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Reasons for CIs before 12 months…

May 4th, 2008 by | Tags: , | 27 Comments »

A friend of mine sent me a very interesting research study about why getting CIs is a very valuable option and why children should receive them before 12 months:

Cochlear implant candidacy in the United States: Prevalence in children 12 months to 6 years of age.

 

27 Comments

shel

May 4, 2008 at 8:21 pm

Cost effective to society? Geez..that is really distressing. If I had a deaf child, I wouldnt implant him/her that early just to save society some money. I think that is a sad state of affairs if the medical community is looking at deaf people like that. We are people, not statistics to reduce the cost to society. This just breaks my heart.

Hearing Mom

May 4, 2008 at 10:39 pm

This is one of the worst pieces of research I have ever seen. It uses estimates to point to subjective conclusions that are based upon no proven research. It is another sales pitch for implanting babies and children, or should I say “neurologically devastated” babies and children, using the researcher’s opinions on cost savings to society as the punch line.

Neurologically Devastated…..Good Grief!! Is this really how they view the Deaf???

Elizabeth

May 4, 2008 at 10:52 pm

“Children who would be considered “neurologically devastated” and the children with absent eighth nerves were excluded from the calculations.”

This statement does not imply that people with hearing loss are neurologically devastated. If you’ll read carefully, what it means is that, in designing the study, researchers excluded people who were deaf due to brain malformations — i.e. children born with anencephaly/microcephaly (no/limited brain development)or children born without an auditory nerve system. These children obviously could not benefit from cochlear implant technology, as they had no auditory nerve present for the CI to stimulate.

Also, the study cites its various sources of information. So, while you might disagree with the conclusions, it is not valid to say that they are not based on proven research.

Hearing Mom

May 4, 2008 at 11:41 pm

Yes, right I did misread that statement. I stand corrected.
However, what research data was involved? If the study cites its various sources then it would be best to include the link.

Older and Wiser

May 5, 2008 at 4:00 am

Just because the surgical implant itself was a success, it does not always mean that they have always learned to verbally communicate effectively and I still would like to see unbiased states on those. a 50.1% success rate, which counts “majority” as majority is a word often used as opposed to showing exact percentages in research links that have been provided in the past, and this would not be good enough and actually not be cost efective to society.

Its already a proven fact that CI do not work for every deaf person. This is the equivalency of me selling you a pinto, yugo, or even an edsel where I could speak highly of it, but they have a terrible history.

Rox

May 5, 2008 at 10:01 am

I don’t understand how getting more of these children implanted would prove to be cost effective for society. Can someone explain this to me?

Elizabeth

May 5, 2008 at 10:44 am

Though the cochlear implant requires an initial outset of money for the surgery, equipment, and follow-up treatment, it is eventually a greater “return on investment” for society. Consider:

“Cochlear implantation accompanied by aural (re)habilitation increases access to acoustic information of spoken language, leading to higher rates of mainstream placement in schools and lower dependence on special education support services. The cost savings that results from a decrease in the use of support services indicates an educational cost benefit of cochlear implant (re)habilitation for many children [...] A cost-benefit analysis based on conservative estimates of educational expenses from kindergarten to 12th grade shows a cost savings of cochlear implantation and appropriate auditory (re)habilitation that ranges from $30,000 to $200,000.” (http://archotol.ama-assn.org/cgi/content/abstract/125/5/499)

Methods which equip children to listen, speak, and function in mainstream schools/society are cost effective because:
-children in mainstream settings with minimal support services means that there is no need to pay interpreter salaries
-saves money on pull-out programs, self-contained special education classrooms
-saves money on transportation, when children can attend their neighborhood schools and do not have to be bussed to schools with special deaf ed programs
-the cost of operating state residential schools for the deaf
-the cost of paying for social welfare for deaf people who have problems finding jobs (not because of their intelligence or skills, but because of communication barriers — I’m not saying signing deaf people are any less capable, but we all know that employers are going to be biased toward someone who can listen and talk to them in spoken English — it might not be right or fair, but it’s true)

RE: Rox’s comment #1, I can understand how talking about any human being, especially children, in ecnomic terms can seem a little unfeeling or crass. It’s hard to perform a “cost-benefit analysis” on a living, breathing human being. I don’t think it’s how any one individual practitioner views his/her charges. Ultimately, however, this is how the government is going to evaluate any kind of social programming, and methods which produce such good results are going to be more likely to receive funding in this era of federally mandated evidence-based practice.

