Learning About My LD: Accepting My Challenges & Finding My Voice

October is Learning Disabilities/Dyslexia/Attention Deficit Hyperactivity Disorder (ADHD) Awareness Month

Lena McKnight


Have you ever sat in a classroom and your teacher asks everyone to read a paragraph out loud? You skim through to see which paragraph has the easiest words to read out loud.

That was me. I was the young girl shaking in my boots when I knew I had to read out loud. Often, I would try to identify the “easy” paragraph, and if I couldn’t find one, I would make the class laugh by getting myself into trouble and taking the pressure off me. I was scared, although everyone thought I was the girl who didn’t fear anything and was tough. I was scared because I saw others do things that I struggled with. Middle school was hard for me. Not only was I dealing with social pressure, but keeping up with my academics was a lot of work in and of itself.

Have you ever just felt like you were different from others? Have you thought that people wouldn’t understand when you expressed your thoughts?

It was very hard for me share the challenges I was facing and explain what was going on for me. I always thought people would think there was something wrong with me. People still tell me, “you’re a tough girl, don’t sweat it.” As a young student, I didn’t talk about my struggles as a way to avoid embarrassment.

What I didn’t know back then was that I have a learning disability. I struggled every day with reading and processing issues. No one had explained to me what my learning disability meant. I had no idea that my individualized education program (IEP) could actually help me succeed. I couldn’t understand how I could do so well in my theatre classes but struggle in others.

Eventually, I fell so far behind in high school that I was not allowed to take any arts classes. I had too many academic classes I needed to complete if I wanted to graduate. So, I dropped out of school. I remember thinking that I would never get a GED (general equivalency degree). But with hard work and determination, I passed the GED exam after trying three times. I was so proud when I passed, and I wouldn’t believe it if anyone told me that I had a disability or needed extra supports after that to succeed. It wasn’t until college that I discovered I was still having trouble.

Soon after getting my GED, I began working at Harlem Children’s Zone. I was listening to the disability specialist speak about the problems high school students will encounter when they enter college. It clicked for me. For the first time, I was able to explain the challenges I faced and I admitted to the specialist that I had an IEP while I was in school. The specialist helped me get testing done so that I would finally be able to prove that I have a learning issue and could receive supports in college. It was like the world turned upside down. I was finally able to get the help I needed. I saw the “perks” of having a disability and getting the services I was entitled to. And, for the first time, I understood what it was I needed help with.

It took me a long time, but I have finally found my voice. I used to be ashamed to talk about my learning issues because I thought I was the only one who struggled, and I worried no one would believe me. But accepting who I am and taking the time to understand what I need has made all the difference. I was lucky to have advocates and people who believed in me. Because of them, I believe in myself and have achieved more than I once thought I could. I am grateful for the ones who stood up with me. Without them, I wouldn’t be who I am today, and I wouldn’t be working to empower others to speak up as well.

Every person with a learning disability deserves the chance to realize their potential and reach their dreams. Understanding yourself and being able to ask for what you need is the first and most important step.


Lena McKnight was born in Norfolk, Virginia and raised in Harlem, New York. She attended public school in New York City until 10th grade and later enrolled in a YouthBuild program where she achieved a High School Equivalency Diploma. Lena then went on to graduate with an associate’s degree and later a bachelor’s degree in Theatre and Sociology in May 2017. Lena has served as a Student Advocate for 10th graders through the Harlem Children Zone and remains involved with YouthBuild. She now works full time and devotes her career to serving kids in her community. Lena is committed to using her voice to have a positive impact on the field of education and on society at large.


Blog articles provide insights on the activities of schools, programs, grantees, and other education stakeholders to promote continuing discussion of educational innovation and reform. Articles do not endorse any educational product, service, curriculum or pedagogy.

Public Charter School Founded to Provide Excellent Reading Instruction to All

Strong Foundations School logo

Assistant Secretary Johnny Collett and Deputy Assistant Secretary Kim Richey visited Strong Foundations Charter School during the 2018 Back-to-School Tour.

October is Learning Disabilities/Dyslexia/Attention Deficit Hyperactivity Disorder (ADHD) Awareness Month.


Seven years ago, one of my former students came to visit me and see the school I helped to found, Strong Foundations Charter School, a public charter school formed to provide excellent reading instruction to all students.

My former student was home from college where he majored in music and also played in two successful bands nearby. As we walked through the halls, he saw the elementary students working, some of whom were in Orton-Gillingham class—a structured reading approach to help students learn to read. I remarked that if he had been in a school like this, he might not have had to struggle so much with reading when he was younger.

His reply was bittersweet to me. “If I had been to a school like this, I might have been able to be your friend sooner.”

Translation: I might not have seen teachers as the enemy and schools as the battleground for so much of my childhood.

As a young teacher, nothing hurt worse than knowing I could teach someone how to read, but having them be so emotionally damaged from failure that they didn’t even want to try.

Time after time, that was my experience.

When I first began working with the student I quoted above, he was in the sixth grade. A bright mathematician, he had never learned to read despite his teachers’ efforts. Now it was my job to teach him to read and spell. For the first three months, every reading lesson was met with refusal and anger. Gradually, he began to have success and respond to my encouragement until finally, by the end of the year, we could accomplish an entire lesson in one sitting.

I had recently been trained in using the Orton-Gillingham approach. I worked as a special educator in a small private school in New Hampshire, and this student was one of many with a similar story. After years of failure, the first hurdle to help them overcome was their hopelessness when faced with the prospect of trying one more time.

I knew, though, that the English language is actually logical and can be taught systematically.

In my experiences, a multisensory structured literacy approach is essential for dyslexic learners and can also be beneficial to all learners.

At Strong Foundations, we accept all students at all academic levels, from low-achieving to high-achieving. Every student receives Orton-Gillingham instruction in a group as part of their regular education curriculum because we believe it is beneficial for all learners. We also believe it will prevent many students from ever struggling to learn to read. We work on building background knowledge using the Core Knowledge curriculum, a sequenced curriculum for kindergarten through eighth grade students.

In the classroom, students receive Orton-Gillingham instruction at a differentiated pace. Students identified with a learning disability in reading normally receive additional Orton-Gillingham instruction at a therapeutic level, so it reinforces what they have learned in the classroom.

Our hope at Strong Foundations Charter School has always been that more schools would see our success and would use structured literacy approaches from the beginning of a child’s reading instruction.

I would like to see teacher-training programs include training in structured literacy approaches so that all elementary and special education teachers are prepared to teach reading.

It has not happened as quickly as I had hoped, but I am seeing some progress.

The story of my student I mentioned above has a very happy ending. I worked with him through ninth grade, when he let his parents know he wanted to stop tutoring because he wanted to learn to play an instrument. His tutoring time with me conflicted with music lessons. We all agreed that if he could maintain his academics without my help, he could “fire me.” He went on to graduate from high school, earn a four-year degree from a prestigious college of music and now works as a professional musician.


Beth McClure has served as the principal of Strong Foundations Charter School for twelve years. She earned a master’s in learning and language disabilities and a master’s in Educational Administration. She is a fellow of the Academy of Orton-Gillingham Practitioners and Educators and currently serves as its president. She recently joined the Professional Standards Board of the New Hampshire Department of Education. Her favorite professional activity is teaching reading.


The U.S. Department of Education does not endorse specific curriculums or approaches to education. Blog articles provide insights on the activities of schools, programs, grantees, and other education stakeholders to promote continuing discussion of educational innovation and reform. Articles do not endorse any educational product, service, curriculum or pedagogy. 

