r

C HAPTER F OURTEEN

Family-Centered Intervention: Proven Strategies

to Assure Positive Outcomes

Arlene Stredler Brown

Introduction
A Model for Evidence-Based Practice:
The Colorado Home Intervention
Program

Newborn hearing screening systems are now

operating throughout North America, in many European countries, and on other continents. As these
programs develop, it is essential to monitor the outcomes of the screening program, the audiologic
assessment program, and the early intervention program treating these children. The fundamental
question to ask is, Do our universal newborn hearing
systems improve long-term outcomes?
It becomes the responsibility of each early intervention program to collect outcome data. These data,
in turn, supply the evidence to support the efficacy of
the early intervention program. Data can be collected
in two ways. Traditionally, the interventionists use
client data. This information identifies a childs developmental skills in the domains that are likely to be
affected by the childs hearing loss. If the early intervention program implements a parent-centered
paradigm, it is appropriate to measure parents needs
and characteristics of the parent-child interaction as
well. A more effective way to monitor program outcomes is to collect aggregate data. This supplies the
evidence that the early intervention program is efficacious. Aggregate data are used to guide program
practices, to prioritize program needs, and to determine funding priorities.

Colorados publicly funded early intervention

program, The Colorado Home Intervention Program
(CHIP), has relied on outcome data for more than
fifteen years. Data are collected from standardized
tests, videotape analyses, checklists, and surveys.

Formal Assessment
The FAMILY Assessment (Hafer and StredlerBrown 2003; Stredler-Brown and Yoshinaga-Itano
1994) is conducted at six-month intervals. The
FAMILY Assessment takes place in a familys home,
and includes active participation by family members.
Assessment information is gathered from a 30minute videotape of a parent and/or caregiver
interacting with the child. Trained coders in the
Department of Speech, Language and Hearing
Sciences at the University of Colorado analyze the
videotape. In addition, each childs parents complete a
series of questionnaires and protocols. Some of the
questionnaires evaluate the childs skills, while
others report on the familys needs.

Standardized Tests
Some information in the FAMILY Assessment is
reported as developmental quotients or age equivalents. This information compares the skills of a particular child to those of typically developing peers. In
addition, some of the tests have norms for deaf and
hard of hearing children. These norms compare the
skills of a particular child to other children with
similar degrees of hearing loss. These data have been

Address correspondence to: Arlene Stredler Brown, CCC-SLP, CED,

Speech, Language, and Hearing Sciences, 2501 Kittredge Loop Road,
Campus Box 409, University of Colorado, Boulder, CO 803090409
U.S.A. e-mail: arlene.brown@colorado.edu

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developed by Yoshinaga-Itano and Sedey (2005) at

the University of Colorado and can be found at
www.csdb.org/chip/chmain.html.

Checklists and Surveys

CHIP regularly conducts surveys of parents,
early intervention providers, and consultants
working with the program. These surveys evaluate
satisfaction with the services delivered by CHIP.
The evidence collected from standardized tests,
videotape analyses, checklists and surveys is used to
support the program practices of the Colorado Home
Intervention Program. The evidence is collected,
evaluated, and used to support modifications to the
early intervention program.

Issue #1: Single Point of Entry into

Early Intervention
Colorados Early Hearing Detection and Intervention (EHDI) program maintains a statewide
database. This database resides at the Colorado
Department of Public Health and Environment
(CDPHE). Data for screening, audiologic assessment,
and early intervention are entered into an electronic
system, the Clinical Health Information Record for
Patients (CHIRP). Program data is generated on
request. In 2003, 74% of the children in Colorado had
their hearing loss diagnosed by three months of age.
The average start of early intervention was five
months of age.
The challenge to Colorados EHDI system is to
maintain, and lower, the average age at which
children enter early intervention. A related issue is to
accommodate requests from parents for service
coordination to be delivered by a person who is an
expert in hearing loss.
In Colorado, ten Regional Colorado Hearing
Resource (CO-Hear) Coordinators are the single
point-of-entry into early intervention for infants and
toddlers who are deaf or hard of hearing. At the time
of diagnosis, the clinical audiologist contacts the COHear Coordinator who, in turn, contacts the family
within 48 hours. A familys first few contacts with the
CO-Hear Coordinator offers them insights into an
unfamiliar system that may appear overwhelming.
The CO-Hear Coordinator meets a family in their
home and provides information about hearing loss,
programs that offer specialized services to young
children who are deaf or hard of hearing, and

unbiased
information
about
communication
approaches. The CO-Hear Coordinators help secure
funding to pay for the direct services. The prevailing
issue is to assure this system of specialized service
coordinators is efficacious and, if so, funded
appropriately.