May 5, 2008 at 10:49 am

Almost all of the CI/AV kids I know have minimal to absolutely no accommodations in school, thereby saving the school systems thousands of dollars during their 13 years of education before college. These kids don’t need interpreters, which also represents a cost savings. One portable soundfield system that cost the school $700 took Rachel through 4 years of high school. Furthermore, the early generation of these kids are now in college, some already having graduated. They are attending regular mainstream schools, some of them at some of the top colleges in the nation. None of these kids that I know require interpreters. It is also highly unlikely that they will be part of the higher unemployment statistics for the deaf population, which, according to the Marion Downs Institute, is at 24%.

This is not to say that there haven’t been kids who have signed who achieved, because I know that there are. However, I do believe that in the ways I have specified above, children who receive CIs as babies or toddlers who are able to function as minimally hard of hearing in the mainstream will need society’s help less.

Anonymous

May 5, 2008 at 3:21 pm

I’ll point out that it is indeed cost-effective for society for all of the reasons that Melissa pointed out (also, reduced expenses for state-sponsored deaf schools and deaf programs), however, it’s not cost effective for the PARENTS. As far as I understand, insurance do not cover AVT therapy (my insurance didn’t at least). My therapist was 40 bucks/hour and when I went to her 3 times a week, that’s a big cost for the parents. Thank goodness my parents tightened their belt and sucked it up for me.

Also, I’m not quite comfortable saying that interpreters are just a “cost” on the state – if you take a step back, and look in the bigger picture, you can see how giving more employment opportunities is not a bad thing (interpreters earn good money, and will spend money) and in the long run, more beneficial for the economy.

But what i think is a true cost to society is deaf on social secuirty/welfare/unemployment. Unfortunately this is PARTLY due to ASL – even if you had two deaf candidates for the same job with similar qualifications, theone who can hear some/voice some would probably be hired. Sucks? yes, but alas, c’est la vie – and EEOC woudl not protect the ASL user (ADA’s employment discrimination laws really have no teeth).

AV mom

May 5, 2008 at 6:18 pm

AV can run from $120 to $180 an hour (insurance billed– and these are just costs I have personally had for my kids), though rates can be modified for those who can’t afford it. Some centers of therapists do offer scholarships, as do some organizations. But the reality for toddlers or babies who are implanted is a likely time of therapy which is less than 4 years (sometimes far less). So they are finished by kindergarten, and require no additional therapy in the school setting or elsewhere.

Insurance absolutely covers AVT in many circumstances. Also, state birth to three programs often cover it in part or fully, some on a sliding scale based on income. Most surgeons include the request for the follow-up therapy in the letter for initial coverage of implantation– meaning, if it’s not covered, you might as well forget it. Without follow-up care it’s useless; you need audiology and at least a minimal amount to learning to listen. Therefore, the insurance companies are bound to the promise to pay for therapy.

I would say that the cost to parents (out of pocket, stress, time) is considered WELL worth it because in the end, the parents don’t have the long term worry of difficulty with education and employment. As a parent, I know that there is a sense of security in the likelihood that they can graduate from college if they so desire, get a job, etc. Yes, some deaf people have their dream job, but it’s more likely that one will be able to pursue one’s choice profession if one can hear. While we all know the famous people who have been deaf and become actors or business people or professors, the statistics are not so great for the rest.