“Voices from the Field” Interview with Caryl Jaques, Director, Little One’s University, Essex Junction, VT

Caryl Jaques

Assistant Secretary Johnny Collett and Deputy Assistant Secretary Kim Richey visited Little One’s University during the 2018 Back-to-School Tour.

Caryl Jaques is the Director of Little One’s University in Essex Junction, Vermont. She earned a bachelor’s of science degree in education with a concentration in psychology at the University of Vermont as well as a master’s degree in education.  She is licensed to teach children ages birth through sixth grade and has been directing child care centers since 1997. Caryl opened Little One’s University in May of 2009 and guided the center to earn a four-star rating in Vermont’s Quality Rating and Improvement System (QRIS) and continuously works to improve the quality of the program.   She is also the proud mother of six children ranging in age from three months to 18 years old. 


How did you begin your career in early childhood?

I graduated from University of Vermont with a bachelor’s degree in elementary education with a concentration in child psychology. I was offered one teaching position but it was too far from my house to commute each day so I started working in a child care center with younger children. I fell in love with it and after a year became the director of the program. We expanded the program from serving just preschoolers (3–5 year-olds) to a program that served infants through 6 year-olds. While I was there, I also went to school and earned a master’s degree in education, which gave me the skills to begin to address the high staff turnover rate. I created an in-house training program that gave staff the opportunity to become lead teachers. After 12 years I decided it was time to open my own child care center. In the new center my teachers and I built a program based on love and empathy for children. Over time our center became known as the center that would take children who were asked to leave other child care centers due do behavioral challenges. Parents of these children struggled to find child care and they absolutely felt the love and commitment we were willing to invest in their children. A high percent of the children we served were at-risk due to being exposed to trauma and toxic stress. Most of these families received subsidies for child care and were not able to pay their co-pay. We became a resource poor center serving the most at-risk population. Love was not enough to provide these children with what they needed. We had excellent teachers but were missing the developmentally appropriate books and materials. We desperately wanted to improve quality but found very little support for programs that were starting out.

What strategies did you use to improve the quality of the early learning experiences you provide?

Five years ago we were selected by the Caring Collaborative as one of the early childhood sites they worked with to infuse resources and services to increase the quality and support families that were living below the poverty level received. This partnership provided our center with materials and resources that helped increase the quality of care and education that our teachers were providing.  The Caring Collaborative provided the financial means for us to engage in trainings on how to work with children that suffered from high levels of trauma and toxic stress. This helped us improve our quality, and as our quality increased so did the money coming in from the child care subsidies (Vermont’s Quality Rating and Improvement System (QRIS)—known as STARS is connected to the state’s tiered reimbursement subsidy system, the higher your center’s star-rating the higher reimbursement you receive for the child care subsidy). The extra money allowed us to purchase materials that helped us continue to increase our quality, which brought new partnerships for our center. For example, we were chosen by the Howard Center to become a therapeutic child care center. This partnership gave us access to professionals with degrees and experience working with children with severe behavioral challenges. We were then more able to identify and meet the needs of our families. We developed a food program through a partnership with our local school district, and we were also able to offer yoga and arts programs for children. We added an onsite resource coordinator to connect families to resources outside of the center in areas that families need support such as finding secure housing. We were no longer a program that just loved children but we were a program doing great things for children and families.

Due to the increase in quality and exposure from the partnership with the Caring Collaborative, our center was able to create a partnership with the Essex Westford School District. The state received a federal Preschool Development Grant (PDG) and our local Essex school district was a subgrantee for the PDG expansion. The school district needed additional high quality classrooms and asked us if we were interested. This partnership meant we could serve four year olds in a high quality classroom and we could hire a licensed teacher with the district paying a percentage of the teacher’s salary. By the district paying a percentage of the salary, we could have 2 assistant teachers in the classroom and buy developmentally appropriate furniture, books, materials and toys for the classroom. The funding that supported the 4 year old classroom allowed us to focus our resources on other classrooms. Overall it helped us improve our quality across the center.  We went from being rated as a two star center (on our state’s QRIS) to almost the highest star rating (five). The great thing is that when you are rated higher on the state’s QRIS you receive a higher reimbursement rate for children receiving the state child care subsidy. We also noticed that with our higher rating we began to attract families that paid out of pocket for child care (not through the subsidy). Without this partnership with the school district we never would have been able to improve our quality.

Johnny and Kim visit Caryl and other special educators in Vermont during 2018 back to school tour.

Johnny and Kim visit Caryl and other early learning providers/special educators in Vermont during 2018 back to school tour.

Why do you think the early learning years are so important?

The early years are so important because they set the foundation for future learning and adulthood. The quality of experiences that a young child has directly impacts the child’s social, emotional and physical development and the adult they will become.  In my experience both with my own children and those attending my center, there is a difference in kids who had access to high quality early learning programs and those who didn’t, which can be seen as they enter elementary school. When we were trying to love children through their tough experiences without resources, it wasn’t enough! When you are able to provide children with high quality experiences you see challenging behaviors diminish and an overall reduction in stress not just for the child and teacher but also for the families. High quality programs have a huge impact on the relationships between a child and his or her family.

How do you work with families?

It is really important to create a strong sense of community among the families you serve. When a child attends our center we are clear at the beginning that we are a partner with the family and that we believe families are their child’s first teacher. We use the strengthening families self-assessment tool for early care and education programs to help promote positive relationships with families. We host family nights once a month in the center bringing families together to discuss different topics and build community. We also have a community swap where families can bring in things they no longer need and trade them for other materials they might need for their home. For families that have children with challenging behaviors, we’ve learned about the importance of building a positive home/school relationship from the beginning so they trust us and understand that our goal is to help their child be successful, not make them feel bad about their parenting. We do our best to engage families early knowing that many of them may not have had the best experiences in school. We also rely on the special interventionists that come to work with some of our children. They often will help with specific strategies we can implement in the classroom and that families can try at home.

What suggestions do you have to improve early childhood services and programs?

There are so many amazing people and resources in the early care and education field. Child care center directors and staff often become isolated and feel like they are responsible for solving the world’s problems alone. My advice is to be open and honest, invite people in and collaborate to best meet the needs of the children you serve.


Blog articles provide insights on the activities of schools, programs, grantees, and other education stakeholders to promote continuing discussion of educational innovation and reform. Articles do not endorse any educational product, service, curriculum or pedagogy.

It Takes a Village

NOTE: October is Down Syndrome Awareness Month

Courtney Hansen holding her two boys on their front porch.

Courtney with her twin sons on their first day of kindergarten in a new state. The boys play t-ball together, love Super Why, biking to the park, and are in the same kindergarten class.

A guest blog by Courtney Hansen. Courtney is a non-attorney special education advocate. She advocates at the local, state, and national level for disability rights, and blogs about it at www.inclusionevolution.com


My son with Down syndrome and his typically-developing twin brother just started kindergarten. The military also just moved us across country this past summer.

There’s been a lot of change this year, and I was often overwhelmed by the idea of my first-born twins starting “real” school in a new state. I cried like a baby their first day of school, but they just marched off to school like they owned the place. I was amazed, but realized that it was the result of years of preparation and help from so many different people. Having a son with a disability has shown me the value of “the village.”

About two years ago, I really started investigating the idea of a fully inclusive education for my son with Down syndrome. I even blogged about my ultimate goal: my twins graduating together in the year 2031.