Collecting the Evidence

To address this issue, the Colorado Home Intervention Program conducted two surveys. One survey
queried the early interventionists, known as CHIP
Facilitators, working with the program. The second
survey was sent to parents enrolled in CHIP.
The parent survey, conducted in May 2003, asked
parents to identify the topics that represented their
needs. Parents reported they wanted information on
the following topics, listed in priority order: information about hearing loss (97%); information about
communication approaches used with children with
hearing loss (97%); specific books, videotapes and
websites related to hearing loss (95%); how to prepare
for the meeting to develop their Individual Family
Service Plan IFSP (87%); information about amplification and technology (82%); names of other agencies that participate in the childs early intervention
program (69%); having their early interventionist
accompany them to hearing tests (51%); information
about the Individuals with Disabilities Education Act
IDEA (1997); meeting adults who are deaf or hard of
hearing (41%); and meeting an advocate (18%).
The other survey, conducted in May 2004, was
mailed to the CHIP Facilitators. The facilitators
reported on the quality of the services provided by the
CO-Hear Coordinators. CHIP Facilitators awarded
the CO-Hear Coordinators high ratings. On a fivepoint Likert Scale, they rated the CO-Hear Coordinators as follows: knowledge about intervention for
children who are deaf or hard of hearing (4.9); disseminates information about training (4.6); responds
to requests promptly (4.5); accessibility (4.5); and provides technical support (4.4).

Evaluating the Evidence

The outcomes of the parent survey show their
desire to have information specifically related to hearing loss. The service coordinators from the Part C system, who serve all children with all disabilities, do not
have this level of expertise. However, the CO-Hear
Coordinators are experts in hearing loss.

Family-Centered Intervention: Proven Strategies to Assure Positive Outcomes

Furthermore, the evidence collected from the

early interventionists supports the role of the COHear Coordinators. They, too, want a service coordinator with expertise in hearing loss. The CO-Hear
Coordinators are knowledgeable about hearing loss,
they are aware of resources in their community, and
they are responsive to the social and political issues
that surround management of hearing loss in early
childhood.

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defined the role of the CO-Hear Coordinator in their

state guidelines (Colorado Infant Hearing Advisory
Board 2004). Figure 1 illustrates the system for entry
into Colorados early intervention program. It is the
CO-Hear Coordinator who contacts the local Part C
agency, assuring each child has access to these valuable resources.

Program Modifications

Issue #2: Implementing

Family-Centered Practices

Rather than depending on the Part C service

coordinator exclusively, Colorado provides funding to
ten Regional CO-Hear Coordinators. Funding is provided by the Colorado School for the Deaf and the
Blind, as well as some local Part C agencies. To document this specialized system of service coordination,
the Colorado Infant Hearing Advisory Committee has

A basic tenet of family-centered intervention is a

commitment to help families to navigate the early
intervention system, to identify resources, to learn
new information, and to adopt strategies to use at
home with their young child. Because many professionals received their pre-service training long before
family-centered practices were defined, they often

Figure 1. The system for entry into Colorados early intervention program.

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seek guidance when they are called upon to deliver

family-centered intervention.
The need to train early interventionists to provide
family-centered intervention is widespread. This
training is appropriate for speech/language pathologists, rehabilitation audiologists, and early childhood
special educators, all of whom are facilitators with the
Colorado Home Intervention Program.

Collecting the Evidence

In a survey conducted in May 2004, CHIP
Facilitators were asked to identify their use of
family-centered practices. Questions were posed in
two ways. The survey asked five true-false questions.
Each question addressed implementation of familycentered, versus child-centered, practices. In addition, five open-ended questions, querying the use of
family-centered practices, were posed to the
facilitators.

Evaluating the Evidence

When answering the true-false questions, 78% of
the CHIP facilitators received a score of 70% or
higher. In response to the open-ended questions, 58%
of the facilitators supplied answers indicating they
were implementing family-centered practices. These
results demonstrate the need for training.

Figure 2. The rubric for a home visit.

