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Improving Outcomes for Children Living in Poverty

Headlines from 2009-10. Number of Poor, Uninsured Likely Up"Wealthy, Poor Are Even Farther Apart"Income Falls, Poverty Rate Rises"More Kids Need Food Stamps"Outside the City, Poverty is Soaring"Left Behind: Changes in Missouri's Economy Send More Families into Poverty". Poverty. Definit

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Improving Outcomes for Children Living in Poverty

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    1. Improving Outcomes for Children Living in Poverty AG Bell 2010 Convention June 2010 Susan Lenihan, PhD - Fontbonne University Gale Rice, PhD - Fontbonne University Jenna Voss, MA, LSLS Cert AVEd. - Central Institute for the Deaf Who’s in the audience Why this topic? Why now? What I’ve been seeing in schools and in early intervention? CID’s Professional Development Focus for 08-09 Who’s in the audience Why this topic? Why now? What I’ve been seeing in schools and in early intervention? CID’s Professional Development Focus for 08-09

    2. Headlines from 2009-10 “Number of Poor, Uninsured Likely Up” “Wealthy, Poor Are Even Farther Apart” “Income Falls, Poverty Rate Rises” “More Kids Need Food Stamps” “Outside the City, Poverty is Soaring” “Left Behind: Changes in Missouri’s Economy Send More Families into Poverty”

    3. Poverty Definitions “the extent to which an individual does without resources…” (Payne, p 7) “families and their children experience poverty when they are unable to achieve a minimum, decent standard of living that allows them to participate fully in mainstream society.” (Cauthen & Fass, p 1) Including: financial, emotional, mental, physical, support systems, role models, knowledge of hidden rules Nccps’s Basic Needs chart p3 in measuring povertyIncluding: financial, emotional, mental, physical, support systems, role models, knowledge of hidden rules Nccps’s Basic Needs chart p3 in measuring poverty

    4. Measuring Poverty in the US from the National Center for Children in Poverty Income standard - $22,050 per year for a family of four (2009) Based on outdated assumptions about family spending Does not accurately count family resources Does not account for where the family lives Originally based on data from the 1950s, the poverty threshold was set at three times the cost of food and adjusted for family size. Since then, the measure has been updated only for inflation. Yet food now comprises only about one-seventh of an average family’s expenses, while the costs of housing, child care, health care, and transportation have grown disproportionately. The result? Current poverty thresholds are too low, arguably arbitrary, and they do not adjust for differences in the cost of living within and across states. NCCPOriginally based on data from the 1950s, the poverty threshold was set at three times the cost of food and adjusted for family size. Since then, the measure has been updated only for inflation. Yet food now comprises only about one-seventh of an average family’s expenses, while the costs of housing, child care, health care, and transportation have grown disproportionately. The result? Current poverty thresholds are too low, arguably arbitrary, and they do not adjust for differences in the cost of living within and across states. NCCP

    5. Children Living in Poverty Over 14 million American children – 19 percent Increased by 21 percent between 2000 and 2008 2.5 million more children living in poverty today than in 2000 Historical context War on Poverty – Poverty rate fell from 23 percent in 1963 to 14 percent in 1969 Currently 17.4% (2006-update) Gap between rich and poor has widened Fourteen million American children live in families with incomes below the federal poverty level, which is $22,050 a year for a family of four.1 The number of children living in poverty increased by 21 percent between 2000 and 2008. There are 2.5 million more children living in poverty today than in 2000. NCCP Fourteen million American children live in families with incomes below the federal poverty level, which is $22,050 a year for a family of four.1 The number of children living in poverty increased by 21 percent between 2000 and 2008. There are 2.5 million more children living in poverty today than in 2000. NCCP

    6. Child Poverty Rates across the US

    7. Low Income Low-income families – those with incomes of less than $44,100 (twice the poverty level) 41%, more than 29 million children in 2008 live in low-income families Not only are these numbers troubling, the official poverty measure tells only part of the story. Research consistently shows that, on average, families need an income of about twice the federal poverty level to make ends meet.23 Children living in families with incomes below this level – for 2009, $44,100 for a family of four – are referred to as low income. Forty-one percent of the nation’s children – more than 29 million in 2008 – live in low-income families. Not only are these numbers troubling, the official poverty measure tells only part of the story. Research consistently shows that, on average, families need an income of about twice the federal poverty level to make ends meet.23 Children living in families with incomes below this level – for 2009, $44,100 for a family of four – are referred to as low income. Forty-one percent of the nation’s children – more than 29 million in 2008 – live in low-income families.

    8. Characteristics of children Black and Latino children are disproportionately represented - about 66%. Immigrant parents can increase a child’s chances of being poor. Single parent families Parental education levels Official poverty rates are highest for young children

    9. Infants and Toddlers In 2008, there were more than 12 million infants and toddlers under age 3 in the US 44% live in low-income families 22% live in poor families Upward trend since 2000 after a decade of decline in the 1990s How many infants and toddlers under age 3 in the United States live in low-income families? Enlarge Figure 1: Infants and toddlers by family income, 2008 There are more than 12 million infants and toddlers under age 3 in the United States. 44 percent – 5.6 million – live in low-income families. 22 percent – 2.9 million – live in poor families. The percentage of infants and toddlers living in low-income families (both poor and near poor) has been on the rise – increasing from 42 percent in 2000 to 44 percent in 2008. During this time period, the overall number of the very youngest children (children under age 3) increased by nearly 11 percent while the number who were low-income and poor increased by 15 percent and 29 percent, respectively. This upward trend in low-income and poor children follows on the heels of a decade of decline in the 1990s. How many infants and toddlers under age 3 in the United States live in low-income families? Enlarge Figure 1: Infants and toddlers by family income, 2008 There are more than 12 million infants and toddlers under age 3 in the United States. 44 percent – 5.6 million – live in low-income families. 22 percent – 2.9 million – live in poor families. The percentage of infants and toddlers living in low-income families (both poor and near poor) has been on the rise – increasing from 42 percent in 2000 to 44 percent in 2008. During this time period, the overall number of the very youngest children (children under age 3) increased by nearly 11 percent while the number who were low-income and poor increased by 15 percent and 29 percent, respectively. This upward trend in low-income and poor children follows on the heels of a decade of decline in the 1990s.

    10. Primary issues Food insecurity 21% of households with children experience food insecurity Housing 50% of families who rent homes, spend 30 percent or more of their income on rent Health insurance 17% of children lack health insurance 31% of poor children lack health insurance in Florida

    11. Recession-Induced Poverty Predictions of an additional 2.6-3.3 million children will fall into poverty Economic costs of recession-induced poverty Lost earnings Health Crime Impact of short-term poverty (less than 4 years) is unknown 74 million children in the US74 million children in the US

    12. Poverty’s Effect on Child Development “Poverty in early childhood poisons the brain.” From a summary of a report from the American Association for the Advancement of Science “Growing up in poverty puts you at a disadvantage at every step.” (Krugman, 2008)

    13. Impact of Poverty on Children with Disabilities Park, Turnbull & Turnbull (2002) 28% of children with disabilities, ages 3-21, are living in poverty Dimensions Health Productivity Physical environment Emotional well-being Family interaction “It is becoming increasingly evident that poverty has a tremendous impact on the educational results of all children, including those with disabilities. Thus, poverty is not a secondary topic in the field of special education services and disability policy anymore.” Add chart from p154 New morbidity p 159 Suggestions for Policy Reform p 159 and Disability Policy p 161 Fragile family concept p 160 Implications for Practice p162 Building a Full Service School Calfee et al Individual practitioner level – p 166 example“It is becoming increasingly evident that poverty has a tremendous impact on the educational results of all children, including those with disabilities. Thus, poverty is not a secondary topic in the field of special education services and disability policy anymore.” Add chart from p154 New morbidity p 159 Suggestions for Policy Reform p 159 and Disability Policy p 161 Fragile family concept p 160 Implications for Practice p162 Building a Full Service School Calfee et al Individual practitioner level – p 166 example