For most other sets of twins graduating together wouldn’t be a goal, because it would just happen automatically. With lower graduation rates for students with disabilities compared to non-disabled students, and even lower rates for student with intellectual disabilities, I knew our path would be hard fought. It all starts in kindergarten of course. So, I worked tirelessly over the past two years to get where we are today. Both Hunter and Troy are in the same class, and Troy is 100 percent included with his typical peers with the appropriate supports to be successful.

Too many kindergarteners with intellectual disabilities don’t have the same opportunity as my son, even though federal and state laws require the continuum of placement to start in general education with appropriate supports. You might ask how I successfully got him included 100 percent of the time and if he really is being successful. I will tell you it all starts with the village, as well as learning you and your child’s rights.

1. Find Your Tribe

Social media can be a blessing and a curse, but for parents of children with disabilities it’s often an awakening.

Getting plugged into the Down syndrome community via social media helped me realize what is possible.

Even though we’ve lived in three states since our twins were born, I’ve been able to make friends in each state and around the country who have shaped my perspective on what it means to live and thrive with an intellectual disability.

Can my son go to college? Of course, because I just talked to Beth whose son with Down syndrome is moving across country to attend George Mason University.

Can Troy really find a meaningful career? Yes! Elizabeth’s son just got another promotion at Kroger.

These friends have pushed me to set high expectations for my son.

2. Lean on Experts

No doubt about it, you are the expert of your child.

When he was little you were up in the middle of the night with his croupy cough, and you’ll be there when he ages out of the system.

Still, we can learn so much from doctors, therapists, counselors, and teachers.

I’ve always taken a hands-on approach to my son’s endless therapy sessions and education.

I always set some of the private therapy and individualized education program (IEP) goals. In return, many doctors, therapists, and teacher have taken the time to really educate me on best practices in my son’s areas of need and given me functional tips to help my son at home.

3. Start Advocating

I started advocating early ensuring my son would receive an inclusive education with proper supports. I attended conferences and special education trainings to learn my son’s educational rights.

You can start local with school board meetings and school superintendents. Request training for teachers in best practices like Universal Design for Learning and Multi-Tiered System of Supports.

At the state level, I advocated for a bill that is now law in Ohio to end organ transplant discrimination for people with disabilities. Many disability organizations provide opportunities to advocate nationally either over social media or in person.

I attended the Buddy Walk on Washington, and had the opportunity to ask my U.S. Senators and House of Representatives to preserve important health care protections for people with disabilities and better fund IDEA. Positive change starts with you and me. So get out there; our children’s futures depend on it!

4. Take a Break

Most parents of children with disabilities are the most tenacious, hard-hitters I’ve ever met, but this heightened existence of higher highs and lower lows can take their toll on Type-A personalities like me.

I have to make a conscious effort to lean on friends and family outside of the disability community.

The military affords our family respite hours every month, and I use every last minute. The only way I can be a superhero for my son is if I take care of myself.

Parenting a child with a disability is a marathon, not a sprint.

Even with the strong start my son has, I know we will hit many bumps in the road.

Will I know when his needs aren’t being met? How will I ensure he’s included, but also gets the support he needs for a successful future?

My best answer is to lean on my village. I wish more people would embrace their “village.” Our children, community, and country would be better for it!

Courtney's two boys

Troy and Hunter


Blog articles provide insights on the activities of schools, programs, grantees, and other education stakeholders to promote continuing discussion of educational innovation and reform. Articles do not endorse any educational product, service, curriculum or pedagogy.

“Voices from the Field” Interview with Briana Harris, Tennessee Early Educator

Briana Harris

Briana Harris, lead teacher at the Cambridge Early Learning Center

Briana Harris is from Henderson, Tennessee, and currently lives in Nashville, Tennessee. She is a lead teacher at Cambridge Early Learning Center, which is part of the Metro Nashville Public Schools system. She earned a bachelor’s degree in elementary education from the University of Tennessee at Martin. She began her early learning career in Nashville as an educational assistant and interim teacher at the Martha O’Bryan Center. She is passionate about early childhood education, her family, and her three dogs!


ED: How did you begin your career in early learning and development?

BH: I’ve known since I was in kindergarten that I wanted to work in early childhood education. I had a difficult childhood. My experiences caused me to be a fragile child and I didn’t trust new people and was afraid of new situations. My kindergarten experience was critical for me. Was school going to be okay? Was it a safe place? I didn’t attend preschool, so kindergarten was my first school experience. My kindergarten teacher, Mrs. Emily Brown, was everything I needed her to be for me as a child. She and her classroom were my safe place when I really needed one. I so clearly remember the love, grace, patience, and kindness I experienced that first year in school. She gave me a sense of belonging in a world that terrified me and I knew that I wanted to be just like her. I wanted to be a teacher and wanted to do for other children what she had done for me. She had the power to help me love school or hate school and I knew I wanted the opportunity to make children’s first year of school positive and meaningful.

My high school offered a program where students could spend time as a teacher’s aide, which was great for those of us interested in an education career. I worked in a first grade class for an hour every day. Then, when I went to college, I went into an elementary education program so I could become certified to teach PreK through third grade. Many people asked me why I was limiting myself, since I could get a degree in teaching kindergarten through 12th grade. This didn’t impact me because I knew that I was passionate about teaching young children. After graduation, I started working at the Martha O’Bryan Center in Nashville, Tennessee, which focuses on serving children living in poverty. It was a great experience and I eventually became a lead early childhood teacher. Then I began teaching at the Cambridge Early Learning Center, a center with only preschool classrooms that is part of the Metro Nashville Public Schools system. This is my third year teaching at Cambridge. I love being in an exclusively early childhood center — there is a lot of singing in the hallways! The downside is my students are only here for a year and I don’t have the opportunity to see them grow as they progress in older grades.

ED: What is your favorite thing about the beginning of the school year and what do you do to prepare for the first day?

BH: Getting to meet the new children and families. For the most part, the children are so excited. Some of them have been in child care or Head Start, but for many of them, it is their first time being in school. I take it very seriously that they enjoy their first school experience from the beginning. After looking at the names on my enrollment list, it really is fun to meet them in person.

In terms of preparation, I remind myself to be patient and go with the flow; having strict educational expectations for the first few days is unrealistic. It is often very hectic with parents and children crying and parents trying to take pictures, and I have to remind myself to be flexible.

Children's cubby cabinet

Children’s cubby cabinet

I want the kids to have a sense of belonging immediately. So, before the first day, I work hard to make sure the kids’ names are on their cubbies and in other places in the classroom. I also work to put pictures of the kids up within the first couple of days since many students don’t yet recognize their written name. We also get their artwork posted in the classroom early. It is really powerful for them to feel like they belong.

The first day can be hard on families, especially if it is their first or only child. The week before school we host Meet the Teacher Night, where families can bring their child in to meet me and see their classroom. This also gives families the chance to speak with me so we can begin to build trust. It is really important to give families the opportunity to ask me questions and see what I’m like. This event has been very successful. I can really tell the difference on the first day of school with children whose families were able to take advantage of coming in before the first day. The children usually settle in much easier.

Some parents have a hard time saying goodbye to their child, particularly on that first day. One of the things I tried to do this year was to have a place outside the classroom where they could take their first day of preschool photo so that after the photo was taken they could say goodbye and their child could enter the class on their own. In our school, we have an archway near the entrance and we really encourage families to say goodbye there. We try to foster independence at the beginning of the year with the kids and work with families to help them understand that this is a good thing!

