Family-centered Early Intervention for Infants and Toddlers who are Deaf or Hard of Hearing (DHH)

In order to promote positive outcomes for infants and toddlers with hearing loss, services actively include the child’s parents and other caregivers. This graphic depicts the events in a family-centered early intervention session.
These chapters describe the underpinnings of family-centered early intervention for children who are DHH.

  • Stredler-Brown, A. (2008). The importance of early intervention. In Madell, J. and Flexer, C. (Eds). Pediatric Audiology: Birth through Adolescence. NY, NY: Thieme.
  • Stredler-Brown, A. (2011). Early intervention: Serving infants and toddlers. In DeConde- Johnson, C. and Seaton, J. (Eds). Educational Audiology Handbook. NY, NY: Thompson Delmar Learning.

FAMILY Assessment (Family Assessment Measuring Individual Learning for the Young Child)

The FAMILY Assessment was designed in response to a request to justify the funding of the Colorado Home Intervention Program (CHIP). The assessment was designed to provide information to document changes in parents’ knowledge base, changes in the communicative interaction between parent(s) and child, and changes in each child’s developmental skills. The FAMILY Assessment has done much more than that. The data collected was analyzed and subsequently used to justify newborn hearing screening programs. And, the currently-funded National Early Childhood Assessment Project (NECAP) uses an adapted version of the FAMILY Assessment.

The FAMILY Assessment includes a group of standard assessment protocols. The information obtained from the assessment is intended to guide the development of each child’s uniquely-designed intervention program. The early interventionist can use the assessment data:

  • to monitor the family and child’s development over time;
  • to compare child outcome data with children who are hearing; and
  • to compare the characteristics of the child to others of similar age, to other children with a similar type and degree of hearing loss, and to other children using the same communication approach.
  • Stredler-Brown, A. & Yoshinaga-Itano, C. (1994). “The FAMILY Assessment: A Multidisciplinary Evaluation Procedure”. In Roush, J. and Matkin, N. (Eds): Infants and Toddlers with Hearing Loss (pp. 133-161). York Press; MD.
  • Hafer, J.C. & Stredler-Brown, A. (2003). Family-centered developmental assessment. In B. Bodner-Johnson & M. Sass-Lehrer (Eds.), The Young Deaf or Hard of Hearing Child: A Family-Centered Approach to Early Education (pp. 127-149). MD: Paul H. Brookes Publishing Co.

Early Intervention Illustrated

This is a three-part video series with information representing a family-centered approach to working with parents and their infants and toddlers who are deaf or hard of hearing.

Family-centered early intervention practices include family members in collaborative decision-making, in goal setting, and in the treatment of their children. The information in these videos demonstrates elements of family-centered early intervention including; active parent involvement, meeting a family’s needs, and strategies that can be used to identify and enhance each family member’s capabilities and competencies. A family-centered approach to early intervention requires therapists to have a unique set of knowledge and skills. These three videos explain and describe these skills.

Early Intervention Illustrated I – The Home Team: This video, the first in the Early Intervention Illustrated series, presents strategies and techniques that can help establish trusting, caring relationships between interventionists and families using the highly successful family-centered approach. Best practices are demonstrated in actual home visits. Parents and professionals share their expertise on how to create true collaboration as The Home Team.
  • Stredler-Brown, A., & Moeller, M.P. (2003). The Home Team: A family-centered approach to working with newly identified babies who are deaf or hard of hearing and their families (DVD). Omaha, NE: Boys Town Press
  • Full DVD available from Boys Town Press

Early Intervention Illustrated II – The Art & Science of Home Visits: How do early interventionists support parents’ learning and the child’s development during home visits with families and their babies or young children who are deaf or hard-of-hearing? The Art & Science of A Home Visit explores the strategies and specific skills necessary to facilitate effective, family-centered early intervention in a young child’s natural learning environments – in the community, in natural routines, and with the family at home.
  • Stredler-Brown, A., Moeller, M.P., Gallegos, R., Corwin, J., & Pittman, P. (2004). The art and science of home visits (DVD). Omaha, NE: Boys Town Press.
  • Full DVD available from Boys Town Press

