{"Affiliation":[{"label":"Affiliation","value":"Education, Faculty of","attrs":{"lang":"en","ns":"http:\/\/vivoweb.org\/ontology\/core#departmentOrSchool","classmap":"vivo:EducationalProcess","property":"vivo:departmentOrSchool"},"iri":"http:\/\/vivoweb.org\/ontology\/core#departmentOrSchool","explain":"VIVO-ISF Ontology V1.6 Property; The department or school name within institution; Not intended to be an institution name."},{"label":"Affiliation","value":"Educational and Counselling Psychology, and Special Education (ECPS), Department of","attrs":{"lang":"en","ns":"http:\/\/vivoweb.org\/ontology\/core#departmentOrSchool","classmap":"vivo:EducationalProcess","property":"vivo:departmentOrSchool"},"iri":"http:\/\/vivoweb.org\/ontology\/core#departmentOrSchool","explain":"VIVO-ISF Ontology V1.6 Property; The department or school name within institution; Not intended to be an institution name."}],"AggregatedSourceRepository":[{"label":"Aggregated Source Repository","value":"DSpace","attrs":{"lang":"en","ns":"http:\/\/www.europeana.eu\/schemas\/edm\/dataProvider","classmap":"ore:Aggregation","property":"edm:dataProvider"},"iri":"http:\/\/www.europeana.eu\/schemas\/edm\/dataProvider","explain":"A Europeana Data Model Property; The name or identifier of the organization who contributes data indirectly to an aggregation service (e.g. Europeana)"}],"Campus":[{"label":"Campus","value":"UBCV","attrs":{"lang":"en","ns":"https:\/\/open.library.ubc.ca\/terms#degreeCampus","classmap":"oc:ThesisDescription","property":"oc:degreeCampus"},"iri":"https:\/\/open.library.ubc.ca\/terms#degreeCampus","explain":"UBC Open Collections Metadata Components; Local Field; Identifies the name of the campus from which the graduate completed their degree."}],"Creator":[{"label":"Creator","value":"Kwon, Eun Young","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/terms\/creator","classmap":"dpla:SourceResource","property":"dcterms:creator"},"iri":"http:\/\/purl.org\/dc\/terms\/creator","explain":"A Dublin Core Terms Property; An entity primarily responsible for making the resource.; Examples of a Contributor include a person, an organization, or a service."}],"DateAvailable":[{"label":"Date Available","value":"2023-05-26T08:04:37Z","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/terms\/issued","classmap":"edm:WebResource","property":"dcterms:issued"},"iri":"http:\/\/purl.org\/dc\/terms\/issued","explain":"A Dublin Core Terms Property; Date of formal issuance (e.g., publication) of the resource."}],"DateIssued":[{"label":"Date Issued","value":"2023","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/terms\/issued","classmap":"oc:SourceResource","property":"dcterms:issued"},"iri":"http:\/\/purl.org\/dc\/terms\/issued","explain":"A Dublin Core Terms Property; Date of formal issuance (e.g., publication) of the resource."}],"Degree":[{"label":"Degree (Theses)","value":"Doctor of Philosophy - PhD","attrs":{"lang":"en","ns":"http:\/\/vivoweb.org\/ontology\/core#relatedDegree","classmap":"vivo:ThesisDegree","property":"vivo:relatedDegree"},"iri":"http:\/\/vivoweb.org\/ontology\/core#relatedDegree","explain":"VIVO-ISF Ontology V1.6 Property; The thesis degree; Extended Property specified by UBC, as per https:\/\/wiki.duraspace.org\/display\/VIVO\/Ontology+Editor%27s+Guide"}],"DegreeGrantor":[{"label":"Degree Grantor","value":"University of British Columbia","attrs":{"lang":"en","ns":"https:\/\/open.library.ubc.ca\/terms#degreeGrantor","classmap":"oc:ThesisDescription","property":"oc:degreeGrantor"},"iri":"https:\/\/open.library.ubc.ca\/terms#degreeGrantor","explain":"UBC Open Collections Metadata Components; Local Field; Indicates the institution where thesis was granted."}],"Description":[{"label":"Description","value":"This dissertation utilized four consecutive studies to examine considerations in the education of students who are deaf and hard of hearing (d\/Dhh) with disabilities to gain a better understanding of how to effectively support the learners, their families, and their schools.   \r\nFirst, a case study of a 9-year-old deaf child with autism from an immigrant family was conducted to understand the educational experiences of d\/Dhh learners with disabilities and to form a foundation for future research. In Study 1, the perspectives of parents and teachers are explored regarding educational eligibility, placement, and intervention. Study 2 examines language and communication factors reported by administrators in educational decision-making and documentation for the case study. Themes are reported across the learner, partners (i.e., parents, educators, peers), and environment based on the Tri-Focus framework (Siegel-Causey & Bashinski, 1997). It is recommended educators implement culturally and linguistically responsive practices in collaboration with parents. \r\nEmploying a non-concurrent multiple baseline design, Study 3 investigates the effects of reading social stories with American Sign Language vocabulary to increase social interaction between d\/Dhh students with autism and their peers across three general education classrooms. The frequency of communicative social behaviors and the duration of social engagement at lunchtime and recess were recorded. The results do not show an immediate effect of the intervention across all participants, although teachers reported the social validity of the intervention as significant. Implications for promoting social inclusion of d\/Dhh students with autism in general education classrooms are discussed. \r\nStudy 4 was conducted to explore practices and considerations in the education of d\/Dhh students with disabilities in British Columbia from the educators\u2019 perspective through an online survey and focus group interviews. Findings from the previous studies provided the groundwork for the survey. Results indicate that equitable services should be delivered according to the needs of students, not by the categorical labels of disabilities. Recommendations are made on how strengths-based approaches can be practiced across the whole learning process including assessment, planning and placement, and intervention. Together, these studies provide theoretical and practical implications for the field as well as an empirical basis for researchers.","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/terms\/description","classmap":"dpla:SourceResource","property":"dcterms:description"},"iri":"http:\/\/purl.org\/dc\/terms\/description","explain":"A Dublin Core Terms Property; An account of the resource.; Description may include but is not limited to: an abstract, a table of contents, a graphical representation, or a free-text account of the resource."}],"DigitalResourceOriginalRecord":[{"label":"Digital Resource Original Record","value":"https:\/\/circle.library.ubc.ca\/rest\/handle\/2429\/84693?expand=metadata","attrs":{"lang":"en","ns":"http:\/\/www.europeana.eu\/schemas\/edm\/aggregatedCHO","classmap":"ore:Aggregation","property":"edm:aggregatedCHO"},"iri":"http:\/\/www.europeana.eu\/schemas\/edm\/aggregatedCHO","explain":"A Europeana Data Model Property; The identifier of the source object, e.g. the Mona Lisa itself. This could be a full linked open date URI or an internal identifier"}],"FullText":[{"label":"Full Text","value":"EXPLORING CONSIDERATIONS FOR THE LEARNER, FAMILY, AND SCHOOL  IN THE EDUCATION OF STUDENTS WHO ARE DEAF OR HARD OF HEARING WITH DISABILITIES  by  Eun Young Kwon  M.Ed., The University of British Columbia, 2007 M.A., Ewha Womans University, 1998 B.A., Chonnam National, 1992   A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF  DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (Special Education)  THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver)  May 2023  \u00a9 Eun Young Kwon, 2023  ii The following individuals certify that they have read, and recommend to the Faculty of Graduate and Postdoctoral Studies for acceptance, the dissertation entitled: Exploring considerations for the learner, family, and school in the education of students who are deaf or hard of hearing with disabilities  submitted by Eun Young Kwon in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Special Education  Examining Committee: Joanna E. Cannon, Professor, Educational and Counselling Psychology, and Special Education, UBC Supervisor  Sterett H. Mercer, Professor, Educational and Counselling Psychology, and Special Education, UBC Supervisory Committee Member  Vicki F. Knight, Associate Professor, Educational and Counselling Psychology, and Special Education, UBC Supervisory Committee Member Lee Gunderson, Professor, Language and Literacy Education, UBC University Examiner M. Cay Holbrook, Professor, Educational and Counselling Psychology, and Special Education, UBC University Examiner    iii Abstract This dissertation utilized four consecutive studies to examine considerations in the education of students who are deaf and hard of hearing (d\/Dhh) with disabilities to gain a better understanding of how to effectively support the learners, their families, and their schools.    First, a case study of a 9-year-old deaf child with autism from an immigrant family was conducted to understand the educational experiences of d\/Dhh learners with disabilities and to form a foundation for future research. In Study 1, the perspectives of parents and teachers are explored regarding educational eligibility, placement, and intervention. Study 2 examines language and communication factors reported by administrators in educational decision-making and documentation for the case study. Themes are reported across the learner, partners (i.e., parents, educators, peers), and environment based on the Tri-Focus framework (Siegel-Causey & Bashinski, 1997). It is recommended educators implement culturally and linguistically responsive practices in collaboration with parents.  Employing a non-concurrent multiple baseline design, Study 3 investigates the effects of reading social stories with American Sign Language vocabulary to increase social interaction between d\/Dhh students with autism and their peers across three general education classrooms. The frequency of communicative social behaviors and the duration of social engagement at lunchtime and recess were recorded. The results do not show an immediate effect of the intervention across all participants, although teachers reported the social validity of the intervention as significant. Implications for promoting social inclusion of d\/Dhh students with autism in general education classrooms are discussed.  Study 4 was conducted to explore practices and considerations in the education of d\/Dhh students with disabilities in British Columbia from the educators\u2019 perspective through an online  iv survey and focus group interviews. Findings from the previous studies provided the groundwork for the survey. Results indicate that equitable services should be delivered according to the needs of students, not by the categorical labels of disabilities. Recommendations are made on how strengths-based approaches can be practiced across the whole learning process including assessment, planning and placement, and intervention. Together, these studies provide theoretical and practical implications for the field as well as an empirical basis for researchers.   v Lay Summary More than 40% of students who are deaf or hard of hearing (d\/Dhh) have additional disabilities (e.g., autism, blindness). Due to varying levels of diverse learning challenges, educators are often uncertain about how to optimally serve these learners. The purpose of this dissertation is to gain a better understanding of how to effectively meet the needs of learners, families, and educators by exploring their concerns, experiences, and educational practices. To achieve this aim, four studies were conducted consecutively. The first two studies report the experiences of a deaf student with autism and his Korean, immigrant family. Study 3 is an experiment to see if reading social stories with sign language vocabulary increases social interaction between d\/Dhh students with autism and their peers in regular classrooms. The last study examines current practices and considerations in British Columbia in the education of d\/Dhh students with disabilities from the educators\u2019 perspectives.  vi Preface The present dissertation is comprised of two published manuscripts and two unpublished papers that outline the considerations for the learner, family, and school in the education of students who are deaf or hard of hearing with disabilities.  Study 1 (outlined in Chapter 2) was conducted in a school district in the Lower Mainland of British Columbia. A version of this manuscript was published as a chapter in the book, Deaf and Hard of Hearing Multilingual Learners: Foundations, Strategies, and Resources in January 2022 by Routledge. The citation is as follows: [Kwon, E. Y., Guardino, C., & Cannon, J. E. (2022). d\/Deaf and hard of hearing multilingual learners with disabilities: A case study of a learner who is deaf with autism spectrum disorder and from an immigrant family. In J. E. Cannon, C. Guardino, & P. V. Paul (Eds), Deaf and Hard of Hearing Multilingual Learners: Foundations, Strategies, and Resources (pp. 219-263). Routledge. https:\/\/doi.org\/10.4324\/9781003259176-7]. Print form is also available through Routledge. Ethical approval was granted by the University of British Columbia Research Ethics Board (H19-01165). Research approval was received from the school district. I led all aspects of this investigation including study design, ethical application, participant recruitment, interviews, data collection, data analysis and interpretation of the data, and manuscript preparation. Drs. Caroline Guardino and Joanna E. Cannon are co-authors of this manuscript. They participated in the triangulation process for qualitative data analysis. Study 2 (outlined in Chapter 3) was also conducted in a school district in the Lower Mainland of British Columbia. A version of this paper has been revised and resubmitted to be considered for a special themed issue, \u201cLanguage, Literacy, and Culture in East Asian Communities\u201d in a peer-reviewed journal related to deaf education. Ethical approval was granted  vii by the University of British Columbia Research Ethics Board (H21-00221). Research approval was received from the school district. I was responsible for all aspects of the research including designing the research questions, collecting, analyzing, and interpreting the data, and manuscript preparation. Drs. Joanna E. Cannon and Caroline Guardino are co-authors of this manuscript. They triangulated the results to facilitate the validation of the data. Study 3 (outlined in Chapter 4) was conducted at three different general elementary schools in two school districts in the Lower Mainland of British Columbia. A poster of this research was presented at the Association of College of Educators \u2013 Deaf and Hard of Hearing Conference, Atlanta, GA on February 14, 2020. A version of this manuscript was published in the Journal of Autism and Developmental Disorders. The citation is as follows: [Kwon, E. Y., Cannon, J. E., Knight, V., Mercer, S., & Guardino, C. (2022). Effects of social stories on increasing social interaction and communicative behaviors of deaf and hard of hearing students with autism spectrum disorders in inclusive settings. Journal of Autism and Developmental Disorders. https:\/\/doi.org\/10.1007\/s10803-022-05430-4]. Ethics approval was granted by the University of British Columbia Research Ethics Board (H19-00004). Research approvals were received from both school districts. I led all aspects of this investigation including study design, ethical application, participant recruitment, implementation of the intervention, data collection, data analysis and interpretation, and manuscript preparation. Drs. Joanna E. Cannon, Vicki F. Knight, Sterett H. Mercer, and Caroline Guardino are co-authors of this manuscript.  Study 4 (outlined in Chapter 5) was conducted at the University of British Columbia. Ethics approval was granted by the University of British Columbia Research Ethics Board (H21-00264). Research approvals were required by and received from three school districts. The other participating school districts did not require approval. I led all aspects of this investigation  viii including designing the study, compiling the questionnaire, developing the ethical application, recruiting participants, conducting the online survey, facilitating focus group interviews, analyzing, and interpreting the data, and preparing the paper. Drs. Joanna E. Cannon and Nancy Norman participated in the triangulation process for qualitative data analysis. Dr. Cannon also assisted with technology needs during the focus groups.   ix Table of Contents  Abstract ......................................................................................................................................... iii Lay Summary .................................................................................................................................v Preface ........................................................................................................................................... vi Table of Contents ......................................................................................................................... ix List of Tables ............................................................................................................................. xvii List of Figures ........................................................................................................................... xviii List of Abbreviations ................................................................................................................. xix Chapter 1: Introduction ................................................................................................................1 1.1 Positionality of Researcher ............................................................................................. 2 1.2 Students who are d\/Dhh with Disabilities ....................................................................... 2 1.3 Theoretical Frameworks ................................................................................................. 5 1.3.1 Vygotsky's Sociocultural Theory ................................................................................ 5 1.3.2 Social Interactionism Theory ...................................................................................... 6 1.4 Demographics and Prevalence ........................................................................................ 8 1.5 Considerations in Educationg d\/Dhh Students with Disabilities .................................... 9 1.5.1 Language and Communication Development ............................................................. 9 1.5.2 Identification and Eligibility ..................................................................................... 11 1.5.3 Educational Placement  ............................................................................................. 12 1.5.4 Assessment and Evidence-based Practices ............................................................... 13 1.5.5 Professional Development ........................................................................................ 14 1.5.6 Collaborative Practices ............................................................................................. 15  x 1.6 Purpose and Structure of Research ............................................................................... 27 Chapter 2: A Case Study of a Learner who is Deaf with Autism Spectrum Disorder and from an Immigrant Family .........................................................................................................19 2.1 Introduction ................................................................................................................... 19 2.1.1 Terminology .............................................................................................................. 19 2.1.2 Demographic and Prevalence Data ........................................................................... 19 2.1.3 Theoretical Frameworks and Approaches ................................................................ 20 2.1.4 Educational Issues and Considerations ..................................................................... 22 2.1.5 Purpose of Research .................................................................................................. 25 2.2 Methods......................................................................................................................... 26 2.2.1 Participants ................................................................................................................ 26 2.2.2 Procedures and Setting .............................................................................................. 27 2.2.3 Data Analysis ............................................................................................................ 28 2.3 Results ........................................................................................................................... 29 2.3.1 Parents' Perspectives ................................................................................................. 29 2.3.2 Educators' Perspectives ............................................................................................. 35 2.3.3 Linguistic and Communication Considerations ........................................................ 41 2.4 Discussion ..................................................................................................................... 45 2.4.1 Educational Eligibility .............................................................................................. 46 2.4.2 Educational Placement .............................................................................................. 46 2.4.3 Intervention ............................................................................................................... 48 2.4.4 Linguistic and Communication Considerations ........................................................ 48 2.4.5 Conclusion ................................................................................................................ 51  xi Chapter 3: Examining the Language and Communication Factors of a Deaf Child with Autism Spectrum Disorder from an Immigrant Family ..........................................................53 3.1 Introduction ................................................................................................................... 53 3.1.1 Tri-focus Framework ................................................................................................ 54 3.1.2 The Learner ............................................................................................................... 54 3.1.3 The Communication Partners ................................................................................... 56 3.1.4 The Environment ...................................................................................................... 57 3.1.5 Purpose of Research .................................................................................................. 58 3.2 Methods......................................................................................................................... 59 3.2.1 Participants ................................................................................................................ 59 3.2.2 Procedures and Setting .............................................................................................. 60 3.2.3 Data Analysis ............................................................................................................ 61 3.3 Results ........................................................................................................................... 61 3.3.1 Document Analysis ................................................................................................... 61 3.3.1.1 The Learner ....................................................................................................... 61 3.3.1.2 The Communication Partner ............................................................................. 63 3.3.1.3 The Environment .............................................................................................. 64 3.3.2 Interview Analysis .................................................................................................... 65 3.3.2.1 The Learner ....................................................................................................... 65 3.3.2.2 The Communication Partner ............................................................................. 67 3.3.2.3 The Environment .............................................................................................. 69 3.4 Discussion ..................................................................................................................... 71 3.4.1 The Learner ............................................................................................................... 72  xii 3.4.2 The Communication Partners ................................................................................... 74 3.4.2.1 Parent Partners .................................................................................................. 74 3.4.2.2 Educator Partners .............................................................................................. 75 3.4.3 The Environment ...................................................................................................... 77 3.4.4 Recommendations ..................................................................................................... 79 3.4.5 Conclusion ................................................................................................................ 79 Chapter 4: Effects of Social Stories on Increasing Social Interaction and Engagement of Deaf and Hard of Hearing Students with Autism Spectrum Disorder In Inclusive Settings........................................................................................................................................................81 4.1 Introduction ................................................................................................................... 81 4.1.1 Social Interactions between Peers ............................................................................. 81 4.1.2 Social Stories as Evidence-based Practice ................................................................ 82 4.1.3 Modifications for d\/Dhh studdents with ASD .......................................................... 83 4.1.4 Research Questions ................................................................................................... 84 4.2 Methods......................................................................................................................... 85 4.2.1 Participants ................................................................................................................ 85 4.2.2 Measures ................................................................................................................... 87 4.2.3 Procedures ................................................................................................................. 90 4.2.3.1 Recruitment ....................................................................................................... 90 4.2.3.2 Research Design and Setting ............................................................................ 90 4.2.3.3 Implementation Fidelity .................................................................................... 92 4.2.3.4 Interobserver Agreement .................................................................................. 93 4.2.3.5 Social Validity .................................................................................................. 93  xiii 4.3 Results ........................................................................................................................... 94 4.3.1 Frequency of Social Initiation and Response of d\/Dhh Students ............................. 94 4.3.2 Frequency of Social Initiation and Response of Peers.............................................. 96 4.3.3 Duration of Social Engagement between the d\/Dhh students and Peers .................. 99 4.3.4 Social Validity ........................................................................................................ 101 4.4 Discussion ................................................................................................................... 102 4.4.1 Variable Effects across Students ............................................................................. 102 4.4.2 Social Validity ........................................................................................................ 107 4.4.3 Limitations .............................................................................................................. 108 4.4.4 Implications for Researchers................................................................................... 109 4.4.5 Conclusion .............................................................................................................. 110 Chapter 5: Education of Students Who are Deaf and Hard of Hearing with Disabilities in British Columbia: Identification and Eligibility, Placement, and Intervention...................111 5.1 Introduction ................................................................................................................. 111 5.1.1 Prevalence of d\/Dhh Students with Disabilities in BC ........................................... 112 5.1.2 Identification and Eligibility ................................................................................... 113 5.1.3 Educational Placement ............................................................................................ 114 5.1.4 Intervention ............................................................................................................. 115 5.1.5 Purpose of Research ................................................................................................ 116 5.2 Methods....................................................................................................................... 117 5.2.1 Participants .............................................................................................................. 117 5.2.2 Procedures ............................................................................................................... 120 5.2.3 Measures ................................................................................................................. 121  xiv 5.2.4 Recruitment ............................................................................................................. 122 5.2.5 Research Design and Data Analysis ....................................................................... 123 5.3 Results ......................................................................................................................... 124 5.3.1 Identification and Eligibility for Service Provision ................................................ 124 5.3.1.1 Current Practices in Identification and Eligibility .......................................... 124 5.3.1.2 Considerations in Identification and Eligibility .............................................. 130 5.3.1.3 Suggestions in Identification and Eligibility................................................... 137 5.3.2 Educational Placement ............................................................................................ 139 5.3.2.1 Current Practices in Educational Placement ................................................... 139 5.3.2.2 Considerations in Educational Placement ....................................................... 144 5.3.2.3 Suggestions in Educational Placement ........................................................... 151 5.3.3 Implementation of Strategies and Interventions ..................................................... 156 5.3.3.1 Current Practices in Intervention .................................................................... 156 5.3.3.2 Considerations in Intervention ........................................................................ 163 5.3.3.3 Suggestions in Intervention............................................................................. 174 5.3.4 Summary of Results ................................................................................................ 185 5.4 Discussion ................................................................................................................... 186 5.4.1 Strengths-based Approaches to Assessment ........................................................... 186 5.4.2 Equitable Services ................................................................................................... 188 5.4.3 Equipping an Educationa Placement ...................................................................... 191 5.4.4 Strengths-based Approaches to Planning and Implementation .............................. 194 5.4.5 Collaborative Practices ........................................................................................... 198 5.4.6 Limitations .............................................................................................................. 200  xv 5.4.7 Future Research ...................................................................................................... 202 5.4.8 Conclusion .............................................................................................................. 202 Chapter 6: Discussion ................................................................................................................204 6.1 Synthesis of the Research Findings ............................................................................ 204 6.1.1 Considerations for d\/Dhh Learners with Disabilities.............................................. 205 6.1.2 Considerations for the Families .............................................................................. 205 6.1.3 Considerations for Schools ..................................................................................... 206 6.1.4 Strengths of the Research........................................................................................ 207 6.2 Novel Contributions of the Research .......................................................................... 209 6.3 Limitations of the Research ........................................................................................ 211 6.4 Future Directions ........................................................................................................ 212 6.5 Conclusion .................................................................................................................. 214 Bibliography ...............................................................................................................................215 Appendices ..................................................................................................................................257 Appendix A. Case Study ......................................................................................................... 257 A.1 Parent Consent Form for Interview......................................................................... 257 A.2 Parent Consent Form for Interview in Korean ........................................................ 260 A.3 Educator Consent Form .......................................................................................... 263 A.4 Parent Interview Questions ..................................................................................... 265 A.5 Educator Interview Questions ................................................................................. 269 A.6 Parent Consent Form for Document Release .......................................................... 270 A.7 Parent Consent Form for Document Release in Korean ......................................... 