Program Modifications
The administrative team for CHIP identified
ways to teach all CHIP facilitators to implement the
family-centered practices. First, a consultant was
hired to provide technical assistance. Next, the CHIP
Clinical Training Manual (Jones 1993) was updated.
The manual was mailed to facilitators, posted on the
CHIP webpage, and the content was presented in
regional and statewide trainings. Third, production of
a videotape series, Early Intervention Illustrated, was
started. This series is being developed by a consortium of programs working with infants and toddlers with hearing loss. As the videos are produced,
they are made available to CHIP facilitators. The first
two videos in this series are The Home Team and Art
and Science of Home Visits (Stredler-Brown 2005).
The second video presents a rubric of the discrete
components of a home visit. The five components of a
family-centered home visit are: reconnect and review,
address priorities, show the craft, assess and evaluate, and reflect on the visit. The rubric for a home visit
is illustrated in figure 2.

Issue #3: Parent Participation

Active parent participation is an essential
ingredient in the success of the children. When
delivering family-centered intervention, the early
interventionist serves as a consultant, forging a relationship with each person in the family. The early
interventionist helps the family members to actualize

Family-Centered Intervention: Proven Strategies to Assure Positive Outcomes

their important role with their child, their role as the

primary facilitators of their childs development.
The most successful children are those with high
levels of family involvement (Moeller 2000). In
addition, research has shown that maternal communication skill predicts early reading skills, higher
language skills, and fewer behavior problems
(Calderone 2000). The challenge, then, is to actively
engage parents in the early intervention program.

Collecting and Evaluating the Evidence

Moeller (2000) studied 112 children with various
degrees of hearing loss. The most successful children
were those with high levels of family involvement.
She found that success is achieved when early identification is paired with early interventions that
actively involve families. Calderon (2000) studied 28
children with pre-lingual hearing loss. She measured
parent involvement in the childs education program
and the characteristics of maternal communication.
Calderons research showed that maternal communication skills correlate with higher language, earlier
reading skills, and fewer behavior problems. Based on
these findings, CHIP looks for ways to actively engage
parents in the early intervention program.

Program Modifications

All sessions occur in the home or in community

settings (e.g., grocery store, neighborhood park).
Sessions are often conducted in the evenings or
on weekends when most family members are
available.
Enlisting families in the assessment process
effectively promotes family involvement. Providing parents with an analysis of the language
model they offer to their child encourages parents
to develop better communication skills.
Sign language instructors have been hired and
trained to provide instruction, in the home, to
families who elect to use sign language.
Access to parent-to-parent connections is readily
available. Colorado has the first chapter of
Families for Hands and Voices, an active parent
organization that provides information, support,
and parent leadership.
Deaf/Hard of Hearing Connections, Colorados
role-model program, is an active project statewide. Most of the children in CHIP have hearing
parents and, consequently, have few interactions

189

with deaf and hard of hearing adults. The role

model shares his or her experiences of growing up
with a hearing loss, what it means to have a hearing loss, and when appropriate, introduces the
family to Deaf Culture. This helps the child and
family develop positive attitudes about hearing
loss.

Issue #4: Child Outcomes

As an evidence-based program, CHIP continually
monitors the outcomes of the children. This is accomplished by collecting assessment data at six-month
intervals. CHIP funds an accountability coordinator
who analyzes the aggregate data.
As a group, the children in CHIP have communication and language skills that are within normal
limits for their chronological, or developmental, age.
However, when specific skills are evaluated, there is
evidence that some elements of language development are more advanced than others.

Collecting the Evidence

Outcome data based on two specific assessment
protocols have been analyzed. These protocols are the
Minnesota Child Development Inventory MCDI
(Ireton and Thwing 1972), and language sampling
(Miller 2002).

Evaluating the Evidence

Assessments on 352 deaf and hard of hearing
children were collected (Sedey 2004a). All children in
the sample had bilateral hearing loss, ranging from
mild to profound. The cognitive ability of these children was estimated to be within the normal range.
Each child was assessed on one to nine occasions
between the ages of six months and 63 years of age.
A full range of communication approaches was used
by the children in the sample. Parents all had normal
hearing and spoke English in the home.
Selected items from two subscales of the MCDI,
the expressive language subscale and the comprehension/conceptual subscale (receptive language),
were studied. The proportion of delay, if any, on specific items was determined. The results are presented
in table 1. Scores above 1.0 indicate that the deaf and
hard of hearing children had skills that emerged, on
average, before those of their hearing peers. Scores
below 1.0 indicate the proportion of delay exhibited by

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deaf and hard of hearing children compared to their

hearing peers. For example, non-verbal skills of the
deaf and hard of hearing children (e.g., points, waves
bye bye, shakes head no) emerge sooner than the
same skill in their hearing counterparts. However,
the acquisition of grammar skills (e.g., puts two or
more words together, uses plural pronouns) is considerably delayed relative to hearing children.

