Resourceful Young Children

Resourceful Young Children
Learning Brief

Wits Centre for Deaf Studies

Scaling up to achieve the dream for national equity and quality in early intervention for the deaf

Category: Resourceful Young Children | Test population-based models of provision | 15 August, 2013 - 14:00



Hearing loss is one of the most prevalent disabilities at birth. In South Africa, 17 babies are born deaf every day. Language is one of the essential components of normal child development and without it significant delays emerge: communication and language foundations are undermined, relationships with parents and siblings suffer, cognitive development (particularly higher functioning, abstract and metacognitive processes) are delayed, and children struggle with literacy and general educational achievements. With 90% of deaf children being born into hearing families who have never been exposed to hearing loss, great trauma and grief is experienced after the diagnosis. Without intervention the impact of the lack of communication and the severe unresolved grief lead to irreparable familial relational damage. In addition, the cost of unidentified hearing loss in terms of specialised education, reliance on state grants as adults, and loss of income due to poor literacy and reduced employability is around R1,000,000 over the lifetime of the deaf individual. Thus early intervention is imperative.

The HI HOPES Strategy

HI HOPES was developed to address the lack of holistic early intervention services available to families with deaf children. We aim to support, inform and empower families in an unbiased way to make informed decisions about their children; and to give these children the opportunity to reach all the appropriate language and developmental milestones that would enable them to become fully-functional adults. A trained, specialised Interventionist, who is from their local community, visits each family that we serve.

Our strategy is to provide personalised, home-based, early intervention support to families with a hard of hearing or deaf child. We employ locally trained Interventionists (Parent Advisors) who visit each family for one hour fortnightly, and who give individualised program support regarding the child and the family’s needs, in the home language of the household. The Interventionist supports the parents by offering unbiased knowledge and information regarding all aspects of their child’s development. The Interventionist supports the deaf child to develop to his/her full capacity. This development is monitored and quarterly assessments of language are done to track their progress.


HI HOPES has been in operation for 7 years and has supported over 870 children and families with hearing loss in 3 South African provinces. We have trained 298 interventionists (including Parent Advisors and Deaf Mentors).

We initially started in the province in which we lived, as we knew and understood the local structures and social dynamics. We appointed an extremely well qualified and respected Program Director, and submitted and received funding to execute our goals. Before beginning our operations we consulted with local stakeholders and representatives from the deaf community and professionals from the field. Their input helped us better frame our program strategy and fostered local support for our initiative. Next we advertised the Interventionist positions, recruited participants and conducted our first training session. The training was challenging and we learnt many lessons from this (see our previous learning brief), which we used to modify future training curricula. Once our program services were fully operational we started getting referrals and we began supporting families in their homes. We also held quarterly meetings for Parent Advisors, and gave them extra support and training as needed.

Running a provincial program came with many challenges such as managing the referral-intervention process, getting administration and paper work processed, communicating with our Parent Advisors, supporting them to develop and grow further. We were the first program of this kind and had to develop our strategy without any best-practice model / template. As such, we have spent a long time modifying and testing operations at the smaller scale to perfect them before attempting to scale-up our operation. After a while we gained credibility and a strong reputation for delivering quality service. Representatives from other provinces contacted us seeking similar service provision. This was encouraging and subsequently we expanded our program into three provinces, and we are currently expanding to two more provinces.


Before growing and scaling up the reach of our services, we have been working toward documenting, improving and solidifying our processes to ensure that we are indeed ready for scaling up. Below are some steps that we will be following as we grow into the 4th province and beyond.

  1. Spend time documenting the program, what needs to be done, the larger project goals, and the smaller steps that need to be taken to achieve these goals. Getting a shared understanding of the service is essential. Keep this as a living document that can be adapted, grown and changed either way.
  2. Make service quality a goal (quality in terms of service to clients, training of interventionists, administration of the programme).
  3. Track and document each step of the program expansion. This will serve as the basis for a new ‘handbook guide’ for future staff. Add to the historiography of the organisation by collecting pictures, graphs, photos of interventionists, graduation certificates, letters and notes from grateful parents, conference presentations, etc. This builds an organisational archive and is useful for later progress tracking.
  4. Clearly define the role of an Interventionist.  Before hiring anyone, first decide what the role and duties of an interventionist needs to be, and list the qualities, skills, and qualifications they need to have. Put this into a job description. Use it during the hiring process to frame interview questions and acceptance criteria.
  5. Provide administrative training. Ensure that each team of Interventionists receives comprehensive training on the administration procedures related to their job. This means carefully explaining how to record and log each home visit, how to submit claims, how to complete and submit assessment tools used to keep track of the child’s progress, etc.
  6. Invest in a record-keeping, information database. Keeping records of all recipients is essential for few research and tracking of progress, quality assurance, reporting to donors, answering critics, for your own records and peace of mind.
  7. Grow leadership in the first site and make sure leaders are strong and well equipped to handle more work and responsibility in the new sites. This is essential, as they will become mentors to new site leaders.
  8. Build an accountability process. Workers on the ground need to report to Provincial leadership; Provincial leadership needs to report to national leadership, and leadership needs to report/be accountable to a board. This accountability loop is essential for the smooth running of a programme of integrity.
  9. Provide program orientation to all team members. Ensure that everyone on the project team (including administrators, leaders, interventionists) receives formal training/orientation about the program. This will ensure that the whole team is “on the same page” with regards to daily operations and organisational vision.
  10. Seek buy-in from key stakeholders and people of influence in the field. This will save many months and even years of fighting and trying to convince people its essential services they need.
  11. Allow the locals to have a say in leadership roles as they get established and understand more of the programme
  12. Acknowledge the ‘outsider’ status and recognise the benefits and limits of this position. Remain true to vision and goals of the organisation but be flexible in adapting the daily operations of the program to the new settings and target audience.


27 St Andrews Street, Parktown, Johannesburg

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In Short

Learn best practice tips for program scale-up and service expansion of a personalised, home-based, early intervention program to support families with a hard of hearing or deaf child.

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