    14. Low-Income Families with Special Needs Children Parish and Shattuch “61% of low-income families reported expenditures of >$0. Among these families, 30% had expenses between $250 and $500 and 34% had expenses of more than $500.” Considerable variability depending on the state’s Medicaid and SCHIP income-eligibility guidelines Financial Burden of Raising CSHCN: Association With State Policy Choices. By: Parish, Susan L.; Shattuck, Paul T.; Rose, Roderick A.. Pediatrics, Dec2009 Supplement 4, Vol. 124, pS435-S442, 8p; Abstract: OBJECTIVE: We examined the association between state Medicaid and State Children's Health Insurance Program (SCHIP) income eligibility and the financial burden reported by low-income families raising children with special health care needs (CSHCN). SAMPLE AND METHODS: Data on low-income CSHCN and their families were from the National Survey of Children With Special Health Care Needs (N = 17039), with a representative sample from each state. State Medicaid and SCHIP income-eligibility thresholds were from publicly available sources. The 3 outcomes included whether families had any out-of-pocket health care expenditures during the previous 12 months for their CSHCN, amount of expenditure, and expenditures as a percentage of family income. We used multilevel logistic regression to model the association between Medicaid and SCHIP characteristics and families' financial burden, controlling state median income and child- and family-level characteristics. RESULTS: Overall, 61% of low-income families reported expenditures of >$0. Among these families, 30% had expenses between $250 and $500, and 34% had expenses of more than $500. Twenty-seven percent of the families reporting any expenses had expenditures that exceeded 3% of their total household income. The percentage of low-income families with out-of-pocket expenses that exceeded 3% of their income varied considerably according to state and ranged from 5.6% to 25.8%. Families living in states with higher Medicaid and SCHIP income-eligibility guidelines were less likely to have high absolute burden and high relative burden. CONCLUSIONS: Beyond child and family characteristics, there is considerable state-level variability in low-income families' out-of-pocket expenditures for their CSHCN. A portion of this variability is associated with states' Medicaid and SCHIP income-eligibility thresholds. Families living in states with more generous programs report less absolute and relative financial burden than families living in states with less generous benefits. [ABSTRACT FROM AUTHOR]; DOI: 10.1542/peds.2009-1255P; (AN 47153788) Presswood – “In the same manner that a free and appropriate education is a civil right for children with disabilities, effective and appropriate instruction is also a civil right for children living in poverty P 132 Financial Burden of Raising CSHCN: Association With State Policy Choices. By: Parish, Susan L.; Shattuck, Paul T.; Rose, Roderick A.. Pediatrics, Dec2009 Supplement 4, Vol. 124, pS435-S442, 8p; Abstract: OBJECTIVE: We examined the association between state Medicaid and State Children's Health Insurance Program (SCHIP) income eligibility and the financial burden reported by low-income families raising children with special health care needs (CSHCN). SAMPLE AND METHODS: Data on low-income CSHCN and their families were from the National Survey of Children With Special Health Care Needs (N = 17039), with a representative sample from each state. State Medicaid and SCHIP income-eligibility thresholds were from publicly available sources. The 3 outcomes included whether families had any out-of-pocket health care expenditures during the previous 12 months for their CSHCN, amount of expenditure, and expenditures as a percentage of family income. We used multilevel logistic regression to model the association between Medicaid and SCHIP characteristics and families' financial burden, controlling state median income and child- and family-level characteristics. RESULTS: Overall, 61% of low-income families reported expenditures of >$0. Among these families, 30% had expenses between $250 and $500, and 34% had expenses of more than $500. Twenty-seven percent of the families reporting any expenses had expenditures that exceeded 3% of their total household income. The percentage of low-income families with out-of-pocket expenses that exceeded 3% of their income varied considerably according to state and ranged from 5.6% to 25.8%. Families living in states with higher Medicaid and SCHIP income-eligibility guidelines were less likely to have high absolute burden and high relative burden. CONCLUSIONS: Beyond child and family characteristics, there is considerable state-level variability in low-income families' out-of-pocket expenditures for their CSHCN. A portion of this variability is associated with states' Medicaid and SCHIP income-eligibility thresholds. Families living in states with more generous programs report less absolute and relative financial burden than families living in states with less generous benefits. [ABSTRACT FROM AUTHOR]; DOI: 10.1542/peds.2009-1255P; (AN 47153788) Presswood – “In the same manner that a free and appropriate education is a civil right for children with disabilities, effective and appropriate instruction is also a civil right for children living in poverty P 132

    15. Poverty and Hearing Loss 53% of individuals with severe to profound hearing loss made less than $25,000 compared to 35% of the general US population Individuals with hearing loss appear to be more vulnerable, both financially and educationally. Access to medical and technological interventions may be limited. Blanchfield, B.B., Feldman, J.J., Dunbar, J.L. and Gardner, E.N. (2001). More likely to be incorrectly diagnosed as learning disabled, less likely to be mainstreamed, and much more likely to drop out of school. Suskind, D. and Gelhert, S. (2009) Most of the severe to profound hearing loss population are poorer than other Americans. Fifty-three percent of families made less than $25,000 compared to 35% of the general US population. The prevalence of severe to profound hearing impairment among the US population ranges from 464,000 to 738,000, with 54 percent of this population over age 65 years. Persons with hearing impairment are more likely to be publicly insured, less likely to have private insurance, have lower family incomes, are less educated, and are more likely to be unemployed than the general population. Approximately half a million Americans are severely to profoundly hearing impaired and appear to be more vulnerable, both financially and educationally, as compared to the US population. As a result, access to medical and technological interventions that may assist their hearing loss may be limited. Blanchfield, B.B, Feldman, J.J., Dunbar, J.L., Gardner, E.N. (2001). The severely to profound hearing-impaired population in the United States: prevalence estimates and demographics. Journal of the American Academy of Audiology, 12(4), 183-189. Most of the severe to profound hearing loss population are poorer than other Americans. Fifty-three percent of families made less than $25,000 compared to 35% of the general US population. The prevalence of severe to profound hearing impairment among the US population ranges from 464,000 to 738,000, with 54 percent of this population over age 65 years. Persons with hearing impairment are more likely to be publicly insured, less likely to have private insurance, have lower family incomes, are less educated, and are more likely to be unemployed than the general population. Approximately half a million Americans are severely to profoundly hearing impaired and appear to be more vulnerable, both financially and educationally, as compared to the US population. As a result, access to medical and technological interventions that may assist their hearing loss may be limited. Blanchfield, B.B, Feldman, J.J., Dunbar, J.L., Gardner, E.N. (2001). The severely to profound hearing-impaired population in the United States: prevalence estimates and demographics. Journal of the American Academy of Audiology, 12(4), 183-189.

    16. Health Disparity Nearly 11 percent of children under age 3 remain uninsured. (2007) 47 million Americans lack health insurance The number of uninsured could reach 54 million by 2019 Get Susskind in Eisenberg Sorkin Health insurance is crucial, but millions lack coverage. Roughly 14,000 Americans lose coverage daily, while the uninsured gain coverage at a much slower rate. 47 million Americans lack health insurance. If nothing is done, the number of uninsured could reach 54 million by 2019. To learn more, read Making Parents' Health Care a Priority. on CIsGet Susskind in Eisenberg Sorkin Health insurance is crucial, but millions lack coverage. Roughly 14,000 Americans lose coverage daily, while the uninsured gain coverage at a much slower rate. 47 million Americans lack health insurance. If nothing is done, the number of uninsured could reach 54 million by 2019. To learn more, read Making Parents' Health Care a Priority. on CIs

    17. Disparities in Cochlear Implantation - Suskind and Gelhert (2009) “…there are strong indications that a disparity exists in both rates of implantation and outcomes between lower SES and minority children and their more affluent counterparts.” Children with hearing loss “who were of lower SES, single parents and/or non-white were significantly less likely than their more affluent counterparts to be referred for cochlear implant evaluation.” “The literature continues to demonstrate the effect of SES on postimplantation success.”

    18. Increasing Access and Quality of Services -Suskind and Gelhert (2009) Families with low SES may have inadequate health literacy and may lack access to internet resources. Need for workforce diversity in encouraging culturally competent services. Financial vulnerability may impact parents’ ability to adequately support their implanted child. Public policy and advocacy are critical to increasing access.

    19. Changing the Odds for Children at Risk Susan Neuman Seven Essential Principles of Educational Programs That Break The Cycle of Poverty Schools fail “because there are multitudes of children growing up in circumstances that make them highly vulnerable”. “And perhaps, the most tragic element of it all is that this cycle of disadvantage is likely to repeat itself over and over again, until we are determined to do something about it.”

    20. Seven Essential Principles Programs that work must: Actively target the neediest children. Begin early in children’s lives Emphasize coordinated services Boost academic achievement through high-quality instruction Deliver instruction by trained professionals Acknowledge that intensity matters Always hold themselves accountable. Actively target the neediest children Begin early in children’s lives. Emphasize coordinated services, particularly for children whose families present multiple risks. Focus on boosting academic achievement through compensatory high-quality instruction. Deliver instruction by trained professionals, not by aides or volunteers. Acknowledge that intensity matters, defending against any dilution of program quality as a waste of public resources. Always hold themselves accountable for results anf for children’s achievment. Actively target the neediest children Begin early in children’s lives. Emphasize coordinated services, particularly for children whose families present multiple risks. Focus on boosting academic achievement through compensatory high-quality instruction. Deliver instruction by trained professionals, not by aides or volunteers. Acknowledge that intensity matters, defending against any dilution of program quality as a waste of public resources. Always hold themselves accountable for results anf for children’s achievment.

