Parents and Their Deaf Children: The Early Years

Appendix B: Letter to Parents, Survey Questionnaire, and Interview Guides

Chapter 1 Letter to Parents, Survey Questionnaire, and Interview Guides Letter to Parents on Gallaudet University letterhead) Spring 1996 To: Parents of deaf and hard of hearing children born in 1989 or 1990 From: Kay Meadow-Orlans, Gallaudet Research Institute Donna M. Mertens, Professor, Department of Educational Foundations and Research Marilyn Sass-Lehrer, Professor, Department of Education We hope you will participate in our research study by completing and mailing the survey form in our self-addressed envelope within two weeks. The purpose of the study is to learn about the kinds of services received by parents and children, how parents evaluate those services, and how parents view their child’s social development and language skills. Your participation is completely voluntary. No benefits that might be available to you would ever be withheld by Gallaudet if you choose not to participate. If you complete the survey form, we can assume that you have chosen to do so and that we have told you that you will not be placed at risk.All information is confidential.You may reply anonymously OR you may give us personal information in order to receive a copy of our report or to volunteer for a follow-up interview. If you have questions , feel free to contact Dr. Meadow-Orlans at the above address or Dr. Carolyn Corbett, Chair of the Institutional Review Board for the Protection of Human Subjects at 202-651-5540. WE BELIEVE THAT OUR RESEARCH CAN BENEFIT PARENTS ANDTHEIR CHILDRENWHO ARE DEAF OR HARD OF HEARING. PLEASE HELP US TO ACHIEVE THIS GOAL. 193 Appendix B Letter to Parents, Survey Questionnaire, and Interview Guides Survey Questionnaire GALLAUDET UNIVERSITY NATIONAL SURVEY SUPPORT SERVICES FOR PARENTS ANDTHEIR DEAF OR HARD OF HEARING CHILDREN These questions should be answered by the adult who spends the most time with the deaf or hard of hearing child. Relationship of respondent to child: ___ Mother ___ Father ___ Other:_____________________ ******************************************************** Section I. Background Information 1. Your child’s date of birth: month ____ day ____ year ______ 2. Sex: ___ Girl ___ Boy 3. Who first suspected the hearing loss? ___ parent ___ other relative ___ medical doctor ___ other professional ___ other (who?) ______________________ How old was your child then?__________ How old was your child when a specialist CONFIRMED the diagnosis? ____________ 4. What is the extent of your child’s hearing loss? ___ Deaf: can’t understand speech, even with a hearing aid ___ Hard of hearing: can understand speech when in a quiet room, with a hearing aid 5. What kinds of instruction or therapy has your child received from a teacher or specialist? ___ Speech therapy: age began: _______________ ___ Auditory training: age began: _____________ ___ Sign language: age began: ________________ ___ Cued speech: age began: _________________ 194 Appendix B ___ Other (1) _____________________________ age began: _______________________ ___ Other (2) _____________________________ age began: _______________________ 6. Does your child have any conditions other than deafness that might affect development or education? ___ no, no other conditions ___ yes (If yes, check all that apply): ___visual impairment ___ cerebral palsy ___brain damage ___ epilepsy ___ health condition ___ developmentally delayed ___behavior problem ___ learning disability ___orthopedic condition ___ attention deficit ___other:_____________________________ 7. Does your child have a hearing aid? ___ no __ yes If yes: age when first fitted with an aid: years_____ months_____ How much does he/she wear the aid? a. at home? ___ always ___ almost always ___ sometimes ___ almost never ___ never b. at school? ___ always ___ almost always __ sometimes ___ almost never ___ never 8. Has a cochlear implant been considered for your child? ___ no ___ yes If yes: Has he/she been evaluated for an implant? __ no __ yes Was surgery performed? ___ no ___ yes When? age: years_____ months_____ Are the results satisfactory? ___ yes, very ___ yes, somewhat __ no Does your child still use the implant? ___ no __ yes ******************************************************** Letter to Parents, Survey Questionnaire, and Interview Guides 195 Section II. Special Services 1. How many different special education programs did your child attend before the age of five?________ In what city or county and state was the program in which your child was enrolled the longest? ____________________________ (state:) __________ Child’s age in that program: _____ to _____ What communication method was used with your child there? ___ speech alone ___ sign  speech ___ sign alone ___ cued speech Did you have a program choice? ___ yes ___...