Category: Resourceful Young Children | Test population-based models of provision | 5 April, 2014 - 12:00← BACK
Thobile is a HI HOPES Early Interventionist. Every two-weeks she takes a taxi to a remote village of the Drakensburg to visit Karabo and his granny in their hut. Karabo is deaf. On this day, Thobile is met by Karabo’s granny at the taxi station and they walk together to the homestead. Karabo’s granny learns how to communicate with him and to promote his language development, increasing his chances at literacy and knowledge development at school. Thobile shares her skills and knowledge with Karabo and with his granny on her only day off from another full-time job. Every time she makes this visit, the whole process takes almost four hours. But this is a sacrifice she is willing to make as she seeks to help families dealing with a deaf young child. She believes these home visits will help Karabo grow up in a safe environment that understands his deafness and allow him to be the best person he can possibly be. That is why she continues with this important task.
In the absence of government funding for early screening and intervention for children born with hearing loss, the onus falls on the community to help support deaf children and their families. Community members and non-profit organisations like Hi HOPES can work together to help ensure that deaf children have equal access to developing skills on par with hearing children. At Hi Hopes we aim to provide home-based support to families with a deaf child, and to also create a collective community understanding of childhood development, of the importance of language acquisition, and of the value of holistic, family-centred, home-based early intervention services.
Deaf children need special language intervention early on in their lives because if they do not have access to language (because they cannot hear) they do not develop communication skills, which have long-term negative impacts on their education and general development. A delay in building language leads to delays in cognitive, socio-emotional, perceptual, and future academic development.
Numerous studies on successful intervention for deaf children and their families show that community-based initiatives – delivered in a family-centred framework – are more effective than centre-based interventions. Thus, the HI HOPES programme wishes to provide home-based care, support, and early intervention for families with a deaf child. In doing so, we can address the lack of holistic, early intervention services available at home that enable families to make informed choices and maximise the language development of their deaf child. In the multicultural South African context this means training a range of diverse people to be Interventions who can conduct home-visits.
The Interventionist, home-based programme strategy
Our strategy is to provide each family with a deaf child an “Interventionist” from the local community who can guide them through the early years of living with a deaf child. We take steps to ensure that the Interventionist is linguistically and culturally appropriate for each family, thus fostering understanding and acceptance from the outset.
Every second week, the trained Interventionist visits the family for an hour and provides them with information, support, and empowerment options about their deaf child. Over time, the Interventionist can support these parents in their journey of raising a child with a hearing loss, by providing unbiased knowledge and information, so that they can make informed decisions regarding all aspects of their child’s development. The Interventionist also helps the family monitor the child’s developmental milestones.
The Interventionist’s goal is to help the family and the deaf child develop the appropriate language/ communication modality (spoken or signed) by age 3-years that will enable him/her to function in a selected preschool facility. This facilitates the transition into preschool because the child has a solid language base on which to develop literacy and academic skills.
The HI HOPES intervention empowers and educates the family to become advocates for their child, and ensures the child’s right to quality healthcare and appropriate education are met. It helps to develop communication and bonding between the family and child; and helps the family through their grief and accept their child for the precious individual that he/she is. We also assist the family in forming an individualised intervention plan that will promote language development. This will then help the child with their socio-emotional and cognitive skills growth and lead to a more holistic and “typical” progression. Finally, we help ensure that the family is provided with appropriate schooling options so that the child can use the foundational skills developed during the intervention process to build more advanced literacy and academic skills.
HI HOPES is currently implemented in Gauteng, KwaZulu Natal, and the Western Cape Provinces, and is also being piloted in the Eastern Cape. It is based on the American SKI HI programme but has been adapted to meet the cultural and social context of South Africa. For instance, the American version requires that the Interventionists have a degree in the field of early childhood or audiology, but in South Africa we do not have enough skilled professionals in this field who can adequately be culturally and linguistically matched to the large varieties of families we have, and so we have opted to use semi-skilled Interventionists.
Benefits of having a community-based Interventionist for deafness
We train people to be Interventionists in the place they come from/live. This means selecting candidates who are familiar with local customs, languages, families, social structures, and physical infrastructure. The training of the Interventionists is an evolving process but we have witnessed that having a community Interventionist has direct and indirect benefits for the deaf children, their families, and the communities.
Raising community awareness of deafness: challenges and solutions
Challenge 1: Newborn baby hearing screening services are not provided as part of the standard care protocol in South Africa. This limits the early detection of hearing loss. An immediate, medical solution to this lack of screening is not foreseeable in the near future.
Solution: In light of this problem we have focused on raising awareness and educating communities about early detection of hearing loss. We have also written an article on the role nurses can play in detecting hearing loss. This will hopefully increases nurses’ knowledge and awareness in their ability to function as screeners as well as the role they play in monitoring development on the Road to Health Card.
Challenge 2: Parents often only become concerned that their toddler is not able to hear when they fail to develop speech and language milestones as a young child. There are a number of communication and speech milestones that should be developed before any child says their first words at around 12 to 18 months. Awareness of these early milestones, and consulting an audiologist aids in earlier detection but many parents cannot consult an audiologist and do not know what these language milestones are because they do not have access to this information or service.
Solution: HI HOPES has developed brochures and posters (displayed at clinics), informing parents of their baby’s early communication milestones.
Challenge 3: Unfortunately, many doctors do not always take parents’ concerns about their child’s hearing seriously and often tell parents they are too anxious, rather than refer them to an audiologist for testing. The multidisciplinary nature of child development means that doctors should be aware of hearing screening and the importance (and ease) of early screening.
Solution: HI HOPES conducts talks at antenatal clinics and paediatric forum meetings to inform doctors of screening and early intervention for children with hearing loss.
Challenge 4: Referral to early intervention services after detection of hearing loss is not mandatory or legislated in South Africa. A better community and cultural understanding of hearing loss and the development of children within specific cultural backgrounds, will inform professionals of the importance of home-based, individualised, culturally and linguistically appropriate intervention services.
Solution: HI HOPES does presentations at conferences to inform the professional community of the role of our home-based interventionist programme, and of the importance and benefits of referral for early intervention.
In this learning brief HI HOPES has described the need for home-based early Interventionists that support deaf children and their families. It has shown that the best intervention programme draws on Interventionists sourced directly from the community. Furthermore, HI Hopes lists four challenges that it has encountered whilst raising awareness of deafness and the need for early intervention, and then suggests how these challenges are currently being addressed.
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In this learning brief HI HOPES describes the need for home-based early Interventionists that support deaf children and their families. It showcases the programme implementation and focuses on the need to draw on Interventionists directly from the community where they live. Furthermore, HI Hopes lists four challenges that it has encountered whilst raising awareness of deafness and the need for early intervention, and then suggests how these challenges are currently being addressed.