    21. The Advocacy Role of the Teacher in Health and Education Evening the playing field and reducing financial and informational disadvantage Parents may lack self-advocacy skills

    22. Arenas of Advocacy Medical and hearing technology Therapy and educational services

    23. Funding Sources for Medical Services and Hearing Technology Commercial insurance Let Them Hear Foundation Medicaid Part C – First Steps in Missouri Bureau of Special Health Care Needs Private funding sources Loaner program – MSD in Missouri State-specific programs for low interest loans

    24. Educational Services and Therapy (Birth-3) Part C – First Steps in Missouri Private insurance Medicaid Bureau of Special Health Care Needs State school for outreach programs

    25. Educational Services and Therapy (3-21) Transition from home-based, family-centered services to center-based services—family support is critical Educational diagnosis may not be accurate Services may be more reflective of a special education model vs. a deaf or hard of hearing model Service providers may not have particular expertise in deafness Classroom acoustic accommodations

    26. Strategies for professionals and future professionals: Identifying Personal Biases We must understand our own “values and attitudes and be prepared to suspend judgment on behaviors, world views, and lifestyles of others that conflict” with our own beliefs. (Thomas-Presswood & Presswood, pg 154) Present, Non-judgmental, Selfless (PNS) David Luterman Aim high! *Think about a time when your personal bias interfered with your ability to serve children and families. How did you overcome such a tendency? First we must understand… Every conclusion we make about a family’s circumstance, how they choose to spend their money, time, energy, etc…all of these judgments are viewed through our own lense of experience. If I wouldn’t do it that way, it must not be the right way to do it. If other people in my circle of friends wouldn’t do it that way, it must not be the right way to do it. If our own parents didn’t do it that way, then if must not be the right way to do it. When in fact…there are many ways to do things. The families we serve have the right to make their own choices. We can help them evaluate the anticipated outcomes of the choices they make, but in the end, it is certainly their right to make a choice. So when we begin to look at the” circumstance of poverty”, it is best if we try to set aside our own judgments, because for most of us, we have no real idea what it is to live in poverty. One way the staff in the Family Center at CID has found helpful in reminding us to suspend such judgment/criticism is to make PNS our department mantra. David Luterman, audiologist turned counselor, has provided our field with much wise guidance on serving families of children with hearing loss. His PNS reminds us to be present in every conversation, session, or home visit. We must put aside our own distractions to be fully present with the family in their time of need Non-judgmental - the crux of the issue when working with families who lack the resources we have (whether those are financial resources, or other ones). Since the family from poverty does without resources we do have (mental capacities, money, support systems, etc) we inherently have a more difficult time relating to them. When we can’t relate, it is safe and easy to go to judgment. Instead we must refrain from passing judgment. Selfless - it isn’t about us…it is about them. Our agenda must be put aside in order to meet the family where they are. (Some of our staff also likes to think of this “s” as sincere. Families can read right through insincere talk. Insincerity does no favors for developing a trusting open relationship.) Finally, we must aim high. When providers model high expectations, families come to believe it is possible to have them. Low expectations on the part of educators and service providers are as detrimental to a family's success as if the family themselves had low expectations. **Audience Participation ActivityFirst we must understand… Every conclusion we make about a family’s circumstance, how they choose to spend their money, time, energy, etc…all of these judgments are viewed through our own lense of experience. If I wouldn’t do it that way, it must not be the right way to do it. If other people in my circle of friends wouldn’t do it that way, it must not be the right way to do it. If our own parents didn’t do it that way, then if must not be the right way to do it. When in fact…there are many ways to do things. The families we serve have the right to make their own choices. We can help them evaluate the anticipated outcomes of the choices they make, but in the end, it is certainly their right to make a choice. So when we begin to look at the” circumstance of poverty”, it is best if we try to set aside our own judgments, because for most of us, we have no real idea what it is to live in poverty. One way the staff in the Family Center at CID has found helpful in reminding us to suspend such judgment/criticism is to make PNS our department mantra. David Luterman, audiologist turned counselor, has provided our field with much wise guidance on serving families of children with hearing loss. His PNS reminds us to be present in every conversation, session, or home visit. We must put aside our own distractions to be fully present with the family in their time of need Non-judgmental - the crux of the issue when working with families who lack the resources we have (whether those are financial resources, or other ones). Since the family from poverty does without resources we do have (mental capacities, money, support systems, etc) we inherently have a more difficult time relating to them. When we can’t relate, it is safe and easy to go to judgment. Instead we must refrain from passing judgment. Selfless - it isn’t about us…it is about them. Our agenda must be put aside in order to meet the family where they are. (Some of our staff also likes to think of this “s” as sincere. Families can read right through insincere talk. Insincerity does no favors for developing a trusting open relationship.) Finally, we must aim high. When providers model high expectations, families come to believe it is possible to have them. Low expectations on the part of educators and service providers are as detrimental to a family's success as if the family themselves had low expectations. **Audience Participation Activity

    27. Strategies: Assessing Family Needs What kind of “poor”? Resources can include: financial, emotional, mental, spiritual, physical, support systems, knowledge of middle class (hidden) rules, role models Maslow’s Hierarchy of needs Allow family to prioritize needs. Our intervention must match need. As a provider we must first identify what kind of need (what kind of poverty) a family has in order to find an appropriate intervention. When families lack resources in one or more areas, they may feel overwhelmed at the gravity of their situation. When we guide families to prioritize their needs, we can tackle the challenge. Eating an elephant one bite at a time. After a family prioritizes their needs, we must probe a bit further to understand what has caused this to become a need. Just because we see a problem, doesn’t mean we understand what is causing the problem. For our interventions to be successful over the long term, the strategy we provide has to match the problem. EX. You don’t use a hammer to tighten a screw. You may be able to knock the screw in place a bit more, but the most effective and efficient tool to use would be a screwdriver or a drill. A similar parallel is in place here. If families are working to achieve all-waking hours device use, we need to figure out what is the actual roadblock to achieving this goal. If the roadblock is “buy-in”, then we need to find a strategy to help families understand the importance of device use all-waking hours. But, for a family who lacks financial resources, maybe the true roadblock is their inability to afford batteries. Why would the family put hearing aids on if they can’t afford to have working batteries. Knowing the true roadblock to achieving this goal, the EI provider can then spend time/energy finding an appropriate strategy, which might include seeking out funding source or discount programs for batteries or assistive technology. As a provider we must first identify what kind of need (what kind of poverty) a family has in order to find an appropriate intervention. When families lack resources in one or more areas, they may feel overwhelmed at the gravity of their situation. When we guide families to prioritize their needs, we can tackle the challenge. Eating an elephant one bite at a time. After a family prioritizes their needs, we must probe a bit further to understand what has caused this to become a need. Just because we see a problem, doesn’t mean we understand what is causing the problem. For our interventions to be successful over the long term, the strategy we provide has to match the problem. EX. You don’t use a hammer to tighten a screw. You may be able to knock the screw in place a bit more, but the most effective and efficient tool to use would be a screwdriver or a drill. A similar parallel is in place here. If families are working to achieve all-waking hours device use, we need to figure out what is the actual roadblock to achieving this goal. If the roadblock is “buy-in”, then we need to find a strategy to help families understand the importance of device use all-waking hours. But, for a family who lacks financial resources, maybe the true roadblock is their inability to afford batteries. Why would the family put hearing aids on if they can’t afford to have working batteries. Knowing the true roadblock to achieving this goal, the EI provider can then spend time/energy finding an appropriate strategy, which might include seeking out funding source or discount programs for batteries or assistive technology.