272 Appendix B. Experimental Study ........................................................................................... 274  xvi B.1 Parent Consent Form............................................................................................... 274 B.2 Assent Consent Form .............................................................................................. 277 B.3 Letter to Teachers and Educational Assistants ....................................................... 279 B.4 Six Social Stories and ASL Vocabulary ................................................................. 281 B.5 Social Validity Questionaire ................................................................................... 286 Appendix C. Mixed-Methods Study ....................................................................................... 287 C.1 Survey Invitiation Letter ......................................................................................... 287 C.2 Survey Questionaire ................................................................................................ 288 C.3 Focus Group Interview Consent Form .................................................................... 301 C.4 Focus Group Guiding Questions ............................................................................. 304   xvii List of Tables  Table 2.1 Demographics of educator participants ........................................................................ 27 Table 3.1 Demographics of administrator participants ................................................................. 60 Table 4.1 Demographics of d\/Dhh participants ............................................................................ 86 Table 4.2 Coding definitions, examples, and non-examples ........................................................ 88 Table 4.3 Summary of mean scores of social validity across educators ..................................... 102 Table 5.1 Demographic information of survey participants ....................................................... 118 Table 5.2 Demographic information of focus group participants ............................................... 120 Table 5.3 Practices in identification and eligibility for service provision .................................. 125 Table 5.4 Prevalence data reported by TDHHs and administrators ............................................ 129 Table 5.5 d\/Dhh students receiving direct services from TDHHs .............................................. 130 Table 5.6 Educational placement options available in BC ......................................................... 139 Table 5.7 Case managers for d\/Dhh students with disabilities ................................................... 140 Table 5.8 Educators' perspective on meeting educational needs ................................................ 141 Table 5.9 Reasons for school transitions .................................................................................... 144 Table 5.10 Professionals available for d\/Dhh students with disabilities .................................... 157 Table 5.11 Challenging factors in intervention........................................................................... 158 Table 5.12 Collaboration ............................................................................................................ 159 Table 5.13 Teacher preparedness ................................................................................................ 160 Table 5.14 Interventions and strategies frequently implemented by educators .......................... 162   xviii List of Figures  Figure 4.1 Frequency of social initiations and responses by d\/Dhh students towards peers ........ 95 Figure 4.2 Frequency of social initiations and responses by peers towards d\/Dhh students ........ 97 Figure 4.3 Estimated duration of social engagement of d\/Dhh students with peers ................... 100    xix List of Abbreviations  AAC \u2013 Augmentative and Alternative Communication ABA \u2013 Applied Behavior Analysis ASD \u2013 Autism Spectrum Disorder ASL \u2013 American Sign Language BC \u2013 British Columbia  BCBA \u2013 Board Certified Behavior Analyst CAEDHH - Canadian Association of Educators for the Deaf and Hard of Hearing d\/Dhh \u2013 deaf\/Deaf or Hard of Hearing d\/Dhh-ASD \u2013 deaf\/Deaf or Hard of Hearing with Autism Spectrum Disorder DML \u2013 Deaf or hard of hearing Multilingual Learner DML-D \u2013 Deaf or hard of hearing Multilingual Learner with Disabilities DWD \u2013 Deaf or hard of hearing With Disabilities  EA \u2013 Educational Assistant EBP \u2013 Evidence-Based Practices GRI \u2013 Gallaudet Research Institute IEP \u2013 Individual Education Plan IPCP \u2013 Interprofessional Collaborative Practice K-12 - Kindergarten to Grade 12 MKO \u2013 More Knowledgeable Other PECS \u2013 Picture Exchange Communication System SLP \u2013 Speech Language Pathologist  xx TDHH \u2013 Teacher of the deaf and hard of hearing UDL \u2013 Universal Design for Learning  1 Chapter 1: Introduction More than 40% of students who are deaf or hard of hearing (d\/Dhh) are reported to experience one or more disabilities (Gallaudet Research Institute [GRI], 2013). Educational settings for these students represent a continuum of placements including all\/part of the day in general education settings, special classes designed for students with disabilities located in general education settings, specialized schools for the d\/Dhh, etc. (Shaver et al., 2014; Terry, 2014). Due to diverse learning characteristics, educators, including teachers of the deaf and hard of hearing (TDHHs), are often uncertain about how to optimally serve this population of learners in their school settings. Extant literature is sparse, especially on the national and provincial levels. The collaboration between professionals, professional development of teachers (i.e., pre- and in-service training), and the involvement of parents are reported to be some of the key factors for success in the education of students who are d\/Dhh with disabilities (DWD). This dissertation includes two published papers and two unpublished manuscripts that investigate the needs of these learners, their families, and educators. This chapter provides theoretical frameworks that support the rationale for the studies presented in this dissertation, along with demographic information and overall considerations that have been addressed in literature in the education of students who are DWD.  1.1 Positionality of Researcher I acknowledge that my previous personal and professional experiences have influenced the research process: what I chose to investigate, who I contacted for investigation, where I conducted the research, and how I interpreted the research data findings (Holmes, 2020). As a teacher of the deaf and hard of hearing, I have worked in several different educational settings including a resource room for d\/Dhh students (i.e., a \u201chub-like\u201d program in a cohort public  2 school), itinerant teaching within a school district, and the School for the Deaf. Most of my students presented with disabilities across varying hearing levels. Their learning characteristics have been diverse and their needs for support were heterogenous. I have witnessed the struggles of both teachers and parents. These experiences have motivated me to pursue further steps in order to explore answers as a \u201cteacher-researcher.\u201d Another influence upon my positionality is my situatedness, or \u201ccultural embeddedness.\u201d As a Korean Canadian who immigrated to Canada 25 years ago, I have been involved in both Korean and English-speaking communities. I often meet new immigrants whose children have disabilities and who struggle with advocating for better services for their children. Jimin in Chapter 2 was one of the children of the parents I spoke with, and I, as a researcher, decided to bring their voices to the field. My perspective toward d\/Dhh learners with or without disabilities has changed over the progression of this research. For a long time, I realized I viewed them as d\/Deaf students with disabilities who needed my expertise; my focus was how to meet their complex needs. While writing the last two chapters, I noticed that I started to see and describe them as individuals who are just as unique as any one of us. I learned I need to hear their own voices. As a learner, I know I have my weaknesses, but when I am able to focus on my interest, curiosity, passion, and strength, I make positive contributions. Thus, as an educator, I continue to focus on my student\u2019s interests, curiosity, passion, and strengths, so that they can also become a contributing member of their family, school, and community. As a motivated learner, I want to allow my values and beliefs to change over time, hopefully, evolving in a positive direction. 1.2 Students who are d\/Dhh with Disabilities A DWD student is defined, within this dissertation, as a student who is d\/Dhh and has one or more disabilities such as intellectual disability (ID), autism spectrum disorder (ASD), or  3 learning disability (LD). The d\/Dhh student population is highly diverse. The learners vary widely in terms of age of onset of hearing loss, degree, type, amplification, and preferred\/chosen communication method (Silverman et al., 2004). Concurrent disability(-ies) with hearing loss contributes to this diversity (Paul, 2015). The overarching term DWD, throughout the dissertation, is used to cover the d\/Dhh individuals in a variety of disability subgroups (e.g., d\/Dhh-ASD, d\/Dhh-ID, d\/Dhh-LD). These learners are described interchangeably as students who are DWD or d\/Dhh students with disabilities, or DWD students.  Deafness is viewed by some as a disability but not by others (Holcomb, 2013; Kent et al., 2003; Leigh et al., 2022; Paul, 2010; Wanis, 2018). In the current education and societal system, hearing loss is regarded or categorized as a disability for funding purposes (British Columbia [BC] Ministry of Education [the Ministry], 2016). Some individuals who identify with the Deaf community, on the other hand, consider themselves a linguistic-cultural minority who use a fully formed language (i.e., American Sign Language [ASL]) and are members of a distinct minority culture (Higgins & Lieberman, 2016). Although not all deaf individuals identify as part of that cultural subgroup, it suggests caution in considering d\/Dhh students to be the same as any other population of students with \u201cdisabilities\u201d (Shaver et al., 2013). With respect to both perspectives, in this dissertation, deafness is described as a hearing difference.  According to the GRI (2013), nearly half of the population of kindergarten to grade 12 (K-12) learners who are d\/Dhh may present at least one disability. The effects of these accompanying disabilities on the development of d\/Dhh children may result in varying levels of challenges across several domains including communication, cognition, and behavior (Carvill, 2001; Carvill & Marston, 2002; Luckner & Carter, 2001).   4 The learning characteristics of DWD students are unique; therefore, each learner requires individual assessment and instructional planning to maximize their potential (Guardino & Cannon, 2021). School accommodations are essential for equitable access to classroom instruction in inclusive educational settings where spoken English is the primary language (Leppo, 2013). Students who are DWD may use different communication forms such as Augmentative and Alternative Communication (AAC) devices, or visual languages such as American Sign Language (ASL). As learners are developing language and communication at home and\/or school, they may also present behaviors that require intervention (Fossett, 2010). Despite these diverse educational needs, evidence-based practices (EBPs) are sparse in the field (Bruce & Borders, 2015; Guardino, 2008; Guardino & Cannon, 2015; Spencer & Marschark, 2010).  During the past 20 years, the inclusive education movement in public schools in Canada has promoted and facilitated the inclusion of the majority of d\/Dhh students into neighborhood school settings alongside their peers (Norman, 2016). Approximately 90% of school-aged d\/Dhh children in the U.S. are educated in general, public-school classroom settings for at least part of the day (GRI, 2013). These learners may receive services from TDHHs, who have reported they lacked skills and were unprepared to support the students who are DWD (Guardino, 2015; Musyoka et al., 2017). Most schools reported that they were not equipped with the support and programming needed for d\/Dhh students with ASD (Delmolino & Harris, 2012). Although families\u2019 involvement is critical in special education (Antia et al., 2002; Ewing & Jones, 2003), those whose children are DWD have reported a lack of dialogue with their child\u2019s school during the process of determining communication modality and educational placement (Singer et al., 2020).   5 1.3 Theoretical Frameworks The theoretical framework that guides this dissertation is Vygotsky\u2019s sociocultural theory on learning and development, which is one of the broad metatheories in psychology (Av-Gay, 2018; Jamieson, 1994; Langford, 2005; Paul, 2009; Skyer, 2020). Vygotsky\u2019s theory has influenced social interactionists, or Social Interactionism Theory, which attempts to explain children\u2019s language acquisition and development (McLeod, 2018; Paul, 2009). Both theories have been reported as applicable in addressing the social and communicative needs of children who are d\/Dhh with or without disabilities (Bruce & Borders, 2015).  1.3.1 Vygotsky\u2019s Sociocultural Theory The metatheoretical framework for this dissertation is based on Vygotsky\u2019s sociocultural theory on learning and development. Sociocultural theory emphasizes that social and cultural forces are mainly responsible for the development of cognition and language while acknowledging the biological origin of diversity in individual learning (Vygotsky, 1978; 1993). He asserts that a holistic understanding of human psychological functioning requires consideration of other factors beyond an individual\u2019s behaviors. Vygotsky\u2019s work highlights the connectedness between an individual's psychological functions and sociocultural process, as articulated by Gindis, \u201cVygotsky considered learning as a shared\/joint process in a responsive social context\u201d (1999, p. 32). In the process, parent-child relations and teacher-student relations are central for learning and development (Vygotsky, 1993)  Vygotsky (1978) highlighted the role of a skillful tutor (i.e., parent or teacher) called the More Knowledgeable Other (MKO). Through social exchanges, the MKO may model behaviors and\/or provide verbal instructions or other forms of meaning-making for the child. The child seeks to understand the actions or instructions provided by the MKO and then internalizes or  6 mediates the information, using it to guide or regulate their own performance. These social exchanges are central not only at home but in all learning contexts, including schools (Wertsch, 1985). With guidance and encouragement from the MKOs, the child learns how to use the language as a means of communicating within the sociocultural environment. Interaction with peers can also be an effective way to develop language and social skills because this type of cooperative or collaborative dialogue promotes cognitive development (Vygotsky, 1978). Thus, in Vygotsky's sociocultural theory, individual development cannot be understood without reference to the social and cultural context within which it is embedded.  There is a growing consensus that any adequate metatheory needs to consider a wide array of factors or conditions that interact within and outside of individuals (e.g., biological, cognitive, environmental, social; Paul, 2009). From the sociocultural perspective, students\u2019 outcomes are not solely attributed to individual innate factors; rather, there are many different variables affecting students\u2019 performance (Av-Gay, 2018). As the theory emphasizes the interdependence between various individuals (e.g., students, parents, and teachers) and their social and cultural environments (Vadeboncoeur, 2017; Vygotsky, 1993; Wertsch, 1985), this perspective may provide educators with necessary insights to understand the individuals who are DWD with a holistic lens rather than focusing on the disability (Siegel, 2013). 1.3.2 Social Interactionism Theory Interactionism, or the interactionist theory (as a micro-metatheory), is one of three broad groups of language theories, along with behaviorist and linguistic theories (Paul, 2009). In general, interactionist theories incorporate tenets from both behavioristic and linguistic approaches, thus being considered a balanced perspective. Interactionists acknowledge that there are a number of factors such as cognitive, social, linguistic, physiological, and environmental  7 that are critical for the development of an individual; the interactive influences of these factors are significant. Within the interactionist framework, there are several major approaches (Bohannon, 2013; Owens, 2012; Whitehead, 2004), depending on the specific focus of models; one of them is the social interactionist approach or Social Interactionism Theory. This group of language theories has been heavily influenced by the work of Vygotsky (Bohannon, 2013; Owens, 2012).  Social interactionists assert that language has a unique, rule-governed structure; however, these structures develop (i.e., emerge or result) from the social functions of language, as evident in human interactions (Paul, 2009). Social interactionists primarily focus on social factors (e.g., pragmatics, communicative interactions, environment) to explain language acquisition. The language-learning process is facilitated by social communication, described as \u201ca complex, reciprocal, dynamic interplay between the child and the social-linguistic environment\u201d (Paul, 2009, p.109). In the dynamic interplay, the input of significant others, or linguistically knowledgeable adults - similar to MKO in Vygotsky\u2019s theory - is important because the input triggers (sets in motion) the innate, unique structures of language, and allows more mature social interaction (Bohannon, 2013). They also believe the linguistic competence of children can only be understood by their performance within a social context.  Social interactionists' approach, as well as Vygotsky\u2019s sociocultural theory, extensively emphasizes the predominance of social and cultural influences and acknowledges the critical contributions of environmental or pragmatic factors to language (and cognitive) development. These influences can include emotions and interactions from the child\u2019s family and significant others at school (i.e., teachers and peers), as well as cultural values associated with them (i.e., families and others; Paul, 2009). Thus, when providing educational services to d\/Dhh children  8 with disabilities, it is important to consider the factors related to families (e.g., linguistic or cultural challenges of parents whose children use a different language or communication mode), educators (e.g., linguistic competence or professional readiness), sociolinguistic environments (e.g., supportive communicative structure, including visual accessibility), and unique learning characteristics attributed to concurrent disabilities. As the Social Interactionism Theory addresses the importance of adult communication partners and the social environment that surrounds the learner, it may provide insight for professionals who work with d\/Dhh learners who are from multicultural backgrounds and\/or have disabilities. Vygotsky\u2019s sociocultural theory on learning and the social interactionists\u2019 approach to language development support the theorizing approaches used in this dissertation.  1.4 Demographics and Prevalence Students who are DWD may constitute approximately 40-50% of the general population of learners who are d\/Dhh (GRI, 2013). This statistic is consistent with several studies including parent-reported data from the National Longitudinal Transition Study-2 (NLTS2) (Leppo et al., 2013) and school-personnel-reported data from the Special Education Elementary Longitudinal Study (SEELS; Marder, 2009). However, ascertaining precise prevalence rates is difficult due to the varied categorization parameters across school districts used to provide services (Mitchell, 2004; Mitchell & Karchmer, 2006). According to Guardino and Cannon (2022), teachers reported a greater incidence rate of DWD students than in the data collected by the GRI at 51.4% (Schley et al., 2013) and 53% (Guardino, 2015). This implies there may be a discrepancy between the teachers\u2019 perspective and the special education classification system when it comes to identifying the educational needs of students who are DWD. Furthermore, due to the sampling issues related to the GRI survey, the population of DWD students may be underestimated  9 (Guardino, 2008); thus, the prevalence of accompanying disabilities with d\/Dhh children should be viewed with caution (Fossett, 2010). And unfortunately, up to date data is currently unavailable because the U.S. based GRI survey is no longer distributed, and this type of demographic data has never been collected in Canada. 1.5 Considerations in Educating d\/Dhh Students with Disabilities There are several considerations in the education of students who are DWD. The studies included in this dissertation attempt to investigate the diverse needs of the learners, especially in the areas of language and communication development, identification and service provision, educational placement, and interventions.  1.5.1 Language and Communication Development It is a long and evolving process for a DWD child to develop language and communication skills. Children with severe to profound hearing loss may require the use of visual modality or language for communication. Hearing parents often struggle to develop fluency in sign language (Singer et al., 2020; Weaver & Starner, 2011); thus, the children may spend a significant amount of time in environments where they do not have access to language and information (Hall et al., 2019; Humphries et al., 2012). Furthermore, when a newborn d\/Dhh child has multiple disabilities, their hearing loss is often diagnosed significantly later compared to a child who does not have a disability (Chapman et al., 2011). The delayed diagnosis of hearing loss due to multiple disabilities may lead to delays in the decision-making and implementation of early intervention services for communication. Overall, communication-related support needs of DWD children are different than those without disabilities (Singer et al., 2020), but these differences and challenges are often overlooked (Knoors & Vervloed, 2011; Whicker et al., 2019).  10 Different types of disabilities accompanying hearing loss can also have varying impacts on language development (Cupples et al., 2014). A physical disability can inhibit the fine motor skills required to perform sign language with fluency (Davis et al, 2010; Westling et al., 2022). Cognitive delay or intellectual disability may limit the d\/Dhh individual\u2019s capacity for communication in any mode (i.e., verbal, visual, written; Bruce & Borders, 2015). Furthermore, both communication and social delays related to ASD are likely to increase communication limitations when they co-occur with hearing loss (Musyoka et al., 2017; Szymanski & Brice, 2008; Szarkowski, Flynn et al., 2014). Challenging behaviors may influence the learner\u2019s level of responsiveness and interfere with the development of effective communication (Siegel-Causey & Bashinski, 1997). Although ASL frequently plays an important role in communication for DWD children, signs may need to be adapted in consideration of the children\u2019s physical or cognitive abilities (Nelson & Bruce, 2019). Other communication tools available to augment communication include AAC devices (Davis et al, 2010; Lee et al, 2013; Musyoka et al., 2017; Nelson & Bruce, 2019; Singer et al., 2020), Picture Exchange Communication System (PECS; Malandraki & Okalidou, 2007), and picture dictionaries (Allgood et al, 2009). Students who are DWD may exhibit varying behaviors as they are developing language and communication (Carr & Durand, 1985b; Durand, 1990; Durand & Merges, 2001). Some behaviors may be a barrier in developing language and communication skills. Due to the severity of communication and other developmental challenges, DWD students are at an increased risk of developing significant behavior issues (Fossett, 2010). Consequently, families may experience difficulty in engaging these learners in typical family routines (Beals, 2004; Ben & O\u2019Leary, 2002; Mirenda et al., 2002). Educators may also experience difficulty in developing educational programs and providing support to families due to a lack of training and expertise in supporting  11 DWD learners (Andrews & Covell, 2007; Cawthon, 2009; Luckner & Howell, 2002; Luckner et al., 2005; Soukup & Feinstein, 2007). In order to mitigate these difficulties, educators and parents should be able to recognize the function of behaviors, introduce an acceptable alternative means to communicate, and support the learner in increasing communication skills (Bruce & Borders, 2015; Easterbrooks & Handley, 2005; Hansen & Scott, 2018).  Some DWD learners come from culturally and linguistically diverse families and may have other unique language and communication needs (see Chapters 2 & 3). Their language and communication needs may vary depending on the form (e.g., sign or spoken language) and the number of languages (e.g., Spanish, Mexican Sign Language, English, ASL) a learner uses or is exposed to at home and school (Cannon et al., 2016). In essence, the unique characteristics of these learners may require highly individualized approaches for language and communication intervention. 1.5.2 Identification and Eligibility Determining eligibility of DWD learners for specialized educational services includes both the identification of a hearing loss that interferes with academic achievement and of a disability (-ies) that qualifies under the education categorization system (Bruce & Borders, 2015). Educators have reported several challenges in the identification and eligibility process for learners with multiple disabilities, particularly those who are DWD. First, the co-occurring disability is more likely to be identified later in a d\/Dhh child than in a child with typical hearing levels (Mandell et al., 2005). Second, educators, who are not knowledgeable across various disabilities, may attribute behaviors of the disability to the learner\u2019s hearing loss and may not refer the student to an educational professional who has expertise in that disability (Erickson & Quick, 2017). Delays in identifying a concurrent disability in a child with hearing loss may  12 contribute to a delay in accessing appropriate services to meet all of the child\u2019s needs (Ewing & Jones, 2003; Wiley & Meinzen-Derr, 2012). Third, due to the complexities of their learning characteristics, conventional assessment procedures may lead to misdiagnoses or overidentification of the accompanying disability such as intellectual disability or learning disabilities (Gilbertson & Ferre, 2008; Knoors & Vervloed, 2011;). Early and accurate identification is necessary to bring relevant professional services in the relevant disability areas to DWD students.  When a DWD student\u2019s first disability designation is not d\/Dhh, they often do not receive services from professionals who have a background and training in language acquisition and its impact on communication and academic outcomes (i.e., TDHH) (Brook, 2012). It is because the education system qualifies a student for special education services based on their \u201cprimary\u201d disability, but not necessarily their \u201csecondary\u201d disability (Guardino, 2015). For example, in one urban school district, only 50\u201360% of the d\/Dhh students with intellectual or multiple disabilities received services related to their hearing loss (Borders, M et al., 2015). Similarly, TDHHs reported that they were likely to provide more services to d\/Dhh students whose special education category is d\/Dhh (32%) than those identified with the category of intellectual disability or multiple disabilities (0\u20134%). In essence, DWD students need services that meet all their needs regardless of the designation(s) the system may or may not assign to the students (Guardino & Cannon, 2022).  1.5.3 Educational Placement Educational placement is one of the most highly discussed topics in the field of education of DWD students (Guardino, 2008; Terry, 2014). DWD students are more likely to be in pullout or separate education settings, such as resource rooms or classrooms with special  13 accommodations suited to their needs (Shaver et al., 2014). d\/Dhh children with developmental disabilities have been historically excluded from schools for the deaf and have been placed in programs for children with developmental disabilities (Ewing & Jones, 2003). Although educators in these programs may be knowledgeable regarding specific developmental disabilities, they might lack a \u201csensitivity to deafness and the educational needs it entails\u201d (Ewing & Jones, 2003, p. 268). In addition, d\/Dhh students with ASD often have a history of moving from one educational setting to another for various reasons, which may slow the growth of the learners (Borders et al., 2017; Borders et al., 2022). Determining the least restrictive or most inclusive environment for DWD students is complex (Fossett, 2010; Shaver et al., 2014; Singer et al., 2020). Singer and Vroman (2019) point out that a general education placement for d\/Dhh students may not always be the most inclusive, especially if they struggle with communication access, academic content, and forming and maintaining social relationships. They suggest considering placing d\/Dhh students in the environment that is the most supportive and culturally sustaining. When DWD students use ASL in general education settings, social interactions and communication with peers become more challenging because teachers, educational assistants (EAs), and peers typically have minimal to no ASL knowledge or skills (Borders et al., 2022). The best educational setting requires accessibility to learning opportunities (Hagger & Aceves, 2017) that focus on the unique strengths and educational needs of an individual learner, rather than their categorical eligibility label (Ewing & Jones, 2003). 1.5.4 Assessment and Evidence-based Practices There is a lack of assessment tools for DWD students (Bruce & Borders, 2015; Cannon et al., 2016; Dale & Neild, 2019; Easterbrook & Handley, 2005). As communication and language  14 delays often result in frustration and may lead to behavior issues, assessment is essential for the selection of appropriate interventions. However, very little research on assessment has been conducted with this unique population of d\/Dhh learners (Bruce & Borders, 2015). As many accommodations or modifications are employed with students who are DWD, designing assessments and tests is one of the most challenging aspects for educators (Cawthon, 2015), especially when educators feel they lack training and resources in teaching DWD learners.   Not surprisingly, there is also a lack of guidance regarding best practices or effective interventions for DWD children (Borders et al, 2022). Suggestions to meet the needs of this complex population include (a) modifications of EBPs developed for children with other disabilities (Bruce & Borders 2015; Borders, Bock et al., 2015; Borders et al., 2016); (b) involvement of peers in interventions to increase social interactions and communication (Borders et al, 2022); and (c) integration of frameworks beyond special education, such as Universal Design of Learning (UDL), with differentiated instruction techniques (Guardino & Cannon, 2022). 1.5.5 Professional Development Research indicates low levels of teacher preparedness for educating DWD students, as shown by the next three studies regarding the levels of teacher preparedness. Musyoka and colleagues (2017) surveyed 40 teachers who were currently working with DWD students. The majority of the teachers had little or no experience using AAC or PECS to communicate with DWD students. Another survey of TDHHs (Guardino, 2015) found only 6% of the respondents indicated they felt prepared to teach d\/Dhh students with disabilities. Even fewer reported receiving direct instruction on how to work with this population during their teacher training program. Scott and Hansen (2020) conducted a survey of TDHHs that work with d\/Dhh learners  15 with ASD, who reported similar experiences of feeling under-resourced, under-prepared, and under-supported. This lack of preparedness might result in lower levels of self-efficacy for teachers (Scott & Hansen, 2020), as they do not believe that they have sufficient resources, training, or ability to achieve a set of goals for their DWD students.    Furthermore, due to a lack of professional training and expertise in supporting DWD students, educators experience difficulty in providing the appropriate support to these learners and their families (Cawthon, 2009; Luckner & Carter, 2001; Luckner & Howell, 2002; Luckner et al., 2005). Thus, teacher training should include assessment and intervention strategies to address the communication, behavioral, learning, social, and physical challenges of DWD students (Bruce et al., 2008; Fossett, 2010; Hyte, 2017; Tess, 2021). Further research and improved training for professionals are required to address the needs of students who are DWD (Guardino, 2015; Luckner et al., 2005). 1.5.6 Collaborative Practices Collaborative practices among professionals are crucial in the education of DWD students (Checker et al., 2009). Due to the diverse educational needs associated with deafness and accompanying disabilities, it may not be feasible for one person to attain all the knowledge and skills across multiple disability-specific fields. Research indicates that the quest for academic, social, and behavioral intervention begins with collaboration between general education teachers, special education teachers, and\/or specialists, who are willing to pool their areas of expertise (Guardino, 2015; Johnson, 2004; Luckner & Ayantoye, 2013). However, there can also be confusion about what responsibilities and roles each professional has in their collaborative work. This may be due to a lack of accepted guidelines or insufficient collaboration time, which can lead to problems with effective services (Antia & Rivera, 2016). Ewing and  16 Jones (2003) consider a transdisciplinary model to be the most applicable because it may result in collaborative planning of team members across disciplinary boundaries and the integration of expertise. Collaboration across disability-specific fields should be used to provide sufficient background knowledge and encourage the practice of working with experts to meet students\u2019 needs (Benedict et al., 2011). Collaboration practices should also involve the family members as an integral part of the educational team (Ewing & Jones, 2003). Research indicates that parental involvement in the education of d\/Dhh students is a key factor in child outcomes (Antia et al, 2002; Calderon & Greenberg, 2000). Strengthening the partnership between a family and their child\u2019s school is a priority in the field of deaf education (Szymanski et al., 2013). However, comparatively little is known about the experiences and perceptions of parents whose children are DWD (Singer et al., 2020). Parents reported that they recognized that neither professionals in deaf education nor the accompanying disability field could perfectly meet their children\u2019s unique needs (Beals, 2004; Fossett, 2010); struggled to secure an appropriate educational placement where their children would be able to access visual language (Ben & O\u2019Leary, 2002); and had difficulty receiving the necessary services from school (Turan, 2016). These parental perceptions inform us of a significant lack of dialogue and an unbalanced partnership between families and educators. For effective collaboration, more coordinated efforts between families and schools are required (Wolf, 2017). As well, research into effective methods for increasing parent involvement is demanded, especially for parents who have limited English proficiency and come from different cultural and education systems (Kinsella-Meier, 2019).  