BILL ANALYSIS AB 2072 Page 1 Date of Hearing: April 20, 2010 ASSEMBLY COMMITTEE ON HEALTH William W. Monning, Chair AB 2072 (Mendoza) - As Amended: April 13, 2010 SUBJECT : Hearing Screening: resources and services. SUMMARY : Requires parents of all newborns and infants diagnosed with a hearing loss to be provided specified information on communication options for children with hearing loss. Specifically, this bill : 1)Requires parents of all newborns and infants diagnosed with a hearing loss to be provided written or electronic information on American Sign Language (ASL), Total Communication, Cued Speech, and Listening and Spoken Language communication options for children with hearing loss, including, but not limited to, information about deaf and hard of hearing organizations, agencies and early intervention centers, and educational programs. 2)Requires that the information noted in 1) above be provided: a) By an audiologist or other related professional at a follow-up appointment after diagnosis with a hearing loss; and, b) By the Early Start Program, upon initial contact with the parents of a newborn or infant newly diagnosed with a hearing loss. 3)Requires that neither the state nor an Early Start Program provider will incur costs for the implementation of the above provisions. EXISTING LAW : 1)Establishes the Newborn and Infant Hearing Screening, Tracking, and Intervention Act which requires every general acute care hospital with licensed perinatal services to offer every newborn a hearing screening test for the identification of hearing loss, as specified, and provide written information on the availability of community resources and services for children with hearing loss to the parents of those who are diagnosed with a hearing loss. AB 2072 Page 2 2)Establishes the California Early Start Intervention Services Act, commonly known as the Early Start program, provides various early intervention services for infants and toddlers who have disabilities to enhance their development and to minimize the potential for developmental delays. FISCAL EFFECT : This bill has not yet been heard by a fiscal Committee. COMMENTS : 1)PURPOSE OF THIS BILL . According to the author, with new developments in Cochlear Implants, more profoundly deaf children are able to hear and speak and can be completely assimilated into society. The author maintains that the maximum time for oral language development is in the first five years of life. By the time children reach age five, the author argues, the ability to learn oral language decreases annually. The author asserts that oral language is one hearing option for the profoundly deaf and hard of hearing, but others include ASL, Cued Speech, and Total Communication. According to the author, a major concern in California is that many parents of infants who are diagnosed with hearing loss are not provided with information on all communication options and are most often unfamiliar with the resources and options that are available to them. The author maintains that this bill will help ensure that parents understand the rights and resources that they have available for their children. 2)BACKGROUND . The California Newborn Hearing Screening program, administered by the California Department of Health Care Services (DHCS), is a comprehensive coordinated system of early identification, intervention, and support services for infants with hearing loss and their families. The goal of the program is to identify infants with a hearing loss prior to three months of age and to link infants with early intervention services by six months. According to DHCS, infants begin developing speech and language from the moment they are born. Studies show that hearing loss occurs in approximately two to four out of 1000 babies. DHCS states that, prior to the Newborn Hearing Screening program, unfortunately, hearing loss was often not identified until 18 months to three years. If an infant has hearing loss in one or both ears, early identification is crucial to preventing AB 2072 Page 3 delayed speech and language development. In California, infants who do not pass the initial hearing screening in the hospital are referred for a rescreening which could be performed before one month of age. Infants who do not pass the rescreening are referred for a diagnostic hearing evaluation. Upon identification of hearing loss, infants and their families are referred to the local Early Start Program, a multi-agency effort by the Department of Developmental Services and the California Department of Education for access to early intervention and related services. Currently parents are provided a packet of information which includes: "Communicating with Your Child" which provides information about local, state and national resources and the DHCS Web site provides links to local, state, and national resources. 