In figure 4, the mean length of utterance is identified on the vertical axis. The age of the children is on
the horizontal axis. This graph demonstrates the
delay exhibited by children who are deaf or hard of
hearing when the length of their spontaneous utterances is compared to the mean length of utterance of
their hearing peers.

Table 1. Proportion of delay of deaf/hard of hearing children

compared to hearing peers

Item

Proportion
of Delay

Non-verbal
Pre-literacy
Colors/Numbers
Rote Language
Early Communication
Concept Vocabulary
Early World Knowledge
Cognitive-Linguistic
Grammar

1.14
1.05
.97
.96
.87
.79
.76
.71
.66

Another measure of child outcomes is examined

through language sampling analyses. Language
samples for 219 children were collected. The children
ranged in age from three to six years. Figure 3 summarizes the total number of utterances produced during a 30-minute language sample. The number of
words the children produced is indicated on the vertical axis. The age of the children, in years, is on the
horizontal axis. The deaf and hard of hearing children
lag behind their hearing peers in the total number of
words they produce. However, the discrepancy
reduces with age.

Figure 4. Comparison of deaf/hard-of-hearing children and

their hearing peers on mean length of utterances in a language
sample

Program Modifications
The programs administrative staff have identified program modifications to address the evidence.
First, the expectations of both CHIP facilitators and
the parents need to be raised. Next, an increase in the
intensity of early intervention services is being
explored. Perhaps children could benefit from more
frequent sessions when they are two years of age, the
age when language starts to develop at an exponential rate. Another consideration is to extend the duration of family-centered services beyond the childs
third birthday. This seems logical in that language
continues to grow quickly during the preschool years
and parents welcome the opportunity to learn new
strategies that facilitate their childs development.

Issue #5: Selecting a Communication

Approach

Figure 3. Comparison of deaf/hard-of-hearing children and

their hearing peers on number of utterances in a language
sample

Early interventionists are expected to help families select a communication approach based on
objective criteria. They accomplish this by offering the
parents information, observing and documenting the
childs communicative behaviors, and identifying a
good match between observable, functional skills and
the communication approaches that are available.

Family-Centered Intervention: Proven Strategies to Assure Positive Outcomes

This plan replaces the passionate, emotional manner

in which families selected a communication approach
in the past. Furthermore, a data-driven approach,
with objective and measurable criteria, gives parents
and interventionists the ability to make informed
decisions based on each childs performance.
The Colorado Home Intervention Program supports the use of all communication approaches. When
parents enroll in CHIP, they are given unbiased
information about all choices. All CHIP facilitators
support this philosophy. The program partners with
parents to discover the approach that is appropriate
for their child and also matches the parents
priorities.

Collecting the Evidence

Fifty percent of the children enrolled in CHIP
change the approach they are using at least one time
during their enrollment in the program. Several
evaluation measures, included in the FAMILY
Assessment, guide the selection process.

Evaluating the Evidence

The publication by Yoshinaga-Itano, Sedey,
Coulter and Mehl (1998) demonstrated the positive
effects of early identification of hearing loss. Children
who were identified and started early intervention
before six months of age had an advantage over their
deaf or hard of hearing peers who were identified
later. This advantage existed irrespective of the communication approach used by the children in the
study.

Program Modifications
All early intervention programs in Colorado work
cooperatively to support young children with hearing
loss and their families. As a result of the newborn
hearing initiative, the state has a working task force
for early intervention that reports to the Colorado
Infant Hearing Advisory Committee (2004). The
activities of the Task Force have created a spirit of
collaboration, replacing an old tradition of competition. In addition, the FAMILY Assessment is offered
to and used by all programs in the state.