17 1.6 Purpose and Structure of Research The overall purpose of this dissertation is to gain a better understanding of how to effectively meet the needs of learners who are DWD and their stakeholders by exploring their experiences, educational practices, and considerations. To achieve this aim, I have consecutively conducted four studies over the last four years, which are included in this dissertation.   First, in 2019, I conducted an intrinsic case study of a 9-year-old deaf child, Jimin (pseudonym), from a Korean immigrant family, who attended a public elementary school in Canada, with a general education classroom placement, and was diagnosed with ASD and global developmental delays. Two manuscripts were developed from this case study. In the first study manuscript (Chapter 2), I investigated the perspectives of the parents and school practitioners who had worked with the student regarding language and communication, educational eligibility, placement, and intervention. The themes from this study may help us gain a better understanding of the experiences and needs of DWD learners, their families, and the professional communities (i.e., school educational teams) working with these students.   In the second study manuscript (Chapter 3), I specifically examined language and communication factors by interviewing three administrators who worked with Jimin and analyzing 38 school documents that were issued to the parents over five years (Kindergarten [repeated] to Grade 3). Within a theoretical framework, the chapter addresses the importance of considering factors across the learner, communication partner, and environment to increase language and communication skills.   The third study (chapter 4) was conducted in the school year of 2019\/2020. I examined the effectiveness of an intervention that combined social stories and ASL vocabulary teaching to increase social communicative behaviors between DWD learners and their peers in three  18 participating general education classes across three different schools. The intervention was implemented to the whole class including DWD learners. To examine the effectiveness of the intervention, the frequency of four communicative social behaviors (i.e., social initiation and response by d\/Dhh students and those by their peers) and the duration of social engagement between DWD learners and their peers were recorded for each participant during lunchtime and recess. The social validity of the intervention\u2019s goals, procedures, and outcomes was also reported by the school teachers and EAs.  The final study of this dissertation (Chapter 5) was conducted in the school year of 2021\/2022. I conducted a mixed-methods research utilizing an online survey and focus group interviews to investigate the practices (the current state) and considerations in the education of DWD students in BC from the educators\u2019 perspectives. One hundred twenty-three educators including TDHHs, classroom teachers, special education teachers, district specialists, and administrators participated in the province-wide survey. The questionnaire was compiled based on the findings from previous studies as well as extant literature in the field. Fifteen educators shared their considerations during the in-depth focus group interviews. Both quantitative and qualitative data were analyzed and reported in the areas of identification and eligibility for service provision, educational placement, and implementation of strategies and interventions. Overall, the studies included in this dissertation have attempted to examine the educational experiences of DWD learners, their families, and the professionals who work with them. While chapters 2, 3, 4 and 5 can be considered as stand-alone papers, these chapters also form part of a larger program of research, with sequential progression across the chapters. Lastly, chapter 6 is the conclusion of the dissertation with overall discussions of research findings, implications from the studies, limitations of the studies, and future research directions.  19 Chapter 2: A Case Study of a Learner: Who is Deaf with Autism Spectrum Disorder and from an Immigrant Family 2.1  Introduction Little is known about students who are d\/Deaf or hard of hearing multilingual learners (DML) with a disability or disabilities (DML-D) because of the dearth of research and publications specific to this population. Demographic data on learners who are DML-D indicate a population whose size is consistent, if not growing. However, precise data for this population of learners is difficult to ascertain. 2.1.1  Terminology Who are DML-D learners? First, these students are d\/Dhh and come from homes where their parents do not speak English nor use ASL. Second, they are learners who have a disability or disabilities (e.g., autism spectrum disorder, learning disability, or emotional behavioral challenges). One might argue that the student\u2019s disability is more prominent in presenting academic, social, or behavioral challenges, than in the fact that they are multilingual learners. However, when referring to this population, I believe that the language, identity, culture, and heritage of the learner should define the student, more so than the disability; therefore, I intentionally highlight their linguistic competence prior to the disability, using the term DML-D. 2.1.2 Demographic and Prevalence Data Demographic data of students who are DML or students who are DWD have been reported as a significant portion of the total population of d\/Dhh students (\u224818\u201347%, respectively; GRI, 2000\u20132013). The data can be disaggregated by the percent of students who are DMLs or students who are DWD, yet the percentage of students who are DML-D has not been reported. Zehler et al. (2003) reported that approximately 9% of the students with Limited  20 English Proficiency were receiving special education services. Approximately 16 years later, as of May 2019, the National Center for Education Statistics reported that 14.2% of the total population of English language learners also receives special education services. The prevalence of each disability among d\/Dhh students is difficult to ascertain. By examining the GRI survey, for example, it is estimated that approximately 2.2% of d\/Dhh students have ASD. This is not too different from the Centers for Disease Control\u2019s report (2018) as well as Szymanski and colleagues\u2019 (2012) which reported the prevalence rate of ASD among the general population to be one in 59 children. The report from the Centers for Disease Control (2018) also indicated that ASD occurs at a similar rate among d\/Dhh individuals as those with typical hearing. Presumably, a similar rate of students with ASD would be found in the DML-D population. There are several caveats with the reliability of the GRI data: (a) professionals were not obligated to complete the survey; (b) professionals may not have received the survey; (c) many students may be in inclusive settings and their general education teacher may not have the information to complete the survey questions; (d) some students attend private schools which are not a part of the public school system and therefore may not have received the survey; (e) smaller or new programs within a district may not have been identified within the GRI database and therefore did not receive it; and (f) teachers or administrators may not have the time to complete the survey (Mitchell, 2004).  2.1.3 Theoretical Frameworks and Approaches Vygotsky\u2019s (1978) sociocultural emphasizes the importance of providing natural experiences that reflect the cultural beliefs and practices of DML-D learners and their families. These experiences build background knowledge in the context of the learner\u2019s heritage culture.  21 The sociocultural theory also accentuates the need for professionals to examine their cultural competence so they can effectively understand, communicate, and interact with DML learners and their families.  Having Vygotsky\u2019s sociocultural theory as the foundation, Guardino and Cannon (2022) develop the framework Tenets of Effective Practices for Learners who are d\/Deaf or hard of hearing with Disabilities. The framework contains four pillars: (a) collaboration, (b) asset-based approach, (c) Zone of Proximal Development (Vygotsky, 1978), and (d) the Radical Middle (Easterbrooks & Maiorana-Basas, 2015; Gardiner- Walsh & Lenihan, 2017). Collaboration can take place through a variety of formats (e.g., face-to-face, virtually, and via emails or texts) to increase communication options between professionals and families. Team members should use an asset-based approach, believing the DML-D learners are capable of learning, thriving, and growing in their homes, communities, and educational environments. Vygotsky\u2019s Zone of Proximal Development helps professionals recognize the learner\u2019s potential and use this information to scaffold learning and increase academic, social, cognitive, and behavioral outcomes (Vygotsky, 1978). The Radical Middle is a holistic approach that respects the DML-D individual and family as well as professional and personal opinions of each team member as they aim to apply a variety of strategies, regardless of their own professional training, orientation, and positionality, to determine what will best support students who are DML-D. Lastly, the researchers, in the framework, encourage educators to implement instruction under the principles of Universal Design for Learning (UDL), in which classrooms can be more accessible learning environments with careful consideration of various learning styles and skill levels (Rose & Gravel, 2010). Components of the framework require careful introspection of educators\u2019 own beliefs; planning for all learners while incorporating culturally responsive teaching (Kieran &  22 Anderson, 2019); understanding the cultural beliefs and practices of others; and thus, making the framework applicable to students who are DML-D.  2.1.4 Educational Issues and Considerations The issues surrounding educational eligibility, placement, intervention, and language and communication considerations for DML-D students were examined in the broader fields of bilingual and special education. This information guided the formulation of the research questions to better understand the unique characteristics of students who are DML-D. Identification and Eligibility. The process of identifying and determining eligibility of a student who is culturally and linguistically diverse or DML-D is complex because they may have \u201cgreater exposure to the gestational and environmental factors, including prior to school entry, that increase the risk for cognitive, behavioral, or physical impairments\u201d (Morgan et al., 2018, p. 262). These predisposed factors often cause students who are culturally and linguistically diverse to be susceptible to misdiagnosis, mislabeling, or misidentification, thus causing over- and under-representation of diverse students in special education (Artiles et al., 2005; Claycomb et al., 2004; Samson & Lesaux, 2009; Van den Bergh & Marcoen, 2004). Many students who are d\/Dhh are also predisposed to genetic and environmental factors, which can cause varying disabilities (Bruce et al., 2022). Professionals in special education have concerns about how to differentiate between pre-dispositional factors that cause delays and those factors that determine eligibility for support services. The answer is partially through varying types of assessment; however, psychoeducational testing is controversial when conducted with students who are DWD and\/or DMLs (Cawthon, 2015; Leigh & Andrews, 2016; Pizzo & Chilvers, 2016).   23 Although assessments exist that test cognitive, language, and literacy skills, these tests do not account for individual differences including family, academic, and social experiences (McCain & Farnsworth, 2018). Standardized assessments for students who are English language learners should be provided in the home and in the first language of the learner; however, not all are available in multiple translations and\/or various sign languages (e.g., Philippine Sign Language or Mexican Sign Language; Cawthon, 2015). In addition, standardized assessments are known to lack cultural sensitivity and results should be considered with caution when making eligibility decisions. For example, test items may contain pictures and references a student who is culturally and linguistically diverse has not been exposed to, depending on their cultural background (Farnsworth, 2016). Multiple assessments including culturally and linguistically responsive tests, administered by various professionals (e.g., teacher, school psychologist, and social worker), in addition to interviews of the child and their family members, are the most accurate forms of identifying students who are DML-D (Pizzo & Chilvers, 2016). After a student is determined to be eligible for services for English language learners and students with special needs, the next step is finding the least restrictive environment that will meet the multifaceted needs of the learner.  Educational placement. While there are multiple services available for students who are culturally and linguistically diverse and are d\/Dhh, determining what is the least restrictive learning environment for students who are DML-D is complex. The most important aspect to the least restrictive environment is having educators and service providers who are trained in linguistically and culturally responsive pedagogy and practices. Involving the family in the educational placement decision-making process is crucial to providing the services and supports a DML-D may need at school. Providing spoken and sign language interpreters, cultural brokers,  24 community cultural workers, and advocates for students with exceptionalities may provide the family with the support needed to understand the referral, educational placement, and services process (Cannon & Guardino, 2022). The limited level of understanding of the Individual Education Plan (IEP) process, combined with a possible lack of knowledge of the predominant cultural language, are barriers for many families who have recently immigrated to English-speaking countries. These barriers must be overcome before they can begin to comprehend the information about their children\u2019s academic and social development, especially those of children with multiple linguistic and special needs. Intervention. Strategies and supports for working with students who are DML or DML-D should follow the principles of culturally responsive pedagogy (Gay, 2010; Higgins & Liberman, 2016; Humphries, 2004; Lucas et al., 2008; MaCain & Farnsworth, 2018; Pizzo & Chilvers, 2016). Teachers who implement culturally responsive pedagogy use explicit instruction and embrace the learners\u2019 assets to build receptive and expressive language skills. Culturally responsive pedagogy includes strategies to engage families as active participants in their children\u2019s development by teaching them how to promote language-rich experiences at home. Most importantly, in a classroom with students who are DML-D, the teacher researches and understands both the student\u2019s disability and culture in order to: (a) build positive relationships, (b) encourage students to integrate their culture and experiences into their learning, (c) differentiate instruction to meet the varying learning styles, (d) connect topics to the strengths of the students, and (e) scaffold instruction to make learning manageable rather than overwhelming (Espinosa, 2013; McCain & Farnsworth, 2018; Pizzo & Chilvers, 2016). Linguistic and communication considerations. Students who are DML-D may have unique communication and language considerations depending upon their exceptionality,  25 strengths, and needs. Students who are DWD may use various communication modes or modalities such as listening and spoken language, sign language, and\/or combinations of the two. Physical disabilities may result in limitations surrounding the use of spoken language and\/or sign language (e.g., those with cerebral palsy affecting the limbs utilizing two-handed signing; Bonvillian et al., 2020a; Bonvillian et al., 2020b; Davis et al., 2010; Westling & Fox, 2000). Developmental delays may limit the d\/Dhh individual\u2019s capacity for communication in one or more modes (Bruce & Borders, 2015). AAC (e.g., speech production devices, communication books, and clickers\/switches) are an option for some learners. A family-centered approach to all communication and language decisions are important to understand the goals for the learner and ways the family can support language and communication acquisition. 2.1.5 Purpose of Research After a search of 247 different combinations of the terms associated with deafness, disabilities, and English Language Learners, only 11 publications about DMLs surfaced, none specifically pertaining to students who are DML and DWD (i.e., DML-D). This case study examined the perspectives of parents and service providers who have or work with a child who is DML-D. Their perspectives regarding the educational eligibility, placement, intervention, and communication and language considerations were explored. The following research questions guided the case study: (1) What are the perspectives of parents and\/or caregivers who are culturally and linguistically diverse with children who are DML-D regarding the eligibility, placement, and intervention processes for their children? (2) What are the educational perspectives of service providers who work with children who are DML-D? and (3) What are the linguistic and communication considerations when working with students who are DML-D and their families?   26 2.2 Methods An intrinsic case study (Baxter & Jack, 2008; Stake, 1995) was conducted due to the interest in understanding a case because of its uniqueness, not necessarily because it represents the population as a whole. In addition, an intrinsic case study is not generalizable across a population of learners; rather it represents a picture of one case, which researchers can build upon to understand a larger population of learners. Ultimately, the intrinsic case study presented within this chapter addresses the research questions through interviews with parents, teachers, and EAs. 2.2.1 Participants Inclusionary criteria for this study were parents, teachers, and EAs of a child who is d\/Dhh, has been diagnosed with a disability (e.g., ASD or intellectual delays), and whose home language is neither English nor ASL. A convenience sampling method was utilized and prospective participants who met the inclusionary criteria in a region of the Pacific Northwest were recruited. A family whose home language is Korean and has a son who is deaf with ASD was contacted and agreed to participate in the study. The son, who is the primary subject of the interviews, was in a third-grade general education classroom when the case study was conducted. He was given the pseudonym \u201cJimin\u201d and will be referred to as such throughout the chapter. Upon permission from the parents, the child\u2019s teachers and EAs were recruited for the study. Three teachers (i.e., teacher of the d\/Dhh, special education teacher, and general education classroom teacher) and two EAs (past and present) agreed to participate and were interviewed. All of the educators had worked with the child for at least two years in the same school. Detailed demographic information about the teachers and EAs is presented in Table 2.1.    27 Table 2.1 Demographics of Educator Participants Participants Roles & responsibilities* Educational background Years with the learner Instructional settings TDHH  Works as district itinerant teacher and co-case manager for Jimin; provides language sessions 1:1 or with other team members 5 years as TDHH  K - G2 30 minutes to an hour individual session on a weekly basis Special Education Teacher Works as case manager in the school; coordinates and writes IEP; provides resources and support to the team; communicates with parents as liaison to the district >10 years as special education teacher & classroom teacher, taking a master\u2019s program in Special Education K - present Ongoing observation and staff supervision; no individual teaching  Classroom Teacher Ensures \u201cthe curriculum is modified for Jimin to help create a place where the child is welcomed and accepted\u201d with EAs >10 years as classroom teacher G1 - G2 Daily classroom teaching; no individual teaching EA1 Provides 1:1 support; teaches Jimin signs  10 months of full ASL immersion program   K - G1 Daily support at school EA2 Provides 1:1 support; facilitates PECS under the direction of TDHH & SLP Previously worked as Behavioral Interventionist, continue learning ASL  G2 - present Daily support at school Note. *Roles and responsibilities are as described by the participant during the interview. 2.2.2 Procedures and Setting The consent forms and interviews were provided in the participant\u2019s preferred language (see Appendix A.1). The child\u2019s teachers and EAs preferred English (see Appendix A.3), whereas the parents preferred Korean (see Appendix A.2). Interviews of all the participants were audio-recorded and transcribed. Semi-structured interviews ranged from 60 to 90 minutes and were conducted over the course of five months. The parents were interviewed on two different  28 days at the father\u2019s office. The educators were interviewed once in a quiet classroom of their choice in Jimin\u2019s school building. Two different sets of interview questionnaires were developed based on the research questions and provided to the participants: one for the parents (see Appendix A.4) and the other for the educators (see Appendix A.5). 2.2.3 Data Analysis A semantic thematic analysis (Braun & Clarke, 2006) of the transcripts was conducted. As described by (Braun & Clarke, 2006; 2012), a semantic thematic analysis involves a systematic process for identifying, organizing, and offering insight into patterns of themes across a data set. This analysis allows researchers to (a) identify commonalities among participant responses, (b) organize the collective or shared meanings and experiences as themes, and (c) offer answers to each research question. The six phases of thematic analysis by Braun and Clarke (2006) were utilized in an inductive approach to coding and analyzing the data. Two university professors in the field of Deaf Education triangulated data with my analysis. Once familiarized with the data (phase 1), the researchers generated initial codes and collated data relevant to each code (phase 2; e.g., educational diagnosis, placement, intervention, and linguistic and communication considerations). From those codes, the researchers independently searched for potential themes (phase 3). The researchers then triangulated the results by reviewing and refining the initial analysis into a coherent set of themes that captured the most important elements for answering each research question (phase 4). During the analysis, the researchers saw themes emerge and overlap across the six interviews. Themes that emerged included: cultural considerations, qualifications, availability, and collaboration. These themes aligned with the codes and helped to further analyze the data set to better understand the overall story of the case study (phase 5). The  29 results and discussion sections that follow are the final phase of the analysis (phase 6) and include explicit examples of the case as related to the literature and the research questions. 2.3 Results  2.3.1 Parents\u2019 Perspectives The parents\u2019 perspective on the educational diagnosis, placement, and interventions are reported here in depth. Additional underlying themes that emerged throughout the interview included: collaboration, community, and psycho-emotional aspects. I begin by providing demographic information of Jimin and his family, then moving into a presentation of the aforementioned themes. DML-D learner and their family. Jimin is a child who is deaf, has ASD, and was born in Canada to parents who immigrated from Korea four years before Jimin was born. Jimin has three siblings, two older brothers and a younger sister, and the primary language in the home is Korean. His siblings are bilingual and regularly use English and Korean. The family had no experience with d\/Dhh individuals and were unaware of Deaf culture and sign languages at the time of Jimin\u2019s birth. Educational eligibility. Jimin\u2019s hearing loss was identified via Newborn Hearing Screening. When he was three months old, he was diagnosed with a profound bilateral hearing loss due to significant bilateral cochlea and auditory nerve abnormalities. The etiology was unknown. His parents felt puzzled, but his mom \u201cthought that technology might help for him to hear better and cope with his hearing loss.\u201d When Jimin was one-and-a-half-years old, his parents took him to South Korea for cochlear implant surgery. Over the next 11 months of use of a cochlear implant, Jimin did not show any response to auditory input. A professional at the Hearing Clinic at a local hospital  30 referred Jimin to the Infant Development Program. Consequently, an Infant Development Worker visited Jimin\u2019s home twice a month over the course of two years, from age one to three years old. At the age of two-and-a-half, Jimin stopped using amplification devices and his parents began using basic ASL to communicate with him. During this time, the Infant Development Worker was concerned about Jimin\u2019s developmental delays, as he displayed some restrictive patterns of behavior, unusual sensory interest, and limited nonverbal social communication. These concerns led the parents to request several diagnostic assessments by the Hearing Loss Team at a local children\u2019s hospital. Jimin, at 3.7 years old, was diagnosed with ASD. With this diagnosis, his parents were shocked and confused. They had \u201cbelieved that his delay or ASD symptoms were caused by his hearing loss\u201d and thought that \u201conce he is able to hear us, his autistic symptoms would be gone.\u201d Jimin\u2019s dad reported that \u201cthe more I learned about autism as a disability not related to deafness and that there will be no cure in his entire life, the more I felt dismayed.\u201d Jimin\u2019s mom stated: At the beginning, I thought we could solve this problem [ASD] too with help, like hearing loss. The more I had learned about ASD, however, the more I was shocked. I came to realize that this condition will be a burden in my entire life.  This diagnosis changed their choices when considering preschool settings for Jimin.  Educational placement. From the time Jimin was identified with ASD and until entering Kindergarten, he received Applied Behavior Analysis (ABA) therapy twice a week and attended two preschools: one where ASL was the primary language of instruction and the another that was an inclusive general education program. The ASL program was housed in a non-profit organization and one of two programs in the province where Deaf educators taught d\/Dhh children and\/or their siblings in ASL. They  31 did not have a specific unit for d\/Deaf children with disabilities. His parents described the preschool staff as looking \u201cburdened\u201d and \u201cembarrassed,\u201d and that they did not seem to know what to do with Jimin because of his behaviors and complex needs. Jimin\u2019s mom also reported that \u201cit was hard for me to communicate with the [Deaf] teachers who used ASL as well as the hearing teachers,\u201d as a Korean language interpreter was not always available to the parents. Due to limited staffing, Jimin was only allowed to attend the specialized preschool two half days per week. Jimin attended a general education preschool program for the other three days of the week where none of the staff knew ASL and communication was limited. Jimin\u2019s parents reported that his behaviors escalated on the days he attended this program. After attending the preschool that used ASL, Jimin entered Kindergarten at the local school for the deaf. Jimin\u2019s eligibility to be placed at the school for the deaf was decided by a committee who determined that he would attend the school for one year, conditional upon his behavior and ability to communicate in ASL. At the end of the school year, the committee determined that he was not eligible to continue in the program based on the supports they determined he required (e.g., placement in a resource room supporting students with autism, services of a behavioral consultant, a peer group of deaf students, and opportunities for his family to develop fluency in ASL). The parents did not agree with this decision. The committee advised the parents to send him to a district resource program for students with ASD. When the parents called the school district principal to inquire about the ASD program, they were told that there was no room for Jimin and no ASL support available in the resource room. When summer concluded, Jimin\u2019s parents registered him for a repeat kindergarten year in a general education school where his siblings also attended.  32 The local kindergarten class consisted of 22 students and a classroom teacher. Under the supervision of the special education teacher in the school, an assigned EA who had signing skills worked with Jimin one-on-one the entire school day. A TDHH visited Jimin approximately once a week to support his language and communication development. Because Jimin had three years of instruction in this academic setting, the professionals working with Jimin were able to develop intervention strategies to address his needs. Interventions. The parents reported the different types of interventions used with Jimin, including ABA therapy and a PECS combined with ASL. The parents realized the importance of these interventions when his negative behavior decreased and his ability to communicate using ASL increased. The school personnel implemented these interventions, but the parents were not always provided the resources or information to use them with Jimin at home. There were instances when Jimin\u2019s mother requested information regarding strategies to use with Jimin, yet her inquiries were not answered. She reported: During the IEP meetings I asked them to share the materials they used at school with Jimin so that I could use them at home. They said yes, but it never happened. Maybe they have forgotten. They did not suggest or send me any materials. When she asked the school staff about the interventions, they were using with Jimin, she was not sure if she communicated her intention clearly. Jimin\u2019s mom noted, \u201cOnce I asked them [EA or special education teacher] regarding what they were doing with Jimin and what Jimin was learning, they looked uncomfortable. I was afraid that my questions were giving them the wrong impression, so I stopped asking those kinds of questions.\u201d His mom offered a potential solution during the interview:  33 I wish they would take videos (even one or two-minutes long) of what they are doing with Jimin and send them to me, rather than writing or speaking to me since I don\u2019t understand English well. However, it would be much easier for me to understand if I could see the videos and to try the interventions or strategies at home if it is not a matter of confidentiality. Sharing intervention information was not the only area of uncertainty for the parents. Collaboration was also intermittent and disjointed. Collaboration and community. While there was limited collaboration with the school staff, the parents found the most comfort from collaborating with community members in their neighborhood and local church. Jimin\u2019s mom shared that \u201cmany people from the church community, especially parents whose children have ASD, shared their stories and encouraged my family\u201d and \u201cA TDHH who speaks Korean has helped me understand the school services available for the future.\u201d At times, collaboration across professionals and community members revealed an imbalance of services and inability to meet Jimin\u2019s needs. Certain children who were deaf with disabilities and attended the same preschool as Jimin received more services than he did. The mother attributed the inequity to parents who \u201craised their voices strongly\u201d. His parents were frustrated that the professionals working with their son were unqualified and potentially biased. Jimin\u2019s mom reported, \u201cTheir concerns were always about his behaviors. They did not know what to do with his behaviors\u201d and \u201cthe regular preschool expressed their difficulties in educating my child due to their limited staff.\u201d Jimin\u2019s dad stated that \u201cit was very obvious that they did not know what to do with [his] child.\u201d This was not the only time where the parents  34 shared the psycho-emotional aspects of having a child with a disability, as well as being culturally and linguistically diverse. Cultural considerations. The parents spoke of their perspective of being immigrants from South Korea in a predominantly English-speaking country (i.e., Canada) and having a child with a disability. Jimin\u2019s mom stated: A thought came to my mind often: what if I was white or deaf, would they treat me the same way? I am actually in their blind spot. They might think that because we don\u2019t speak English well and cannot communicate with ASL either. She reported incidents where she was uncertain of her English comprehension: \u201cAs an immigrant, I am often guessing while listening to or reading their instructions. Does it mean they did this this way or not? I am often uncertain of what they are saying.\u201d Jimin\u2019s dad also reflected, \u201cI felt that [the camp for families with deaf child(ren)] was for only white people. They did not show any consideration for my child. Jimin did not know ASL much and had behaviors. It was very obvious that they did not know what to do with my child.\u201d Jimin\u2019s challenging behaviors, coupled with the parents\u2019 difficulty learning English and ASL simultaneously, resulted in a feeling of isolation and incongruity with the Deaf (ASL users) and hearing (English speakers) communities that surrounded them. Jimin\u2019s mother equated her experience of learning language to the needs of her son: I talked to them [the Education Committee]. Just as I am an English language learner, the more I am exposed to English speaking environment, the more fluent I become. My child would be the same. If he had to stay in a hearing school, how would my child access language and be exposed to his language [ASL]?  35 In addition to these struggles, the mother also shared that she suffered from depression for a one-to-two-year period when Jimin was young. To answer the first research question, the data analyses revealed the following parent perspectives about their son\u2019s eligibility, placement, and intervention experiences in school: (a) Jimin\u2019s early intervention settings did not have personnel with training in special education and ABA techniques; (b) finding a primary school educational placement for Jimin with access to instruction in ASL and professionals trained in ABA techniques was challenging and complex; (c) Jimin\u2019s parents did not have a strong understanding of the Canadian school system and the district\u2019s referral and placement process; (d) the family and professionals working with Jimin identified ABA, and PECS combined with ASL as effective interventions; (e) although collaboration was limited between the parents and school personnel, they found comfort in their community; and (f) the parents perceived linguistic and cultural barriers when they attempted to express their concerns and advocate for their child. 