Educational Services and Language Congruency in Low-Income Children Who Are Deaf or Hard-of-Hearing

Children who are deaf or hard-of-hearing (DHH) receive educational services through the Individuals with Disabilities in Education Act (IDEA). However, access to language-congruent providers varies considerably. Sociodemographic factors are associated with poorer hearing care access and outcomes in DHH children.

Prospective cohort study.

4 tertiary children's hospitals.

This is a secondary, ad hoc exploratory study of DHH children aged 0 to 27 months enrolled in a randomized clinical trial (CT.gov: NCT04928209). Participants were dichotomized based on 266% Federal Poverty Level into higher and lower income cohorts. Comprehensive assessment of each participant's DHH service providers, including their language proficiency, was performed. The number of unique DHH providers and their characteristics was quantified. Associations between participant and DHH provider characteristics were evaluated.

Among 205 DHH children, 69 (33.7%) were of higher income, and 64 (31.2%) had a primary language other than English at home. 179 (87.4%) of families had a language-congruent DHH provider. Compared with DHH children from high-income homes, those from lower-income homes had a similar overall number of DHH providers, but were significantly less likely to have a language-congruent provider (81.6% vs 98.6% for higher-income children, P = .001), receive supplemental, private specialized speech-language therapy (1.5% vs 10.1%, P = .004), and have access to teletherapy (11.8% vs 34.8%, P < .001).

Lower-income children had a similar number of DHH providers as their higher-income counterparts. However, they were significantly less likely to have language-congruent providers or supplemental speech-language teletherapy services beyond their IDEA-mandated IFSP.