    28. Maslow’s Hierarchy of Needs

    29. Strategies: Documentation Document “the agreement” Use of a contract that highlights the 3-strikes rule Observe trends Phone call logs Cumulative rosters/contact information Guide families to begin their own “documentation” Use of a calendar Programming reminders in cell phones Documentation is very helpful for EI providers to observe trends when working with families who lack resources. Some challenges that we face when working with families from poverty include difficulty in keeping appointments, not being home when we come for a scheduled session, etc. This is frustrating for providers and can result in discontinuation of services. We attempt to set the tone of our relationship by clearly laying out each party’s responsibilities. We highlight things like - coaching, so caregivers must be present and participate in each session, please call to cancel the appointment to prevent “no-show” status, three “no-show/no-call” incidents will result in discontinuation letter, When families understand our role and we can have honest conversations about the family’s responsibilities, our providers feel less taken advantage of or less like the bad-guy who has to discontinue a family. When we keep phone call logs, noting each time we make contact with a family it serves two purposes. We may find that the family’s phone is disconnected during the latter part of a month. If money is running tight, then the pay as you go phone plans often don’t get paid, and phones are temporarily shut off. We suggest calling again after pay-day, or soon after SSI/disability benefit checks are received. Often when families get money to pay the phone, the phones are working again! Over time, we learned that when we would re-print new rosters each month, we were taking old phone numbers off and replacing them with new ones. This led to us consistently feeling frustrated that numbers were always changing or getting out of date. Now, the EI providers tend to hang on to the older rosters because they are often a valuable resource of previous contacts. If a family’s current phone gets shut off, we try older numbers. If families move fairly often, keeping other addresses of prior residences is sometimes useful. We also want to continue to support families in becoming more independent, responsible, and successful at navigating the hidden rules of education and early intervention. One way we do this is by offering our families calendars or pocket planners to keep track of appointments and visits. We’ve found really cute purse calendars at the dollar store. Also, working in a school, we often get promotional calendars from businesses who want us to purchase all school agendas/calendars. Those are nice to offer to families as well. Since we know some parents can’t possibly keep track of one more piece of paper, we also suggest they program the dates into their cell phones since many families, regardless of their financial resources, have cell phones that they highly value. Documentation is very helpful for EI providers to observe trends when working with families who lack resources. Some challenges that we face when working with families from poverty include difficulty in keeping appointments, not being home when we come for a scheduled session, etc. This is frustrating for providers and can result in discontinuation of services. We attempt to set the tone of our relationship by clearly laying out each party’s responsibilities. We highlight things like - coaching, so caregivers must be present and participate in each session, please call to cancel the appointment to prevent “no-show” status, three “no-show/no-call” incidents will result in discontinuation letter, When families understand our role and we can have honest conversations about the family’s responsibilities, our providers feel less taken advantage of or less like the bad-guy who has to discontinue a family. When we keep phone call logs, noting each time we make contact with a family it serves two purposes. We may find that the family’s phone is disconnected during the latter part of a month. If money is running tight, then the pay as you go phone plans often don’t get paid, and phones are temporarily shut off. We suggest calling again after pay-day, or soon after SSI/disability benefit checks are received. Often when families get money to pay the phone, the phones are working again! Over time, we learned that when we would re-print new rosters each month, we were taking old phone numbers off and replacing them with new ones. This led to us consistently feeling frustrated that numbers were always changing or getting out of date. Now, the EI providers tend to hang on to the older rosters because they are often a valuable resource of previous contacts. If a family’s current phone gets shut off, we try older numbers. If families move fairly often, keeping other addresses of prior residences is sometimes useful. We also want to continue to support families in becoming more independent, responsible, and successful at navigating the hidden rules of education and early intervention. One way we do this is by offering our families calendars or pocket planners to keep track of appointments and visits. We’ve found really cute purse calendars at the dollar store. Also, working in a school, we often get promotional calendars from businesses who want us to purchase all school agendas/calendars. Those are nice to offer to families as well. Since we know some parents can’t possibly keep track of one more piece of paper, we also suggest they program the dates into their cell phones since many families, regardless of their financial resources, have cell phones that they highly value.

    30. Strategies: Keeping Everyone Safe Provider safety Morning visits Red, Yellow, Green folder calls Honest talk Family safety Be cautious of suggesting too many changes or embellishments to the routine Examples - Is outdoor play appropriate? Is the background noise (dryer, TV, fan) masking something? We must consider the safety of our providers as well as the families. When we work with families of generational poverty, they often reside in neighborhoods where others are also impoverished. The crime in these neighborhoods is often more prevalent than in the neighborhoods where our providers live, so we enact some policies to keep everyone safe. If at any point a provider feels uneasy about going in a family’s home, we discuss our worries with the IFSP team and make an alternative plan. One family walks to the community center to meet our provider for sessions. For a couple other homes, our providers go in pairs. We encourage our providers go on morning home visits, because in general there is less activity (riff-raff) in the mornings. Daylight makes everyone feel safer as well. We have an option that if a provider is feeling unsure they can enact the colored folder plan. Before the provider leaves the center for a visit, she makes a plan with another staff member. The staff member at the office will call the providers cell phone (which she’ll intentionally leave on) and ask “What color folder did you want me to look for?” The provider in the home could say green if all is well and she feels safe. She’d say yellow if she’s not sure about safety and wants the staff member at school to call back after 10-15 more minutes. She’d say red if she isn’t safe and needs an excuse to leave. If the staff member hears “red” then she tells the provider that there is an emergency back at the school and that she needs to come back immediately. This way the provider has a reasonable excuse to leave the home without making the family feel awkward/offended. We should also say that families are often aware of the “dangers” of their neighborhoods. Generally, if a provider asks about safety concerns, or asks about ways for the family to “look out”. Ex. One provider pulled up at a family’s home and saw a large group of men lingering on the porch. The provider didn’t feel comfortable and drove on. Later when she called the mother and told her of the discomfort, the mother apologized and didn’t realize that her cousin and his friends hanging out would be intimidating to the young female provider. The mother made sure that the circumstance wasn’t repeated. As providers we must also be cognizant of how our suggestions can impact the family’s sense of safety. When we don’t fully understand the reasons behind certain parts of a family’s routine, we may suggest something that isn’t comfortable for the family. While outdoor play can provide great language and listening opportunities, if the neighborhood isn’t safe, we wouldn’t want to be suggesting it. If the family needs to keep the TV on, or they dryer running to block out frightening noises or sounds of violence, we need to consider what we’re suggesting when we so easily guide them to eliminate background noise. This may seem like one of those strategies we would suggest to all families we serve, however if the family isn’t going to feel comfortable implementing such a strategy, then why waste our/their time. We must consider the safety of our providers as well as the families. When we work with families of generational poverty, they often reside in neighborhoods where others are also impoverished. The crime in these neighborhoods is often more prevalent than in the neighborhoods where our providers live, so we enact some policies to keep everyone safe. If at any point a provider feels uneasy about going in a family’s home, we discuss our worries with the IFSP team and make an alternative plan. One family walks to the community center to meet our provider for sessions. For a couple other homes, our providers go in pairs. We encourage our providers go on morning home visits, because in general there is less activity (riff-raff) in the mornings. Daylight makes everyone feel safer as well. We have an option that if a provider is feeling unsure they can enact the colored folder plan. Before the provider leaves the center for a visit, she makes a plan with another staff member. The staff member at the office will call the providers cell phone (which she’ll intentionally leave on) and ask “What color folder did you want me to look for?” The provider in the home could say green if all is well and she feels safe. She’d say yellow if she’s not sure about safety and wants the staff member at school to call back after 10-15 more minutes. She’d say red if she isn’t safe and needs an excuse to leave. If the staff member hears “red” then she tells the provider that there is an emergency back at the school and that she needs to come back immediately. This way the provider has a reasonable excuse to leave the home without making the family feel awkward/offended. We should also say that families are often aware of the “dangers” of their neighborhoods. Generally, if a provider asks about safety concerns, or asks about ways for the family to “look out”. Ex. One provider pulled up at a family’s home and saw a large group of men lingering on the porch. The provider didn’t feel comfortable and drove on. Later when she called the mother and told her of the discomfort, the mother apologized and didn’t realize that her cousin and his friends hanging out would be intimidating to the young female provider. The mother made sure that the circumstance wasn’t repeated. As providers we must also be cognizant of how our suggestions can impact the family’s sense of safety. When we don’t fully understand the reasons behind certain parts of a family’s routine, we may suggest something that isn’t comfortable for the family. While outdoor play can provide great language and listening opportunities, if the neighborhood isn’t safe, we wouldn’t want to be suggesting it. If the family needs to keep the TV on, or they dryer running to block out frightening noises or sounds of violence, we need to consider what we’re suggesting when we so easily guide them to eliminate background noise. This may seem like one of those strategies we would suggest to all families we serve, however if the family isn’t going to feel comfortable implementing such a strategy, then why waste our/their time.