2.3.2 Educators\u2019 Perspectives Across the five educators who were interviewed, common themes emerged in five different areas: educational placement, qualifications, collaboration, intervention strategies, and psycho-social aspects. Educational Placement. The educational team shared three concerns regarding Jimin\u2019s educational placement: (a) Jimin would benefit from instruction in an ASL-English bilingual classroom, (b) the educational referral and placement process was not clear, and (c) an ideal placement does not exist in the area where Jimin\u2019s family resides. The educators believed Jimin would benefit the most from being immersed in an educational setting where all students and staff communicated using ASL. The TDHH saw Jimin  36 \u201cgetting tiny and tiny, better language directly every day from an EA who is not proficient in signs.\u201d She stated, \u201cwe knew he needed a certain level of language [to attend the school for the deaf and] we struggled to even give him that level of language, so we were caught in limbo because we couldn\u2019t get his language up because of lack of exposure.\u201d The classroom teacher was also concerned about Jimin\u2019s current placement, \u201cmost people in the classroom cannot speak his language. So, he\u2019s in silence. There\u2019s a deficit in language.\u201d The second EA (EA2) pointed out that this language deficit \u201cis exacerbating other challenges that he has\u201d such as behaviors and socialization. As mentioned above, however, when the educators were seeking a way to fully immerse Jimin in \u201chis first language,\u201d the team felt frustrated over the referral process which was not clear to them. The special education teacher reported: I don\u2019t understand what their criteria is and how they evaluated him. It just seems like it\u2019s sort of we went through the motions, and then it just kind of stopped. So, I don\u2019t know if there\u2019s been an official reapplication and an official rejection or what. When an ASL specialist came to visit Jimin to assess his language skills, the results were incongruent from the team\u2019s observations. While the classroom teacher and EA2 saw Jimin learn some signs and engage in basic communication, the specialist did not report the same findings. The EA2 pointed out: [the specialist] didn\u2019t have the skills to communicate with a kid with autism who needs quite a different approach, so they [are]coming in and just meeting him the first time or the first couple of times, they didn\u2019t have a lot of luck getting any response from [Jimin].  37 The team discussed the ideal placement for Jimin. As stated by the special education teacher, the parents and team members wanted \u201chim in an environment where he can succeed with full immersion of sign.\u201d Ideally, they suggested that Jimin should be amongst other deaf children, with and without ASD, who use ASL\/English bilingual instruction throughout the day. In addition, many team members agreed that this \u201cideal\u201d classroom would need to have a professional trained in ABA to assist with challenging behaviors. Qualifications. The team members working with Jimin had varied expertise, rather than the comprehensive skillset needed to effectively serve Jimin. The needed skills included: (a) knowledge and use of ASL and ABA techniques, and (b) a firm understanding of those who are d\/Dhh and have ASD. Many of the team members reported their inability to confidently serve Jimin. The TDHH stated: It was definitely the autism piece that I did not know. This case was so severe I knew that behaviors were getting in the way of language, but I did not know necessary how to reduce his behaviors with ABA techniques, so I found that challenging, very multi-faceted and overwhelming for me. Coupled with the teachers\u2019 feeling of needing further training, there were no other professionals with both ABA and ASL communication skills in the school district. Currently, the EA2 has ABA training and is learning ASL while working with Jimin. The special education teacher expressed concern: As a teacher, I could tell you where a kid\u2019s at and where he needs to go next and what kind of strategies work for that. I don\u2019t have that skill set for ASL, and the EA doesn\u2019t have that [skills]. We\u2019re going to hit a ceiling of the skill sets we have.  38 Not only did the educators feel unprepared and underqualified to work with Jimin, but their situation was also exacerbated by the lack of time to collaborate. Collaboration. The educators reported the challenges and successes they had when collaborating as a team and working with other specialists. The main challenge reported was the lack of multi-dimensional expertise in understanding and meeting the complex needs of the learners who are d\/Dhh with ASD. The team members had some knowledge about special education, but with minimal professional guidance in terms of ASD support and ASL assessment; as such, they struggled to have a comprehensive picture of how to meet Jimin\u2019s unique needs. A district specialist in ASD provided consultation for the team; however, more frequent collaboration with the TDHH was needed to meet Jimin\u2019s needs surrounding his ASD and deafness. Furthermore, the team had limited time to work in a cohesive manner with professionals regarding intervention strategies. The TDHH mentioned that \u201cit was hard on the heart because you wanted to make progress and you wanted to give everything but everyone at the table only had limited time and limited resources\u201d while \u201cknowing the child deserves more.\u201d Successful collaboration occurred when the team members met regularly to design and implement a specific intervention. The TDHH stated, \u201cin the third year, the SLP, and I, and EA worked as a team in every session to focus on language development and extending the student\u2019s attention to be able to sit longer. The SLP provided the PECS,\u201d the TDHH paired the PECS with ASL, and the EA gathered evidence of how Jimin used this combination. The TDHH reported: \u201cso, we decided to go on the same day, for the same session, and that\u2019s when we started to make the most progress.\u201d Accordingly, this collaboration led to positive outcomes for Jimin. Another collaboration included an ASL specialist who worked with Jimin\u2019s EA2 virtually via live streaming and taught the EA2 ASL signs to use during instruction. Although the team\u2019s  39 collaborative work was limited and challenging at times, they continuously made efforts to address Jimin\u2019s needs through a variety of intervention strategies. Interventions. The team has worked on improving Jimin\u2019s language, behavior, social, and academic skills as his IEP indicated. The team reported that Jimin made steady progress in the third year when ABA skills were consistently utilized in his routines through ASL. The special education teacher stated, \u201cit is structured with visuals, paired with signs, and he [Jimin] responds to it. He\u2019s very strong at copying the signs, and you can see him trying them out spontaneously from time to time.\u201d His EA2 accredited consistency and strong repetition as the key factors to Jimin\u2019s improvement, \u201c[we\u2019re] having an activity that\u2019s just the same every day, and then you change it slowly over time as he\u2019s mastering targets so that consistency and repetition and predictability [is] very important for him.\u201d Once the functions of his behaviors were understood and his sensory needs were satisfied and managed, his language started to improve. The team also noticed that Jimin became more engaged in class activities and motivated to socialize with his peers when his EA2 assisted him to interact with them systematically and repeatedly during activities (i.e., Circle Time). The classroom teacher reflected that \u201cthe ABA things, the structure, the very structured way of doing things, having a motivator even just a high five\u201d were successful to get Jimin engaged in her classroom. She worked to ensure that \u201cJimin was just part of the classroom\u201d and acknowledged that \u201cwe\u2019re communicating with Jimin too as part of the class\u201d using \u201csign language.\u201d However, she admitted that there was a heavy reliance on the EA2 as it was he who systematically set up Jimin\u2019s routines, directly implemented interventions, and continuously collected data (e.g., videos) as evidence of his language development in the classroom.  40 Psychosocial Aspects. Jimin seemed to be well-accepted by his hearing peers thanks to, as his EA1 stated, \u201chis giggling and peaceful nature,\u201d although his EA2 also observed that \u201che seems to prefer being on his own anyway and quite happy in his own world doing his own thing.\u201d Throughout Jimin\u2019s third year in his general education placement setting, his EA2 noted: He [Jimin] was showing more and more interest in his peers and wanting to, there were kids he would gravitate towards in the class. He would, his ability to interact meaningfully or in a complex way with them is very limited, of course, but he would go after them and touch their arms and give them hugs and stuff. So, you know, he was becoming increasingly social, even if he didn\u2019t have the skills to do that properly. However, Jimin\u2019s special education teacher observed that, as Jimin was the only deaf student in a hearing classroom, \u201che started to be drawn to the kids and teachers with sign\u201d in the hallway and playground which were shared with the school for the deaf. His classroom teacher perceived that \u201cthey [the class] seem to be more caring; they\u2019re forgiving, like he\u2019s accepted, and kids were still interested in being near him.\u201d Due to his sensory-seeking behaviors, such as nose picking and playing with his saliva, \u201cthere were some kids who were a bit less comfortable about that\u201d; however, as his EA2 stated, \u201cthere were a handful of kids who are really keen to be involved with Jimin, they\u2019d tell [sign] him, \u2018oh, it\u2019s time to come and line up now and he\u2019d follow their instructions.\u201d The classroom teacher also reported that she was more connected to Jimin as he showed responses to her signs and asked for her attention. To answer the second research question regarding the perspectives of the educational team, the analysis revealed that the team determined that an educational environment where  41 personnel have knowledge of deafness, ASL, ABA techniques, and learners with ASD would most benefit Jimin\u2019s linguistic, social, and behavioral goals. Collectively they felt unqualified to fully assess his language skills and that they needed more support and resources to effectively teach Jimin. None of the team members had a firm understanding of ASD combined with deafness. There were no experts or EAs who possessed both ABA and ASL skills within the district. Successful collaboration to implement interventions occurred only when the team members systematically planned and met with district specialists. Although Jimin was well-accepted by his peers in the general education classroom, the team agreed that his current setting did not provide him with sufficient ASL language exposure. 2.3.3 Linguistic and Communication Considerations Linguistic considerations included any language-related factors that were discussed and shared, including language choices for Jimin (while at school) and his parents (during meetings with school personnel). Communication considerations were defined as any response that involved a reference to communication between the parents, educational team, and\/or district specialists. Linguistic Considerations. When Jimin did not respond to listening and spoken language after receiving his cochlear implant, his parents began using ASL to communicate with him. His mom took some ASL courses but often struggled with English vocabulary. PECS was introduced for a brief time during Jimin\u2019s preschool years but was not successful. Once Jimin\u2019s receptive comprehension of ASL began during his first three years of elementary school, his disruptive behaviors decreased and communication with his peers and staff increased. PECS was then reintroduced in combination with ASL, which proved to be successful when implemented consistently.  42 Jimin\u2019s parents and many of the educators working with him were aware of his linguistic needs. His parents strongly advocated for Jimin to be immersed in a signing environment because they believed that \u201cmore exposure would bring more language proficiency\u201d. The special education teacher described that Jimin was \u201cat a critical point he needs to move to an immersed language environment\u201d and noticed that \u201che was starting to be drawn to signing peers and adults on the playground.\u201d The TDHH and EA2 used labeling (e.g., book, paper, and friend) and requesting signs (e.g., eat, write, and go) with Jimin. In Jimin\u2019s classroom, he did not have ASL role models to promote opportunities for learning language and social interactions. Jimin did not have occasions to acquire language through incidental learning\u2014the act of watching or hearing others use the language in which one is learning. His EA1 noted: He needs to be in a social situation and see signing as a conversation, not just me giving him directions. [It is] so conflict resolution. How [would] you know kids cause hurt with other kids and that kind of things? So, it\u2019s the conflict resolution between the students. It\u2019s how an adult will deal with situation with the student, all of that is missing. He\u2019s not getting any of that. So, he has no idea if in our classroom, we have a situation that needs to be resolved [but nobody tells him]. Communication considerations from parent\u2019s perspective. Jimin\u2019s parents reported that the most challenging aspect of Jimin\u2019s education has been communicating in both English and ASL with him and school personnel. When Jimin\u2019s mom began learning ASL she was often confused because she was simultaneously learning English. She describes this experience as the following:  43 In the beginning of learning ASL, when each basic sign was introduced word by word, I thought I could learn that language. However, when the deaf teacher wrote the vocabulary for the signs people did not understand, I actually did not know the English vocabulary either. I could not laugh with the other classmates. The textbook was filled with unknown English vocabulary and the deaf teacher did not understand why I needed to look at my electronic dictionary instead of practicing signing during the class. I did not have time to do both. There were also communication challenges with spoken language interpreting services. Jimin\u2019s mom reported that the English-to-Korean spoken language interpreters often seemed unqualified and became disruptive in meetings because they \u201cdid not know appropriate terminologies and not have relevant knowledge\u201d; she also reported that \u201csome interpreters did not interpret all the words they heard, and they skipped unfamiliar parts.\u201d To remediate the situation, Jimin\u2019s mom attempted to bring a friend who was bilingual to the meetings, but they were not a trained spoken language interpreter nor were they familiar with special education terminology. During meetings in Jimin\u2019s early intervention years, his mom stated that she \u201cunderstood 20\u201330% at the beginning\u201d of the discussion. She chose to \u201cjust try to understand the most important parts, like conclusion, future direction, what to do, etc.\u201d without having a Korean language interpreter. Because communication was a challenge, Jimin\u2019s mom and dad both reported that they felt they could not properly advocate for Jimin. His dad shared that he struggled with both English and ASL. With regards to communicating with Deaf staff, his mom stated, \u201cI missed lots of information even through the ASL to English interpreter because of my poor English. I had to email her when I felt I did not fully understand the conversation. The most difficult part was to  44 advocate my child on the spot.\u201d As stated above, Jimin\u2019s mom tried to reconcile her lack of understanding by following up meetings with emails. However, she disclosed: Emailing did not work because they wanted to make a decision on the spot and I could not tell them what my child needed properly. After those meetings I was upset and often cried at home. There were so many meetings that I could not find help for each time. Daily communication with the staff became easier by the third year of school; however, it was still challenging for the parents to understand the information exchanged quickly during meetings, especially when the team discussed educational placement options for Jimin. His mom shared that she \u201cunderstood up to 80%-ish [of the meetings].\u201d Communication consideration from educators\u2019 perspective. The educational team members felt that they could comfortably converse with Jimin\u2019s mom, more so than with his dad. Typically, his mom attended school meetings alone. The educators perceived that Jimin\u2019s mom did not have difficulty communicating about the day-to-day matters; yet, in meetings, her expressions sometimes indicated a lack of understanding. The teachers stated that collaborating with parents is very important, especially when developing goals and implementing strategies. The TDHH and special education teacher made some efforts to provide information about school interventions (e.g., why and how PECS would work to improve Jimin\u2019s ASL) but stated that insufficient time in meetings limited these discussions. At times, the professionals did not agree about the levels of Jimin\u2019s language and communication skills. In part, this seemed to be caused by the lack of expertise in both ASD and  45 deafness, which led to different judgements and assumptions of Jimin\u2019s language skills and behavioral challenges. For example, the TDHH noted: The SLP and I agreed that he [Jimin] was doing some form of babbling with his signs and the ASL specialist felt that it was stimming, not babbling. But they never saw what we saw, and we could never catch a video of it to show them so there were so many different opinions of what it could be. Team members were frustrated that the work they were doing with Jimin was not leading to a more appropriate educational setting that provided continuous ASL exposure. His EA2 admitted: \u201cyeah it\u2019s very frustrating how what seems like, what should be, even the two schools are just intermeshed as they are, how difficult it was for a deaf student to get access to a deaf classroom.\u201d In summary, the linguistic and communication considerations of both the parents and educators were analyzed to answer the third research question. Results revealed the importance of providing information in the families\u2019 home language. Jimin\u2019s parents were overwhelmed when trying to learn two new languages simultaneously (English and ASL), while also adjusting to new educational terminology (e.g., audiogram, intervention, IEP, and ABA). Unqualified interpreting services caused communication breakdowns and misunderstandings. Both the parents and educators agreed that when ASL was paired with PECS, Jimin\u2019s disruptive behaviors decreased and communication with peers and staff emerged. Clear, transparent communication among the professionals, as well as with the parents, was essential for effective services to be implemented. 2.4 Discussion The purpose of this case study was to understand the perspectives of the parents and the educators of a deaf child with ASD whose home language is Korean, regarding eligibility,  46 placement, intervention, and linguistic and communication considerations. With minimal research to guide our practice, a case study can provide a foundation to understanding critical considerations that may influence the educators\u2019 practice and the parents and\/or caregivers\u2019 decision-making process. Furthermore, case studies provide a basis in which to build the research base for larger and more complex studies. From this case study, the following codes and themes emerged: educational eligibility, placement, intervention strategies, linguistic and communication considerations (codes) and psychosocial\/emotional impact, qualifications, availability, and collaboration (themes). 2.4.1 Educational Eligibility The parents reported a drastic change in educational choices when Jimin\u2019s ASD was diagnosed. Finding professionals who had experience and knowledge of DMLs with ASD was extremely difficult. A transdisciplinary approach across educators and professionals revealed their knowledge of ASD, ABA techniques, ASL instruction and assessment, and working with d\/Dhh learners, yet none had training across all niches. Assessing ASL, including differentiating between babbling and self-stimulating behaviors, how to assess and progress-monitor ASL with PECS support, and how to support the parents in reinforcing all these factors in the home setting were the academic and behavioral challenges experienced by all participants. Jimin\u2019s transdisciplinary team may benefit from recommendations in the literature to include d\/Dhh mentors and cultural brokers as well as educators who have experience working with learners who are DWD or DML-D (Jackson et al., 2015).   2.4.2 Educational Placement Borders and colleagues (2017) have noted that d\/Dhh students with ASD often have a different trajectory between educational placements, as exemplified by Jimin\u2019s case. Jimin  47 experienced multiple early intervention settings: a kindergarten class at the school for the deaf and then three years in a general education classroom with a full-time EA. The educational team from his current setting, including the parents, perceived that Jimin would be better served in a signing educational environment. Ewing and Jones (2003) asserted that the best educational setting is one that emphasizes the unique strengths and needs of an individual child rather than their categorical eligibility label. Wehmeyer (2009) reminds parents and professionals: \u201cThe most salient characteristic of current efforts to promote inclusion and access to the general education curriculum is that the focal point has shifted primarily from where a student receives his or her educational program, to what and how the student is taught\u201d (p. 262). I would add that of equal importance is the qualifications and preparedness of whom is teaching the child in the placement options available. Placement in a general education classroom alone will not guarantee improved outcomes for students with severe disabilities (Kurth et al., 2015). Students who are DML-D may need a classroom with support for learning and participation, with special consideration given to the students\u2019 culture, disability, and mode of communication chosen by the family (Leigh et al., 2020). Utilizing Universal Design for Learning during instructional planning may provide this type of learning environment and follows the Tenets of Effective Practice framework (Guardino & Cannon, 2022; Rose & Gravel, 2010).  In Jimin\u2019s case, qualified professionals who are fluent in ASL and have experience working with learners who are d\/Dhh and have ASD should be involved in the planning and placement decisions. The referral and placement process for Jimin may be enhanced if his parents were able to locate a cultural broker and\/or advocate in special education that would assist them in navigating the process. Jimin\u2019s transdisciplinary team may also consider  48 connecting with nearby school districts to see if they have personnel with the expertise to provide further insight into placement options. 2.4.3 Intervention All of the educators who participated in the study felt unqualified to fully assess Jimin\u2019s language skills and determine effective interventions. Borders et al. (2016) reinforced this notion by recognizing that professionals who work with children with ASD are often inadequately prepared to provide services to those who are d\/Dhh because of the children\u2019s unique needs with a dual-sensory diagnosis. The educators working with Jimin were implementing PECS combined with ASL, which appeared to be increasing Jimin\u2019s expressive and receptive language skills. Repetition and consistency also appeared to be effective in Jimin\u2019s understanding routines and classroom activities. Although the educational team felt unprepared, they worked together to determine the most effective interventions for Jimin. His parents also seemed unprepared about how to best use interventions in the home. Jimin\u2019s mother had a helpful suggestion to video-record examples of how the EA and the teachers implement interventions with Jimin so that she  has a visual, non-linguistic resource to refer to when she is at home and working with Jimin. In addition, she is able to share the intervention videos with siblings and Jimin\u2019s father so they can participate in the development of targeted skills. 2.4.4 Linguistic and Communication Considerations Many families who are culturally and linguistically diverse and recent immigrants struggle to acquire English and acclimate to a new country. As Jimin\u2019s parents struggled with their own language barriers and unfamiliarity with the Canadian medical and education systems, they struggled to cope with Jimin\u2019s deafness and ASD. His parents believed that Jimin\u2019s hearing could be improved or \u201cfixed\u201d with a cochlear implant as they did not have a full understanding  49 of the technology and physiological factors related to hearing loss (Spencer & Marschark, 2003) (Although they were informed about the risks and the limitations of surgery, as well as the slim likelihood that the cochlear implant would be successful due to auditory nerve damage, they decided to go forward with the surgery. Their decision was more likely influenced by their Korean culture, which may consider them uncaring if they did not attempt all possible avenues for Jimin\u2019s future. When Jimin\u2019s parents chose ASL as his primary mode of communication, they too pursued learning the language, yet struggled when attending ASL classes. Instructors who use English-based vocabulary to make a correlation or connection to signs in ASL should be aware that parents who are culturally and linguistically diverse may also be learning English while taking ASL courses. In which case, these learners need more time to process and connect vocabulary. It is also important for families of DML-D children to have skilled language interpreters and\/or cultural brokers to assist them in understanding terminology (Bowen, 2016) pertaining to their children\u2019s education and behavior. These professionals can also assist with determining and choosing appropriate educational and behavioral services, as well as their rights and responsibilities regarding those services (Akamatsu & Cole, 2003). Understanding professional discussions and advocating for their children during school meetings require parents to have an advanced English proficiency level due to the complexity of topics discussed. Cultural brokers can provide support and guidance that are culturally sensitive (e.g., explaining how the educational placement is the same and different to the process in their home country to provide context for a discussion about where their child will receive services and support). Bowen and Baker (2022) stress the importance that information is communicated with parents in their  50 preferred language and in multiple ways before they have to make any decision. This allows families to process information and discuss with extended family members, religious advisors, mental health professionals, or any other support systems the families use to make decisions and understand their children\u2019s education better. Recommendations made to families should be feasible and realistic for them to commit to and implement. Furthermore, the parents\u2019 silence should not be understood as agreement as it could be due to a lack of understanding or their cultural practice. Schools or organizations should provide a written agenda with the names and titles of the meeting attendees prior to the meeting, especially for meetings concerning services, evaluations, and future educational placements of the child. Administrators should allot additional time during meetings so that sufficient discussion and clarification of concepts and agenda items take place during the meeting. Parents should be given additional time to make decisions, so they can confer with parent advocates, cultural brokers, and other allies to ensure that they understand the content and conditions of what has been shared with them. Ineffective interpreters can make parents feel confused and skeptical as to whether they have all the information needed to make an informed decision about their children\u2019s education (Bowen, 2016; Steinberg et al., 2003). When Jimin\u2019s mom tried to advocate for more services from the staff at his preschool, only an ASL interpreter was provided to facilitate discussions with the teachers, although she was still developing an understanding of English. Akamatsu and Cole (2003) assert that two or more relay interpreters should be used for communication between a family that is culturally and linguistically diverse and d\/Deaf teachers. One interpreter is needed to translate the family\u2019s home language to English, and another interpreter is needed to interpret English to ASL and vice versa. Ideally, the family\u2019s interpreter is also a cultural broker,  51 who understands the cultural values, the expressive style, and the help-seeking practices of the parents (Akamatsu & Cole, 2003; Cole, 1998). By having two interpreters, professionals can better understand the family\u2019s responses, questions, and\/or opinions as well as the behaviors of the DML-D child. Furthermore, with skilled interpreters and the use of a cultural broker, parents can feel more secure that they obtained the most accurate and ample information available. 2.4.5 Conclusion Professionals need to develop an understanding of the personal lens through which they view and define their own culture, as well as the cultures of others (Cannon & Guardino, 2022). By doing so, they may reduce the biases and assumptions they may have about disabilities, multilingualism, and other cultures. This self-reflection aligns with the radical shift needed in the field toward respecting the needs and preferences of learners when designing research and practice (Easterbrooks & Maiorana-Basas, 2015). By examining the parents\u2019 and teachers\u2019 perspectives, professionals may better understand ways to implement more culturally and linguistically responsive practices when working with DML-D students and their families. For a child to succeed in their learning, educators must be able to find ways to coordinate with the family and engage them to actively participate in their child\u2019s education (Akamatsu & Cole, 2003; Bowen & Baker, 2022, Cole, 1998; Jackson et al., 2015). As professionals, educators can empower parents and build a healthy partnership with them by acknowledging their needs. One possibility for building those partnerships, based on the results of this study, includes the idea of a network for DML-D students and their families. This recommendation is based on the parents\u2019 comment that a TDHH who is Korean was helpful for them to understand the school system. Establishing an online website where professionals who are multilingual and have cultural competence are available to provide consulting or mentoring services to the parents of  52 DML-D children might be helpful. Professionals could also create webinars, blogs, or forums in various languages to function as ways to create healthy dialogue between families and professionals via virtual platforms. Virtual services such as tele-practice or tele-intervention are already being used with positive outcomes to deliver audiology, early intervention services, SLP sessions, and other services in remote communities and isolated teaching settings (Bowen & Baker, 2022; Jackson et al., 2015) and are recommended for practitioners and parents of d\/Deaf children with disabilities (Guardino, 2015). Another possibility for building school capacity would be for programs to hire an outreach consultant for learners who have complex needs. The professional could (a) possess expertise in the education of learners with exceptionalities, (b) consult with school districts to form a transdisciplinary team for learners with complex needs, (c) administer comprehensive assessments and\/or connect with professionals who can, and (d) train staff and share resources in working with learners with complex needs. Jimin and his parents would likely benefit if an outreach consultant with these skills became a part of his transdisciplinary team. There is a high level of diversity among the DML-D population; therefore, the concerns and challenges of each DML-D learner and their family are likely different than those described in the case study or vignettes presented. The DML-D child brings with them unique learning needs, background experiences and knowledge based upon the family\u2019s culture and access to education, as well as other characteristics. For example, DML-D learners vary in the form and number of languages they may use or be exposed to at home and school, as well as the type of disability(ies) they have. Further case studies are needed to understand the specific needs of DML-D students and build the research base of practices and interventions that most benefit these learners and their families (Enns, 2017).  53 Chapter 3: Examining the Language and Communication Factors of a Deaf Child with Autism Spectrum Disorder from an Immigrant Family 3.1 Introduction Language development for d\/Dhh children is often delayed because of reduced access to language (Bruce & Borders, 2015; Moeller, 2000). For children who were born to hearing parents and their first language is ASL, exposure to fluent models may be lacking (Beal-Alvarez & Huston, 2014). When deaf children are born to recently immigrated families with limited English proficiency, developing ASL as the child's first language may be challenging (Pizzo, 2016). Language-learning characteristics become more complex with learners who have a disability that impacts their communication (e.g., ASD; Davis et al., 2010; Knoors & Vervloed, 2011; Vernon & Rhodes, 2009).   Approximately 6-11% of d\/Dhh learners come from homes where families use a language other than English or ASL and have a disability (Cannon et al, 2016; GRI, 2013; Zehler et al., 2003). Data from the GRI (2013) indicate that up to 35% of d\/Dhh students come from homes where a language other than English or ASL is used. These statistics may be increasing as the overall bilingual population is growing (Cannon et al., 2016; Pizzo, 2016). Approximately 40% of d\/Dhh students have a disability or disabilities and 2.2% are reported as having ASD (GRI, 2013). In Canada, nearly a quarter of the immigrants speak a language from Asia as their primary language (Statistics Canada, 2011). This includes d\/Dhh learners with ASD who come from Asian families, and there is minimal research on this population. It is necessary to examine the language needs of these learners as distinct from the larger population of d\/Dhh children.  