ED: How do you know if the first day was a success?

BH: I like to think of it as a success if the children leave with smiles on their faces. We often have tears at the beginning of that first day, but if they leave school with smiles and say they want to come back by the end of the day then I think it was a success. We might have tears again on the second morning, but again, if they leave happy by the end of the day then I think it was a success. It might still be scary to get dropped off, but those smiles show me that they did have fun and enjoy school, which is my goal for those first few days.

ED: What advice do you have for other early learning teachers on strategies to use at the beginning of the school year, to make the rest of the year a success?

BH: My advice is to systematically focus on building strong social and emotional skills for the first month to six weeks. Our school uses the Pyramid Model for promoting social and emotional competence in young children and we start implementing this on the first day. We did home visits a couple of weeks ago and many parents wanted to know when we were going to teach letters and numbers. We share with families how important it is that we start out with a focus on social-emotional skills. Starting school is a huge transition for kids. Children need to be able to identify their emotions and develop skills for how to deal with different emotions. We start the year learning our schedule and routines, discussing what is expected of members of our classroom, exploring how to be kind to one another, and understanding that it is okay to get upset while learning skills to calm ourselves. We also spend a lot of time on problem-solving, including how to be fair with one another and how to solve problems without needing an adult. The children need to learn to function successfully as a class and by spending the time on social and emotional competencies those first several weeks of school, classroom management is easier and the entire year can be practically seamless. After that, you can easily dive into the academics.

On a last note, recently, our state recognized the importance of social-emotional development. In January 2018, they released updated Tennessee Early Learning Standards for four-year-olds in our state. I was very happy to see that the updated standards strengthened the importance of social-emotional development. This is all so important because, if children don’t feel safe and loved in their classrooms, they aren’t going to be able to learn!


Blog articles provide insights on the activities of schools, programs, grantees, and other education stakeholders to promote continuing discussion of educational innovation and reform. Articles do not endorse any educational product, service, curriculum or pedagogy.

Briana Harris (thumbnail)
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Briana Harris Lead Teacher Cambridge Early Learning Center Nashville, Tennessee

“Voices from the Field” Interview: Dan Gaffney, Leading Efforts to Improve and Expand Early Childhood Opportunities in Northwest Oregon

Dan Gaffney

Dan Gaffney

Dan Gaffney is a veteran educator and administrator, having spent 17 years with the Seaside School District in Oregon as an elementary principal and special education director. He later coordinated Clatsop County’s Preschool—Third Grade (P-3) Collaboration project to align programs and professional development for those working and involved with the education and care of children from birth to age 8. He also developed and directed Clatsop County’s early childhood health and education screening for 3 years. Dan has served on Oregon’s Northwest Early Learning Hub Governance Committee and Clatsop County’s Way to Wellville Strategic Council. Most recently, Dan directed the U.S. Department of Education-funded Preschool Pay for Success Feasibility Study involving Clatsop and Tillamook Counties in Oregon.


ED: How did you begin your career in education and then choose to focus on the importance of early learning?

Dan: I spent 37 years as a K–12 educator. First as a teacher, 13 years as elementary principal, and four years as a special education and English language learner director. All of these experiences really helped me understand the importance of the early childhood years. Being a special education director connected me with a broader education community that includes the medical community working with preschoolers who have or are suspected of having a disability. During the last five years, I’ve worked on preschool to third grade alignment. This has involved working with early childhood experts and the medical community to run a health and development screening clinic available to families with young children in our community. It has addressed a need in our community and connected these families much earlier to both the educational and health systems.

Our community is relatively rural, about 100 miles from Portland, Oregon, and on the coast. One of the things that struck me when I moved here 30 years ago is that people here are resourceful and pull together when there is a need. We find ways to address challenges which can be hard when you are far from a major metropolitan area. Our poverty rates continue to grow. In the elementary school where I was principal, 35 percent of students qualified for free and reduced lunch when I first started. Now, 17 years later, almost 70 percent of students qualify for free and reduced lunch. Our community has also become much more diverse with schools seeing increasing numbers of English language learners. Recognizing these changes in our community broadened my awareness of the challenges families with young children experience and led me to early childhood advocacy work. It also connected me to others at the state and local level working to improve early learning opportunities for young children in need. It has been fun and rewarding working with others who are passionate about improving services and programs for families and young children.

ED: What efforts have you and your community been involved in to improve the quality of early childhood programs and services?

Dan: I coordinated Clatsop County’s Preschool—Third Grade (P-3) Collaboration (funded through the Oregon Community Foundation). This project supported the alignment of educational programs, parenting programs and professional development for early childhood providers, school district teachers and administrators, healthcare professionals, and others involved in the education and care of children from birth to age 8. We called this initiative Clatsop Kinder Ready and brought together leaders from our Hispanic community and county government, preschool and K–12 educators, and others who delivered services to our young learners. That led us to do early childhood health and education screening clinics where families could bring in preschool-aged children and receive free health, developmental, and education screenings, and if needed, follow up with appropriate services. We conducted a couple of these each year. This effort relied on many volunteers—nursing students from the college, local Head Start staff, interpreters from the Hispanic Council, local high school students, elementary school staff, physicians, school psychologists, and others. We also provided transportation support when needed. It was a great example of the community working together.

Then, the state started funding Early Learning Hubs, which are charged with getting cross-sector partners to work together to create local systems that provide families and young children with the support they need. Our Northwest Early Learning Hub was able to take on the screenings, and now the hub is working to improve the link between screenings and the need for appropriate referrals and further evaluation.

A new piece of this work that our community started last year is the Welcome Baby project. The group that worked together under Clatsop Kinder Ready recognized we needed to do something to connect with families of new babies. Following the successful work in other Oregon communities who developed a welcome box, we decided to create welcome baby baskets that include needed baby supplies and a community ABC book. In the ABC book, each letter of the alphabet represents a service available in the community. Last I heard, we had given out over 100 of these in the two local hospitals where each family also connects with a social worker. Last May, we held a county-wide baby shower and invited all the families of babies that had been born in the last year to meet other families and service providers. Participants shared information about different programs and services available for young children and families. The county health department is going to take on the Welcome Baby program and we hope it can be sustained. It has increased awareness and excitement about the importance of these early years and what’s available to help families.

ED: How has your community benefitted from your Preschool Pay for Success (PFS) Feasibility Study and other early learning efforts?

Dan: We were thrilled we had the opportunity to explore how to expand high-quality preschool programs in our community through the Preschool PFS Feasibility Study. More specifically, the purpose of the study was to determine whether or not PFS was a feasible approach for this. Complementing the study were efforts by the Sorenson Impact Center at the University of Utah. Their data experts came in and helped us examine data from eight local school systems and Oregon’s Department of Education that could help inform our efforts.

There have been many benefits of conducting the PFS feasibility study. First, it broadened our set of partners engaged in our early learning work. Having a grant from the U.S. Department of Education really helped us to connect with partners at the University of Utah, the state, and other early learning partners and to form true collaborations. One of the unique partners we have here is the Coast Guard. We have over 600 Coast Guard families living in the county and two additional ships are being reassigned to our area. Our partnership with the Coast Guard extends to serving the needs of their families. They are interested in exploring what they can do and offer in terms of resources to help their families and the broader community around early learning. Our project also attracted interest from state leaders within the education department’s early learning division and the Children’s Institute, Oregon’s largest children’s advocate organization.

