2011
For Bilingual Families Only!
Use of Interpreters
Make your
B.I.D.
Briefing
Interaction Debriefing
(Langdon, 2002)
Interaction Phase
Thank you Hearts for Hearing!
Use of Dual Language Resources
Clinician explains
strategies and
activity using the
resource in one
language
Clinician provides
positive
verbal/nonverbal
feedback
Parent reads the
concepts in the
other language
Parent continues
or repeats the
activity in the
other language
Clinician
demonstrates the
strategies in an
activity in one
langugage
Parent observes
Refer to a Language Teacher
• In some cases, the services of a language teacher
who can teach the target language may be helpful.
• SLP works with the language teacher to
coordinate services. This language teacher
may/may not be a teacher of the deaf.
• The two professionals share techniques and/or
strategies and implement parallel lessons that
facilitate improvement in both languages.
Take Home Messages
• Bilingualism with hearing impaired children is a
team effort; at the same time, it is no less difficult
than helping a hearing impaired child acquire one
language.
• The achievement of bilingualism with hearing
impaired children is not necessarily related to
parent education level
Take Home Message
• With normal cognition and no other disabilities,
duration of deafness, inconsistent use and/or
inappropriate amplification seem to be the largest
contributing factor (s) to a child’s reduced facility
for learning any spoken language in a timely
manner.
Take Home Messages
• Providing individual services in the minority
language while immersing the child in a majority
language center based program does not impair the
child’s ability to learn the majority language.
• Oral deaf preschool teachers play a critical role in
the majority-language immersion process for
severe-profoundly deaf children who come from a
mono-lingual, minority-language speaking home.
Questions?
William.m.douglas@vanderbilt.edu