Personally, as a parent, even my batteries are covered by insurance. They would amount to less than $400 a year. I pay a $20 co-pay each time we arrive for therapy. We only have it every 2 weeks, and will be finished in less than 2 year’s time. My children are ready for mainstreaming by preschool. My insurance even covers broken parts, though we sometimes buy a few extras for our peace of mind; it all adds up to a couple of hundred dollars a year. Compare all of that to the cost to my personal savings and retirement down the road if my child was making less than the poverty level vs. carrying their own weight… well, family is family, and I do know that we would help our kids out if they needed it. So we have probably saved a heck of a lot by implanting. In the next few years, about the only cost I foresee that will be new is one of those shaker or blinking alarm clocks.

To tell the truth, I foresee a day when very, very little AVT will be needed by only a few individuals due to increasing early implantation and improvement in the CI technology (or hair cell regeneration). Costs will only go down to parents, though of course we all pay, in a way, for scientific discovery. What remains to be seen is the difference between how interpreters have viewed CIs vs. how AVTs will view the improvements. Who will bow out gracefully? Knowing the therapists I’ve known, I believe that they will have a massive party and be thrilled that their clientele is decreasing!

This is not the only study regarding infants and young children. There are at least dozen more out there from the last decade, and they ALL point to the benefits of CIs for infants… either from cost analysis, from their ability to understand or speak commensurate with their peers, or from other vantage points.

May 5, 2008 at 6:26 pm

Anonymous -

20 years ago when Rachel began AVT, insurance did not cover it. However, that has changed over the years, and insurance does cover it and, in fact, started paying for Rachel’s sessions in 1991. I think that certification of AV therapists has helped, along with the advent of the CI putting AV much more in the mainstream.

May 5, 2008 at 7:20 pm

There is another impact to consider. The types of jobs you study for is impacted by your verbal ability. I would imagine that if you broke down the types of jobs that nonverbal Deaf study for, versus the types of jobs CI deaf study for, you would see a marked difference.

Anonymous

May 5, 2008 at 8:26 pm

Wow, it seems like my insurance was behind – my sessions were never covered and I got my implant in ’91.

sessh. However, I am happy to hear that insurance is starting to pick up the bill because..

KL – I am involved in the legal profession, which is a pretty verbal-heavy profession and there is very little deaf representation here, CI or not. In fact, most o the deaf people I know are signers, but I think that will change as the first generation of pediatric CIs graduate from college.

shel

May 5, 2008 at 8:57 pm

Society’s discrimination at its worst…that’s what I am seeing from this article and from some of these comments. It shouldnt be that way. I have nothing else to say cuz I cant believe what I am reading.

Anonymous

May 5, 2008 at 9:38 pm

let me just make this clear – I desest the fact that parents have to make a choice like this. I don’t blame parents for choosing the route that will open up more doors for their children. I doubt anyone can say that there are equal opportunities for ASL users in every respect becasue, unfortunately, discrimination in employment is there, english problems are there (although I am not convinced this is entirely due to ASL, but the way that it is taught).

I’m the last person to deny that ASL users experience more discrimination than oral/AVT users. However, I do question whether it is better for society to simply encourage parents to not teach their children ASL and use the AVT/oral method exclusively because that doesn’t help remedy the discrimination at all. It makes it worse because there will be less and less services for ASL users.

I must admit, this does bother me, but I’m not sure I can do much about it. It’s a shame, really – America is supposed to be a melting pot after all.

Just a mom to three boys

May 6, 2008 at 8:28 am

Again, we are all looking at this study through different eyes.

I think that many still have the image of some secret meeting at AV centers where they talk about how bad ASL is for deaf children. It’s not like that at all. We will never agree as to how best to provide language for our deaf children. If a family’s goal is for their child to have spoken English as a primary language, AVT is a viable option. It’s proven. It’s successful when all steps are followed as mentioned by Rachel in other blogs. My family’s goal is not for our child’s primary language to be ASL and secondary to be English; therefore, we would not have chosen bi-bi/tc/etc. It’s not about society being ashamed of ASL. It’s about choosing an approach and sticking to it. While many believe that I am “playing Russian Roulette” with his life, I beg to differ. I have provided him with language, it happens to be spoken English..but it’s language. I would wholeheartedly support a family’s choice to provide ASL as a primary language as well.