191

Issue #6: Cochlear Implants and

Communication Approach
In Colorado, as in most states, children with
severe and profound hearing loss are receiving cochlear implants in record numbers. Parents regularly
ask if the communication approach they are using
with their child before implantation should change
after their child receives the implant.
There is often concern on the part of parents,
physicians, and audiologists that the use of sign language after implantation will limit development of
oral communication. However, clinical practice suggests that this is not the case for the children in
Colorado.

Collecting the Evidence

The assessment information obtained through
the FAMILY Assessment evaluates the language
skills of children with cochlear implants. Outcome
data using two different instruments, the MacArthur
Communicative Development Inventory CDI
(Fenson et al. 1992) and spontaneous language
sampling, have been analyzed.

Evaluating the Evidence

Fifty-four deaf children who received cochlear
implants were included in this study (Sedey 2004b).
All children were implanted by five years of age, ranging from 13 months to 51 years. The children had
no additional disabilities that could interfere with
language development, had parents with normal
hearing, and English was the primary language
spoken in the home. Twenty-nine of the children used
simultaneous communication prior to implantation.
Simultaneous communication was defined as those
children who signed at least 50% of their utterances,
recorded on a language sample before implantation.
Figure 5 illustrates the childrens use of signed
and spoken vocabulary on the MacArthur CDI. The
vertical axis identifies the percent of words that are
produced. The horizontal axis identifies, in six-month
increments, the age of the children before and after
implantation. The findings indicate that all of the
children reduced their use of words in the sign-only
mode. The percentage of words produced in both

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A Sound Foundation Through Early Amplification

Figure 5. Use of signed and spoken vocabulary on the MacArthur Communicative Development Inventory for children before and
after cochlear implantation

signed and spoken modes is relatively stable over

time. Most significant is the finding that 1824
months after implantation, the children start to
increase the number of words produced using speech
only.
Figure 6 provides the results of analysis of the
language samples of these children. The same pattern is observed. On this graph, the vertical axis identifies the percentage of words used in the spontaneous
language sample. The horizontal axis identifies the
age of the children before and after implantation.
Again, the number of words produced in the sign-only
mode significantly decreases over time. The number
of words produced using both sign and speech plateaus and eventually declines. The number of words
produced using speech only increases dramatically
over time.

Program Modifications
This information has reinforced a long-held practice by CHIP. Families have always been encouraged
to continue to use the same communication approach
selected before implantation once the surgery
occurred.

Issue #7: Development of Functional

Auditory Skills
The early interventionist, along with the childs
parents and the clinical audiologist, develop an auditory skills program for the child. This therapeutic
program teaches the child listening skills, skills that
correlate with speech development for children who
are deaf or hard of hearing. The development of auditory skills is systematic (Laughton and Hasenstab
2000) and follows a prescribed hierarchy. In order to

Figure 6. Use of signed and spoken vocabulary according to results from language sampling for children before and after cochlear
implantation

Family-Centered Intervention: Proven Strategies to Assure Positive Outcomes

achieve optimal outcomes, specific strategies must be

incorporated into the childs routines.
The FAMILY Assessment has always included a
checklist of functional auditory skills (CaleffeeSchenck and Stredler-Brown 1992). The original
checklist had only fourteen skills.

Collecting and Evaluating the Evidence

The Checklist of Auditory Skills had a limited
number of skills and, therefore, did not provide
sufficient data to document progress made by the
child. Nor did the 14-item list provide interventionists
with adequate material to guide their intervention.

Program Modifications
The Colorado Home Intervention Program
funded development of a new tool, the Functional
Auditory Performance Indicators FAPI (StredlerBrown and DeConde Johnson 2003; Stredler-Brown
2003). The items on this instrument provide a comprehensive list of functional auditory skills. The
profile divides auditory skills into seven hierarchical
categories. A childs skill level, at any point in time,
can be objectively measured using this profile. In addition, the tool serves as a curriculum for teaching
auditory skill development.

Issue #8: Children with Unilateral

Hearing Loss (UHL)
Current data (Lee, Gomez-Marin and Lee 1998)
suggest the prevalence of unilateral hearing loss in
the newborn population to be approximately 1/1000
births. The newborn screening system in Colorado
routinely identifies children with UHL.
One challenge is to identify those children with
UHL who are experiencing delays and to support
their parents as they make the necessary accommodations for their child. In addition, efficacy data
are needed to develop a treatment protocol for
children with unilateral hearing loss.