3)COMMUNICATION OPTIONS. a) ASL . According to the National Association of the Deaf (NAD), ASL is a visual language in which the brain processes linguistic information through the eyes. The shape, placement, and movement of the hands, as well as facial expressions and body movements, all play important parts in conveying information. Sign language is not a universal language, each country has its own sign language, and regions have dialects, much like the many languages spoken all over the world. Like any spoken language, ASL is a language with its own unique rules of grammar and syntax and grows and changes over time. ASL is used predominantly in the United States and in many parts of Canada. ASL is accepted by many high schools, colleges, and universities in fulfillment of modern and "foreign" language academic degree requirements across the United States. According to a January 2008 policy statement of NAD, deaf infants and children should be given the opportunity to acquire and develop proficiency in ASL as early as possible. NAD takes the position that as a fully accessible visual language, ASL should be made available to every deaf infant, in addition to any assistive technologies that may be used to take advantage of the deaf infant's access to the language(s) used by their families and care providers. b) Total Communication . According the Clearinghouse on AB 2072 Page 4 Disabilities and Gifted Education, Total Communication is an approach to deaf education that aims to make use of a number of models of communication such as sign language, oral, auditory, written and visual aids, depending on the particular needs and abilities of the child. Total Communication is a philosophy rather than a methodology. As a result, the implementation of Total Communication philosophy with one child could look entirely different than its implementation with another child. c) Cued Speech . According to the National Cued Speech Association (NCSA), Cued Speech is s system of communication used with and among deaf or hard of hearing people. NCSA maintains that it is a phonetic-based system which makes traditionally spoken languages accessible by using a small number of handshapes (representing consonants) in different locations near the mouth (representing vowels), as a supplement to lipreading. d) Listening and Spoken Language . According to the Alexander Graham Bell Association for the Deaf and Hard of Hearing (AG Bell), cochlear implants were developed in the 1970s to help profoundly deaf individuals who gained little or no benefit from hearing aids. When hearing is functioning normally, complicated parts of the inner ear convert sound waves in the air into electrical impulses, which are sent to the brain and recognized as sound. A cochlear implant works in a similar manner. When surgically implanted behind the ear, the electronic device is able to bypass damaged hearing cells and stimulate the auditory nerve to restore partial hearing. Cochlear implants provide enhanced sound detection and the potential for greater speech understanding. According to AG Bell, hearing aids are electronic, battery-operated devices that amplify sound to improve listening comprehension. It collects sounds from the environment via a microphone, amplifies those sounds and then directs the amplified signal into the user's ear through a tiny speaker. Hearing aids can be monaural (one ear) or binaural (two ears). Using hearing aids in both ears generally provides superior benefit compared to a monaural hearing aid and is strongly recommended for children who are learning to listen and talk. AB 2072 Page 5 4)TECHNOLOGY . "Through Deaf Eyes" is a two hour Public Broadcasting Service (PBS)-produced documentary that explores 200 years of Deaf life in the United States. As part of the outreach campaign for the documentary, PBS provided information about how technological changes over the years have impacted the deaf community. For example, the invention of the radio offered news, music, and weather warnings, but not to deaf people. Telephones became a barrier to employment and access. Technology also changed education and the physical condition of deafness as hearing aids, FM systems, and cochlear implants came to be used. Technological "advancements" were often assessed differently by hearing and deaf people. The development of the telecommunications device for the deaf (TTY/TDD) radically changed the quality of life for deaf and hard of hearing people in the United States by allowing deaf and hard of hearing people to communicate by phone. By the mid 1980s, TTY/TTDs were in widespread use in the homes of deaf people and in many businesses and government agencies. A host of other technological advancements, many of which took advantage of residual hearing, became available to deaf people. Progressively smaller and lighter weight hearing aids were developed. The early electronic hearing aids of the 1950s required large, heavy batteries and came with instructions on how to discretely tuck batteries into underclothing. Later versions could be stored in a pocket or clipped to a belt, and eventually behind-the-ear hearing aids were available. However, not all technological developments have been universally accepted by the deaf community. The cochlear implant inspired both strong support and vehement opposition. Among deaf people, the implants are generally hailed as a boon for individuals who lost their hearing later in life, but their use for deaf children became controversial. The effectiveness and risks of the implants are a major part of the debate, but there is an additional conflict between those who view deafness as a physical impairment and those who see it as a valued part of cultural identity. As cochlear implant surgery has become more common