    31. Strategies: Keeping Children Safe Protecting children from child abuse and neglect Identify abuse/neglect Observe, understand, respond to OUR children (Harold Johnson, 2010) Factors influencing risk to children -Comorbidity of poverty & CA/N “Poverty…has been linked with maltreatment, particularly neglect…and found to be a strong predictor of substantiated child maltreatment.” (DHHS, 2003)

    32. Strategies: Providing Resources and Support “Get by” - Temporary Resources Bus passes Printed schedule of transportation system Batteries, diapers, clothing, food, etc ** Be aware of the slippery slope headed towards enabling! Ongoing Resources Use the IFSP team: social worker Religious community Hospital Medical transportation SSI, Medicaid, DHHS/Regional Center Certain challenges are most easily met by providing a specific resource/gift. Some of these resources are just to help a family “get-by” while others are more long-term. We have one board member who has decided he’d pay for public transportation costs for families if they temporarily need it to continue services. The staff in our early intervention program are aware of this resource and offer it as needed. Sometimes, just helping families become aware of the public transportation in the area is assistance enough. In St. Louis, the Metro website allows you to enter a beginning and ending address. It then maps the specific modes of transportation, rates, and time schedules (including directions for walking/transferring lines). Some families also need more tangible resources on a temporary basis. Our staff knows area food banks, shelters, etc and has made referrals for families. None of those resources are going to support a family over the long term. For families who will need more sustained support, we find the IFSP team to be the most helpful. EI programs should have resources, like social workers, when most basic family needs overshadow individual child needs. Remember Maslow, if the most basic needs aren’t met, we aren’t going to get anywhere on communication type goals! We have also found support through local religious organizations (clothing, food, even social work services). Children who have Medicaid can get additional resources through the hospital or medical home if the early intervention program cannot provide it. Medical transportation, only to doctor or audiology appointments - not school - is available to children who receive public aid. This is sometimes challenging for families to navigate since it takes several days advanced planning. The medical transportation coordinator often has to call the doctor/audiology offices to verify the appointment. Our early intervention providers have helped families complete the SSI application process. Children with hearing loss don’t automatically qualify, but we encourage most families to apply. Sometimes when children are denied SSI, a second application changes the outcome. It seems that the employee who reviews the application has a lot to do with who is found eligible. In our area, some hospitals only take certain Medicaid plans (All Kids not Harmony, etc). Occasionally our EI providers need to help families contact their Medicaid case worker/office in order to switch plans that will allow them access to more services. Finally, we have found that referring families to the regional center or the local department of health and human services sometimes lead to additional support. In our area, the Part C services are through the department of education, so these types of programs, housed under different government agencies, can prove helpful. Most government resources have very clear guidelines online, but since many families from poverty don’t have consistent access to the internet, we have occasionally had sessions at a library or at our center to help the families navigate the web resources. Certain challenges are most easily met by providing a specific resource/gift. Some of these resources are just to help a family “get-by” while others are more long-term. We have one board member who has decided he’d pay for public transportation costs for families if they temporarily need it to continue services. The staff in our early intervention program are aware of this resource and offer it as needed. Sometimes, just helping families become aware of the public transportation in the area is assistance enough. In St. Louis, the Metro website allows you to enter a beginning and ending address. It then maps the specific modes of transportation, rates, and time schedules (including directions for walking/transferring lines). Some families also need more tangible resources on a temporary basis. Our staff knows area food banks, shelters, etc and has made referrals for families. None of those resources are going to support a family over the long term. For families who will need more sustained support, we find the IFSP team to be the most helpful. EI programs should have resources, like social workers, when most basic family needs overshadow individual child needs. Remember Maslow, if the most basic needs aren’t met, we aren’t going to get anywhere on communication type goals! We have also found support through local religious organizations (clothing, food, even social work services). Children who have Medicaid can get additional resources through the hospital or medical home if the early intervention program cannot provide it. Medical transportation, only to doctor or audiology appointments - not school - is available to children who receive public aid. This is sometimes challenging for families to navigate since it takes several days advanced planning. The medical transportation coordinator often has to call the doctor/audiology offices to verify the appointment. Our early intervention providers have helped families complete the SSI application process. Children with hearing loss don’t automatically qualify, but we encourage most families to apply. Sometimes when children are denied SSI, a second application changes the outcome. It seems that the employee who reviews the application has a lot to do with who is found eligible. In our area, some hospitals only take certain Medicaid plans (All Kids not Harmony, etc). Occasionally our EI providers need to help families contact their Medicaid case worker/office in order to switch plans that will allow them access to more services. Finally, we have found that referring families to the regional center or the local department of health and human services sometimes lead to additional support. In our area, the Part C services are through the department of education, so these types of programs, housed under different government agencies, can prove helpful. Most government resources have very clear guidelines online, but since many families from poverty don’t have consistent access to the internet, we have occasionally had sessions at a library or at our center to help the families navigate the web resources.

    33. Strategies: Educate Caregivers on Diverse Instruction Help families select quality childcare or early education programs When “families are not able to afford the cost of high-quality preschool programs” they are often “unaware of the characteristics of high-quality preschool programs” (Thomas-Presswood & Presswood, pg 118) http://www.childcareaware.org/ Teach what makes “good instruction” Relevant Multi-cultural Appeals to variety of learning modalities Families from poverty may have difficulty selecting quality childcare centers and early education programs. If the only programs in their neighborhoods are not of high quality, they may believe those are their only options. In St. Louis, we have a valuable resource in the Child Day Care Association, however if you check out the website for Child Care Aware, you can search for a similar resource in your community. These agencies will help families select quality childcare centers. The CDCA in St. Louis even has an “Inclusion Specialist” who can help families select a placement for their child with special needs. The inclusion specialist can also provide support to the childcare provider. We can spend time during our sessions talking with families about what characteristics to consider when selecting childcare. I think that EI providers in our field are quite used to talking about things related to listening and language development - i.e. searching for good room acoustics, low teacher child ratio, etc. But it is important that our conversations with parents include a variety of characteristics that make for quality instruction. Families from poverty may have difficulty selecting quality childcare centers and early education programs. If the only programs in their neighborhoods are not of high quality, they may believe those are their only options. In St. Louis, we have a valuable resource in the Child Day Care Association, however if you check out the website for Child Care Aware, you can search for a similar resource in your community. These agencies will help families select quality childcare centers. The CDCA in St. Louis even has an “Inclusion Specialist” who can help families select a placement for their child with special needs. The inclusion specialist can also provide support to the childcare provider. We can spend time during our sessions talking with families about what characteristics to consider when selecting childcare. I think that EI providers in our field are quite used to talking about things related to listening and language development - i.e. searching for good room acoustics, low teacher child ratio, etc. But it is important that our conversations with parents include a variety of characteristics that make for quality instruction.

    34. Strategies: Diverse Instruction (contd) (Thomas-Presswood & Presswood, pgs 126-127) Provide opportunities for children to work together. Use reality-based learning methods. Encourage interdisciplinary instruction, considering individual learning preferences. Engage students in learning. Involve teacher modeling of learning behaviors. Allow children to explore and apply critical inquiry and reasoning. Encourage home-school collaboration. Employ multicultural teaching approaches. Involve accelerated learning techniques. Emphasize brain-compatible instruction. Many of the strategies that we are used to seeing in OPTION school programs are just the same “best practices” in early education programs, however families from poverty may not know to seek these out for their child. These include: Provide opportunities for children to work together. Use reality-based learning methods. (i.e. - language experiences) Encourage interdisciplinary instruction, considering individual learning preferences. Engage students in learning. Involve teacher modeling of learning behaviors. (modeling, expanding, self talk, parallel talk, etc) Allow children to explore and apply critical inquiry and reasoning. Encourage home-school collaboration. (home visits, family sessions) Employ multicultural teaching approaches. Involve accelerated learning techniques. Emphasize brain-compatible instruction. (developmental synchrony, not remedial approach)Many of the strategies that we are used to seeing in OPTION school programs are just the same “best practices” in early education programs, however families from poverty may not know to seek these out for their child. These include: Provide opportunities for children to work together. Use reality-based learning methods. (i.e. - language experiences) Encourage interdisciplinary instruction, considering individual learning preferences. Engage students in learning. Involve teacher modeling of learning behaviors. (modeling, expanding, self talk, parallel talk, etc) Allow children to explore and apply critical inquiry and reasoning. Encourage home-school collaboration. (home visits, family sessions) Employ multicultural teaching approaches. Involve accelerated learning techniques. Emphasize brain-compatible instruction. (developmental synchrony, not remedial approach)