Second, and this excited people from the beginning, the study allowed us to pull together data we hadn’t had time or resources to pull together before. This renewed look at data solidified many of our assumptions but also provided us with new information. For example, we now have data showing us that the mobility of families in our community is a big issue. We can see the percentages of our students that are moving regularly across the eight school districts in our community; these data will be helpful in responding to this issue and better meeting the needs of our transient students. Data were really valuable for internal planning and when reaching out externally to clearly demonstrate the extent of our community’s needs. It made a case for expanding high-quality preschool and helped us develop specifics for how to reach families with young children.

Third, through the feasibility study we conducted a cost benefit analysis of preschool expansion and resulting transportation needs in our community. This helped us understand its cost and potential benefits, and understand when and how those benefits occur. Finally, being part of a feasibility study allowed us to consider doing things a little bit differently. We were new to the PFS concept, but it has helped us think about how we can expand on what worked for some of our families and children with the greatest needs.

ED: What suggestions do you have for others interested in expanding access to high-quality early learning programs?

Dan: Collaborate; don’t try to do it on your own. Find out who else has interest, expertise, and connections that are beneficial to not just families and children, but to the overall community. Think about connecting with businesses and your local chamber of commerce. For example, we learned one of our local fish processing centers was looking at buying slots in a local child care program and building that into their employees’ compensation so they could retain high-quality workers. We then brought them into our efforts since they were motivated to support their employees.

Don’t be afraid to reach out to leaders who might seem like they aren’t interested. Have your two minute elevator speech ready—be concise about what you are doing and why, and what the possibilities are. Over the course of my career, and with much practice, I have learned how to make a compelling pitch and have refined my approach with leaders.

Finally, be ready for ups and downs. There definitely isn’t an easy path in this work, but when you have a core group that is committed and willing to dream together and work together, you can keep the momentum going.


Blog articles provide insights on the activities of schools, programs, grantees, and other education stakeholders to promote continuing discussion of educational innovation and reform. Articles do not endorse any educational product, service, curriculum or pedagogy.

“Voices from the Field” Interview with Kate Roper and Eve Wilder, Massachusetts Early Childhood Comprehensive Systems Project

Eve Wilder and Kate Roper

Eve Wilder and Kate Roper

Kate Roper is the Assistant Director of Early Childhood Services in the Bureau of Family Health and Nutrition at the Massachusetts Department of Public Health (DPH). Roper oversees several state and federal grants, including Project LAUNCH and Early Childhood Comprehensive Systems (ECCS) grants, and co-leads the Massachusetts Pyramid Model State Leadership Team. Roper has been in the field of early childhood education since 1978 as an infant teacher, teen parent child care director, trainer, adjunct faculty member, and independent consultant and curriculum developer.

Eve Wilder is the ECCS Coordinator at DPH’s Bureau of Family Health and Nutrition. Wilder has managed early childhood projects at DPH through the state’s ECCS grant for over 7 years. She has worked to strengthen early childhood systems of care in a variety of capacities since 2005, from providing home-based services to young children with autism spectrum disorders, to policy and program development at the Massachusetts legislature and DPH.


ED: How did you begin your career in early childhood?

Kate: I’ve always had a passion for understanding why people become forces for good. So, in college, I ended up with a joint major in psychology and education. I became more interested in early childhood by spending time in the nursery school on campus. At first I thought focusing on kindergarteners was too old, and then I decided focusing on preschoolers was too old. In my first job out of college, I ended up as an infant teacher in a child care program that was focused on supporting families going back to work. Here I gained an understanding of the importance of working with the whole family. Later, I earned a master’s degree in human development and worked with high-school-aged young parents. I started working alongside social workers and guidance counselors, and became familiar with the family systems model, where the family is central to supporting healthy development in their young child. I also began adjunct-teaching at local colleges on early childhood development and started consulting with the Massachusetts Department of Public Health (DPH).This eventually led to a position working directly for the DPH Bureau of Family Health and Nutrition. In 2003, Massachusetts was awarded an Early Childhood Comprehensive Systems (ECCS) grant from the U.S. Department of Health and Human Services’ (HHS’) Health Resources and Services Administration (HRSA). I started working on the ECCS grant which, at that time, was very open-ended and focused on coordinating across systems of family support, parenting education, early education and care, health, and mental health. Eventually, in 2006, I became the director of our ECCS grant. That year was also the inaugural year of the Massachusetts Department of Early Education and Care (EEC) and we partnered with them to build a strong emphasis on mental health. In 2009, we received a Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health) grant from HHS’ Substance Abuse Mental Health Services Administration (SAMHSA) and I took on leading that project as well.

Eve: My career in early childhood started in college. I volunteered at a family shelter where I helped to provide child care. There was a boy living with his mom at the shelter who, at the age of four, was diagnosed with autism. I was blown away by the lack of supports for him and his mom and the late age of his diagnosis. That really motivated me to learn more about the various systems in place to help children and families—health, education, and social services—and to identify and find solutions to cross-systems-level issues. After I graduated from college, I became a specialty early intervention provider under the Individuals with Disabilities Education Act (IDEA) Part C, where I worked for several years providing home-based services to young children with autism spectrum disorders (ASD). I learned first-hand how the family and community context impacts child development. I then had an opportunity to work as a legislative aide for a member of our state legislature. It was fascinating working on the policy side, helping draft bills related to early childhood health and development. Eventually I earned a master’s degree in public health. I became a Leadership Education and Neurodevelopmental Disability (LEND) program fellow, and was able to focus on systems and policy issues impacting children with special health care needs. I started at DPH as a graduate student intern working with Kate and came on as staff when a position opened up on the ECCS grant. I’ve been at DPH for seven years working on both ECCS and the state’s Early Learning Challenge (ELC) grant.

ED: What efforts have you and your organization been involved in to improve the quality of early childhood programs and services?

Kate: For the first eight years of our ECCS grant we mostly functioned as a convening and development office that served any of the state’s early childhood collaborative projects and technical assistance (TA) opportunities. For example, we worked with the Children’s Trust to bring Strengthening Families to the state; and with EEC to being implementing the Pyramid Model. We convened a state leadership team for Pyramid Model implementation. We also used our convening power to develop an Early Childhood Mental Health Strategic Plan, which led the state to apply for and receive a SAMHSA systems of care grant and our Project LAUNCH grant. Our efforts were really focused on working with other state agencies to develop initiatives that benefit young children. It worked out nicely that during this phase, EEC invited us to the table when they applied for and were awarded the ELC grant. As one of four agencies within the state to receive ELC funding, we helped lead efforts to develop coordinated TA focused on trauma-informed care and family mental health. We also helped bring more of a health focus to child care in the state by building capacity in regional offices and by hiring regional nurses.

Eve: Prior to the ELC grant and regional nurses, our ECCS grant built capacity for health consultants supporting early learning and care programs. These consultants provided basic information when it came to working with children with complex medical needs or addressing the outbreak of a virus. When we put four regional nurses into the field, it was great because they provided direct medical support around medication administration (including asthma and severe allergies), worked with young children with diabetes, helped address the obesity crisis, and more. Unfortunately, when the ELC grant ended, we were not able to find a way to sustain this health work, including funding for the nurse positions. We have, however, tried to maximize the resources that were developed under ELC through TA and train-the-trainer approaches. We’ve had to be creative and adaptable in partnering with colleagues within DPH and across the early education field to sustain many components of the work.

ED: How has your ECCS project evolved over time?