To have a comprehensive understanding of language and communication characteristics of a d\/Dhh learner with ASD from a culturally and linguistically diverse family, professionals are  54 urged to look to adjacent fields, especially from the field of ASD or multiple disabilities (Borders et al., 2022). Theories and frameworks that have been widely used for language and communication interventions, such as the tri-focus framework (Siegel-Causey & Bashinski, 1997), may be useful when trying to understand the language learning characteristics and educational needs of d\/Dhh learners with ASD.  3.1.1 Tri-Focus Framework  The tri-focus framework by Siegel-Causey and Bashinski (1997) recognizes the impact of communication partners and environmental contexts for learners who have multiple disabilities and communicate without the use of symbols. To improve the communication and language of these learners, the framework encompasses three essential components to consider: the learner, the communication partner, and the environment. The learner refers to the individual with complex communication needs. Considerations for the learner include levels of responsiveness, current communicative development, and challenging behaviors. The partner refers to individuals who engage with the learner and considers strategies to facilitate interactions and to teach communication skills. The environment refers to both physical and social features of communicative settings and considers any barriers and\/or supports in the environment that impact the student. All three foci are interrelated; they affect and are affected by each other.  This framework suggests professionals move beyond assessment and intervention focused only on the individual with disabilities (Bruce & Bashinski, 2017) and increase awareness of the communication partners and the environment. This framework can be utilized to build a holistic picture of the complex language profiles of d\/Dhh learners with disabilities. A similar perspective was suggested when examining language factors of d\/Dhh students who come from multicultural families. Pizzo (2016) highlighted findings from research that dual  55 language acquisition may be affected by individual, familial, and societal factors. These factors may affect the quality of linguistic input the learner receives and the exposure pattern of the language at home and school. Therefore, it is important for practitioners who work with these learners to compile an individualized language and communication profile that encompasses all three components. 3.1.2 The Learner  This study focuses on a learner who is d\/Dhh, has ASD, and comes from a home where Korean is the primary language. The value or status of native and additional languages within the family, community, and society at large impacts the learner: their motivation to learn, and the accessibility of, the use of, and the proficiency in each respective language (Hagger & Aceves, 2017). These factors affect how efficiently a child acquires the competence of the language use (Pizzo, 2016; Tabors & Snow, 2002). Different types of disabilities for d\/Dhh learners can also have variable impacts on language development (Cupples et al., 2014) and communication and social delays (Musyoka et al., 2017; Syzmanski & Brice, 2008; Szarkowski, Mood et al., 2014). Challenging behaviors may influence the learner\u2019s level of responsiveness and interfere with development of effective communication (Siegel-Causey & Bashinski, 1997). Characteristics of any disability coupled with deafness are multiplicative rather than additive, with all elements of both disabilities impacting communication, cognition, social development, behavior, and physical development (Bruce et al., 2008; Davis et al., 2010; Luckner & Carter, 2001). 3.1.3 The Communication Partners The communication partner refers to anyone who might engage or be engaged by the learner in a communicative interaction (Siegel-Causey & Bashinski, 1997). Limited English proficiency and sociocultural differences may create barriers for parents in developing and  56 improving their skills as communication partners for their children. When d\/Dhh children with ASD in inclusive settings use ASL, social interactions with peers may become more challenging because teachers, EAs, and peers typically have minimal to no ASL knowledge or skills (see Chapter 4).  Linguistic challenges of parents. In a predominantly English-speaking country, a parent who is a recent immigrant or refugee may vary greatly in their level of English proficiency, which may affect their ability to participate in their children\u2019s education (Antony-Newman, 2018; Shin, 2006). Limited English proficiency is defined as using a language other than English at home and speaking English \u201cless than very well\u201d (Ryan, 2013, p.1). The Asian population has the highest rates of limited English proficiency (i.e., 35%) in the United States (Ramakrishnan & Ahmad, 2014). The significant differences in English proficiency among Asian subpopulations compared to Europeans may be due to differences in: (a) the alphabet; (b) concepts or words derived from different cultures; (c) language structure; and (d) language-teaching methodologies (i.e., more focus on grammar than speaking or listening). Low English proficiency may limit parents\u2019 involvement in school programs and services (Song & Murawski, 2005). Sociocultural challenges of parents. Most immigrants are not familiar with the school service system of the new country (Antony-Newman, 2018). Especially when their children have disabilities, parents need to learn what programs and professional services are available and how to access them (see Chapter 2; Shin, 2006). It is important for the parents to understand their roles in the educational decision making when they seek optimal services for their children. In many Asian cultures, including Korea, parents have a deep respect for teachers and tend to follow their professional judgement (Song & Murawski, 2005). This may inhibit them from seeing themselves as equal partners (Huntsinger & Paul, 2009; Sohn & Wang, 2006).  57 Additionally, due to the unfavorable perception of disability including deafness in Asian cultures (Kim-Rupnow, 2001), some families may experience social isolation within their own communities, further preventing them from reaching out to learn more about the available educational services for their children. When parents become familiar with their role in their children\u2019s education and the educational system, they can be stronger communication partners with the professionals working with their child.  Challenges of the educator partners. Educators, including teachers, EAs, and therapists, are important communication partners who impact the development of language, literacy, and social skills of d\/Dhh learners (Morgan et al., 2014). As the number of d\/Dhh students who are culturally and linguistically diverse has steadily increased, TDHH need to develop attitudes, knowledge, and skills to educate a diverse population of students as well as to collaborate with parents and professionals from other fields (Cannon & Luckner, 2016). Research directly involving TDHH or other professionals\u2019 experience with d\/Dhh students with diverse cultural backgrounds or their preparedness to teach these students is minimal (Becker & Bowen, 2018; Guardino, 2008).  3.1.4 The Environment The environmental context, the third component in the tri-focus framework, encompasses both the physical and social aspects of the setting in which communication with a learner takes place (Siegel-Causey & Bashinski, 1997). The physical context might include any settings in which the learner is likely to participate (e.g., home, school, community). The social environment is the communicative contexts that are necessary to address when we attempt to enhance the communication initiations and responses of learners who have multiple disabilities (e.g., conversations with peers). Partners who interact with learners who have multiple  58 disabilities are responsible for creating an environmental context where appropriate natural support for communication is provided (Carr & Carlson, 1993; Halle, 1982, 1987). Physical environment. Determining the least restrictive learning environment for d\/Dhh students with disabilities and diverse cultural backgrounds is complex. Generally, modifications of the physical communication environment for d\/Dhh learners include seating arrangements, organization, lighting and so on (Fullerton & Guardino, 2010), which may influence students\u2019 behavior and engagement (Guardino & Antia, 2012). Depending on students\u2019 culture, disabilities, and mode of communication, modifications may be required to increase the accessibility of learning opportunities in the environment.   Social environment. The social environment significantly influences the interaction between the learner and partner. Natural contexts influence the learner\u2019s behavior and provide a dynamic environment for communication (Siegel-Causey & Bashinski, 1997). Modifying social aspects of the environment is central to providing communication opportunities for students with disabilities (Bruce & Bashinski, 2017). The educational team is responsible for continuously providing communication-rich environments through collaboration with family members, peers, support staff and community members (Snell et al., 2010). 3.1.5 Purpose of Research  Understanding the language learning characteristics of a d\/Dhh learner with ASD who comes from a home where the primary language is Korean will assist educators in equipping adult communication partners with linguistically and culturally responsive strategies. As there is very minimal research of the distinct communication and language profiles of this population, examining factors across each component is necessary (Cannon et al., 2016). Therefore, this research question was: What language and communication factors were considered across the  59 learner, partner, and environment regarding a learner who is deaf with ASD and from an immigrant family from: (a) the educational records and (b) interviews with administrators? 3.2 Methods To better understand the educational experiences of these learners and to form a foundation for future research, I conducted an intrinsic case study (Baxter & Jack, 2008; Stake, 1995) of a 9-year-old boy, Jimin (pseudonym), who comes from a Korean immigrant family, attends a general elementary school in Canada, and was diagnosed with ASD and global developmental delays. Collected data from the case study include interview transcripts from both parents, five practitioners (i.e., teachers and EAs), and three administrators as well as 38 educational documents issued to parents. The data was used for two different studies; each of the studies was developed with different research purposes. The interview data from the parents and practitioners were analyzed for Study 1 (see Chapter 2) to examine the perspectives of parents and educators on eligibility, placement, intervention, and language and communication considerations. The other part of the data (i.e., interviews of administrators, school documents) was analyzed for Study 2 (the current chapter) to specifically examine language and communication factors reported in educational documents and by administrators.  3.2.1 Participants The inclusionary criteria were school administrators who have worked with Jimin and his family. Upon permission from the parents (see Appendix A.1), administrators who were involved in Jimin\u2019s education were recruited (see Appendix A.3). Three administrators agreed to participate and were interviewed: the vice principal of the school for the deaf from when Jimin was enrolled in their Kindergarten (Adm 1), the principal at Jimin\u2019s current general education school setting (Adm 2), and the director of a provincial program for students who are d\/Dhh  60 (Adm 3). Detailed demographic information about the three participants is presented in Table 3.1.  Table 3.1 Demographics of Administrator Participants   Participants Roles &  responsibilities Educational background Years with the learner Educational setting Adm 1 Part of the Deaf Education Committee as the representative of the school for the deaf; supports teachers and parents in the school 5 years working in the school for the deaf; worked as TDHH for more than 30 years K the school for the deaf  Adm 2  Oversees IEP; works with team and parents; attends IEP meetings; supervises EAs  Not identified K (repeated) - present  the public elementary school Jimin was attending Adm 3  Director of the provincial outreach program for the d\/Dhh and a member of the provincial Deaf Education Committee; screens for K entry (e.g., filming the child\u2019s use of language) and provides assessments of students\u2019 progress 2 years classroom teaching at the school for the deaf; 9 years itinerant TDHH in general educational settings; 2 years educational consulting; 6 years as director of the d\/Dhh program K \u2013 present  Deaf Education Committee -assessed and reviewed Jimin\u2019s progress in language development Note. *Roles and responsibilities are as described by the participant during the interview. 3.2.2 Procedures and Setting To answer the research question, two types of data were gathered through the case study: (1) educational documents (i.e., IEPs and school progress reports provided by Jimin's parents) and (2) semi-structured interviews with participants. Copies of 38 documents from the last five years (kindergarten [repeated] to Grade 3) were provided by the parents to me and then were deidentified. These documents included six early childhood assessments reports, six audiological reports, nineteen school reports, and seven Individualized Education Plans (including initial and final versions). I then conducted interviews with all three participants, each audio-recorded and  61 transcribed. Two participants were interviewed in their school offices (Adm 2 and 3) and the third at their home (Adm 1), in their preferred language of English (Adm 1 and 2) or ASL (Adm 3) via a certified ASL interpreter.  3.2.3 Data Analysis The documents and interview data were analyzed using a semantic, thematic analysis (Braun & Clarke, 2006). Two university professors in the field of Deaf Education and myself triangulated the qualitative data. Through the analysis, the researchers identified commonalities among participant responses, categorized the commonalities into themes through the triangulation of data across the researchers, and attempted to answer the research question from these themes. The documents were also used to clarify interview data and to create a learner profile.   3.3 Results 3.3.1 Document Analysis Jimin received special education services under the primary category of ASD; he also qualified for services under the designation of d\/Dhh. His IEP included his strengths and needs related to his disabilities. A limited number of language assessment reports was available. Most of the strategies written in his IEPs were focused on teaching Jimin skills for school engagement. Language and communication themes are reported across the learner, partner, and environment. 3.3.1.1 The Learner Strengths and needs. Overall, Jimin was described as a calm, loving, and social student. The IEPs from kindergarten to grade 3 consistently reported Jimin as \u201ca fast learner who learns new signs quickly, is quick to learn right from wrong by observing his environment, cooperates well with familiar staff, and is able to express his wants in highly preferred activities.\u201d Areas in  62 need of improvement were reported as mostly communication and behavior. He was described as having a limited attention span and sensory-related behavioral issues (e.g., touching others\u2019 skin, playing with his phlegm), difficulty in transitioning to non-preferred activities, playing with peers in parallel, and limited expressive language.   Language development and progress. Language assessment data of Jimin\u2019s expressive and receptive language skills were minimal in the documents provided. One school report written by his TDHH and SLP when he was in Grade 2 indicated that, based on observations and three non-standardized assessments tools, Jimin demonstrated an overall delay in core language skills for his age. His receptive language skills were more developed than his expressive language skills. He used a combination of PECS, signs, and gestures to convey his messages, predominantly for his wants and needs. He demonstrated an understanding of common classroom instructions (1-2 step directions) and was able to provide the appropriate sign when asked \u201cWhat is this?\u201d. His communication ability was inconsistent across different staff members or peers. Often, Jimin would negate a request from others by ignoring his communication partner. According to the latest report in Grade 3, with support, \u201che continued to greet peers, has been learning to choose friends to play with outside, more of his peers learning how to interact with him. He has shown increased interest in his peers and will increase engagement with peers who sign to him.\u201d  School reports indicated that Jimin made progress \u201cin learning an array of new vocabulary using PECS and ASL, social skills such as turn-taking, and improving attention and eye contact.\u201d However, his TDHH and SLP noted, \u201chis progress was limited due to the inability to access information in ASL from native or fluent signers.\u201d A further challenge to social communication was \u201cthe fact that the vast majority of people who he was in contact with know  63 little or no ASL, so their communication with Jimin was limited to a small number of key signs, and gestures, visuals, and physical interaction.\u201d They strongly recommended \u201can immersion into an ASL environment\u201d to support Jimin\u2019s language and communication development, which was consistent with other school reports.   IEP goals. The goals in Jimin's IEPs were focused on five areas: expressive and receptive language, behaviors, and social and fine motor skills. Goals related to academics started to appear in his Grade 2 documents. Goals were repeated over the years in his IEPs, but the objectives were updated yearly, based on his progress. The criteria for each objective, the methods to measure the objectives, the persons (team members) who work for each goal, or the achievement of objectives were not reported in his IEPs.    Strategies. There were a variety of strategies suggested in Jimin's IEP in order to meet his language, social, and behavior goals. Most of them were focused on teaching Jimin general fine motor skills (e.g., a variety of dexterity-based activities, finger placement) or providing materials for his sensory needs (e.g., tactile sand, sensory box) and academic learning (e.g., small whiteboard, loop scissors, ball crayons). Curricular adaptations were suggested, including the use of a PECS binder to provide choices and the provision of visual and tactile cueing (e.g., darken the outlines of shapes to be traced or colored within, use Wikki Stix to outline shapes). 3.3.1.2 The Communication Partners Jimin\u2019s primary communication partners at school were an EA (full-time), a TDHH (30-40 minutes weekly), and an SLP (30 minutes weekly).   Strategies suggested for parents. School reports from both special and general school systems recommended Jimin\u2019s parents to: (a) continue developing fluency in ASL; (b) participate in Jimin\u2019s educational program; (c) increase understanding of the sociological,  64 communication, and educational implications of his hearing loss and autism diagnosis; (d) continue using ASL and PECS at home; and (e) provide exposure to the deaf community. There was no multicultural worker, cultural broker request, or otherwise mentioned in all of the documentation provided to increase parent communication and involvement with the school.  Strategies suggested for educators. Jimin\u2019s educational team did not have an ASD specialist or behavioral consultant who continuously supported the team except during the kindergarten year at the school for the deaf. Instead, his TDHH was expected to have the knowledge and skills to collect data regarding his behavior management. The IEP reported, \u201cTDHH will determine baseline starting with basic needs, routines, emotions\u201d because \u201csensory seeking behavior delays him to follow through on the interaction.\u201d A note reading, \u201csensory vs. activity; which should be first? -> teach language ASL first then next,\u201d from the IEP document reflected the team\u2019s struggle with managing Jimin\u2019s behaviors.  The IEPs included a few strategies to enhance the educators\u2019 skills as communication partners: (a) access to ASL specialists for the EA by email or during office hours to improve ASL skills; (b) implementation of a list of sensory activities; (c) participation in workshops for ASD; and (d) modelling of proper sentence formation in ASL for Jimin. 3.3.1.3 The Environment Physical environmental modifications. There were a limited number of environmental strategies that the team considered in order to meet Jimin\u2019s needs. During his first two years of schooling, the environmental modifications were mostly to satisfy his sensory needs. As he progressed through school, more strategies were suggested to increase Jimin's accessibility to language and communication. Physical environment modifications were noted, including: (a) access to a sensory garden or area of low stimulation in the classroom to assist self-regulation  65 (e.g., couch or soft space); (b) provision of a sized table and chair so his feet were flat on the floor for stabilization, with the tabletop at his elbow height; and (c) strategic positioning of his preferred items and PECS binder.  Considerations for social contexts. Some modifications in Jimin\u2019s social contexts were also recommended in his IEPs and reports: (a) partial cross-inclusion to give Jimin access to the school for the deaf to interact with proficient Deaf signers and peers; (b) development of a peer group that will play with Jimin in structured and\/or unstructured settings; (c) participation in social groups through extracurricular activities, including within the Deaf community; and (d) opportunities for ASL practice. 3.3.2 Interview Analysis The language and communication themes that emerged from the analysis of the three interviews with school administrators are presented across the learner, partner, and environment in a descriptive nature. 3.3.2.1 The Learner Across the three interviews, four common themes emerged regarding the needs of the learner: (a) how Jimin\u2019s complex language and communication would be best supported; (b) a collaborative team effort is needed to have a holistic view of the learner; (c) data-based decision-making should be utilized; and (4) visual language to develop communication is important.  Complex language profile. The first theme that emerged from the analysis was how to best support Jimin\u2019s complex language and communication needs. Adm 1 described, \u201cthe very challenging thing about so many of our kids with complex needs is deciding what\u2019s more of a priority.\u201d Adm 2 shared the same struggle: \u201cjust the complexities of his profile would make it that much more [difficult], ...is the autism piece more important than the deaf piece?\u201d The  66 administrators had different perspectives about how to best support Jimin. While Adm 2 believed that \u201cthe goal is to improve his communication skills\u201d because of the importance of \u201cthe ability for him to sign his needs back. Even if they\u2019re simple one or two words, [it] has been very important in being able to manage his behaviors. He would wet his pants\u2026. that was just his inability to communicate.\u201d However, Adm 3 emphasized that Jimin\u2019s primary designation wasn\u2019t deafness but ASD, and that if his negative behaviors associated with ASD improved, so would his language. Collaborative team approach. All three administrators reported that a collaborative team of professionals is required to evaluate the present level of the learner\u2019s performance, make educational decisions, and implement interventions. Adm 3 suggested that for any decision, it is important to have a holistic view of the learner\u2019s needs, including social-emotional growth and cognitive development.  Data-based decision-making. To document Jimin's progress in language and communication, all three administrators highly emphasized the need for data collection. Adm 3 stated videos of his expressive and receptive language skills were collected to evaluate his progress, especially for collaborative team decision-making regarding school placement.  Importance of visual language. All administrators agreed on the importance of access to visual language for Jimin. Adm 3 stated, \u201cbeing able to access visual language and visual communication for all of our [deaf] students regardless of where they\u2019re placed is important.\u201d They emphasized that providing visuals (e.g., signs, pictures, visual schedules) are essential to increase Jimin\u2019s accessibility to classroom content. Adm 1 stated that deaf students with ASD do not all have the same characteristics in learning language; some still need to use picture support. Adm 1 remembered, \u201che [Jimin] didn\u2019t seem to be taking it [ASL] in. It was more focusing on  67 pictures\u201d during kindergarten at the school for the deaf. PECS seemed to be more effective than ASL at the beginning for Jimin. Adm 2 believed that more exposure to ASL would help Jimin develop his language and communication skills. 3.3.2.2 The Communication Partners The administrators reported that there were communication gaps with Jimin\u2019s parents due to language barriers. His parents\u2019 understanding of spoken English varied depending on the complexity of the topics, and the administrators were exasperated by the fact that they did not always have a Korean interpreter. They emphasized the importance of collaborative work with professionals to properly serve Jimin. Challenges in collaboration reported were (a) outside experts (e.g., certified behavioral analyst or behavioral consultant) were not always available; and (b) there was a high need for EAs and teachers who have skills in both ASL and ABA.  Parent Partners  Communication gap. Administrators reported some \u201ccommunication gaps\u201d with the parents. Adm 1 reported that the mother\u2019s English was \u201cquite broken\u201d when Jimin entered kindergarten at the school for the deaf though she \u201cdefinitely knew what her desire was and what she wanted.\u201d Adm 1 emphasized the importance of communication between teachers and parents to support the child\u2019s learning at home: \u201cIf teachers and parents can communicate, I think that\u2019s way better because parents can take information home from what the teacher said, and they can help the child out at home.\u201d Adm 3 also reported a communication gap with the parents: \u201cI am not sure how much mom really gets from the explanation. Oftentimes, I get repeated questions, the same question over and over again, even though I thought I explained well.\u201d Adm 2 had a different impression of the mother\u2019s communication abilities when Jimin was in Grade 3: \u201cI think that the fact that they\u2019re Korean doesn\u2019t impact this because they have enough English that  68 they can clearly express themselves in meetings, and any time she comes to speak to me, she\u2019s articulate.\u201d Overall, depending on the complexity of topics (e.g., ABA techniques or behavioral intervention plans, reinforcing language concepts from school, district referral process) and types of conversations (e.g., formal meeting vs. informal greeting), the mother\u2019s understanding seemed to vary. During his kindergarten year, according to Adm 1, the parents had a Korean interpreter for meetings. In the following years, however, parents did not have a Korean interpreter, as Adm 3 stated, \u201cWe have offered [parents] to bring in a spoken language interpreter, and they refused.\u201d According to Adm 2, \u201cThere are ASL to English interpreters available so the communication with the [deaf] staff can be done regardless.\u201d Adm 3 tried to ensure access to necessary information for the referral process for the parents by offering \u201cbrochures printed in mom\u2019s first language\u201d and emailing the mother the online link to the organization's English and ASL website.   Educator Partners  Collaboration across professionals. All three administrators emphasized the importance of collaboration to meet the complex needs Jimin presented. The educational teams included Jimin\u2019s classroom teacher, EA, TDHH, SLP, behavioral consultant, occupational therapist, administrators, and outside experts for advice when needed. For example, during the first kindergarten year, when the team struggled to know how to communicate with Jimin, collaborating with a district behavioral consultant was helpful to understand his behaviors. Adm 1 described, \u201cshe (the consultant) would come in and observe, and she would help to work on developing positive behavior support plans for the child, and then she would come back and check-in, and try to help, kind of on-the-spot training with the staff to work with the child.\u201d Collaborations were not easy because learning hands-on skills from the behavioral consultant  69 through interpretation was challenging for the deaf staff due to unfamiliar ABA terminology and limited time. In addition, support from outside experts was not always available to the team.  Skill level and professional development. All administrators reported it was very frustrating for the team to find skillful EAs and teachers who have both ASL and behavior management skills. Adm 1 mentioned that \u201cthere\u2019s the belief that they need a visual language but in practice, we don\u2019t have the resources and the staff to support those complex children (in the school for the deaf).\u201d Adm 2 added, \u201ca skilled EA who is deaf themselves or who is trained in deaf education would be the best. But just being deaf and being able to sign isn\u2019t enough. You have to have someone who is persistent, consistent, who really understands the autism piece in order for them to make the signing piece accessible.\u201d Adm 3 suggested teaching ASL to EAs who have ABA skills to work with learners like Jimin.    The teams in both school settings (the school for the deaf and general education) did not have a professional or teacher who possessed a comprehensive understanding and skill set in both behavioral interventions and deaf education. Adm 3, a former TDHH, mentioned, \u201cI was not ready to work with a student who was deaf with additional challenges, autism, behavioral issues, vision loss, any of those things where I really needed to do my own homework, and ask people, and look into things, talk to people with experience, ask to come and observe how they work with those students.\u201d Adm 1 and 2 insisted that the ministry and school districts need to work on providing cross-training and recruitment to teachers and EAs.  3.3.2.3 The Environment The administrators reported different perspectives on how to provide the optimal environment to develop Jimin\u2019s language skills. All participants reported there is no one, ideal placement for Jimin, but a visual environment is essential for his language development.  70 Environmental modifications through inclusive practices (e.g., reverse inclusion, teaching peers ASL) were recommended to increase communication opportunities for Jimin.  Placement. While the importance of a visual environment was emphasized by all the administrators, they did not completely agree on which educational setting would provide Jimin with the best support for his language and communication development. Adm 2 wondered where Jimin could obtain the optimal learning environment to further develop his language skills. In Jimin\u2019s third year in the general school, Adm 2 stated, \u201cnow that his behaviors have been managed, an ABA-skilled EA in a signing environment would be ideal for him because learning his first language better would open up his world.\u201d Thus, Adm 2 suggested an alternate idea of \u2018reverse inclusion\u2019 or \u2018shared learning\u2019 where Jimin partially joins and learns from a small-sized classroom in the school for the deaf while being registered in the current general classroom. Adm 2 pointed out that \u201cideally it doesn\u2019t matter which school he is registered in but for him to be allowed services\u201d is more important. In Jimin\u2019s case, as the two schools shared the same building facilities, Adm 2 hoped for \u201ccombined efforts\u201d between the systems.  Visual Environment. Adm 3 stated it is important for educators to consider modifications in the general education environment in order to be accessible for d\/Dhh learners. They suggested, \u201cPart of it is educating classroom teachers about what environments really need to be happening for the deaf child. Maybe they\u2019re too close to a window, or they\u2019re too far away from a window, or they need different lighting happening, and the class always needs to know ASL. All the classmates of any students. so, that needs to be taught as well.\u201d Adm 3 also reported that with support from school district level professionals and classroom modifications, the general education setting should be able to meet Jimin\u2019s learning needs.   71  Social contexts for interaction. All agreed on the importance of providing social contexts that could promote Jimin\u2019s language development. Adm 2 believed, \u201cJimin needs to be with other deaf kids. He needs to be with students in a signing environment. In a regular classroom, he\u2019s only in a signing situation with his EA specifically\u201d. Adm 3 recommended that social contexts of general education settings be modified to create an ASL-friendly environment. Modifications may include:  \"Teach the classroom sign language. Have posters on the wall that indicate signs for weekly learning. Not just in one classroom but have the school do an inclusive day where everyone learns a few signs or learns the alphabet, things like hello, please, thank you, help me\/you, monthly or weekly. Have an annual get-together with the school, have the opportunity to have deaf education specialist come in and talk about communication, and have deaf adults come into the classroom and talk about making the environment more accessible visually.\"  Adm 1 also pointed out that availability of social interactions with peers and staff should be thoroughly considered when assessing the complex needs of a learner\u2019s language and their progress.  3.4 Discussion Students who are deaf, have a disability or disabilities, and come from a home where their parents\/caregivers do not speak English nor use ASL, are complex by nature and nurture. By nature, Jimin posed unique challenges as an individual with both deafness and ASD. Jimin\u2019s language and communication needs were dependent on his parents understanding of his disability and the interventions appropriate to use with a child who is deaf with ASD. Jimin was also dependent on a school system and the professionals working within the system to nurture  72 and understand how to merge critical developmental strategies across two fields: deaf education and the education of students with ASD. There are no teacher training programs that currently prepare educators to work specifically with students who are d\/Dhh with ASD in the country. The challenges faced by Jimin\u2019s parents, educators, and school administrators are well-represented in this case study. The following section will present a discussion of how we can move forward as a field to better serve these individuals. Recommendations are made to provide professionals and families with the tools these learners need for successful language acquisition and communication skills across the home, school, and community environments. 