    35. Strategies: Build Relationships Provide frequent feedback and authentic affirmation. There is hope in words! Make families feel comfortable. Consider your own appearance/dress. Avoid bringing in fancy toys/equipment. Instead bring or leave toys when appropriate. Teach families how to use what they have or create homemade items. Allow families to network with others who face similar challenges. Talk about “hidden rules” discrepancy (Payne, pg 42-43) School systems function according to middle class rules, so conflict may arise for families from generational poverty. Tardiness for medical/audiological appointments School-friendly behaviors for IEP meetings Even with very limited resources, we must have hope. The age old adage “talk is cheap” is key here. Words are free yet they will do great things for children living in poverty. The Hart & Risley study showed that one major difference between families from different socio-economic classes was the quantity of talk. This discrepancy in words had long term affects on children’s performance in kindergarten and beyond. If we as EI providers can help families understand the power of talk, we can profoundly improve outcomes for young children. Coaching families on ways to enrich their talk through modeling, expanding, self, and parallel talk is without a financial cost! How hopeful and what a gift that parents, even from poverty, can provide their children. In order to build the relationship that is so necessary in early intervention, providers must be aware of the impact of their presence. We must consider what we wear and how this makes families feel. Will dressing down be viewed as an insult to families? Will wearing our business casual clothing seem too “fancy” for play in their home? What about our jewelry or hair styles? There is no one way to handle this…just being aware can prove helpful. While we know it is not best-practice in EI to bring in toy bags, we still see providers doing it. Sometimes rules are made to be broken, but if you are going to break them, please consider the repercussions. If children are without toys, then yes, perhaps when we bring them, for one hour they’ll have an enriching experience, but if we aren’t willing to leave the toys to be used and used, then are we setting children up for disappointment and families for embarrassment? We must look at what materials are available to families. It has been said that teachers of the deaf can make a language experience out of anything…so we should do just that.Before birthdays or holidays when many families get new toys for their children It may be helpful to “think aloud” about the toys that families are considering purchasing. If we can help families thoughtfully select toys that will grow with their children, or select toys that will provide more “bang for the buck” educationally, then that can be an appropriate family session activity. Ruby Payne uses the concept of “knowledge of hidden rules” to describe the set of values, habits or unspoken understandings that members of any given group accept as normal. Payne suggests that in America we recognize this concept for racial or ethnic groups, but we aren’t acknowledging this for economic groups yet. The lack of knowledge of the hidden rules can cause a breakdown. For example, if a family from poverty doesn’t understand how the school system values time and schedules, then they may not see why showing up 35 minutes late for their child’s appointment is interpreted as insulting or disrespectful of the professional’s time. This is because there is a discrepancy on how each class values time - in general - those from poverty are concerned about the present so decisions are based on immediate feelings or survival. Whereas, middle class values of time are more about the future and the future ramifications of one’s decision. Another example relates to the hidden rules of language. IN poverty the casual register is most commonly accepted, whereas in middle class (i.e. schools) the formal register is expected. We’ve seen this discrepancy come to life time and time again in IEP meetings when school professionals talk in a way that can be quite different than how families generally communicate. As EI providers, we can begin to educate families from poverty about these differences so they feel equally empowered to make a choice about how they will behave. This isn’t to say that families must change to fit school systems, or that school systems must change to appease families. Rather, openness and acknowledgement of these differences can empower both parties to have a greater level of understanding for one another. Even with very limited resources, we must have hope. The age old adage “talk is cheap” is key here. Words are free yet they will do great things for children living in poverty. The Hart & Risley study showed that one major difference between families from different socio-economic classes was the quantity of talk. This discrepancy in words had long term affects on children’s performance in kindergarten and beyond. If we as EI providers can help families understand the power of talk, we can profoundly improve outcomes for young children. Coaching families on ways to enrich their talk through modeling, expanding, self, and parallel talk is without a financial cost! How hopeful and what a gift that parents, even from poverty, can provide their children. In order to build the relationship that is so necessary in early intervention, providers must be aware of the impact of their presence. We must consider what we wear and how this makes families feel. Will dressing down be viewed as an insult to families? Will wearing our business casual clothing seem too “fancy” for play in their home? What about our jewelry or hair styles? There is no one way to handle this…just being aware can prove helpful. While we know it is not best-practice in EI to bring in toy bags, we still see providers doing it. Sometimes rules are made to be broken, but if you are going to break them, please consider the repercussions. If children are without toys, then yes, perhaps when we bring them, for one hour they’ll have an enriching experience, but if we aren’t willing to leave the toys to be used and used, then are we setting children up for disappointment and families for embarrassment? We must look at what materials are available to families. It has been said that teachers of the deaf can make a language experience out of anything…so we should do just that.Before birthdays or holidays when many families get new toys for their children It may be helpful to “think aloud” about the toys that families are considering purchasing. If we can help families thoughtfully select toys that will grow with their children, or select toys that will provide more “bang for the buck” educationally, then that can be an appropriate family session activity. Ruby Payne uses the concept of “knowledge of hidden rules” to describe the set of values, habits or unspoken understandings that members of any given group accept as normal. Payne suggests that in America we recognize this concept for racial or ethnic groups, but we aren’t acknowledging this for economic groups yet. The lack of knowledge of the hidden rules can cause a breakdown. For example, if a family from poverty doesn’t understand how the school system values time and schedules, then they may not see why showing up 35 minutes late for their child’s appointment is interpreted as insulting or disrespectful of the professional’s time. This is because there is a discrepancy on how each class values time - in general - those from poverty are concerned about the present so decisions are based on immediate feelings or survival. Whereas, middle class values of time are more about the future and the future ramifications of one’s decision. Another example relates to the hidden rules of language. IN poverty the casual register is most commonly accepted, whereas in middle class (i.e. schools) the formal register is expected. We’ve seen this discrepancy come to life time and time again in IEP meetings when school professionals talk in a way that can be quite different than how families generally communicate. As EI providers, we can begin to educate families from poverty about these differences so they feel equally empowered to make a choice about how they will behave. This isn’t to say that families must change to fit school systems, or that school systems must change to appease families. Rather, openness and acknowledgement of these differences can empower both parties to have a greater level of understanding for one another.

    36. Strategies: Increase Agency-wide awareness Poverty simulation: Interfaith Partnership-Faith Beyond Walls Book study: A Framework for Understanding Poverty, Ruby Payne Anonymous adopt a family Resource simulator www.nccp.org Our school dedicated an entire year of professional development to better understand how poverty affects the families we serve. We believe that a greater understanding of poverty, agency-wide, would enhance our ability to serve all families. Personally, in EI I tend to believe our staff had the most real-life experience with families from poverty since we were the ones going into the homes. However, every staff member who interacts with the families really found benefit in participating in this focused professional development. We began the year by participating in a poverty simulation sponsored by a local non-profit agency. For one real hour, our staff role-played what life might be like for a week in poverty. Some staff members acted as business owners, social agency providers, or government employees following scripts on how to work at the WIC office, teach at the public school, man the police station, or even cash paychecks at the local “Quick-Cash” business. Other staff members had to navigate the public transportation system, make their food stamps last, keep track of their children, show up for appointments, and wait in line at all of these places. The scripts were painful, but all based on real life circumstances. The conversation following this simulation was eye-opening for many. We de-bunked many myths about people who live in poverty. Our staff also used the Ruby Payne book as our book study, meeting monthly to discuss the assigned readings. Instead of doing a food or clothing drive for another community agency, we opted to adopt families in our own school. The five families we helped were all kept confidential except for the one or two staff members who coordinated the effort. It certainly felt good to be taking care of our own. The National Center for Children in Poverty from Columbia University has a great website with many helpful resources for educating ourselves and our staff. One particular resource allows you to simulate a budget for your family based on national poverty levels. You can change the number of dependents and the percentage of income based on the federal level. It is truly eye-opening to see how difficult it can be to ever get ahead, much less get by. This awareness kind can lead to compassion and understanding. Our school dedicated an entire year of professional development to better understand how poverty affects the families we serve. We believe that a greater understanding of poverty, agency-wide, would enhance our ability to serve all families. Personally, in EI I tend to believe our staff had the most real-life experience with families from poverty since we were the ones going into the homes. However, every staff member who interacts with the families really found benefit in participating in this focused professional development. We began the year by participating in a poverty simulation sponsored by a local non-profit agency. For one real hour, our staff role-played what life might be like for a week in poverty. Some staff members acted as business owners, social agency providers, or government employees following scripts on how to work at the WIC office, teach at the public school, man the police station, or even cash paychecks at the local “Quick-Cash” business. Other staff members had to navigate the public transportation system, make their food stamps last, keep track of their children, show up for appointments, and wait in line at all of these places. The scripts were painful, but all based on real life circumstances. The conversation following this simulation was eye-opening for many. We de-bunked many myths about people who live in poverty. Our staff also used the Ruby Payne book as our book study, meeting monthly to discuss the assigned readings. Instead of doing a food or clothing drive for another community agency, we opted to adopt families in our own school. The five families we helped were all kept confidential except for the one or two staff members who coordinated the effort. It certainly felt good to be taking care of our own. The National Center for Children in Poverty from Columbia University has a great website with many helpful resources for educating ourselves and our staff. One particular resource allows you to simulate a budget for your family based on national poverty levels. You can change the number of dependents and the percentage of income based on the federal level. It is truly eye-opening to see how difficult it can be to ever get ahead, much less get by. This awareness kind can lead to compassion and understanding.