Eve: In 2012, HRSA changed the guidance for ECCS and increased its emphasis on infants and toddlers. For our grant, we chose to address and mitigate toxic stress on the development of infants and toddlers in two local communities, Springfield and Chelsea. The first phase of this work had fewer defined parameters so our two communities did a lot of relationship building, including identifying a common vision for addressing toxic stress. We are now in the later phase, known as the ECCS Impact Project, which has additional structure, a focus on measuring our impact, and increased funding. As an ECCS grantee, we are part of a Collaborative Improvement and Innovation Network (CoIIN), which is a multidisciplinary team of federal, state, and local leaders working together to tackle a common problem. HRSA supports CoIINs that address a range of topics. We participate in the ECCS COIIN. The primary aim of the ECCS grant is to show a 25-percent increase in age-appropriate developmental skills among our participating communities’ 3-year-old children. With our two communities and our state-level partners, we discussed and defined what that means for us. Once we did this, the CoIIN guided us through using a Plan-Do-Study-Act methodology to impact change.

When we first convened our teams in Chelsea and Springfield, we focused on identifying where the needs were in these communities. We found that we have a strong IDEA Part C system, relatively high levels of developmental screening, and nearly universal health insurance coverage for children. However, we are still challenged by persistent inequities in health and development outcomes for young children of color and those living in poverty. Through a partnership with a local United Way program’s developmental screening initiative, we are training parents from the communities on how to use the Ages and Stages Questionnaire (ASQ), a developmental screening tool, and how to reach out to families that are not connected to existing programs. We do this through local institutions and establishments such as libraries, parks, and laundromats. This approach is focused on building connections to isolated or not-yet-engaged families, talking with them about their child’s development and, if there are any concerns, helping these families connect to resources and services.

Another exciting piece of this ECCS grant is a coordinated database for ASQ that we are building in partnership with the United Way. Parent screeners enter screening data into the database, and then other programs (with a data sharing agreement) can see the data at the aggregate community level. The goal is to begin to identify trends in the community. We have found this to be particularly helpful in Boston. When we were completing the ECCS grant application, we realized that we didn’t have a consistent health and development measure for young children at the population level, and this ASQ database has been our first step towards developing one. We are also exploring how we might build on some data integration efforts that DPH is undertaking, including a community-level dashboard that includes aggregate data, as well as ways to use de-identified but matched data across data sets. This allows us to look at aggregate data from various data sets (and keep individual data private) so we can identify areas of risk and the outcomes of interventions. The final piece of our ECCS grant that we’re trying to accomplish is to make more of a collective impact in the state, across agencies and funders, by building processes and networks that sustain the work.

ED: What suggestions do you have for others interested in using systems-level work to improve early childhood services and programs?

Kate: Cross-systems work is really powerful, and having HRSA funding for the convening and systems-building work in our state has been extremely useful. We recommend you start with a small project; build trust; and learn about other agencies’ and partner organizations’ strengths, expertise, and resources. Sustainability is always a challenge, so bring it into the work from the very beginning. Try to be creative and intentional about bringing outside partners in to help.

The other suggestion we have is to keep showing up to meetings. Attend those meetings where at first you aren’t comfortable, but eventually you can learn the language of that other system. For example, the word “assessment” means something different depending on who you are talking to and about. As you bring together folks from different disciplines and programs, become a translator across systems. ECCS has allowed us to be like Switzerland, a neutral convener. And always remember the focus of this work that we’re doing: it’s about children and families.


Blog articles provide insights on the activities of schools, programs, grantees, and other education stakeholders to promote continuing discussion of educational innovation and reform. Articles do not endorse any educational product, service, curriculum or pedagogy.

Kate Roper
Posted by
Assistant Director of Early Childhood Services, Bureau of Family Health and Nutrition, MA Department of Public Health
Eve Wilder
Posted by
Early Childhood Comprehensive Systems Coordinator, Bureau of Family Health and Nutrition, MA Department of Public Health

She Will Never…

Note: May is Better Hearing and Speech Month.

Rene Averitt-Sanzone

Rene Averitt-Sanzone
Executive Director
Parents’ Place of Maryland

Those were the words I heard over and over again when my oldest child was born 27 years ago. She will never read past a third grade reading level; she can only hope for a menial or labor-oriented job; this is the best her writing will ever be so maybe you should just accept it, maybe you are in denial. Sound familiar? I am sure that I am not alone as a mom. Many of us have heard these words from well-meaning and well-intended professionals who are only trying to help.

In July of 1990, I gave birth to a very healthy and beautiful baby girl, Laurin. I mean, she was adorable (seriously, picture the Gerber baby. That was Laurin.). She seemed to be doing everything ahead of the developmental milestones: crawling, sitting up, etc. But then, on Christmas when Laurin was five months old, my sister came to me and said, “I just tripped and knocked over some pots and pans behind Laurin and she didn’t startle.”

It is safe to say that this single moment radically changed my world.

Throughout the next month, I tested Laurin’s hearing: clapping my hands behind her, clanging pots and pans, you name it. Yes, sometimes she turned and other times she did not. What’s a mom to do? It was then time for Laurin’s six-month well-baby checkup. I told our family doctor that I thought there might be a problem with Laurin’s hearing. His fateful response was, “It seems unlikely, but you are her mother and you know her best. Let’s just get her hearing checked.” All I could visualize was my Gerber baby sitting with big clunky headphones strapped on her head. How in the world could they test her hearing? All I knew of hearing tests was from my elementary school days—sitting very still, listening intently for a beep so I could raise my hand. Before we walked out of our doctor’s office, we had an appointment to see an audiologist.

The next few weeks were a blur—lots of crying, lots of testing, lots of unknowns, and then the audiology appointment. To be honest, I was so lost. It was like I stepped into a whole other world—one of strange words and acronyms, ABR, amplification, speech banana, Db, frequency… this was just the start of all of the special education lingo that was to follow shortly after our audiology appointment. So yes, Laurin’s auditory brainstem response (ABR) was basically a flat line. I’m not sure exactly what I felt, but I can say that Laurin was clueless. All she wanted to do was to play and explore the world around her. Our audiologist broke the news to us in a very direct and factual way, which was such a relief. He also said that he could be wrong. We went for a second ABR and his diagnosis was confirmed—she was profoundly deaf in both ears. Bilateral deafness; yes, another new vocabulary term added to my repertoire.

Looking back, I didn’t realize that the diagnosis was the easy part of this journey. After the diagnosis, our audiologist informed us that we needed to decide on a methodology. Huh? Consider amplification. Hmm? He also shared that there were very strong and opposing opinions about what were the best ways to teach children who are deaf. Later I learned that this was an understatement. He sent us off to do our research. Now remember, this was 27 years ago, and there was no internet. We went old school: our local library. We checked out every book they had on deafness and began to read.

I also received a wide array of advice: there is a residential program 30 minutes down the road; do not take no for an answer. I clung to this advice, which firmly cemented that I was Laurin’s mom and I had to make the decisions. It came from a Parent Educator at the Exceptional Children’s Assistance Center, North Carolina’s PTI (parent training and information center). Little did I know, my Parent Educator would later become my confidant and mentor. Just knowing that she was on the other end of the phone, or joining us for a training session, was such reassurance as we journeyed through Laurin’s life.

Four years later, we decided to have another baby. We felt like we had things somewhat under control. Laurin was fully included with her peers in our local childcare program. The school system was doing all kinds of creative supports and services for her. Her team and I decided that it was time for a cochlear implant. I had it all mapped out: surgery on June 1, second baby the middle of July—what could go wrong? Everyone told me that Laurin’s deafness was a fluke, right?