Collecting the Evidence

In Colorado, a sample of 30 infants and toddlers
with UHL were identified. These children were tested
at six-month intervals using the complete FAMILY
Assessment protocol. Comprehensive demographic
data were collected as well.

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Evaluating the Evidence

First and foremost, the hearing loss of 7% of the
children progressed to bilateral hearing loss within
the first year of life (Sedey, Carpenter and StredlerBrown 2002). A review of each childs audiological
report indicates another 7% had bilateral hearing loss
all along. In these cases, the minimal amount of hearing loss in the better ear was mild enough to pass the
newborn hearing screen. Fifteen of the children in the
original sample met criteria for further analysis.
Three protocols in the FAMILY Assessment were
used; specific subtests of the Minnesota Child Development Inventory, the MacArthur Communicative
Development Inventory, and spontaneous language
sampling. Among the children in this group, 27%
exhibited language delays and an additional 7% had
language skills in the borderline range. These are
significant findings as only 5% of their hearing peers
exhibit delays on these instruments.

Program Modifications
As a result of these data, a statewide protocol for
intervention, specifically for children with unilateral
hearing loss, was created. Parents receive consultative support. In addition, those children with delays
in communication and language receive direct
services.
A grant from the Centers for Disease Control
supports the development and enhancement of this
statewide plan. Three regional coordinators with
expertise in hearing loss will increase the intensity of
services delivered to families by making regular
phone calls and conducting home visits. Families will
be encouraged to participate in an abbreviated
version of the FAMILY Assessment to monitor each
childs development. Should a child develop a delay in
communication, speech, or language, direct services
are then offered.

Issue #9: Consultation Services

A unique characteristic of CHIP is the fact it
embraces and offers all communication approaches.
In addition, many of the children on the program
have additional disabilities. Both of these issues can
be addressed through training and consultation.
CHIP Facilitators receive their pre-service training as Teachers of the Deaf/Hard of Hearing, Speech/
Language Pathologists, or rehabilitation audiologists.

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While each of these training programs prepares professionals to work with deaf or hard of hearing children, each facilitator needs additional information in
order to diagnose and treat a childs additional
disabilities.
In addition, because the program offers all communication approaches, each CHIP Facilitator is
required to have and maintain competencies in many
skill areas. Facilitators continually request technical
assistance as they work with children and their
families.

Collecting the Evidence

Demographic data of the children enrolled in the
program are collected and analyzed each year. This
information provides insight into the additional disabilities the children have and the special treatment
they may need. In addition, CHIP Facilitators identify their priorities for in-service training by completing an annual survey. A third avenue used to gather
evidence is to analyze child data from the FAMILY
Assessment.

Evaluating the Evidence

Demographic data show that 50% of the children
enrolled in CHIP change the communication
approach they are using at least one time while
enrolled in the program. Demographic data also show
that 40% of the children enrolled in CHIP have additional disabilities.

Program Modifications
Training is provided to all CHIP facilitators to
teach them requisite skills to support all communication approaches. Trainings are conducted statewide
and within designated regions. The newest training
program uses mentors. Mentors provide much
needed one-on-one teaching.
Specialty consultants make home visits with the
CHIP Facilitator. There is an array of consultants
including the Oral Communication Consultant, a
physical therapist, a clinical audiologist, a social
worker, a clinical psychologist, a functional vision
specialist, a network of parents, and deaf and hard of
hearing role models. These consultants contract with
the program to provide training, technical assistance,
and home visits on discipline-specific topics. The
benefits of these consultative visits are evaluated by

both the family and the Facilitator and submitted, in

writing, to the program director.

Summary
Evidence-based practice is one of the most distinguishing features of the Colorado Home Intervention Program. Evidence guides program practices. It
helps to prioritize funding. It provides a guide for
interventionists as they create an individualized
early intervention program for the 250 children on
the program and their families. The evidence supports objective, outcome-based decision-making.
Parents and interventionists have applauded this
characteristic of the program.

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Calderon, H. 2000. Parent involvement in deaf childrens
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early reading, and social-emotional development.
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Caleffee-Schenck, N. and Stredler-Brown, A. 1992. Auditory Skills Checklist. Available from the Colorado
Home Intervention Program, 33 N. Institute Street,
Colorado Springs, CO 80903.
Colorado Infant Hearing Advisory Committee 2004.
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Family-Centered Intervention: Proven Strategies to Assure Positive Outcomes

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