BACKGROUND: Many families of children who are deaf or hard of hearing (DHH) pursue the development of spoken language through the use of advanced hearing technology and intensive, specialized listening and spoken language (LSL) intervention services. LSL practitioners utilize caregiver coaching to transfer knowledge and skills to parents, equipping them to effectively support their child's listening and language development. Caregiver coaching builds parents' capacity to implement intervention strategies within daily routines to maximize learning opportunities to reach this goal. While caregiver coaching is a hallmark of LSL practice, there is a lack of consensus and paucity of evidence to support its use with children who are DHH learning to listen and talk. The purpose of this research was therefore to gain a greater understanding of caregiver coaching practices in LSL services for families of children ages birth-3 who are DHH. OBJECTIVES: 1) to provide a synthesis of the literature and identify gaps in the existing knowledge base regarding coaching in LSL services, 2) to gain insight into practitioners' and caregivers' experiences with coaching in LSL services, and 3) to gain a better understanding of coaching practices in LSL services with families of children who are DHH. METHODOLOGY: The first objective was addressed by performing a scoping review of the literature to synthesize the relevant research and professional practice recommendations and identify gaps in the knowledge base regarding coaching caregivers in LSL practice. The remaining objectives were addressed through qualitative, semi-structured interviews and video observation discussions with LSL practitioners and caregivers to gain insight into caregivers' perspectives and practitioners' perspectives and practices. Interviews were conducted with 14 practitioners and 13 caregivers at three intervention sites in the US and Canada. These sites represent three different service delivery models of LSL intervention for families of children who are DHH. RESULTS: The scoping review findings revealed a lack of consensus in the literature regarding the principles and practices of caregiver coaching in LSL services. We presented the following topics found in the literature: coaching practices, training for coaching, the effectiveness of coaching, and recommendations for coaching. Caregivers reported coaching as a positive experience; however, coaching practices differed among sites and between practitioners, supporting the results of the scoping review. The caregivers indicated factors that contribute to a positive coaching relationship, including practitioner characteristics, establishing explicit expectations, and adapting to caregivers' changing needs over time. The practitioner interviews also supported a lack of consistency in coaching practices between sites and indicated that underlying beliefs impact how practitioners coach and engage caregivers. CONCLUSION: The findings from this dissertation provide practical, actionable steps that LSL practitioners can implement to develop and support the caregiver coaching relationship. These findings have the potential to inform professional preparation and development activities to better equip practitioners to engage caregivers in the intervention process, and ultimately, positively impact the listening and spoken language outcomes of the children they serve.

Many positive outcomes have been documented for children with hearing loss utilizing current treatment approaches such as early identification and intervention, including appropriately fit sensory devices and communication modes that focus on listening and spoken language. However, challenges related to social-emotional development have been widely observed. The development of communication skills in children with hearing loss is impacted by many factors, including the degree of hearing loss, the child's age at onset and identification, the presence of other disabilities, and when the child receives intervention. While there are a variety of therapeutic options available for children with hearing loss to develop communication skills, listening and spoken language is of particular interest to parents with normal hearing. In addition to affecting social competence and participation, problems with social-emotional development are linked to poor academic performance. This study examined the social-emotional development of a small group of young children who communicated using listening and spoken language as measured by parent and caregiver report. Three psychosocial scales were used to evaluate the children's social-emotional development in comparison to peers. These results were analyzed within the context of other demographic variables. One of the five children was identified as facing problems with social-emotional development.

Mastery of basic concepts is an academic building block for preschool children in early education programs. Research shows that understanding basic concepts (e.g. top, under, fast, now, all, behind, full and short) is important for academic success and higher order thinking. Experts in the field of concept acquisition agree on six strategies for teaching basic concepts. These strategies include: using positive examples and negative examples, highlighting critical features of concepts through continuous conversion, isolating the concept, the order in which the examples are presented, and teaching generalization. This study investigated the extent to which nine preschool teachers of children with hearing loss used four of the six strategies (using examples, non examples, continuous conversion, and isolating the concept) during a 20-minute lesson in which a new basic concept was taught. Results indicated that teachers do well with using examples to teach basic concepts, but they lack sufficient use of the other three strategies for teaching basic concepts.