Title: Developing and testing the EPID Tool: Early Parent Interaction in Deafness.
Funder: Health Education England

Abstract: Developing and testing the EPID Tool: Early Parent Interaction in Deafness. Background:Despite early identification and the early provision of hearing aids and cochlear implants through newborn hearing screening, many deaf children arrive at nursery with delayed attention and language skills. The greatest predictor of deaf children's language skills is the quantity and quality of parental communicative behaviours. Ninety percent of deaf children are born to hearing parents who have little experience of deafness, so families need to rapidly acquire knowledge and skills in how best to communicate with their deaf children.Currently, there is no assessment tool that evaluates a parent's interaction skills when they are communicating with their deaf child. This brings the risk that deaf children do not receive appropriate language stimulation during critical language learning periods, with damaging consequences for later academic outcomes and bigger potential burdens on families, and education and health systems, as more support is required long term. Aim:The overall aim of this research project is to support effective communication between hearing parents and their deaf babies aged 0-3. An observational assessment tool will be developed for Speech and Language Therapists (SLTs) and Teachers of the Deaf (ToDs) to assess and monitor parents' interaction behaviours. Methods:1. Systematic review of existing research to identify which parent interaction behaviours help to develop communication in pre-school deaf children (9 months) 2. National survey of SLTs and ToDs (with follow-up focus groups) to ascertain which parent behaviours are assessed, monitored and recommended as the most helpful for supporting children's communication development and why (12 months) 3. The results of 1 and 2 will be combined and presented to experts via an e-delphi to gain consensus on the most important parent communicative behaviours to monitor. This will form the assessment tool (11 months). 4. The tool will be tested for its acceptability, reliability and its usefulness in identifying targets for intervention (3 months). Impact and Dissemination:The study will create an observational tool for SLTs and ToDs to use in their practice. Training days scheduled around the country will ensure the tool is implemented across health and education systems in England. Through collaboration with charities, parent-friendly leaflets and videos will be created and made available online for families. The findings of this research will be shared at conferences, in open-access research journals, professional bulletins and family magazines. To be maximally accessible to families, professionals and the deaf community, there will be a website, blog and Twitter profile. A user group of hearing parents of deaf children and a steering group of expert SLTs, TODs, academics and charity employees will consult and collaborate with the researcher on each phase of the study, including dissemination. The steering group will be a mix of hearing and deaf professionals. By improving the communication skills of parents, the risk of their children experiencing lifelong communication difficulties may be reduced. Improved communication means improved educational attainment, improved functioning within the hearing world and reduced burden and cost on health and education systems.

Lay abstract: Developing and testing the EPID Tool: Early Parent Interaction in Deafness.Background:Deafness delays the development of a child's vocabulary, grammar, speech sounds and social skills. Despite early identification and amplification (i.e. hearing aids and cochlear implants) through The Newborn Hearing Screen, many deaf children arrive at nursery with difficulties in communication and language skills. The most reliable predictor of deaf children's future language skills is the quantity and quality of parental interaction. Ninety percent of deaf children are born to hearing parents who have little experience of deafness within their existing family, so families need to rapidly develop knowledge and skills in how best to interact with their deaf children. Speech and Language Therapists (SLTs) and Teachers of the Deaf (ToDs) are the first professionals to support families in the home. Currently, there is no tool that measures a parent's interaction skills when they are communicating with their deaf child. This gap brings great risk as deaf children who do not receive appropriate language stimulation during the early years can suffer long-lasting damaging consequences for later academic outcomes. If early difficulties are not addressed, the burden on parents, carers and professionals can increase, as more support is required for a longer time.Aim:The overall aim of this research is to support parents in communicating effectively with their deaf children. This study will create an observational tool for SLTs and ToDs to assess and monitor parents' interaction behaviours. Research Plan: Review and learn from all existing research that identifies the effective parent interaction behaviours that help develop pre-school deaf children's communication. Send a survey to SLTs and ToDs to gain an understanding of current assessment work in pre-school deafness. Carry out follow-up focus groups to discuss how much of their current practice is evidence-based. Set up an international, online discussion for SLTs, ToDs and academics in deafness, and ask them to rate which parent behaviours are important for developing communication. The behaviours that professionals agree are most important will be included in the observation tool. After completion, we will check if the tool is suitable and useful for families and professionals.Patient and Public Involvement:Parents, professionals and charity employees have already helped to shape the direction of this application and will continue to provide support during the research. A user group of hearing parents of deaf children and a steering group of expert SLTs, TODs, academics and deaf organisations will collaborate with the researcher on each phase of the study, including sharing findings. The steering group will be a mix of hearing and deaf individuals. Sharing Findings:The findings of this research will be shared through local, national and international conferences as well as publications in open-access research journals. Articles will be written in professional subscription magazines as well as in charity magazines aimed at families. A website, blog and Twitter profile will provide regular updates about the study (in both English and British Sign Language). Impact:The study will create an observational tool for SLTs and ToDs to use in their practice. Training days around the country will ensure the tool is implemented across health and education systems in England. Through collaboration with charities, information leaflets and videos will be made available online for families. This study matches one of the themes of the NHS Long Term Plan: 'making sure everyone gets the best start in life'. By improving the communication skills of parents, the risk of their children experiencing lifelong communication difficulties can be reduced. Improved communication means better educational attainment, improved functioning within the hearing world and a reduced burden on health and education systems.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: EAR