Her sister came on the fourth of July, and yep, you guessed it, she was another baby who was deaf. I wish I could say that I didn’t cry, but I did. However, this time I was a pro at the vocabulary and acronyms. This time, her big sister had already blazed the trail. Fast forward 20 plus years, and I am an empty nester. Both girls are grown and married. The youngest graduated college two years ago. And Laurin, her big sister? Well, as someone who was told she’ll struggle, and of course never earn academic honors…she of course graduated high school with honors, in the top 10% of her class; went onto college (which wasn’t for her); lived abroad; worked a variety of jobs until she figured out her path; and will graduate from college this May!

To say that I am proud of both of my daughters is the understatement of the century. I’d like to think that I played a role in their success and accomplishments, but truth be told, they came into this world as amazing women! It took persistence, and truly a village’s worth of blood, sweat, and tears from more people than I can name to make success and happiness a reality for them.

So what’s next for me? Hopefully grandbabies one day!


Blog articles provide insights on the activities of schools, programs, grantees, and other education stakeholders to promote continuing discussion of educational innovation and reform. Articles do not endorse any educational product, service, curriculum or pedagogy.

Improving Early Childhood Intervention

Note: May is Better Hearing and Speech Month.

The Early Childhood Personnel Center (ECPC) logo

Infancy and early childhood are important times of life for all children, but more so for those who have delays in development. These delays may be from genetic conditions, disabilities, various risk conditions, or unknown reasons. While families may be the first to recognize a difference in their child’s developmental progress, professionals trained and licensed in early childhood intervention have the skills and knowledge to detect a developmental delay and to then provide intervention to remediate and/or minimize its impact on a child’s development.

Traditionally, professionals train in a single discipline that usually corresponds to an area of development. For example, speech-language pathologists are experts in the development of communication. Likewise, physical therapists are experts in a child’s physical or motor development. Additionally, most disciplines are trained to offer services and intervene across a broad age range—the lifespan of an individual. When a person completes a program of study in a discipline, the individual is then licensed in that discipline to provide services to persons across the lifespan.

These training and licensing practices create two challenges to providing effective early childhood intervention to infants and young children and their families:

  • Interventions may be focused to specific areas of development by discipline specific interventionists (e.g. an occupational therapist provides specific motor intervention and does not incorporate any other areas of development into her therapy/intervention); and
  • Interventions may be provided by a person who does not have any specific experience or competence in infancy or early childhood.

To address these challenges, the Early Childhood Personnel Center (ECPC), which is funded by the Office of Special Education Programs (OSEP) at the U.S. Department of Education, joined representatives from seven national organizations to examine the professional knowledge, skills and competencies that all disciplines should have when providing intervention to infants and young children.*

First, ECPC identified personnel standards (i.e., knowledge and skill statements) for each of the disciplines represented by the organizations. This yielded 752 individual standards. The organizations and ECPC aligned and reduced these standards until four thematic areas emerged that encompassed all disciplinary standards. Representatives of the seven organizations endorsed these as equally important to all disciplines providing early childhood intervention services. These representatives also operationally defined each area, which are contained in the following table:

Operationalized Definitions of the Four Core Competency Areas

CORE COMPETENCY AREA DEFINITION
Family Centered Practice Family-Centered Practice is culturally competent practice in natural settings that involves and actively engages the family in decision-making and the provision of services/therapy.
Interventions Informed by Evidence Evidenced Based intervention requires the use of scientifically based evidence to inform all screening, assessment, intervention/instruction and evaluation delivered to an individual child and family. Databased intervention and instruction refers to the process of collecting data about a child’s level of performance and designing and implementing a plan (e.g. IEP, IFSP) of instruction/ intervention that is evidence-based and focused on remediating a child’s and family’s needs.
Coordination and Collaboration Coordination and collaboration refers to working across professionals from other disciplines and community organizations in every facet of intervention/instruction.
Professionalism Professionalism requires all who provide early childhood intervention to have knowledge and skills in the laws, policies, practices that govern their professional discipline. It also requires that all in early childhood intervention demonstrate professional ethics and advocacy with each infant, young child and family they work with. Professionals in early childhood intervention will also take responsibility to improve their knowledge and skills through professional development and self-reflection.

The organizations’ boards endorsed these areas and definitions, and the organizations are now working with the ECPC to identify and validate indicators for each competency area. Training and materials will then be developed for both preservice and in-service audiences to teach and support early intervention professionals from multiple disciplines to provide interventions for the infants and young children across developmental areas.

It should be noted that these competencies will not replace the need for therapists and teachers to retain expertise and be licensed in their own discipline to address the needs of the infant or child. Rather, it will help ensure the effectiveness of integrating all developmental areas into a child’s interventions.


* The seven organizations included: The Council of Exceptional Children (CEC), the Division of Early Childhood (DEC), the American Occupational Therapy Association (AOTA), the American Physical Therapy Association (APTA), the American Speech-Language-Hearing Association (ASHA), the National Association for the Education of Young Children (NAEYC) and Zero to Three.


Blog articles provide insights on the activities of schools, programs, grantees, and other education stakeholders to promote continuing discussion of educational innovation and reform. Articles do not endorse any educational product, service, curriculum or pedagogy.

“Voices from the Field” Interview with Will Eiserman, ECHO Initiative

Will Eiserman with a back pack in the woods

Will Eiserman, Director, Early Childhood Hearing Outreach (ECHO) Initiative at Utah State University.

Will Eiserman is the Director of the Early Childhood Hearing Outreach (ECHO) Initiative, at the National Center for Hearing Assessment and Management, Utah State University. As Director of the ECHO Initiative, he has led a national effort to assist Early, Migrant, and American Indian/Alaska Native Head Start programs in updating their hearing screening and follow-up practices. Working in close collaboration with a team of pediatric audiologists and other Early Hearing and Detection Initiative (EHDI) experts, Eiserman has been responsible for the design of training systems, mechanisms for tracking and follow-up, and evaluation strategies associated with early and continuous hearing screening activities. His career has focused on a variety of efforts to improve early intervention systems for children with special needs, and on meeting the psycho-social needs of children with craniofacial disfigurements and their families. Eiserman’s perspective is influenced by his extensive international and cross-cultural experiences that include work in Ecuador, Vietnam, Costa Rica, Russia, and Indonesia.


ED: How did you begin your career in early learning and development?

WE: I first earned my doctorate in educational research and development, and then had an opportunity to do post-doctoral work in early intervention research that was funded by the U.S. Department of Education’s Office of Special Education Programs (OSEP). The project, based at Utah State University, looked at a common set of assumptions about early intervention for young children with disabilities and developmental delays. This was back in the late 1980s, and we were exploring questions such as, “Is early really better in terms of when we intervene with children with disabilities? Is more intervention better than less? What types of interventions are more effective with children experiencing different types of developmental delays?” It was really exciting. Ours was part of the research that set the stage for developing the early intervention (EI) and early childhood special education (ECSE) programs that are now under the Individuals with Disabilities Education Act (IDEA).

I continued my work on EI/ECSE when I moved to the University of West Florida, where we focused on inclusion and family engagement. We provided a lot of training and technical assistance (TA) for local programs on supporting the role of families in EI, and helped programs think of ways to provide interventions for young children with disabilities in more inclusive environments. I then had an international opportunity through a Fulbright fellowship in Indonesia, where I taught research and development methods in social sciences.