in deaf children and have become more widely used, the emphasis of the debate has changed. The focus now is on the deaf child's exposure to visual language and the type of support and educational services the child receives. AB 2072 Page 6 5)SUPPORT . Supporters of this bill state that more children are born with permanent hearing loss than any other birth defect. Supporters maintain that recent advances in technology and educational practice make it possible for most deaf or hard-of hearing children to make similar progress to their typically-hearing peers if diagnosis and treatment happen early, preferably during the first few months of life. According to supporters, one of the most important things for parents of a newly-identified child who is deaf or hard of hearing is knowing that they will be able to communicate with their child. Supporters assert that the method of communication chosen by parents is a very personal decision, and parents need to know what alternatives are available. Supporters argue that programs and resources are available in California to support various options, but many parents of newly-identified deaf or hard of hearing children do not even know what options exist. Supporters maintain that this bill will ensure that all parents of children diagnosed with hearing loss will be provided information about communication options and resources which will result in less confusion about the availability of resources. 6)OPPOSITION . The opposition of this bill states that they believe that each infant and toddler, including those identified deaf and hard of hearing, should have every opportunity to learn language. The opposition argues that the focus of this bill about "communication options" is misleading and picking one option over another would only rob the child of the ability and opportunity for full language acquisition. According the opposition, Californians who are deaf request the need for sign language to be respected and support early intervention services acquiring sign language as well as English. The opposition also argues that audiologists are not the appropriate experts to advise parents and families about language acquisition because audiologists are trained to measure and "treat" hearing loss by recommending hearing aids or cochlear implants. The opposition maintains that it is the right of a deaf infant and toddler to acquire full language acquisition through visual language so that by the time the child starts Kindergarten and first grade, the child is ready to learn, receive an education, ultimately graduate, enter postsecondary education and enter the world of work as productive tax-paying citizens. AB 2072 Page 7 7)PREVIOUS LEGISLTION : a) AB 2555 (Torrico), Chapter 245, Statutes of 2008, requires the existing notice of parent rights and procedural safeguards provided to parents or guardians of pupils with disabilities to include information regarding the state special schools for pupils who are deaf, hard of hearing, blind, visually impaired, or deaf-blind. b) AB 2780 (Gallegos), Chapter 310, Statutes of 1998, the Health Services Budget Act establishes the Infant Hearing Screening Program to provide hearing screening tests for children at risk for deafness and a system to provide follow-up and assessment services. c) AB 1836 (Eastin), Chapter 1126, Statutes of 1994, expands legislative intent and makes other changes related to special education for hard-of-hearing and deaf pupils. Specifically, states intent that individuals with exceptional needs be offered special assistance programs which take into consideration, for hard-of-hearing or deaf children, the individual's need for a sufficient number of age and language mode peers and for special education teachers who are proficient in the individual pupil's primary language mode. 8)POLICY CONCERNS . a) On page two, line 11 the bill indicates that information will be provided to parents by audiologists and "other related professionals." The author may wish to clarify who is being referred to as "other related professionals." b) The bill indicates that neither the state nor the Early Start Program provider shall incur any cost for the implementation of this bill but does not indicate who will pay for the development and distribution of the proposed materials to be provided to parents. c) Without the involvement of a state agency in the development and distribution of the proposed materials, how can the state be assured that the information being provided to parents is comprehensive, evidenced-based, unbiased, and accurate? AB 2072 Page 8 REGISTERED SUPPORT / OPPOSITION : Support California Coalition (sponsors) American Federation of State, County and Municipal Employees California Academy of Audiology California Association of Private Special Education Schools California Coalition California Hospital Association California Speech-Language Hearing Association Numerous individuals Opposition ASL Presents LLC California Association of the Deaf California Association of the Deaf, Sacramento Chapter Center on Deaf Inland Empire Community Deaf and Hard of Hearing Service Center, Inc. Deaf Counseling, Advocacy, and Referral Agency IMPACT NorCal Services for Deaf and Hard of Hearing Numerous individuals Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916) 319-2097