    37. Case 1: Child T - 2 yr, 2 mo Background Fit with bilateral hearing aids for a mild to moderate HL Large family - Mom and siblings have HL too EI provider began home visits at age one Reside in government housing without reliable transportation Present Levels Slight receptive delay, expressive delay ~9mo Family priorities: “Get Child T caught up with his speech and language so he can talk and hear as good as he can.” Unstated challenges Transportation to and from audiology/medical appointments Lack of toys/educational materials in the home Inconsistent HA usage Planning ahead for transition out of EI This mother was highly motivated to achieve more/better for her children and for herself. She needed temporary resources to get going, but with support became self sufficient and achieved her goals. Transportation to and from audiology/medical appointments One main challenge for this family was/continues to be transportation. The mother is very participatory in sessions, and as long as home visits continue, family will have support. Getting to audiology is sometimes challenging, but the parent educator helps the family navigate the public transportation and/or use of medical transportation. This will also be a challenge when the child transitions out of EI at age 3. Lack of toys/educational materials in the home In order to support language and listening opportunities at mealtime, the EI provider offered to come at a mealtime. When she arrived, she learned to put her own pre-conceived notions about mealtime routines aside, as this family had their own routines that were quite different from the EI providers. The family only used disposable paper products, so dishwashing was not familiar/authentic. The mother placed sheets of newspaper on the kitchen floor where each child was to sit and eat. The children ate their meals off of the floor - sitting on the newspaper since that was the clean spot to eat. They also knew to throw their plates away when they had finished. The EI provider was initially shocked/saddened by this situation, but was able to respect the mother’s ability to establish such routines. Only when the EI provider had established a bond with the mother was the mother willing to be vulnerable and share the mealtime routine with her. It was then that the mother and provider could move forward and talk about ways to model language to further enhance this routine. Inconsistent HA usage The child’s hearing aids kept getting confused with his siblings or misplaced in the home. Since the family had little resources in the way of toys/materials at home… the EI provider brought shoeboxes and materials to decorate the boxes. Each child was able to make a special place for the Has and related equipment. Planning ahead for transition out of EI After many sessions with the family, the mother shared more and more about the type of services her daughter was (or wasn’t) receiving from her local public school. The 5 year old sister was receiving speech therapy as part of her IEP, but no where in the IEP was it noted that she had a HL. After the mother began to learn about the options for transition for Child T, she had many more questions and came to the realization that the services her 5 year old was receiving were not appropriate. The admissions coordinator at the oral school where Child T receives audiologic services/home visits was able to guide mom about her rights. The mother got an advocate and eventually the older sister’s IEP was rewritten. Her district now contracts with the oral school to provide appropriate services. This mother was highly motivated to achieve more/better for her children and for herself. She needed temporary resources to get going, but with support became self sufficient and achieved her goals. Transportation to and from audiology/medical appointments One main challenge for this family was/continues to be transportation. The mother is very participatory in sessions, and as long as home visits continue, family will have support. Getting to audiology is sometimes challenging, but the parent educator helps the family navigate the public transportation and/or use of medical transportation. This will also be a challenge when the child transitions out of EI at age 3. Lack of toys/educational materials in the home In order to support language and listening opportunities at mealtime, the EI provider offered to come at a mealtime. When she arrived, she learned to put her own pre-conceived notions about mealtime routines aside, as this family had their own routines that were quite different from the EI providers. The family only used disposable paper products, so dishwashing was not familiar/authentic. The mother placed sheets of newspaper on the kitchen floor where each child was to sit and eat. The children ate their meals off of the floor - sitting on the newspaper since that was the clean spot to eat. They also knew to throw their plates away when they had finished. The EI provider was initially shocked/saddened by this situation, but was able to respect the mother’s ability to establish such routines. Only when the EI provider had established a bond with the mother was the mother willing to be vulnerable and share the mealtime routine with her. It was then that the mother and provider could move forward and talk about ways to model language to further enhance this routine. Inconsistent HA usage The child’s hearing aids kept getting confused with his siblings or misplaced in the home. Since the family had little resources in the way of toys/materials at home… the EI provider brought shoeboxes and materials to decorate the boxes. Each child was able to make a special place for the Has and related equipment. Planning ahead for transition out of EI After many sessions with the family, the mother shared more and more about the type of services her daughter was (or wasn’t) receiving from her local public school. The 5 year old sister was receiving speech therapy as part of her IEP, but no where in the IEP was it noted that she had a HL. After the mother began to learn about the options for transition for Child T, she had many more questions and came to the realization that the services her 5 year old was receiving were not appropriate. The admissions coordinator at the oral school where Child T receives audiologic services/home visits was able to guide mom about her rights. The mother got an advocate and eventually the older sister’s IEP was rewritten. Her district now contracts with the oral school to provide appropriate services.

    38. Case 2: Child J - 14 mo Background: Child J has frequent seizures (without diagnosis) and severe- profound HL in one ear, moderate in other oldest of two children (younger sibling 3 mo old) residing with mother, father, paternal grandmother, and two other families (paternal siblings with their own children) EI provider suspected that mother suffered emotional abuse Present Levels Child delayed in motor skills (receiving PT) as well as communication Very social - smiling, giving hugs, enjoyed seeing people who came and went from house Family priorities:”Child J will not use high-pitched scream for everything. ” Unstated challenges Very limited financial resources - neither parent working Home was not conducive to having EI visitors Domestic abuse to unknown extent This was a family that participated and made good efforts but continued to be enabled. She didn’t take ownership of her own success or that of her child. This was a classic case of generational poverty…it was all that she knew and she wasn’t at a point that she wanted to break out of the cycle. This situation was challenging to the EI provider because the mother truly wanted help, however, was never quite able to follow-through with her own responsibilities. The EI provider began doing weekly home visits and initially all seemed to go OK. The mom was receptive to the suggestions to enhance play. The family had lots of toys in the living room area, and given the full house of people, there were always communication partners (including other young children) coming and going. The mother bought into hearing aid use early on and the child quickly got accustomed to wearing the HAs since he could likely receive some benefit from them. One day the father was present for the session, ironing clothes nearby, but didn’t choose to participate. When probed about the father’s interest in participating, the mother opened up that the father really likes the younger child (without special needs) more than Child J. The father even calls Child J names in front of the mother. When the couple fights, the father threatens to take the younger sibling and leave the mother with Child J. The mother was cautious about opening up about their relationship when they were in the home, given that the home was owned by the child’s paternal grandmother. The mother has no support from her own family as they have been astranged for several years. Some time passes and the mother confesses to the EI provider that when they play during a session and get the Child J making vocalizations it disrupts the other members of the house. The EI provider grows concerned that her presence in the home is leading to further abuse of the mother (mostly emotional as there is no obvious evidence of physical violence towards the children or mother). Home visits were discontinued but the mother chose to ride the bus to the center to receive services. The school provided the family with gift cards and donated clothes/toys/diapers at the holidays since the mother expressed concern. The EI provider suggested that the IFSP team seek social work support. The EI provider helped the mother complete social security/disability paperwork to bring in additional financial resources. The family cut ties with all providers and the school after the IFSP team decided it was no longer safe to have providers in the home. The mother was unwilling/unable to take advantage of a local shelter for abused women and children, instead choosing to remain in her situation. Some months later the mother called the audiologists to get an appointment for new earmolds and more batteries. At that time she was not interested in resuming EI services. This was a family that participated and made good efforts but continued to be enabled. She didn’t take ownership of her own success or that of her child. This was a classic case of generational poverty…it was all that she knew and she wasn’t at a point that she wanted to break out of the cycle. This situation was challenging to the EI provider because the mother truly wanted help, however, was never quite able to follow-through with her own responsibilities. The EI provider began doing weekly home visits and initially all seemed to go OK. The mom was receptive to the suggestions to enhance play. The family had lots of toys in the living room area, and given the full house of people, there were always communication partners (including other young children) coming and going. The mother bought into hearing aid use early on and the child quickly got accustomed to wearing the HAs since he could likely receive some benefit from them. One day the father was present for the session, ironing clothes nearby, but didn’t choose to participate. When probed about the father’s interest in participating, the mother opened up that the father really likes the younger child (without special needs) more than Child J. The father even calls Child J names in front of the mother. When the couple fights, the father threatens to take the younger sibling and leave the mother with Child J. The mother was cautious about opening up about their relationship when they were in the home, given that the home was owned by the child’s paternal grandmother. The mother has no support from her own family as they have been astranged for several years. Some time passes and the mother confesses to the EI provider that when they play during a session and get the Child J making vocalizations it disrupts the other members of the house. The EI provider grows concerned that her presence in the home is leading to further abuse of the mother (mostly emotional as there is no obvious evidence of physical violence towards the children or mother). Home visits were discontinued but the mother chose to ride the bus to the center to receive services. The school provided the family with gift cards and donated clothes/toys/diapers at the holidays since the mother expressed concern. The EI provider suggested that the IFSP team seek social work support. The EI provider helped the mother complete social security/disability paperwork to bring in additional financial resources. The family cut ties with all providers and the school after the IFSP team decided it was no longer safe to have providers in the home. The mother was unwilling/unable to take advantage of a local shelter for abused women and children, instead choosing to remain in her situation. Some months later the mother called the audiologists to get an appointment for new earmolds and more batteries. At that time she was not interested in resuming EI services.