This is a melting pot. It’s clearly seen when reading these blogs. What would be more discriminatory is if you told me that my deaf child must use ASL as his primary language and written English could be his secondary. That is what many seem to want, and that would equal discrimination.

May 7, 2008 at 12:36 am

Hi,

I’m honestly intrigued by your blog. I love your writing and how you are so talented in pushing forward your beliefs. I really do respect you for that.

I’m deaf, Jewish, 20 years old, and would love to email you and get to know you better on a personal level. You can check out my blog for information on me.

Hoping to hear from you! :-)

- Leah

Deaf/Oral Lady

May 7, 2008 at 5:40 pm

Hello Hearing parents of CI children. Please ask your children if the teachers, AVT teachers, anyone ABUSE them??? Please WATCH OUT in oral/CI school. Thank you!!!!

jillio

May 7, 2008 at 10:06 pm

“Cost effectiveness to society” is nothing more than double speak for sales pitch. The fact of the matter is, the majority of students with CI in a mainstream placement continue to require extensive accommodation. Not to mention which, when Medicare and Medicaid are paying up to 80% of the cost forthe initial surgery and activation costs, society is indeed accepting the burden financially. Not to mention which, basing the decision to implant on what will be financially acceptable to society is the most offensive justification one can come up with. Jusdt more forced assimilation, in my mind. Anyone who opts for CI should do so because they have made an informed decision for themselves regarding the perceived personal benefit for the individual…not because it will cost their neighbors less. Is this what it has come to?

jillio

May 7, 2008 at 10:11 pm

This is a attempt to collect data to find ways to reach even more implant candidates by the medical communoty. In other words, it is market research designed to increase business.

All this supports is the idea that the medical community will stop at nothing in order to increase the number of surgeries they perform. What ever happened to patient centered practice? Its all about business and profit.

Joshua Bartholomew

May 8, 2008 at 6:28 am

Can we have the link to it the actual study.. so that we can draw better informed conclusions?

Rachel, if you are an example of someone who has been sucessful in a aquiring English Language via aural means, then it’s one that is constantly undermined by your lack of critical appraisal, forethought, and comprehension in the articles you present.

May 8, 2008 at 1:58 pm

May 8, 2008 at 2:04 pm

From “Cost-Utility Analysis of the Cochlear lmplant in
Children,” Andre K. Cheng, MD, PhD; Haya R. Rubin, MD, PhD: Neil R.
Powe, MD, MPH, MBA; Nancy K Mellon, MS; Howard W Francis,
MD;John K. Niparko, MD, Johns Hopkins University, Journal of the American Medical Association, August 16, 2000.

“A child provided with the implant saves society more than $53,000 by requiring fewer special education services and having a higher income potential, the report said.”

The full article takes into account the costs of the surgery and follow-up.

Joshua Bartholomew

May 8, 2008 at 10:28 pm

The link is inaccessible.. you have to register.

May 9, 2008 at 10:58 am

It’s not a for pay site. You can register for free.

May 10, 2008 at 9:36 am

[...] an impairment, a disability, for which some medicos come up with such dehumanisating terms as neurologically devastated, implanted, or users of sign language or assistive listening [...]

jillio

May 11, 2008 at 9:32 pm

Regarding the estimated $53,000 in special education services: that is a figure that can vary widely depending upon the child, and the services provided. $53,000 is a high end estimate.

Regarding greater employment opportunity: as the number of early implanted children have not yet reached the age to begin a career, that is something that can only be hypothesized, not something that can be supported through research. Longitudinal data simply is not available for the population. Once again, just propoganda designed as a selling point.