3.4.1 The Learner All the administrators reported challenges in understanding Jimin\u2019s needs related to his deafness as well as ASD. These findings are consistent with those from the interviews of Jimin\u2019s teachers (see Chapter 2). Determination of a learner\u2019s \u201cprimary need\u201d impacts services, strategies, and accommodations they may receive on their IEP (Borders et al., 2016). However, a needs-based profile does not inform an educational team about how a student learns and which strategies may be effective. Instead, it is necessary to compile a comprehensive learner profile that includes characteristics related to their disabilities, their home background, the level of preparedness of both parent and educator partners, and the physical and social environment. One of the critical factors for educators to consider in developing a comprehensive profile is how the behaviors of a d\/Dhh learner with ASD affect their communication and language (Bruce & Borders, 2015; Easterbrooks & Handley, 2005). All behaviors serve a communication function (Zane et al., 2014). These behaviors may have been reinforced by a communication partner and\/or in a certain environmental context. Thus, partners should recognize the function of behaviors, introduce an acceptable means to communicate that  73 function, and support the learner in developing those communication skills. For example, as PECS is one of the suggested interventions for d\/Dhh learners with ASD (Bruce & Borders, 2015), Jimin\u2019s team implemented the communication system successfully. PECS has been established as an evidence-based intervention within the field of ASD to increase communication acts within a social context (National Professional Development Center on Autism Spectrum Disorders: NPDC, 2014). PECS may eventually increase the learner\u2019s use of ASL (Malandraki & Okalidou, 2007).   The theme of data-based decision-making revealed that teacher observation and teacher-made assessment tools (i.e., video language sample, teacher-made checklist) were only used to evaluate Jimin\u2019s present ASL levels of performance. When assessing a learner\u2019s ASL skills, however, research-based ASL assessments (e.g., ASL Expressive Skills Test: ASL EST, https:\/\/northernsignsresearch.com\/asl-expressive-skills-test\/; Visual Communication and Sign Language Checklist for d\/Dhh Children, https:\/\/vl2parentspackage.org\/milestones) are needed to measure both receptive and expressive language process. Assessment suggestions for learners with disabilities include: (a) provide visually rich and interactive assessment formats that can facilitate meaningful and authentic engagement for the learner (Cawthorn, 2015); (b) allow multiple response formats with clearly articulated test construct and maintenance under different conditions, adapted from universal design for learning (Liu & Anderson, 2008; Thompson et al., 2002); and (c) include assessment data across different partners (e.g., parents, siblings, peers, deaf individuals) and contexts (e.g., home, classrooms, playground) (Pizzo & Chilvers, 2016).   74 3.4.2 The Communication Partners 3.4.2.1 Parent Partners Equipping communication partners with knowledge about the learner is critical to the communication development of individuals with severe disabilities (Bruce & Bashinski, 2017; Siegel-Causey & Bashinksi, 1997). To collaborate as equal partners, both parents and educators need to learn how to communicate with each other to achieve the language goals for the learner. Educators' unawareness of parents' linguistic and cultural states might cause misunderstanding of communication intentions. Adm 3 believed they had well explained the entry criteria for the school for the deaf and did not understand why Jimin\u2019s parents repeated the same questions. The parents preferred communicating via email due to their English while Adm 3 wondered why the parents avoided having direct conversations. Considering that English-speaking parents with d\/Dhh children with disabilities reported feeling unincluded in educational planning and uninformed regarding their child\u2019s school life (Turan, 2016; Whicker et al., 2019; Zaidman-Zait et al., 2015), these sentiments are likely magnified with families from culturally and linguistically diverse backgrounds. The educational team must ensure that parents have equal access and invitations to participate in the decision making of their child\u2019s education plan as access to information is essential to supporting and maximizing collaboration between the home and school.    To strengthen the partnership with multicultural parents, professionals should provide culturally- and linguistically-responsive services (Antony-Newman, 2018; Guo, 2011; Lopez et al, 2001; Shin, 2006; Sohn & Wang, 2006; See Chapter 2). Culturally-responsive teachers try to understand a family's cultural characteristics, respect their cultural values, and cultivate their strengths. This includes providing jargon-free information about the student\u2019s progress in the  75 family\u2019s home language. In Jimin\u2019s case, none of the school documents collected in the study were translated into the home language of his parents. The copies provided to us by his parents contained handwritten notes with Korean definitions and translations for school jargon, documenting their struggle to understand many concepts used in special education. Providing visual evidence of assessment (e.g., videos, pictures, a collection of work samples) can also help parents understand their children\u2019s progress. Language support through interpretation and translation is essential to increase immigrant parents\u2019 involvement (Antony-Newman, 2018; Dyson, 2001; Ladky & Peterson, 2008). Attention should be given to parents\u2019 readiness as a communication partner. In Jimin\u2019s reports, educators recommended Jimin\u2019s parents to continue developing fluency in ASL, use PECS at home, and have Jimin exposed to people within their local Deaf community. Although these strategies could be beneficial, parents who do not have English proficiency and little knowledge about how to use PECS (without ABA techniques) may not be able to implement them. One idea to equip parents with these skills is to establish an online website where professionals who are multilingual and culturally competent can provide consulting and modeling services (see Chapter 2). Additional research is needed to address how to meaningfully support families to implement strategies that shape communication within consistent routines and in well-developed communicative contexts (Bruce & Bashinski, 2017). 3.4.2.2 Educator Partners In this case study, administrators stressed the importance of collaboration among professionals to meet Jimin\u2019s complex needs. However, the educational team had limited time to collaboratively implement interventions to develop Jimin\u2019s language. Collaboration was inconsistent amongst the professionals. Perspectives regarding Jimin\u2019s progress in learning ASL  76 were also incongruent (see Chapter 2) and lacked consistent research-based assessment methods. When professionals communicate, collaborate, and coordinate their services, alongside of the parents, this may help to reduce parental dissatisfaction (Giangreco et al., 1991; Isarin et al., 2015; Whicker et al., 2019) and lead to more effective services. A commitment to interprofessional collaborative practice (IPCP; World Health Organization, 2010) is required for all members of the educational team for d\/Dhh learners similar to Jimin. IPCP involves the collaboration of professionals and family members who hold different knowledge, experiences, and perspectives about the learner (Bruce & Bashinski, 2017; Erickson, 2017). This may allow parents whose first language is not English to participate in discussions and decisions about educational programming with appropriate interpreting services (Cheatham, 2011) and allow team members with diverse areas of expertise to share assessment and instruction of communication skills. Bruce and Bashinski (2017) state that effective IPCP in communication intervention considers the learner\u2019s characteristics, the knowledge and skills required of communication partners, and effective environmental arrangements to support communication. Thus, IPCP is critical to addressing the complex needs of individuals with severe disabilities (Feiler & Watson, 2010; Horn & Kang, 2012; Ogletree, 2017), including d\/Dhh learners with disabilities (Isarin et al., 2015; Nelson & Bruce, 2019; Zaidman-Zait et al., 2015). Another concern addressed in the results was the skill level and professional development for professionals. There is a lack of individuals with expertise in both deafness and autism who could provide guidance in understanding the language and communication characteristics of these learners. It is recommended in Chapter 2 that an outreach consultant for d\/Dhh learners with diverse needs who (a) possesses expertise in the education of learners with exceptionalities  77 (including ABA techniques); (b) administers and\/or connects with professionals who can conduct comprehensive assessments; and (c) empowers the school team with consultation and resources. Scott and Hansen (2020) identify a need for cross-training teachers between ASD Education and Deaf Education to provide teachers with a sufficient toolkit of approaches incorporating the collective knowledge of both fields. One possible approach is a provision of virtual workshops and digital resources for teachers in each field that include effective strategies for language and communication of students with ASD (Scott & Hansen, 2020).  A paraprofessional or EA may be one of the most significant communication partners for learners with disabilities. The administrators reported that Jimin made steady progress in the third year when he started to work with an EA who had ABA skills and basic signing. The EA, with a collaboration of TDHH and SLP, implemented interventions with consistency and collected gathered evidence of how Jimin used a combination of PECS and ASL. Paraprofessionals also have an important role in establishing positive relationships between the learner and other students and improving social behaviors and participation in class lessons (Westwood, 2018). All the participants reported that it is extremely challenging to find an EA with both ABA and ASL knowledge. The participating administrators stressed that the school district or ministry should take action to mitigate the need for highly skilled EAs. 3.4.3 The Environment Physical Environment. All the administrators who participated in this study emphasized the importance of the accessibility to visual language, although they had different perspectives on the ways to provide the optimal educational placement for Jimin. While Jimin\u2019s parents and his educational team in the general education setting insisted that he be immersed in a full signing environment for more ASL exposure, Adm 3 stated, \u201cbeing able to access visual  78 language and visual communication for all of our [deaf] students regardless of where they\u2019re placed is important.\u201d Szymanski and her colleagues (2012) suggest that a placement in a school for the deaf may provide a naturalistic language environment for d\/Dhh learners with ASD. Constant exposure to sign language may help d\/Dhh learners with ASD better develop communication, behavior, and socialization skills than those who are not educated in such an environment. However, when d\/Dhh students have ASD, merely placing them in an ASL environment may not automatically promote meaningful communication or social interaction. Thus, coordination between deaf education and ASD services is necessary (Myck-Wayne et al., 2011; Zaidman-Zait & Curle, 2016). Regardless of where a d\/Dhh learner with disabilities is registered, systematic modification of environmental variables should be considered to engage the learner in communicative interaction (Siegel-Causey & Bashinski, 1997). By improving physical proximity to potential interaction partners, communicative opportunities may increase (Downing et al., 2015). Incorporating a learner\u2019s particular needs and preferences in the communicative context is key to facilitating accessibility and engagement in the classroom environment (Smith & Herlich, 2014).   Social Environment. Social aspects of the learning atmosphere are central to support communication (Bruce & Bashinski, 2017). In Chapter 4, Jimin and his peers in a general education classroom showed zero to very minimal social interaction during lunch time and recess during a typical school day. Even when the entire class learned ASL vocabulary combined with social stories, social interaction did not immediately increase. Jimin\u2019s peers, who were in grade 3\/4, may have been reluctant to using ASL because of shyness, which is common when learning a new language. This situation demonstrates the challenges of adjusting the communication  79 methods used within a social environment when the majority of people need to learn a new language. It is suggested in Chapter 4 that peer-mediated training (e.g., Circle of Friends: Kalyva & Avramidis, 2005; O\u2019Connor, 2016; Schlieder et al., 2014) be incorporated to increase peer interaction in general education classroom settings. Peer mediated interventions involve systematically teaching peers without disabilities to engage learners with ASD in positive and meaningful social interactions (Sam & AFIRM Team, 2015), contributing to a learner\u2019s participation and communication skill development (Bashinski, 1995).  3.4.4 Recommendations Overall, the focus of the communication intervention efforts of Jimin\u2019s team remained on the learner; minimal attention was paid to equipping the communication partners (both parents and educators) or modifying the physical and social environment to optimize natural communication opportunities. Modelling and coaching (Bruce & Bashinski, 2017) may support communication partners to develop greater sensitivity and responsiveness to the unique expressions of d\/Dhh learners with ASD. Through an assessment of learning environment characteristics (e.g., Analyzing Behavior State and Learning Environment: ABLE; Bashinski, 1995), various external environmental variables that influence the learner\u2019s interaction with the environment can be examined. This could be concurrently implemented with communication interventions. Shifting the focus from the learner to the entire framework may support practitioners to gain a comprehensive picture of the learner\u2019s needs and increase communication and language. 3.4.5 Conclusion Learners who are d\/Dhh, come from Asian families, and have ASD are a small minority of the d\/Dhh population. The unique characteristics of these learners may require highly  80 individualized approaches for communication intervention. The tri-focus framework and the IPCP are essential to considering and sharing knowledge about the learner\u2019s unique expressions and the strategies that best support their language and communication across environments (Bruce & Bashinski, 2017). To strengthen the partnership with parents, culturally and linguistically responsive practices are needed. Providing families and educators with resources to increase and support language and communication development is a crucial step to better understanding this unique population.  81 Chapter 4: Effects of Social Stories on Increasing Social Interaction and Engagement of Deaf and Hard of Hearing Students with Autism Spectrum Disorder in Inclusive Settings 4.1 Introduction Evidence-based practices (EBP) to increase communication and social interaction of students who are d\/Dhh with ASD are critically needed, especially when these students are in inclusive settings. Over the past two decades, it has become common practice to teach students who are d\/Dhh in general education classrooms with support from an itinerant TDHH. To successfully include d\/Dhh students in inclusive settings, adaptations may be necessary (Raver et al., 2014). Merely placing d\/Dhh students in an inclusive setting may not automatically facilitate meaningful social interaction, peer acceptance, and\/or improvement in the students\u2019 social communication skills (Antia et al., 1993; Antia et al., 2002; Bobzien et al., 2013; Hyde & Power, 2004; Weisel et al., 2005). Approximately 40% of d\/Dhh students present with one or more disabilities (GRI, 2013) including ASD. One in every 59 d\/Dhh students is estimated to exhibit characteristics of ASD (Szymanski et al., 2012). Considering that students with these additional challenges often require more specific approaches to promote social integration, there is a dearth of research on practices that can guide practitioners in promoting social interaction and communication between students who are d\/Dhh with ASD (d\/Dhh-ASD) and their peers in general education classrooms.  4.1.1 Social Interactions between Peers  Peer interaction is a fundamental component of social development and necessary for all children. Educators in public schools are often concerned about socially integrating children with varying levels of hearing since they may not easily participate in social activities with their peers  82 due to limited access to spoken language and verbal cues (Bat-Chava & Deignan, 2001; DeLuzio & Girolametto, 2011; Peterson, 2004; Stinson & Antia, 1999). Given that children with ASD may have deficits in social communication and interaction (American Psychiatric Association, 2013), challenges may be much greater in children who have both a hearing loss and an ASD (Davis et al., 2010). Researchers suggest modifying established practices from the field of ASD or multiple disabilities because (a) little guidance is provided regarding effective interventions related to communication and social skills for children who are d\/Dhh-ASD (Bruce & Borders, 2015) and (b) interventions from the field of d\/Dhh itself may be inadequate to meet the needs of this complex population (Borders et al., 2016; Bradley et al., 2008). Professionals providing services to learners are urged to look to adjacent fields when determining intervention practices, specifically those from the field of ASD and severe and multiple disabilities which have been developed to address communication, socialization, and behavioral needs (Borders et al., 2022) 4.1.2 Social Stories as Evidence-based Practice Social stories or social narratives is one of the 27 interventions that the National Professional Development Center on Autism Spectrum Disorder identified as EBPs for students with ASD (Wong et al., 2015). A social story describes a situation or concept in explicit terms, depicting relevant social cues, perspectives, and common responses of typically developing individuals (Gray, 2004). This intervention has been shown to be an effective strategy in improving social interaction and communication in children with ASD (Chan & O\u2019Reilly, 2008; Crozier & Tincani, 2007; Schneider & Goldstein, 2010), as well as in improving the classroom behavior of students with intellectual disabilities (Beh-Pajooh et al., 2011; Kim et al., 2014).   83 4.1.3 Modifications for d\/Dhh Students with ASD To use social story interventions for students who are d\/Dhh-ASD, modifications might be necessary. In previous studies, social stories were introduced as spoken or written language with or without visuals (Raver et al., 2014). However, in a meta-analysis of social story interventions for students with ASD, Kokina and Kern (2010) find that if a child has difficulty reading or understanding spoken language, using written text as a method of explaining social stories is ineffective. When using any of the EBPs established in the field of ASD for students who are d\/Dhh-ASD, it is important to consider potential modifications to the intervention (Borders et al., 2016; Borders et al., 2022; Bruce & Borders, 2015). Modifications suggested in the literature to suit the unique needs of learners who are d\/Dhh-ASD include: (a) inclusion of their peers in implementation of the intervention and (b) incorporation of ASL vocabulary to increase communication between learners who are d\/Dhh-ASD and their peers.   First, both learners who are d\/Dhh-ASD and their peers should be included when implementing an intervention involving social interactions and incorporating communication (Borders et al., 2022). Fees et al. (2014) introduced a social story to all of the students in six inclusive preschool classrooms instead of teaching only the targeted students with diverse developmental disabilities. The researchers reported that the intervention improved both individual and group behaviors, including students with disabilities and those without. When peers were engaged, they regulated their own behavior and also served as models or assistants to teachers for children with developmental challenges (Fees et al., 2014). Unlike academic or literacy skills, social or communicative behaviors involve peers as communication partners; thus, it is essential to include both the learner who is d\/Dhh-ASD and peers in social skill interventions to effectively change behaviors.  84 Second, when implementing social skill intervention for students who are d\/Dhh-ASD, it is important to include strategies for incorporating communication that can be used by both the student who is d\/Dhh-ASD and their peers (Borders et al., 2022). When students who are d\/Dhh-ASD in inclusive settings use ASL, social interactions with peers may become more challenging (Borders et al., 2022) because teachers, EAs, and peers typically have minimal to no ASL knowledge or skills. Classroom peers may not have language tools to effectively interact with the d\/Dhh students who communicate using ASL. This may cause them to withdraw and remain as spectators. Thus, when implementing social stories for learners who are d\/Dhh-ASD, modeling ASL vocabulary related to the social story to all of the children in a classroom may increase social interactions between students who are d\/Dhh-ASD and their peers.  Despite the unique aspects of teaching learners who are d\/Dhh-ASD, only one empirical study to date has examined the effect of social stories for d\/Dhh students in inclusive settings. Raver et al. (2014) evaluated the effects of dyad-specific social stories on the communication and social skills of four preschoolers with varying hearing levels in their inclusive preschools. Four children with typical hearing levels from the inclusive preschools served as play-partners for the target participants with hearing loss. Results showed improvements in verbal comments and play turns from three of the four d\/Dhh participants. When an intervention that is effective for learners with ASD are used, the intervention needs to be modified in consideration of the unique communication aspects d\/Dhh learners may experience (e.g., limited access to auditory signals or use of signed systems of communication; Borders et al., 2016).  4.1.4 Research Questions The purpose of this study is to investigate the effectiveness of an intervention to increase social interactions and communicative engagement between students who are d\/Dhh-ASD and  85 their peers in inclusive settings. Specifically, the research questions examine whether a functional relation exists between social stories and improvements in social interaction among d\/Dhh-ASD students and their peers in inclusive settings. The social stories for this study were modified to suit the needs of students who are d\/Dhh-ASD (Bruce & Borders, 2015; Borders et al, 2016), including (a) teaching the stories to the whole class, not only to the d\/Dhh student with ASD and (b) the addition of ASL vocabulary.  The following research questions are addressed: 1.  Does whole-class implementation of social stories with ASL vocabulary increase (a) social initiations and responses of d\/Dhh students with ASD, (b) social initiations and responses of their peers, and (c) social engagement between d\/Dhh students with ASD and their peers? 2. Do the educators perceive the goals, procedures, and outcomes of the intervention as socially important and acceptable in their inclusive settings? 4.2 Methods 4.2.1 Participants Three d\/Dhh students with ASD, along with 63 classroom peers in three different general education classrooms (with approximately 21 students in each class) agreed to participate in this study. Inclusionary criteria consisted of d\/Dhh students who: (a) use ASL; (b) have been diagnosed with ASD, as confirmed by their teachers and parents; (c) are in primary school; (d) have limited social interaction skills with their peers at school, as reflected in teachers' reports and researcher observations; and (e) are the only student who is d\/Dhh-ASD in their general education class. Table 4.1 shows the demographic characteristics of the three d\/Dhh participants. To ensure confidentiality, all participants were given pseudonyms. All three participants attended  86 a third-grade general education classroom with full-time EA support. The skill sets of each EA varied, and the level of peers\u2019 exposure to ASL in the school setting also varied. Table 4.1 Demographics of d\/Dhh Participants Participants Hearing status Disabilities  Language and literacy Instructional settings Jimin Profound hearing level; inner ear anomalies bilaterally; no assistive technology Diagnosed with ASD at age of 3; moderate intellectual delays Primary language is ASL; emerging one and two-word phrases (e.g., red sock, more swimming), no literacy skills yet Support from full-time EA with behavior intervention and ASL skills; 22 peers with exposure to d\/Dhh students and staff from the school for the deaf who shared their school facilities (e.g., hallway, playground) Ali  Moderate hearing level; uses hearing aids, FM system, and soundfield system at school Diagnosed with ASD at an early age Uses three-to-four-word ASL sentences (e.g., (you) want (to) play (with) me?); uses some spoken Arabic at home; emerging level English language and literacy Support from full-time EA and ASL interpreter; 20 peers with exposure to other d\/Dhh students in the school and staff (e.g., ASL interpreters, Deaf EAs, and Deaf Language Acquisition Support Workers)  Rain  Severe to profound hearing level; no assistive technology used Diagnosed with ASD at an early age, cerebral palsy, developmental delays due to Cytomegalo-virus during pregnancy Uses one-word ASL signs (e.g., eat, more) and writes one to two-word phrases; comprehends simple written messages (e.g., Time to work now, iPad off, wait), some behavioral issues (i.e., grabbing, poking others) Support from full-time EA with some ASL skills; 21 peers without exposure to ASL in the school prior to Rain\u2019s placement in the class   87 4.2.2 Measures To examine the effectiveness of the intervention, the frequency of four communicative social behaviors and the duration of social engagement with peers were observed. Because the d\/Dhh students used ASL, words, signs, and gestures, these aspects of communication were coded equivalently. Interactions toward any adult or in response to an adult\u2019s prompt were not coded. Definitions, examples, and non-examples for the observed behaviors are detailed in Table 4.2 and discussed below. Using a smartphone software application (i.e., Behavioral Timer) all social interactions were measured using a direct observation coding system (Ledford et al., 2016). For all observations, data were collected for 20 minutes: 10 minutes in the classroom during lunchtime and another 10 minutes on the playground during recess time following lunch.               88 Table 4.2 Coding Definitions, Examples, and Non-examples Code Definition Examples Non-examples Social Initiation: (by d\/Dhh student and   by peer Verbal, signing, or gestural initiations that are directed toward a peer in neutral or positive manner  Greeting; praising; questioning; commenting on the peer\u2019s activity; handing a toy to another peer; asking if the peer wishes to join an activity; offering assistance during play; holding their hand and moving together toward Any interaction directed to an adult or by an adult\u2019s prompt; any negative verbal or nonverbal interaction; unintelligible utterance that is not directed to any peer; self-stimulation without a peer within a meter (e.g., oops, oh no, yeah) Response: (from d\/Dhh student and from peer) Verbal, signing, or gestural response toward a peer who has initiated positive\/ neutral social behavior; and each consecutive social interaction after the first initiation Complying with another student\u2019s request; replying to a verbal or signing interaction; looking at a child in response to their name sign or to shoulder-tapping by a peer A behavior that occurs later than 10 seconds after a peer\u2019s initiation or response Social Engagement between d\/Dhh student and peer(s) Saying one or more understandable words or signs while positioned within 3-5ft of a peer and with body oriented toward the peer, directing a gesture or movement toward a peer, making a cooperative response, playing with toys or materials as intended, or imitating a peer Playing chase; adding a block to a structure that peers are building together; sharing materials playing a cooperative game; running to the monkey bars with a peer Wandering; sitting on a swing or at the top of the slide alone; walking in a repetitive sequence; leaves the activity area (< 3-5 ft outside of specified area); inappropriate problem behaviors (e.g., destroying or throwing item toward a peer); staying with group but parallel play Note. The coding scheme used for this study has been adapted from the prior work of Delano & Snell (2006), Ledford et al., (2016), Owen-DeSchryver et al., (2008), and others using similar codes for social interaction research (e.g., Davis et al.,1996; Thiemann & Goldstein, 2001).  Communicative Social Behaviors. The frequencies of four communicative social behaviors were measured using a frequency or event recording system: (a) d\/Dhh student\u2019s social initiation towards a peer, (b) peer\u2019s social initiation toward the d\/Dhh student, (c) d\/Dhh student\u2019s response to the peer\u2019s initiation, and (d) peer\u2019s response to the d\/Dhh student\u2019s  89 initiation. The number of social initiations and responses made by the d\/Dhh students and their peers were recorded in each 20-minute session that are comprised of two separate 10-minute periods. When a conversation occurred between a d\/Dhh student and a peer, each consecutive social interaction after the first initiation was scored as a response (Owen-Deschryver et al., 2008).  Social Engagement. Duration of social engagement with peers included the time that the d\/Dhh student spent interacting with their peers or engaged appropriately in activities in proximity with peers. Playing with materials or using facilities on the playground appropriately, however, did not count as \u201cengaged\u201d if the d\/Dhh student or peer was by themselves or not interacting with a peer during the time observed. Duration of social engagement between the d\/Dhh student and their peers was calculated using a 10-second momentary time sampling procedure (Ledford et al., 2016). At the end of each 10-second interval, cued by a tone or vibration from their phone, data collectors coded either \u201cengaged (occurrence)\u201d or \u201cnot engaged (non-occurrence).\u201d For each session, the researcher calculated the percentage of intervals that the d\/Dhh student was engaged with peers to determine the time spent together. For example, if there were 20 intervals coded as \u201cengaged\u201d for 10 minutes of an observation, the percentage of intervals with engagement would be 33% (total number of 10-second intervals for 10 minutes is 60; 20\/60 x 100 = 33). Social Validity. Classroom teachers and EAs completed a questionnaire to rate statements regarding the social validity of the intervention on a Likert-type scale from 1 (strongly disagree) to 5 (strongly agree) (See Appendix 4.1). The statements included the importance of skills taught, perceived effectiveness, appropriateness, and future use in their classrooms (Chan & O\u2019Reilly, 2008).   90 4.2.3 Procedures 4.2.3.1 Recruitment After obtaining university ethics and school district research approval, school principals and classroom teachers were contacted to see if they were interested in participating in this study (see Appendix B.3). Those who were interested then sent home an explanation of the study and parent consent forms to potential d\/Dhh student participants (see Appendices B.1 and B.2). The first three available participants who met the inclusionary criteria and whose parents consented were included as participants for the study. 4.2.3.2 Research Design and Setting Single case research methodology, also referred to as single-subject experimental research, was used in this study to assess the effects of social stories with ASL vocabulary on social interactions between students who are d\/Dhh-ASD and their hearing peers in inclusive settings. While case studies are purely descriptive and not experimental, single-case designs can be used to examine the effectiveness of an intervention through a functional relationship between an intervention and its outcomes (Cannon et al., 2016; Kazdin, 2011; Kratochwill et al., 2010). This methodology has been acknowledged for decades as it is well suited to address educational practices and answer applied problems (Barlow et al., 1984; Odom, 1988; Tawney & Gast, 1984), especially with low-incidence populations such as d\/Dhh students (Bullis & Anderson, 1986; Cannon et al., 2016; Guardino & Antia, 2008). One of the most common single case designs is multiple baseline design, in which researchers replicate the comparison between the baseline (i.e., pre-intervention condition) and intervention outcomes across at least three different behaviors, contexts, or participants to ensure internal validity (Cannon et al., 2016; Ledford & Gast, 2018). In this study, however, as the d\/Dhh participants were integrated across three  91 different schools in two different school districts, establishing contemporaneous baselines would have been very difficult; therefore, a non-concurrent multiple baseline design across participants was used (Ledford & Gast, 2018). I observed and collected data on the targeted social behaviors of the students who are d\/Dhh-ASD and their peers during the lunchtime and recess periods. The data were collected in the classroom during lunch and on the playground during recess because these unstructured and non-instructional times provide consistent opportunities for students to participate in social interactions (Kurth et al., 2015; Owen-Deschryver et al., 2008; More et al., 2013). When conducting observations, I remained as far away from the students who are d\/Dhh-ASD as possible while still ensuring that I could hear any verbal interactions or see signs and gestures. This study had three phases: baseline, intervention, and follow-up.  Baseline. During the baseline phase, data collection was conducted three days per week until a stable level and trend occurred, at which point the intervention was introduced to the first participant who is d\/Dhh-ASD and their peers. During baseline, the classroom teachers read stories to the whole class or provided students with free time to complete independent work. This process was repeated for all remaining students.  Intervention. Each intervention session was comprised of reading a social story and modeling five targeted ASL vocabulary, which were embedded in the story (see Appendix B.4). I modeled ASL vocabulary as she read each social story. A total of six social stories were used in this study in each setting. The researcher created the stories following Gray\u2019s (2004) guidelines. The stories were reviewed by two professors in Special Education at a local university who are experts in d\/Dhh and ASD respectively and two elementary school teachers to ensure their compliance with Gray\u2019s criteria and appropriateness of the content. The stories were intended to  92 provide the students with prosocial communication strategies in order to increase social interactions between students who are d\/Dhh-ASD and their peers in inclusive settings. Topics were specific to the activities during lunchtime and recess, including greetings, expressing feelings, sharing and turn-taking, and playing and working together. Each story consisted of six to seven PowerPoint slides and contained visual illustrations directly related to the text, based on recommendations from previous research (Kokina & Kern, 2010).  