    39. Case 3: Child K - 2 y, 6 mo Background Born to a mother who took drugs throughout pregnancy Medical complications - tetralogy of fallot, nearsightedness, gross and fine motor delay, bilateral mild HL (wears two Has) Child in foster care, placed with a single parent, working full- time, who has intentions to adopt the child Present Levels Uses single words with quiet voice Family priorities: “Child K will call her family members by name instead of saying Mama for everyone.” Unstated challenges Inconsistent HA use, often getting lost or broken Full-time in childcare settings, some caregivers are more aware of Child K’s needs than others Lack of carry-over of communication enhancing strategies This was a working single parent who was heavily reliant on the childcare system. She had appeared to have good buy-in during sessions, but seemed to have difficulty carrying over to her real life. She didn’t outwardly ask for support as she could provide the basic needs for her child (food, clothing, shelter, etc). This situation was an example of working poor and this mother was only able to provide limited enrichment for her child since she was primarily concerned with “getting by”. Initially, this child was in a childcare setting less than 1 block from the family’s apartment. After the EI provider did one session in the childcare center, concerns arose about the child’s safety and care. Since the child was behind in language development including small size, the center had placed her in the room with the 1 year olds - developmentally inappropriate. The toys were not stimulating for her, and there were no language models. The staff did not seem interested/motivated in maintaining the hearing aid use. The EI provider delicately expressed her concerns to the mother. The mother agreed that she wasn't overly comfortable with the child’s care. The EI provider put the family in touch with the CDCA and collectively they explored other options for care. The mother worked for the largest employer in St. Louis - a hospital system. After a short time on the wait list, the child was enrolled at the company early childhood center. The child received PT, OT, and speech services from a local children’s hospital under the traditional medical model - ie, Mom waited in the waiting room while Child K participated in individual therapy. Mom seemed able to take time off work for these appointments, but often had difficulty keeping EI sessions as a priority. The EI provider initially offered to do evening home visits, but after several missed sessions (mom forgot and wasn’t quite there when provider arrived) and a bit of discomfort on behalf of the provider for going into this family's apartment complex after dark, these were mutually discontinued. Instead, the provider met mom at the childcare center at the end of her work-day when the mom would pick up Child K. This set-up seemed to work because the EI provider could do 1/2 the session with the childcare providers and 1/2 with the mom. The EI provider continued to have concerns about the rate of progress given her mild hearing loss. It seemed that this mother would participate in sessions but had difficulty carrying over language and communication strategies at home. This was a loving family, but never fully appreciated the impact of the hearing loss…likely had other priorities such as working enough hours to provide basic needs for the family. Mom was usually tired by the time they got home from work/childcare at 6:30…just in time to feed child and begin bedtime routine. This was a working single parent who was heavily reliant on the childcare system. She had appeared to have good buy-in during sessions, but seemed to have difficulty carrying over to her real life. She didn’t outwardly ask for support as she could provide the basic needs for her child (food, clothing, shelter, etc). This situation was an example of working poor and this mother was only able to provide limited enrichment for her child since she was primarily concerned with “getting by”. Initially, this child was in a childcare setting less than 1 block from the family’s apartment. After the EI provider did one session in the childcare center, concerns arose about the child’s safety and care. Since the child was behind in language development including small size, the center had placed her in the room with the 1 year olds - developmentally inappropriate. The toys were not stimulating for her, and there were no language models. The staff did not seem interested/motivated in maintaining the hearing aid use. The EI provider delicately expressed her concerns to the mother. The mother agreed that she wasn't overly comfortable with the child’s care. The EI provider put the family in touch with the CDCA and collectively they explored other options for care. The mother worked for the largest employer in St. Louis - a hospital system. After a short time on the wait list, the child was enrolled at the company early childhood center. The child received PT, OT, and speech services from a local children’s hospital under the traditional medical model - ie, Mom waited in the waiting room while Child K participated in individual therapy. Mom seemed able to take time off work for these appointments, but often had difficulty keeping EI sessions as a priority. The EI provider initially offered to do evening home visits, but after several missed sessions (mom forgot and wasn’t quite there when provider arrived) and a bit of discomfort on behalf of the provider for going into this family's apartment complex after dark, these were mutually discontinued. Instead, the provider met mom at the childcare center at the end of her work-day when the mom would pick up Child K. This set-up seemed to work because the EI provider could do 1/2 the session with the childcare providers and 1/2 with the mom. The EI provider continued to have concerns about the rate of progress given her mild hearing loss. It seemed that this mother would participate in sessions but had difficulty carrying over language and communication strategies at home. This was a loving family, but never fully appreciated the impact of the hearing loss…likely had other priorities such as working enough hours to provide basic needs for the family. Mom was usually tired by the time they got home from work/childcare at 6:30…just in time to feed child and begin bedtime routine.

    40. References: American Association for the Advancement of Science. (2008). Financial Times. Cauthen, N. & Fass, S. (2008) Measuring income and poverty in the United States. New York, NY: National Center for Children in Poverty, Columbia University, Mailman School of Public Health. Cauthen, N. & Fass, S. (2008). Ten important questions about child poverty and family economic hardship. National Center for Children in Poverty, Columbia University, Mailman School of Public Health. Krugman, P. (2008). Poverty is poision. New York Times, February 18. Linden, Michael, (2008). The cost of doing nothing: The economic impact of recession-induced child poverty. First Focus.www.firstfocus.net Direct audience to look at our resource handout for additional resources not specifically referenced in the talk. Direct audience to look at our resource handout for additional resources not specifically referenced in the talk.

    41. References: Luterman, David. (2001). Counseling persons with communication disorders and their families. Pro Ed. National Center for Children in Poverty. (2009). Family resource simulator. Retrieved from http://www.nccp.org/tools/frs/ Neuman, S. (2009). Changing the odds for children at risk: Seven essential principles of educational programs that break the cycle of poverty. Westport, CT. Praeger Publishers, Parish, S. Shattuck, P. & Rose, R. (2009). Financial burden of raising CSHCN: Association with state policy choices. Pediatrics, 124(4), pS435-S442,

    42. References: Park, J., Turnbull, A. & Turnbull, H. (2002). Impacts of poverty on quality of life in families of children with disabilities. Exceptional Children,68(2), 151-170. Payne, R. K. (1996). A framework for understanding poverty. USA: aha! Process, Inc. Suskind, D. & Gelhert, S. (2009). Working with children from lower SES families. In L. Eisenberg (Ed.), Clinical Management of Children with Cochlear Implants. (pp. 555-572), San Diego: Plural Publishing. Thomas-Presswood, T., & Presswood, D. (2008). Meeting the needs of students and families from poverty: a handbook for school and mental health professionals. Baltimore, MD: Paul H Brookes Pub Co. White, V., Chau, M. & Yumiko, A. (2010). Who are America’s poor children: The official story. http://www.nccp.org/publications/pdf/text_912.pdf

    43. Child Abuse/Neglect References: Harold A. Johnson, Michigan State University – Child Abuse/Neglect Wiki; retrieved from: http://deafed-childabuse-neglect-col.wiki.educ.msu.edu/ Department of Health and Human Services. (2003). Emerging Practices in the Prevention of Child Abuse and Neglect. Office on Child Abuse and Neglect. Retrieved from http://stage.childwelfare.gov/preventing/programs/whatworks/report/report.pdf

    44. Contact us: Susan Lenihan Slenihan@fontbonne.edu Gale Rice Grice@fontbonne.edu Jenna Voss Jvoss@cid.edu

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