Early Intervention Illustrated III – Language Partners: This video, the third in the Early Intervention Illustrated Series, shows several families using a variety of communication approaches as they provide a language-rich environment for their deaf or hard-of-hearing children. Effective strategies are demonstrated: communicating feelings, encouraging thought, and making language accessible.
  • Stredler-Brown, A., Moeller, M.P., Gallegos, R., & Corwin, J. (2007). Language partners: Building a strong foundation (DVD). Omaha, NE: Boys Town Press.
  • Full DVD available from Boys Town Press

Functional Auditory Performance Indicators (FAPI)

This tool is a guide for the development and implementation of an auditory training curriculum. It was developed as a practical way for a parent, a therapist, or a teacher to understand the hierarchical skills used to teach a child to listen.

CATEGORIES: This progress monitoring tool has seven listening categories arranged in hierarchical order. Embedded in the categories are a total of 31 discrete skills that are also presented in hierarchical order:

  • awareness and meaning of sounds
  • auditory feedback and integration
  • localizing sound source
  • auditory discrimination
  • auditory comprehension
  • short-term auditory memory
  • linguistic auditory processing

CONDITIONS: Each skills is considered in light of the complex listening situations that exist in the world around us. Each skill is measured in these dynamic listening conditions:

  • auditory v. visual cues v. auditory stimulus alone
  • close proximity v. far away
  • quiet environment v. noisy situation
  • with prompts v. to listen spontaneous responses
  • closed set v. open set
  • familiar words v. unfamiliar words
  • words v. sentences
  • active listening v. engagement in other activities

For accountability, this progress-monitoring tool includes a scoring paradigm. This allows the early interventionist, therapist, teacher and parents to quantify the improvements in listening that are made over time and, subsequently, to measure the effectiveness of the treatment plan. The profile identifies a child’s unique strengths and needs and is used to create goals for the child’s individualized program.

The adults who are implementing the auditory training curriculum develop the activities associated with each skill. In this way, the auditory learning curriculum is considerate of each child’s age, the environment, and the current listening skills. A dynamic auditory learning curriculum changes rapidly.

  • Stredler-Brown, A. & Johnson, C. DeConde (2001). Functional Auditory Performance Indicators: An Integrated Approach to Auditory Development [on-line].
  • Full handbook available here



There is a critical need to deliver appropriate therapy and educational services to children when they live in remote or rural areas of the country. The delivery of high-quality services through telehealth (aka; telepractice, telemedicine, tele-intervention) can be used to deliver early intervention, therapeutic, and educational services to children who are deaf or hard of hearing (DHH). For infants and toddlers, telepractice can provide early access to family-centered services that are delivered by experts in hearing loss, irrespective of where either party lives. For school-age students, telepractice has the potential to connect learners with experienced professionals, including teachers of the DHH and speech-language pathologists who may not be assigned to a student’s school.

The delivery of educational and therapeutic services, via telehealth, is harnessing existing technology to provide high-quality intervention to more children in the United States and around the world. Where a child lives need not dictate access to services. Nor should one’s geographic location dictate the type of services or communication approach chosen. Using telepractice, each child has an opportunity to learn from experts who may live at previously incapacitating distances from a family’s home.

  • Houston, K. T. (Ed.) (2013). Telepractice in Speech-Language Pathology). San Diego, CA: Plural Publishing, Inc.
  • Stredler-Brown, A. (Ed.) (2012). Current Knowledge and Best Practices for Telepractice. The Volta Review [Monograph], 112(3).
  • Visit the TACIT Study website

Colorado Home Intervention Program (CHIP)

This family-centered early intervention program, currently housed at the Colorado School for the Deaf and the Blind (CSDB), serves families of children with hearing loss, from birth to age three, in the surroundings of their own homes. When serving as the director of this program, each family received an individualized program, with an individualized communication approach, that fit both the family’s needs and the child’s learning style. The program encouraged parents to actively participate in setting goals for their child’s intervention.
  • Visit the CHIP website here