The intervention sessions took place just before lunch since social stories are recommended to be read immediately prior to the targeted activities in previous literature (Kim et al., 2014). The classrooms were also used as lunchrooms, so students remained in the same room after the intervention. The 15- to 20-minute intervention sessions were conducted three times per week by the researcher for two weeks.  Follow-up. The first follow-up observation occurred two weeks after the final intervention session for each participant. They were conducted three times, once every two weeks. The classroom teachers and EAs were asked to answer the social validity questionnaire for the second time four weeks after the intervention ceased. 4.2.3.3 Implementation Fidelity To ensure that intervention was delivered as designed, an independent observer, who was a doctoral student in Special Education, completed an implementation fidelity checklist that specified the components of a treatment session in 33% of the intervention sessions across three participants. This variable was calculated by dividing the total number of components completed accurately by the total number of correct plus incorrect components and multiplying by 100 (Maione & Mirenda, 2006).   93 4.2.3.4 Interobserver Agreement The same independent observer also collected data simultaneously on the target behaviors of participants for 15 out of the 43 (35%) observation sessions, balanced across participants and study phases. I provided the interobserver with training sessions that included: (a) a review of the coding manual (as shown in Table 4.2); (b) practice coding by watching sample videos that were taken during a summer community program where children with ASD were included; and (c) pilot observation of actual interactions between the d\/Dhh students and peers during lunchtime and recess. Once the interobserver and I completed the coding practice with 90% or higher accuracy on pre-recorded role plays, pilot observations of the students in the inclusive classrooms started. 100% agreement for two, 20-minute, consecutive pilot observations was achieved prior to data collection in the baseline phase. For frequency of social initiations and responses, interobserver agreement (IOA) was calculated by comparing the observers\u2019 frequencies of each targeted social behavior within two-minute intervals of the 20-minute observation sessions using point-by-point agreement. For duration of social engagement with peers, point-by-point agreement was calculated for each 10-second interval. IOA was calculated by dividing the total number of agreements by the total number of agreements plus disagreements and multiplying by 100. The average IOA was 85% for frequency of social initiations and responses, and the average agreement for duration of social engagement was 99%.  4.2.3.5 Social Validity  The questionnaire was conducted twice: first at the end of the intervention phase, and second during the follow-up phase. Classroom teachers and EAs were asked to evaluate the social significance of goals, procedures, and outcomes of the intervention by answering the social validity questionnaire provided (see Appendix B.5).   94 4.3 Results The result of the implementation fidelity checklist was 100% in all intervention sessions across all participating classes. As shown in Figures 1, 2, and 3, the results did not show an immediate effect of the intervention across all participants on increasing social interaction and engagement although two participants and their peers showed some improvements during the follow-up phase.  4.3.1 Frequency of Social Initiations and Responses of d\/Dhh Students Figure 4.1 displays the results related to the frequency of social initiations and responses by the students who are d\/Dhh-ASD across the baseline, intervention, and follow-up phases. Each data point represents the number of social initiations and responses during a 20-minute observation session.               95 Figure 4.1 Frequency of Social Initiations and Responses by d\/Dhh Students Toward Peers     96 During the baseline phase, all three participants showed zero to very low, stable levels of unprompted social initiations (ranging from 0-1). Jimin had 1 response on average (ranging from 0-2). Ali showed 2 responses on average (ranging from 0-4). Rain\u2019s responses remained zero during this phase. After the intervention was introduced, Jimin and Rain did not show any changes in the numbers of both social initiations and responses towards their peers. Ali displayed an increase in both social initiations (ranging from 0-7) and responses (ranging from 1-10) after the first story was introduced to the class. This behavior was sustained for the following three data points; however, both his initiation and response decreased to low levels for the remaining three observations. Both Jimin and Ali showed lower levels of social initiations than social responses. Rain did not demonstrate any attempts for social initiation and responses during the entire intervention phase.  During the follow-up phase each participant showed different trends in the target social behaviors. Jimin showed no social initiations during the follow-up phase, which was consistent with his baseline and intervention phase. The number of his social responses became higher (ranging from 0-8) approximately four weeks after the intervention ceased. Social behaviors of Ali, in both initiation (ranging from 1-23) and response (ranging from 5-12), showed a steep accelerating trend. This trend continued through the final observation, where his initiations were much higher than his responses. During the follow-up phase, Rain remained at zero to one for the number of initiations and responsive social behaviors.  4.3.2 Frequency of Social Initiations and Responses of Peers Figure 4.2 shows the results related to the frequency of social initiations and responses made by peers towards the d\/Dhh-ASD student in their class across all three participants.   97 Figure 4.2 Frequency of Social Initiations and Responses by Peers Toward d\/Dhh Students    98 Overall, during the entire three phases across the three classes, except the follow-up of Ali\u2019s peers, peers of the d\/Dhh-ASD students initiated (data ranging from 0-15) more than they responded (data ranging from 0-7).   During the baseline condition, Jimin\u2019s peers had a low, stable level of social initiations (ranging from 0-2) and responses (ranging from 0-1). Ali\u2019s peers initially demonstrated 8 social initiations, but they did not initiate during the following session. Baseline data continued to be highly variable throughout the five observation sessions, ranging from 0-8. The final data point of baseline showed a decelerating trend of social initiations. Peers\u2019 responses to social initiations by Ali were zero to very low and stable, ranging from 0-1. Rain\u2019s peers initiated and responded one time, each during the baseline phase. During the intervention phase, social initiation by Jimin\u2019s peers were somewhat variable but at a slightly higher level than the baseline (ranging from 0-3). There was no social response by Jimin\u2019s peers, as no initiation from Jimin occurred. Ali\u2019s peers showed an immediate increase in the level of both social initiation and response when the intervention was introduced. However, there was a steep decrease in the middle of the phase, and the social behaviors did not recover to the high level seen in the beginning of the intervention phase. There was no communicative attempt made by Rain\u2019s peers as the data series is parallel to abscissa.  During the follow-up sessions, Jimin\u2019s peers displayed increased initiations across the three observations (ranging from 2-15), particularly for the final two data points. The peers responded twice to Jimin\u2019s responses during the second observation session of the follow-up phase (ranging from 0-2). Ali\u2019s peers resumed a similar level of social initiation displayed at the beginning of the intervention phase (ranging from 6-11). Their social response data were variable but at a much higher level (ranging from 2-14) than the previous phases, aligning with an  99 increase in Ali\u2019s initiation. There was a downward trend in both initiating and responding to Ali by the end of the follow-up phase. Peers of Rain attempted one social initiation during the three follow up sessions, which resulted in a response from Rain. 4.3.3 Duration of Social Engagement between d\/Dhh Students and Peers The graph in Figure 4.3 shows the estimated duration that each of the three students who are d\/Dhh-ASD was engaged with their peers, respectively. This duration was estimated by calculating the percentages of intervals of \u201cengaged\u201d interactions during each 20-minute session for baseline, intervention, and follow-up phases.                  100 Figure 4.3 Estimated Duration of Social Engagement of d\/Dhh Students with their Peers      101 Throughout the baseline condition, all participants who are d\/Dhh-ASD spent 0 to 2% of the time engaged with their peers, except for outliers of up to 7%. During the intervention phases, there were little changes in the duration of social engagement of Jimin and Rain, and their peers respectively. Ali and his peers showed an increased level of social engagement for the first half of the intervention phase with a range of 34 to 44%. There was a noticeable decline in the percentage of intervals after the fourth data point and the level remained 1 to 3% of time engaged until the end of the phase.  During the follow-up phase, Jimin did not show any engagement with his peers for the first data point. There was a dramatic increase for the second data point to 48% followed by a decline to 30% engagement for the last data point. Ali and his peers were socially engaged at higher levels with a range of 28 to 53% (an average of more than 40%), gradually increasing throughout the entire follow up condition. The levels of engagement of Rain and his peers were no different from the previous phases. 4.3.4 Social Validity Table 4.3 shows the social validity scores collected from the nine classroom teachers and EAs on a Likert-type scale from 1 (strongly disagree) to 5 (strongly agree). According to their evaluation, the average social validity score was 3.92 (ranging from 3.46 to 4.30) during the intervention phase and 4.13 during the follow-up (ranging from 4.03 to 4.02). The average social validity scores for each class were 3.69 (Jimin\u2019s), 3.74 (Ali\u2019s), and 4.65 (Rain\u2019s). Most scores ranged from neutral to agree, indicating the teachers and EAs were likely to agree that the intervention has socially important goals, acceptable procedures, and socially important outcomes.   102 Table 4.3 Summary of Mean Scores of Social Validity Across Educators Statements Intervention phases Follow-up phases Jimin Ali Rain Avg. Sam Ali Rain Avg. Social importance of the goals 3.67 4.33 4.89 4.30 3.33 3.89 4.89 4.03 Acceptability of the procedures 3.89 3.33 4.75 3.99 4.17 4 4.89 4.35 Social importance of the outcomes 3.22 3 4.16 3.46 3.83 3.89 4.33 4.02 Average 3.59 3.55 4.60 3.92 3.78 3.93 4.70 4.13 Note. 1=strongly disagree, 5=strongly agree 4.4 Discussion This study evaluated the effectiveness of using social stories combined with modeling ASL vocabulary to increase social interactions and engagement of students who are d\/Dhh-ASD and their peers in inclusive school settings. Researchers implemented the intervention in three classes, each of which included a student who is d\/Dhh-ASD. The results indicated no functional relation between the intervention and an increase in social interaction across the three students who are d\/Dhh-ASD and their peers; rather, the results demonstrated basic effects on all dependent variables for only one student and his peers. These findings differ from previous research in which social stories were identified as an effective strategy for improving social interaction and communication in (a) children with ASD (Chan & O\u2019Reilly, 2008; Crozier & Tincani, 2007; Schneider & Goldstein, 2010), (b) d\/Dhh students in inclusive settings (Raver et al., 2014), and (c) classes where students with developmental disabilities were included (Fees et al., 2014). This variability of the effectiveness requires researchers and educators to view the results cautiously before another social story intervention is repeated for students who are d\/Dhh-ASD in inclusive settings. 4.4.1 Variable Effects across Students As an EBP, social story interventions have been widely used in a variety of settings to support the social development of students with ASD. However, as the guidelines for the  103 implementation have changed over time (Gray, 2004; Gray & Garland, 1993) with little to no research to rationalize the changes (Leaf et al., 2020; Leaf & Ferguson, 2017), some researchers pointed out that the effectiveness of social stories could be variable due to the differences in implementation (i.e., in isolation or in combination with another intervention) and construction (More et al., 2013; Wahman et al., 2019). Thus, the complexity of implementation and construction should be considered carefully for a target population. In this study, considering the unique needs of the students who are d\/Dhh-ASD, the intervention was implemented (a) with the whole class, rather than one-on-one and (b) by modeling ASL vocabulary. The social stories in this study were constructed using the guidelines provided by Gray (2004) but not individualized to each participant and their peers (Fees et al., 2014). These modifications may be limitations when ascertaining which components of the social story intervention contributed to its variable effectiveness in this study. To interpret the variable effects of the intervention, the following will be discussed: (a) the student skill and language level, (b) delayed effect of the intervention, (c) environmental factors, (d) supporting staff roles, and (e) social validity. Additional modifications (e.g., role play, practice, video models) to the social story interventions and\/or additional readings of each story may have been beneficial for all of the students in the class.   Student skill level. Although all three d\/Dhh participants were in the same grade level, met the inclusionary criteria, and their baseline data points were similar (almost zero to very low), they displayed a wide range of abilities in language and communication, cognitive and physical development, and regulation of behaviors as shown in Table 1. For example, while Ali was able to make requests with three to four ASL signs in a sentence structure, Rain constantly presented requests with physical aggression (e.g., grabbing peers\u2019 hair). Although Rain's intention appeared to be genuine engagement or to gain attention with his peers, these types of  104 communicative attempts deterred peers from interacting with him and were not included in the data collection for social initiations or responses. Given the acquisition of successful response and initiation behaviors is considered to be imperative for the establishment and the continuation of successful communication between the student with ASD and their peers (Kok et al., 2002), the three participants were at different readiness levels in their social interactive skills. Some students might need to acquire prerequisite behaviors or need additional modifications to the intervention in order to benefit from social stories (Kalyva & Avramidis, 2005). When examining the efficacy of social stories and considering elemental modifications for the population, the individual differences among students (More et al., 2013; Schneider & Goldstein, 2010) and other features (e.g., partners, physical and social environment; Leaf et al., 2020) should be considered throughout the course of the intervention. Each of the three participants displayed lower levels of social initiations than responses across the phases, which is consistent with evidence that social initiation skills are more challenging to acquire for most students with ASD (Kabashi & Kaczmarek, 2017; Kalyva & Avramidis, 2005; McDonald & Hemmes, 2003). In contrast, the overall social initiations by peers outnumbered their responses, as presented in Figure 2. The number of social initiations and responses by peers in each session were higher than those by the student with d\/Dhh-ASD in the same class, as with previous studies (e.g., Koegel et al., 2012).  Delayed effect. There was a delayed effect, as illustrated by the data in the follow-up phases (see Figures 1, 2, and 3), although the intervention did not appear to have an immediate effect on participants\u2019 social interaction. Jimin\u2019s responses and his peers\u2019 initiations noticeably increased in the follow-up phase. Both Ali and his peers\u2019 social initiation and responses  105 comparably improved in the follow-up phase as well. Thus, a longer duration of their social engagement was exhibited. This delayed effect could be due to one of the unique aspects of the intervention, which involved modeling ASL vocabulary to the whole class. ASL was a new language for most of the peers to learn. It was observed across settings that the peers practiced the ASL vocabulary they learned through the sessions with each other but not as often with the students who are d\/Dhh-ASD. Knowledge of ASL by the peers was also not assessed. Participating peers in grade three or four might be shy about using ASL accurately and immediately after the intervention, which is common when learning a new language. In this study, each of the six social stories were read only one time to each class over a two-week period, and five different ASL vocabulary were modeled at each time, for a total of 30 new ASL vocabulary words. This timeline may not have been sufficient to investigate the effectiveness of this intervention, considering the time it takes to acquire a language. Future research should examine the determination of adequate dosage (i.e., number of times or frequency of dose; Parker-McGowan et al., 2014), the number of words modeled per session and the total number, an evaluation of acquisition of the ASL vocabulary, and the duration of each social story intervention (Schneider & Goldstein, 2010) in order to generalize the delayed effect. Environmental factors. Some environmental factors could support the delayed effect during the follow-up phase, which was quite evident in Jimin\u2019s and Ali\u2019s classes, contrary to Rain\u2019s. Rain was the only deaf student in his school, while Jimin and Ali were not. Jimin\u2019s and Ali\u2019s schools also had staff who were d\/Dhh. There were also school-wide events (e.g., holiday concert with the school for the deaf) or support programs (e.g., ASL club) in Jimin\u2019s and Ali\u2019s schools where their peers were continuously exposed to ASL. The school\u2019s social environment  106 may have supported Jimin\u2019s and Ali\u2019s peers use of ASL with their d\/Dhh-ASD peers more so than Rain\u2019s.  The classrooms\u2019 physical environment might have impacted peer engagement (Giangreco et al., 2010; Guardino & Antia, 2012;). All three classes had the same seating arrangement: four to five desks were physically touching in pods. While Jimin and Ali were seated in one of the clusters, Rain was only paired with his EA at the back of the classroom. This physical environment likely limited Rain\u2019s social engagement with the rest of his class and influenced his behavior as well as the behavior of the other students towards Rain (Giangreco et al., 2010).  Supporting staff. As a possible confounding variable, the one-on-one EAs\u2019 previous experiences, knowledge, and skills may have affected the intervention. Although all three students who are d\/Dhh-ASD received full-time EA support, each EA\u2019s skill sets and roles were quite different. Jimin\u2019s EA had previously worked as a behavioral interventionist for children with ASD; therefore, he may have a deeper understanding of effective social skill instruction. It was observed during the follow-up phase that he facilitated social interactions between peers through coaching in the classroom and on the playground. In Ali\u2019s class, the EA supervised Ali very closely and continued conversations with him during the observations for the second half of the intervention phase. During this time his peers rarely approached Ali, which led to a drop in data points in the middle of the intervention. During the follow-up phase, the school removed the supervision, and some peers invited Ali to play with them and were socially engaged with him for most of recess. For Rain, a new EA was assigned to him on the day the intervention phase started. Although the EA was proficient in ASL skills, it was her first EA position, and Rain\u2019s behavior issues escalated while adjusting to working with a new person. A part of the role of EAs who work with students who are d\/Dhh-ASD in inclusive settings is to facilitate peer social  107 interactions. Thus, in-service training for support staff should be provided to increase daily instances of positive interaction through general instruction regarding social skills and specific teaching of playground games and rules (Vicker, 1998; Wahman et al., 2019).  4.4.2 Social Validity The average in the follow-up phase (4.13) increased across all three classes compared to the average in the intervention phase (3.92). This may support the delayed uptake of the intervention by the educators since the student participants showed delayed effects as well. Therefore, the period of intervention may need to be extended to see more long-term effects on social interaction and communication. As shown in Table 4.3, Rain\u2019s classroom teacher and EAs rated social validity as the highest across all three classes in all three areas: goals, procedures, and outcomes of the intervention (4.89, 4.82, and 4.25 respectively) although Rain\u2019s class showed no progress. There were no interviews as to why they perceived the social validity of the intervention so highly, but two possibilities could be speculated. First, compared to the other two classes, there had been little support for Rain and his peers to socially engage with each other and receive support from a behavioral analyst or the benefits of a school-wide inclusion program. Prior to the study, Rain\u2019s teachers shared their struggles with finding ways to improve social inclusion in his class and appeared to look forward to having the opportunity to be part of this study. Second, educators reported that when the social stories and ASL vocabulary were introduced to the students, the class\u2019s overall engagement throughout the day increased. Students approached me the researcher to check if their signs were correct and share their experiences of using ASL with Rain. Rain's classroom teacher also stated how much her class enjoyed the intervention and asked for extra materials to help them continue learning ASL after the study was completed. Although not  108 reflected in the single case design data, the social validity scores provide a meaningful measure to show the influence of the intervention to the participant's class. 4.4.3 Limitations The limitations of this study include generalizability and inability to isolate the effect of including ASL vocabulary in teaching the social stories. This study was conducted at three schools with only three students who are d\/Dhh-ASD. Future research is needed to determine if the results could be generalized to a greater population of students and in different learning environments. As previously noted, there were possible confounding variables that may have contributed to variability in intervention effects (e.g., EA skills, ASL club). A replication study could be designed to control for these variables and determine a more accurate effect of the intervention. Researchers should also attend to the contributions of each intervention component to determine whether behavioral changes are the result of social stories, the impact of the other component (i.e., ASL vocabulary modeling), or a combination of both (Schneider & Goldstein, 2010; Wahman et al., 2019).  Another limitation, or as a possible reason for the lack of treatment effect to increase social interactions, might be related to the time of observation. As previous research recommended to observe social interactions during unstructured, non-instructional time (Kurth et al., 2015; More et al., 2013; Owen-Deschryver et al., 2008), data collection in this study took place at lunch and recess time. However, 86% of all interactions occurred during recess and only 14% during lunchtime. This may be due to the classroom lunch environment, as students stayed at their desks while having lunch and most of the students hurried to finish their lunch to go outside for recess. Some peers had conversations naturally at their clustered desks while eating; however, some participants who are d\/Dhh-ASD were not able to access their peers\u2019  109 conversation due to limited auditory input or their peers\u2019 lack of ASL skills. In future research, consideration of the times when students have the most opportunities for social interaction could be individualized for each setting\/school environment.  4.4.4 Implications for Researchers There is a great need to modify interventions that have been found to be effective in adjacent fields for individuals who are d\/Dhh-ASD (Borders et al., 2022; Bruce & Borders, 2015). Social story interventions may be utilized in combination with other developmentally appropriate strategies or interventions depending on a student\u2019s abilities and situations (Leaf et al., 2020; Vicker, 1998; Wahman et al., 2019). For example, when a student who is d\/Dhh-ASD experiences isolation in the classroom and develops inappropriate communicative engagement, a social story intervention might not be effective by itself to increase social interactions with peers. Rather, it might have a more powerful impact when combined with other tailored strategies (e.g., functional communication training, role modeling, video modeling) as part of their positive behavior support program. As most of the peer initiations were made by two or three of the same peers, the researchers suggest incorporating a peer-mediated training (e.g., Circle of Friends: Kalyva & Avramidis, 2005; O\u2019Connor, 2016; Schlieder et al., 2014) or direct coaching approach with volunteering peers. Increasing social interactions require reciprocal efforts, not only by the targeted student in the inclusive environment but by the whole class community. 4.4.5 Conclusion Social interactions between students who are d\/Dhh-ASD and their peers are essential for success in inclusive educational settings and can improve the quality of life for individuals with disabilities. In order to best meet the complex needs of this population, identification of effective interventions is necessary. The current study investigated an intervention that combined teaching  110 social stories and modeling ASL vocabulary. While the results may not indicate a clear treatment effect across the three d\/Dhh participants and their peers, it is important to note the study is the first social story intervention to be conducted with students who are d\/Dhh-ASD and their peers as a whole class. Possible confounding variables include individual differences and environmental factors, which may explain the various effects of the intervention. In addition, students might need additional supports or practice to improve social communication and proficiency with ASL, including in vivo rehearsal or coaching, as well as peer-mediated instruction.    111 Chapter 5: Education of Students Who are Deaf and Hard of Hearing with Disabilities in British Columbia: Identification and Eligibility, Placement, and Intervention 5.1 Introduction Nearly half of all d\/Dhh students may experience at least one disability (e.g., intellectual disability, ASD, learning disability) along with their hearing loss (GRI, 2013). Due to diverse learning characteristics and varying levels of challenges, educators, including TDHHs, are often uncertain about how to optimally serve this population of learners in their school settings. Each subpopulation (e.g., students who are d\/Dhh with autism spectrum disorder, students who are d\/Dhh with a learning disability) makes up a minority of the school-age population (GRI, 2013); however, each learner has unique needs that require specialized knowledge and highly trained teachers (Guardino & Cannon, 2022; Scott & Hansen, 2020;). In order to improve the quality of educational services for these learners, it is important to consider the perspectives of educators working with students who are DWD (Guardino & Cannon, 2015; Luckner & Carter, 2001; Musyoka et al., 2017; Scott & Hansen, 2020). There is minimal literature available regarding identification and eligibility, educational placement, and appropriate instructional strategies for working with students who are DWD. In BC, the majority of students who are DWD attend school in an inclusive setting with support from an itinerant TDHH, while others attend specialized schools or programs for learners who are d\/Dhh. Given the low incidence of students who are DWD, it may be challenging for school districts to (a) identify and assess the needs of the learners, (b) locate resources for educational practices, and (c) allocate trained teachers to work specifically with this population (Scott & Hansen, 2020). The purpose of the study is to investigate practices and considerations  112 regarding identification and eligibility, placement, and interventions for students who are DWD in BC from the perspective of educators. 5.1.1 Prevalence of DWD Students in BC The Ministry delineates the diagnostic and identification criteria for children with special needs across twelve designations (BC Teachers\u2019 Federation, 2017) According to the Ministry\u2019s Special Education Services: A Manual of Policies, Procedures, and Guidelines (2016), \u201ca student considered to be deaf or hard of hearing is one who has a medically diagnosed hearing loss that results in a substantial educational difficulty\u201d (p. 79). Once the eligibility is affirmed by designated professionals, students who are d\/Dhh are assigned the classification of the letter code F. This also indicates eligibility for an IEP that includes accommodations and remedial supports with supplemental funding from the Ministry. Under this category system, students who are DWD may be identified with (a) the designation of F and another designation as the primary or secondary designation (e.g., d\/Dhh with autism, d\/Dhh with learning disability), (b) the designation of F and are suspected of having a disability; or (c) a special education designation and a proof of hearing loss by a designated professional (i.e., audiologist) without F designation.  A public report released by the BC government in the 2019\/2020 school year (https:\/\/news.gov.bc.ca\/releases\/2019EDUC0069-001642) states there was a total of 545,805 students enrolled in BC schools, and 73,107 students (approximately 13%) were receiving special education services. The Education Analytics of the Ministry (modified in January, 2021; https:\/\/catalogue.data.gov.bc.ca\/dataset\/student-headcount-by-special-needs-category), reported that, during the same school year, there were 1,345 students (1.8%) who received services under the category of F. This number only represents d\/Dhh learners whose primary designation is F and excludes the number of d\/Dhh learners whose secondary designation is F or who have no F  113 designation since these students are under a different disability category, for an equal or greater amount of supplemental funding, as their primary designation. As any secondary designation does not affect the amount of funding school districts can receive, some districts may not assign learners a secondary designation. For this reason, it is difficult to accurately report the number of students who are DWD in the province.  5.1.2 Identification and Eligibility Educators and professionals may not identify the hearing level of learners who are DWD at the same ages as those without a disability and consequently the learners may not receive d\/Dhh services (Ewing & Jones, 2003; Lennan, 1982; Powers et al., 1987; Powers et al., 1988; Roth, 1991). An accompanying disability is also more likely to be late-identified for learners who are DWD than for a learner without hearing loss (Erickson & Quick, 2017; Mandell et al., 2005). Moreover, when other challenges are prominent, hearing status is likely to be overshadowed and unidentified (Erickson & Quick, 2017). Weak assessment procedures may also lead to misidentification if an assessor does not consider the multiplicative nature of hearing loss and a disability (Knoors & Verbloed, 2011). Delays in identification may lead to delays in receiving relevant special education services within provincial educational systems (Borders, Meinzen-Derr et al., 2015; Wiley & Meinzen-Derr, 2013), as identification is required for students to be eligible for services from educational professionals who have expertise in each disability category (Guardino & Cannon, 2022). Even when an accompanying disability is identified, under BC\u2019s current designation and funding system, a student is not guaranteed to receive educational services for the disability. As schools are asked to report only the primary designation of a student (MyEducation BC, 2021), the secondary designation or other disabilities are not necessarily recorded. Therefore, the  114 presence of students who are DWD is often masked by the primary disability category label (Wagner & Blackorby, 2002), and as a consequence, DWD students do not always receive \u201cspecial education services that are directly related to the student\u2019s hearing loss on a regular basis from a qualified TDHH\u201d (The Ministry, 2016, p.8).  Moreover, there is neither a reference nor guidance regarding how a designation is determined to be \u201cprimary\u201d or \u201csecondary\u201d nor an explanation about how services for primary and secondary designations differ; as a result, the educational services provided across the school districts for DWD students are inconsistent. Thus, there is a necessity for the Ministry, school districts, and schools to deliberate on how students\u2019 needs are identified and optimally served by qualified professionals. 5.1.3 Educational Placement The BC Ministry of Education promotes an inclusive education system \u201cin which students with special needs are fully participating members of a community of learners\u201d (The Ministry, 2016, p.2). To become fully participating members of a school community, students must have a shared language (Schmidt, 2021). According to the Council of Service Providers (CSP, 2023), a diverse group of stakeholders - including educators, administrators, parents - who represent all organizations for and service providers to d\/Dhh individuals in BC, there were approximately 1,200 d\/Dhh students in K to 12, with 1,086 attending 60 school districts and approximately 100 attending \u201ccluster\u201d programs or received online education in the year of 2019\/2020 in the province. A cluster program is where there is an existing community of d\/Dhh students in a school and is designed to respond to the unique communication, learning preferences, and needs of many d\/Dhh students. In 2003, there were 14 cluster programs in the province including two specialized independent schools, four provincial resource programs, and eight district programs. This number decreased to six in 2022 with one specialized independent  115 school, one provincial resource program, and four district programs. Namely, while the overall population of d\/Dhh students in BC has remained relatively constant over the last two decades, the number of specialized \u201ccluster\u201d programs for d\/Dhh students has decreased. This reduction implies that increasing numbers of d\/Dhh students are receiving less specialized educational programming and services in 2022 than they did 20 years ago.  