A common thread across these experiences is the social integration and empowerment of individuals with special needs or disabilities. They allowed me to see how often there is a constellation of variables that impact the social placement of individuals with disabilities, and how that can be addressed through policies and support.

ED: What are periodic hearing screenings and why are they so important for healthy early learning and development?

WE: When you ask early childhood educators what is important for young children, one of the things they discuss is language development. Language is at the heart of social-emotional development, cognitive development, and school readiness. As conscientious as most early childhood professionals are about promoting language, there is less awareness about the importance of monitoring the status of hearing throughout the early years of development. We tend to think about language primarily as expressive, but we are not as attentive to receptive abilities. Monitoring children’s hearing status is an important investment in healthy language development. If there are concerns, we can intervene and ensure there is minimal impact on language development.

I direct the Early Childhood Hearing Outreach (ECHO) Initiative, which is part of the National Center for Hearing Assessment and Management (NCHAM). NCHAM has been funded for over 25 years by the U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA/MCHB) as a national resource center. It has been instrumental in expanding

  1. hearing screenings, and
  2. the follow-up that may be necessary based on the results of the hearing screening for young children.

Over the last two decades, significant advancements have been made through the provision of newborn hearing screenings. These screenings are now available to more than 95 percent of the children born in the U.S. This is transformative and has dramatically changed the life landscape for individuals who are born hard-of-hearing or deaf.

The work of the ECHO Initiative arose from the observed success of newborn hearing screening efforts across the nation. Recognizing the significant changes newborn hearing screening represented for children and families, the HHS Head Start Bureau (now Office of Head Start) raised an important question about the technology that was making newborn hearing screening possible: whether any of it could be used to continually monitor the status of hearing for the children ages birth–3 years old who were being served in Early Head Start (EHS) programs. Head Start and EHS programs are required to ensure that all children in their programs receive evidence-based hearing screenings. We couldn’t think of any reason why the newly available technology wouldn’t work with this population, but it had never been done. This would require EHS program staff to be trained to screen young children with the Otoacoustic Emissions (OAE) screening method. While research suggested increased likelihood that continuous screening would result in additional identification of children with hearing loss as a result of late-onset or progressive loss, we weren’t sure what we would actually find.

The ECHO Initiative began as a pilot project with a handful of EHS programs in three states: Oregon, Washington, and Utah. From this pilot we discovered that yes, we can train early childhood program staff to conduct the OAE screenings and, in fact, staff often already had the set of skills most needed for conducting the screenings—getting young children to cooperate! Additionally, we found that when you screen 0–3-year-olds with the OAE, you do in fact find children with hearing loss that have not been previously identified. Newborn hearing screening programs have been shown to identify approximately three babies in 1,000 with permanent hearing loss. We found that in the 0–3-years-old range, subsequent to newborn screening, we typically identify another one to three children in 1,000 who have permanent hearing loss. This finding was consistent with research that had suggested the incidence of permanent hearing loss doubles between birth and the time children enter school; from about three in 1,000 at birth, to about six in 1,000 when children reach school-age. This finding was very compelling and led to what has been a multi-decade commitment from the Office of Head Start, in collaboration with HRSA/MCHB, to support the provision of evidence-based hearing screening and follow-up practices for all children in EHS and Head Start across the nation. This has occurred through the availability of online resources, training, and TA. Our website includes a broad array of resources and information about training and TA opportunities that help promote evidence-based hearing screening for young children.

ED: What are some of the challenges you have experienced in promoting regular hearing screenings, and what strategies have you tried to overcome them?

WE: Obviously, the use of technology nearly always involves some costs. Hearing screening equipment has associated costs, whether you’re using OAE, the recommended hearing screening method for children 0–3 years of age, or Pure Tone screening (historically used with 3–5-year-olds). Training is critical and needs to be provided in a timely fashion. It should also respond to high staff turnover, which is a reality in nearly all early care and education environments. To address these needs, the ECHO Initiative offers online trainings. We also partner with audiologists in locations across the country who can assist individual programs to conduct evidence-based hearing screening and follow-up practices.

Another challenge inherent in implementing any health or educational screening program has to do with ensuring the necessary follow-up occurs when children do not pass. There are multiple reasons why a child might not pass a hearing screening. Our data show that about 25 percent of children in the birth-to-age-3 range don’t pass the initial OAE hearing screening on one or both ears. We don’t recommend, however, that all of those children be referred for further evaluation. Instead, our protocol recommends screening these children again in 2 weeks, at which point we consistently see the “not pass” rate decline to about 8 percent. This may be due to screener error during the first screening; a transient condition that caused fluid in the middle ear and prevented an ear to pass the screening; or even a temporary wax blockage that worked its way out during the transpiring 2 weeks. For children who don’t pass the second screening, we recommend families go to a health care provider for a middle ear evaluation and treatment, if necessary. It is not uncommon that these children are found to have had an ear infection that wasn’t noted. This is not the completion of the screening process, however. Once any middle ear disorder is addressed, we screen the child again to see if they pass. If they still do not pass, then the child is referred to a pediatric audiologist for a complete audiological evaluation. You can see that there are potential challenges in supporting families to complete these many follow-up steps. Additionally, the availability of pediatric audiologists can present as a challenge. We have found that EHS and Head Start staff are often very skilled and innovative in supporting families through the completion of all follow-up, and recognizing that monitoring hearing is a critical part of promoting language development during the early years.

Spreading the message about the importance of hearing screenings is an ongoing challenge. We want to increase the awareness of this for parents, caregivers, and providers of health and educational services throughout early childhood. Given that the status of hearing can change at any time in a child’s life, we cannot rely on any single screening, but must screen periodically. We’ve developed several short videos about the importance of monitoring hearing throughout early childhood, and we invite viewers to share them and help us spread the word:

ED: What suggestions do you have for others interested in expanding regular hearing screenings as part of high-quality early learning programs?

WE: We encourage people to explore the resources and learning opportunities we have available on the ECHO website. In developing our various resources, we have recognized that those doing hearing screening nearly always have many other responsibilities as well. We have tried to provide a comprehensive set of resources so that programs can easily develop evidence-based practices without having to recreate the wheel. And we’ve tried to provide resources that are applicable and relevant across a variety of early childhood program contexts, including center-based or home-based programs; rural or urban program settings; and programs serving children in Head Start-funded programs, IDEA Part C, or health care settings. We also try to make our resources helpful across our stakeholder groups, which include many partners with an interest in increasing periodic hearing screenings—health care providers, IDEA Part C early intervention programs, EHS and Head Start programs, child care providers, families, and the Early Hearing and Detection Initiative (EHDI) programs within states.

My final suggestion is to be aware of the assumptions we often make in early childhood. We don’t ever want to assume a child can hear before that has been verified. For example, even if a child turns toward sound, that doesn’t give you enough information to know that the child’s hearing is in the normal range. We also don’t want to just assume a child has been assessed. Unless you have ear-specific results from an objective screening that was conducted within the last year, you really can’t be certain of the current status of a child’s hearing. Finally, we must caution that, even if a child passes an objective hearing screening, any concerns about a child’s hearing ability or language development would warrant a referral for a complete audiological evaluation.


Blog articles provide insights on the activities of schools, programs, grantees, and other education stakeholders to promote continuing discussion of educational innovation and reform. Articles do not endorse any educational product, service, curriculum or pedagogy.

Will Eiserman
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Director, Early Childhood Hearing Outreach (ECHO) Initiative, National Center for Hearing Assessment and Management, Utah State University