The Ministry (2016) states that \u201cmost students who are deaf or hard of hearing can and should be educated in their local school district.\u201d They mention four programming options for students who are d\/Dhh: \u201c(a) a regular class with direct, frequent support from a qualified itinerant teacher of the deaf and hard of hearing; (b) a resource room staffed by a teacher of the deaf and hard of hearing; (c) a self-contained class staffed by a teacher of the deaf and hard of hearing who has access to the appropriate support services; and\/or (d) an individual program for students with hearing loss and additional special needs\u201d (p.81). However, there is no specific description in the manual about what the \u201cindividual program\u201d for students who are DWD should entail. Although all of the options may be applicable for students who are DWD, not all school districts may have all of the four placement options. Determining the most inclusive or the least restrictive environment for students who are DWD can be complex for school teams and families (Fossett, 2010; Singer et al., 2020). 5.1.4 Intervention Researchers have noted that there is a dearth of assessment tools and evidence-based practices (EBP) for students who are DWD (Bruce & Borders, 2015; Cannon et al., 2016; Dale & Neild, 2019; Easterbrook & Handley, 2005). It is challenging to find appropriate assessment tools that can inform TDHHs and other professionals of the appropriate interventions for the learners (Cawthon, 2015). As interventions from the field of deaf education itself may not always  116 be adequate to meet the needs of this population with complex needs (Borders et al., 2016; Bradley et al., 2008; Guardino & Cannon, 2022), professionals are urged to look to adjacent fields (e.g., special education for other disabilities) when determining intervention practices and modify them to meet the needs of students who are DWD (Bruce & Borders 2015; Borders et al., 2016; see Chapter 3).  Furthermore, Guardino and Cannon (2022) encourage professionals to integrate systems from the broader field of education, such as UDL, into their instruction or other professional practices when working with students who are DWD. UDL is a framework that promotes a strengths-based approach to meet the needs of all learners, not only those with disabilities, through accessible environments (Center for Applied Special Technology [CAST], 2011; Rose & Gravel, 2010). Lesson and intervention planning should utilize the UDL framework to develop accessible learning activities through differentiated instruction techniques and collaborative practices (Guardino & Cannon, 2022). The principles of the UDL guidelines emphasize a student\u2019s strengths and potential, and set up a context in which they can live, learn, work, or play (Wehmeyer, 2020).  5.1.5 Purpose of Research This research will explore practices and considerations in the education of students who are DWD across four areas: identification, eligibility, educational placement, and intervention from the perspective of their educational professionals, in an effort to respond to the dearth of information about school services for these learners in BC.  The research questions are: 1. What are the current practices and considerations in identification and eligibility for special education services for students who are DWD?  117 2. What are the current practices and considerations in determining educational placement for students who are DWD? 3. What are the current practices and considerations in implementing strategies and interventions for students who are DWD? 5.2 Methods 5.2.1 Participants The participants in this study were educators who worked with DWD students within the last three years in a BC school setting. A total of 147 educators participated in the survey. Twenty-four cases (responses) were deleted due to missing values (i.e., respondents who failed to provide any information regarding the research questions). The resulting sample is comprised of 123 educators: 60 TDHHs, 11 administrators (five school-based administrators, two administrators at the district level, one administrator at the provincial level, and three directors or coordinators of a related school setting), 17 classroom teachers, 21 special education teachers, and 14 district specialists (see Table 5.1). In the study, each participant was recognized by an identifier that consists of the two letters for job types and two-digit numbers (nominal as a label): TD is for TDHHs, AM is for administrators, CL for classroom teachers, SP for special education teachers, and DS for district specialists and others. The majority of participants worked at public schools in either urban or suburban areas. More than 70% of the participants worked in general education classroom settings. The rest of the participants worked in resource classrooms for students with disabilities, resource classrooms for d\/Dhh students, specialized school settings for d\/Dhh students, etc. The participants\u2019 years of teaching experience varied; approximately half of the participants worked in their position for  118 more than 10 years and about 15% of educators worked less than two years. Table 5.1 shows the demographic data in detail. Table 5.1 Demographic Information of Survey Participants Demographic characteristic Response (n) Percentage (%) Living areas 129    Urban 52 40.3   Suburban 51 39.5   Rural 26 20.2 School system 126    Public school 96 76.2   Independent school 19 15.1   Private school 11 8.7 Educational setting 121    General education classroom with district specialists 85 70.2   Resource classroom for students with disabilities 16 13.2   School setting for d\/Dhh students 9 7.4   Others (e.g., a provincial program) 6 5.0   Resource classroom for d\/Dhh students 5 4.1 Job title 123    TDHH 60 48.8   Special education teacher  21 17.1   Classroom teacher  17 13.8   District specialist or others 14 11.4   School-based administrator 5 4.1   Director or coordinator of related school setting 3 2.4   District-level administrator 2 1.6   Provincial-level administrator 1 0.8 Years in the position 122    Less than 2 years 18 14.8   3-5 years 34 27.9   6-10 years 16 13.1   10-20 years 32 26.2   More than 20 years 22 18  There were 60 TDHHs who participated in the survey. 80% (n=48) of the TDHHs worked as itinerant teachers, providing support students in general education classrooms. 8% (n=5) of them worked in special school settings for the d\/Dhh, 7% (n=4) in the resource classroom for d\/Dhh students, 3% (n=2) in the resource classroom for students with disabilities, and 2% (n=1)  119 in a provincial program. Administrator respondents came from different-sized school settings where d\/Dhh students they served per year were more than 200 hundred students (n=1), between 50 and 100 (n=1), between 10 and 50 (n=1), and less than 10 (n=5). The allied professionals who participated in the survey worked with a range of d\/Dhh students with disabilities over the last three years: 41.5% worked one or two, 31.7% between three and five, 9.8% between five and ten, and 17.1% worked with more than 10 students.  Nineteen educators who completed the survey indicated their interest in taking part in a focus group discussion. Three of them were not able to participate due to their schedule; one did not respond to a follow-up email. A total of 15 attended one of the six focus group interviews: six TDHHs, three administrators, five school-based special education teachers, and one district SLP. Table 5.2 shows the demographic data of the focus group participants.               120 Table 5.2   Demographic Information of Focus Group Participants Identifier Years in the position Title Session participated TD22 10-20 Itinerant TDHH #1 TD24 3-5 Itinerant TDHH #1 TD54 >20 Itinerant TDHH #1 TD15 <2 Itinerant TDHH #2 TD36 10-20 Itinerant TDHH #2 SP04 6-10 Inclusive Team Teacher* #2 SP12 3-5 Special Education Teacher + itinerant TDHH #3 DS06 5-10 District SLP #3 SP16 3-5 Special Education Teacher* #3 (Emailed) TD27 3-5 Itinerant TDHH #4 SP10 3-5 Resource Room Teacher* #4 SP19 3-5 Learning Support Teacher* #4 AM10 >20 School-level administrator #5 AM12 10-20 School-level administrator #5 AM03 >20 District-level administrator #6 Note. Titles are used differently in school districts for school-based special education teachers.  5.2.2 Procedures Following institutional ethical approval, an online survey was developed for this research study using Qualtrics. Participants had one-time entry access to the survey via a link sent in an invitation email. Once accessed, participants were able to view a welcome screen that explained the purpose of the study, inclusionary criteria, and anonymity of collected data, along with an indication of UBC ethics approval. By clicking the NEXT button to take the survey on the screen, participants were regarded as providing their consent. The questionnaire took approximately 20 to 25 minutes for participants to complete. To thank participants for their time, they were entered into a draw to win one of four $50 gift certificates.  On the last page of the survey, participants were asked to write their contact information (i.e., email address) if they were interested in taking part in a focus group discussion. A follow-up email was sent to them with a consent form (see Appendix C.3). Once the signed consent form was received, they were asked to indicate their availability for an interview using an online  121 scheduling website. Participants were notified of the date and time, the online meeting link, and guiding questions two weeks prior to the interview. Six focus groups were conducted over a two-week period after data collection from the survey was completed.  All focus group sessions were conducted via video conferences using Zoom. I facilitated the sessions, and Dr. Cannon, my supervisor, observed the participants and assisted with any technical issues. Each focus group session lasted about 60 minutes. The entire sessions were recorded. I transcribed all the sessions using the Zoom transcription as an initial draft, which was edited by viewing the recordings of each focus group. Each focus group session had one to three participants upon their availability. All of the focus group participants received a $20 gift certificate to compensate their time. 5.2.3 Measures Survey questionnaire. A 59-item questionnaire was developed to explore practices and perspectives of educators who worked with students who are DWD (see Appendix C.2). The conceptual development of the questionnaire was based on (a) an extensive literature review of educators' perceptions and experiences of teaching DWD students (e.g., Guardino, 2015; Luckner & Carter, 2001; Musyoka et al., 2017; Scott & Hansen, 2020) and (b) an analysis of descriptive data from the previous case study (see Chapters 2 & 3) and findings from the single case design study (see Chapter 4).   A pilot study was conducted with seven recently retired educators: two TDHHs (one of whom was hard of hearing), three administrators at the district and school level, one classroom teacher, and one district psychologist. All of them had knowledge and experiences in the education of DWD students and also understood the purpose of the research. They completed the  122 survey questionnaire and provided feedback in terms of the form and content of the survey. The questions were refined based on their feedback. The questionnaire consisted of three sections followed by four questions about the participants\u2019 demographics: 27 questions on identification and eligibility, 14 on educational placement, and 18 on interventions. Some questions were given to all participants, while some were specified only for educators in certain jobs such as TDHHs, administrators, and allied professionals (i.e., classroom teachers, special education teachers, and district specialists). Subsequent questions could differ depending on the participant\u2019s responses. Thus, not every participant had to answer all 59 questions. The survey questionnaire was strategically arranged with 47 close-ended and 12 open-ended questions. The close-ended questions were one of four different types of multiple-choice questions: singular choice, checklist type, rank order, and Likert scale of 1\u20135 (1: strongly disagree to 5: strongly agree). There were 12 open-ended questions that allowed participants to type responses with no limitation on the word count. Focus Group Interviews. There were seven guiding questions for the group interviews (see Appendix C.4). These interviews were designed to gather in-depth information about the considerations that participants addressed with concrete examples. This allowed me to further understand the perspectives of educators who worked with DWD students (Pei et al., 2013). Thus, the questions were not newly devised but very similar to several open-ended survey questions. 5.2.4 Recruitment Purposeful sampling was used to identify potential respondents meeting the inclusion criteria (Campbell et al., 2020; Etikan et al., 2016). This method was employed because the  123 population of students who are DWD are a low-incidence population in the school system (Scott & Hansen, 2020). Survey invitations (see Appendix C.1) were emailed to listservs of leading organizations for d\/Dhh students, including the Canadian Association of Educators for the Deaf and Hard of Hearing (CAEDHH)-BC, Provincial Outreach Program: Deaf and Hard of Hearing (POPDHH), Provincial Outreach Program for Students with Deafblindness (POPDB), Provincial Outreach Program for Autism and Related Disorders (POPARD), Provincial Inclusion Outreach Program (PIOP), Children\u2019s Hearing and Speech Centre of BC, BC Provincial School for the Deaf, and Family Network for Deaf Children. The emails were also sent to directors and\/or coordinators of Inclusive Education in 60 school districts and 273 independent schools in BC for distribution to their staff. Certain school districts requested a separate research application package in order to have the survey distributed. The survey was also posted on social media such as BCEdAccess\u2019s Facebook, which has more than 3,000 parents of students with disabilities and Dr. Baumbusch\u2019s twitterhandle@InclusiveEdn.  A reminder for the completion of the survey was sent twice through the listserv of CAEDHH-BC: one was two weeks after the survey link was released and another after a month. There were no other processes for recruitment for the focus group interviews other than the invitation through the survey. 5.2.5 Research Design and Data Analysis A mixed methods research design was applied as this study utilized qualitative and quantitative approaches by taking two types of data collection procedures (i.e., a survey and group interviews) (Maxwell, 2018). Two types of data were integrated to answer the research questions. Descriptive statistics on the responses to the closed-ended questions of the online survey were obtained through Qualtrics to report the current practices of the education of  124 students who are DWD. Responses to the open-ended questions of the survey and interview transcripts from the focus group sessions were analyzed using a semantic, thematic analysis (Braun & Clarke, 2006) to report the educators\u2019 considerations as well as some of the current practices in the areas of eligibility and identification for service provision, educational placement, and implementation of intervention strategies. Responses from all participant educators (i.e., TDHH, administrators, district specialists, others) were coded and analyzed together to answer all three research questions by finding common themes in the responses. The anonymized data were shared with two professors in deaf education to triangulate the common themes.  5.3 Results I examined current practices and considerations surrounding educational eligibility, placement, and intervention for students who are DWD from the survey and interviews. Across each area, quantitative information about the current practices from the survey are presented, then I present the themes regarding considerations and suggestions that emerged from both the survey open-ended questions and focus group interviews.  5.3.1 Identification and Eligibility for Service Provision 5.3.1.1 Current Practices in Identification and Eligibility for Service Provision Table 5.3 shows the responses to the survey questions regarding current practices in identification and eligibility for service provision in the education of students who are DWD.      125 Table 5. 3 Practices in Identification and Eligibility for Service Provision Questions Responses (n) Percentage (%) Ways to identify accompanying disabilities*  121     Assessments by school team incl. school psychologist 88 72.7   Request from classroom teachers 70 57.9   Request from parents 56 46.3   Data from Response to Intervention\/Multi-tiered system 28 23.1   Assessment by outside professionals 5 4.1   Other 2 1.7 Whether a secondary designation is assigned 109    Yes 86 79.5   No 23 20.5 Persons who decide the primary designation 109    School-based team 35 32.1   District-level administrators 31 28.4   School psychologist 21 19.3   Case manager 8 7.3   Other (e.g., outside professionals, parents)  11 12.9 Criteria determining for primary designation (when the funding amount is the same as for d\/Dhh designation)  79    Varies depending on the case or up to administrators 53 67.1   d\/Deaf or hard of hearing 8 10.1   Autism Spectrum Disorder 5 6.3   Physical disability or chronic health impairment 4 5.1   Profound intellectual disabilities 0 0   Others (e.g., don\u2019t know) 9  Services for disabilities with less funding or high incidence designations (i.e., no additional funding) 78    Support from any staff currently available 35 44.9   Direct professional service only with 2nd designation 14 17.9   Consulting services only with 2nd designation 10 12.8   Few additional services without 2nd designation 10 12.8   Other (e.g., vary by schools, depend on resources) 9 11.5 Effects of the secondary designation 82    Varies depending on needs 53 64.6   Yes 15 18.3   No 9 11.0   N\/A 5 6.1 Ways to access services for disabilities without designations 20    Team will contact district professionals 15 71.4   Classroom teacher will ask principal 2 9.5   Might not have access to other services 2 9.5   Other 1 4.8  126 Whether students receive sufficient services 104    Strongly disagree  20 19.2   Somewhat disagree 30 28.9   Neither agree nor disagree 12 11.5   Somewhat agree 29 27.9   Strongly agree 13 12.5 Note. *The percentage to this multiple-selection question is calculated by dividing the number of respondents who selected the option by the total number of the respondents to the question; thus, the total of the percentages does not add up to 100%.   Identification. More than 70% of respondents who answered the question reported that DWD students\u2019 additional special needs were identified through assessments by the school team, including school psychologists. Only about 4% of respondents answered that their DWD students\u2019 additional needs were identified by assessment by outside professionals. At school, about a half of the students\u2019 additional needs were identified via teacher or parent referrals.   Eligibility. Almost 80% of respondents answered that their DWD students\u2019 needs were recognized by primary and secondary designations for special education services. The decision of which disability is the primary designation was made mainly by school-based teams, district-level administrators, or school psychologists. When accompanying disabilities of a d\/Dhh student were under the same funding category (i.e., \u2018F\u2019 designation; Level 2 funding), the criteria to determine the primary designation varied depending on the case or was up to administrators. Only 10% of respondents answered that a d\/Dhh designation is always considered primary when a learner has an accompanying disability(ies). When accompanying disabilities are under the disability category that provides less or no funding (i.e., Level 3 funding or high incidence), almost half of the respondents answered that their d\/Dhh students with disabilities would receive support from any staff currently available, even if the accompanying disability was not recognized as a secondary designation. Around 10% of respondents answered that the possibility to receive either direct or  127 consultative services would be increased when the accompanying disability in the categories was determined. At the same time, a similar percentage of respondents reported that, if a secondary designation is not determined, it would be rare for a DWD student to receive services for accompanying special needs. 18.3% of respondents confirmed that having a secondary designation affects the educational services that DWD students receive, whereas more than 60% reported that this varies depending on each student\u2019s needs. According to both groups, the effects varied depending on (a) the nature or severity of the disabilities presented along with hearing loss, (b) awareness or understanding of disabilities by the school (i.e., administrators), and (c) availability of resources (i.e., specialists). In their experiences, having a secondary designation is likely to (a) allow student\u2019s needs to be prioritized over others on high caseloads; (b) \u201cprovide a more complete picture of the student\u2019s needs and program planning\u201d (AM09), (c) bring in additional experts to the team (i.e., district level specialists) and more hours of support (i.e., direct EA hours, access to a resource room); and (d) involve parents in advocating for their child\u2019s needs. Overall, SP18 shared that \u201chaving a secondary designation allows these students to receive the level of education services that are not only beneficial but necessary for such students.\u201d There were about 10% of respondents who denied that having a secondary designation affected the services because the amount of funding available for support is still the same and there is no \u201cextra resources being put forward regarding any second designation\u201d (SP01). According to this group, in order for the students to get access to other educational services, mainly the case manager or school-based team would contact district professionals for additional services. However, there was about 10% of respondents who answered that the students might not have access to other educational services without a secondary designation. Overall, about half of  128 participants disagreed strongly or somewhat with the statement that their DWD students have received sufficient services from them and other professionals to meet their educational needs. However, another 40% of the respondents agreed strongly or somewhat, with about 10% of participants who neither agreed nor disagreed. Prevalence of d\/Dhh students with disabilities. As shown in Table 5.4, 54 out of 60 TDHH participants responded to questions about DWD prevalence; they reported different percentages on three categories: (a) d\/Dhh students on their caseload who presented disabilities or additional educational needs, (b) d\/Dhh students who were identified as having one or more disabilities, and (c) d\/Dhh students who had a secondary designation. TDHHs reported a higher percentage of d\/Dhh students with additional needs than the d\/Dhh students with identified disabilities, and an even smaller percentage of students whose disabilities have secondary designations. Administrators were asked to only report the percentage of d\/Dhh students presenting additional needs or disabilities within the d\/Dhh population that were under their administration. More than 60% of them reported that the prevalence of DWD students was under 40% of their d\/Dhh population. Their answers about the prevalence were based on their direct experience with the students, reviews of caseloads, or the student information system (e.g., IEP). Due to the characteristics of their roles, allied professionals were not asked the same prevalence questions as above. Instead, they reported that the students they worked with had different designation status: only the d\/Dhh designation (58.5%), d\/Dhh as primary and another designation as secondary (39.0%), d\/Dhh as secondary designation (29.3%), or no d\/Dhh designation (17.1%).    129 Table 5.4 Prevalence Data Reported by TDHHs and Administrators Among your d\/Dhh students Presented additional needs or disabilities  Identified or diagnosed as deaf with disability Had a secondary designation TDHH Admin TDHH Admin* TDHH Admin* n % n % n % n % n % n % <5% 3 6 2 25 7 14   12 22.2   5-20% 7 14 1 12.5 16 32   14 25.9   20-40% 21 42 2 25 13 26   14 25.9   40-60% 14 28 0 0 12 24   7 13.0    >60% 5 10 2 25 2 4   1 1.9   N\/A   1 12.5     6 11.1   Note. *No data were gathered in this section. Direct TDHH services. About two-thirds of TDHHs provided direct regular services (i.e., work with the student on a regular basis such as daily, weekly, or bi-weekly) to all students who have F designation, whether it was the primary designation or not. About 20% of participating TDHHs reported that they provided direct services to any d\/Dhh students \u201cwho have medically diagnosed hearing loss that results in a substantial educational difficulty (Ministry of Education, 2016)\u201d even if the students did not have F designation. There was about 15% of TDHHs who provided their regular services only to students whose primary designation is F. This group of TDHHs provided consulting services instead to both d\/Dhh students and their school staff or only their school staff when d\/Dhh students do not have F as primary; none of these TDHH respondents answered that no support was provided because students\u2019 primary designation was not F (See Table 5.5).        130 Table 5.5 d\/Dhh Students Receiving Direct Services from TDHHs Students receiving direct services Responses from TDHH Responses from administrator n  % n  % Students with primary d\/Dhh designation 8 16 0 0 Students with d\/Dhh designation 31 62 3 37.5 Students who are d\/Dhh  11 22 5 62.5  For the same question on the subject of direct TDHH services, responses from administrators were comparably different. More than 60% administrator participants answered that their TDHH provides services to all d\/Dhh students \u201cwho have medically diagnosed hearing loss that results in a substantial educational difficulty (Ministry of Education, 2016)\u201d even if they do not have F designation. The rest of them reported that direct TDHH services are provided to students as long as they have F designation, whether it is primary or secondary. None of these administrators answered that direct TDHH services were limited to students whose primary designation is F (see Table 5.5).  5.3.1.2 Considerations in Identification and Eligibility for Service Provision To answer the first research question regarding considerations of DWD students\u2019 identification and eligibility to access special education services, the educators\u2019 perspectives are reported here in depth. The themes that emerged throughout the survey open-ended questions and focus groups included: (a) assessments for identification, (b) eligibility for educational services, and (c) service provision between districts. Assessments for identification. Educators reported that the identification of disabilities for students who are DWD is challenging due to its complexity and a lack of professionals who can assess learners with a solid understanding of their language development. As dual or multiple disabilities of DWD students were often \u201cmasked\u201d by the lack of language exposure, it  131 was hard for educators to know what is impacting their DWD students' learning. For example, \u201cit is hard to untangle: is it autism or is it a hearing loss, or behavior?\u201d (TD27), \u201cif there are attention issues, is it due to the hearing, or is it due to \u2018attention\u2019 issues?\u201d (TD36), \u201cwe're still concerned about whether his learning difficulties are from the hearing or ELL or learning disability\u201d (SP04), \u201cis it the hearing loss that is causing the behavior or learning needs or are these separate and then how do we support this child and what supports does the child need\u201d (SP08). Educators reported it was difficult \u201cto get them an assessment where people can tease out\u201d (TD36) what truly impacts students\u2019 learning.  Educators further pointed out that the language challenges of DWD students made it more strenuous to identify students\u2019 true capability or needs. This was repeatedly brought up during the focus groups. AM12 pointed out:  The language challenges make it hard to decide what's happening for a child right away.  Until we input the language and give them all those opportunities to get the language, it's hard to tell what else is going on [here]. Even outside psychologists have a hard time separating it. It's a hard job. SP19 also addressed that \u201cmany students have such extreme communication barriers due to language deprivation that it makes it hard to diagnose additional disabilities.\u201d  Due to the above challenges, educators sometimes felt confused about where to take their DWD students for assessments in order to know how to support them:  It's all a bit confusing to me\u2026 I was told that if a child has significant hearing loss, refer them to a hearing loss team in a provincial hospital first. [but some educators say] \u2018oh, well, this can't all be explained by the hearing loss.\u2019 And now we're being told no, no, no, don't do that. So that's a little bit confusing. (AM10)   132 And the assessment outcomes were not always accurate as shown in the example below:  I have a five-year-old who just came to kindergarten. Last spring, they took him [for an autism assessment]. And the psychologist wrote a four or five-page report, basically documenting the things he couldn't do but then also only spent 15 minutes with him because he wouldn't sit at the table and do what they wanted. And then (the psychologist) came out and told the grandmother that, \u201che won't do anything we want him to do. We're going to give him 52.\u201d I don\u2019t know where he got that number. So, he gets an EA for school. And the truth is - I've been with this kid for five months now that the psychologist gave him a global developmental delay diagnosis, not an autism diagnosis. But he's not global delay, he doesn't have cognitive [challenges]. He's got trauma, he's got a wild family history. And he's got a hearing loss. (AM12) There was a prevalent concern among the participants about a long waitlist for psycho-educational assessment by professionals. Due to a lack of professionals, it may take approximately 18 to 24 months to be assessed by a team of specialists including a psychologist. Moreover, there were few assessment providers in the province who had sufficient experience or expertise regarding the complex needs of DWD children, especially in language and communication development. TD36 stated, \u201cI always feel like you need somebody to understand both, but I don't know where you find that in BC.  I know there's someone in Ontario. But that's a little far away.\u201d AM10 pointed out as well that it is critical to find someone who is able to:  tease out the hearing loss versus something else and is willing to put extra time to try to figure out\u2026so that the student actually gets [what they need]. It's not even so much about  133 the diagnosis; it is just about what is going on, and how we best place and support this student. Hindrances to timely assessments may often delay services at school. Participants reported that obtaining psycho-ed assessments from a school psychologist and getting a secondary designation for services were time-consuming processes. TD24 shared an example, \u201cthe student had an F designation with conductive hearing loss, and we suspected a learning disability too, so she ended up getting a Q designation [Learning Disability], but it took about four to five years.\u201d During the 2020 pandemic, an additional concern arose that delayed timely assessments at school was that: The kindergarten screenings haven't been taking place because the health units have not been able to get access to the school setting and do those screenings\u2026so some of these students [who have a dual diagnosis] are going to end up getting diagnosed really late with a hearing loss, particularly if there\u2019s another medical need that\u2019s more visible and taking up more of the parents\u2019 time. (SP12)  Overall, respondents regarded that a lack of professionals with the expertise to assess learners make it harder for students to get their needs identified accurately and timely for service access. Eligibility for services. Another concern often expressed by respondents was how the current designation-based funding model considers students\u2019 eligibility for services. Many respondents commented about BC\u2019s existing funding formula. To be eligible for special education services, a student must have one of the Ministry of Education designations in the system. DS06 pointed out during the interview that \u201ca child doesn\u2019t get an EA unless they have a designation for funding wise. Because they don't have that (a designation), [they can\u2019t get the services], and it\u2019s heartbreaking to see that.\u201d To get a designation, however, \u201ckids have to show  134 that there's a significant impact on their education [from the disability]\u201d (DS06). Therefore, this system was regarded as a \u201cdeficit funding model\u201d because the student needs to fail before being considered for service eligibility. DS06 further expressed:  This child is also a student in a district or in BC, so why should we wait for a designation? Especially right now, the waiting period for a child to get a designation\u2026 it's about two to three years. And they've lost the last opportunity already with all the interventions and the strategies. This kid should have had it for these past three years.   AM03 seconded this concern, \u201cI would say about the things on a deficit model. You know, it should be if kids are deaf or hard of hearing, they should be getting support, we shouldn't be waiting for them to fail.\u201d As the current funding model is designation-based (i.e., solely funded according to primary designations), d\/Dhh students with multiple disabilities and\/or likely multiple designations do not necessarily have access to related educational services at school. AM10 remarked: If a d\/Dhh student has additional diagnoses and\/or challenges, they can only receive one designation (for funding). They can be deaf and hard of hearing or they could be autistic. They can't be both. This puts the student at risk for not receiving support for areas of challenge. For some students, this can have a significant impact on their ability to access all of the supports they require to reach their potential.  A district-level administrator (AM03) highlighted:  There's a potential for a student who's physically dependent to actually not be recognized as a student who's deaf or hard of hearing, as far as the ministry is concerned. That said, we wouldn't make sure that that student was on the caseload for the teachers of the deaf  135 and hard hearing and that the services that would be needed for the student would be provided.  This matter was resonated in the following examples from practitioners, \u201cmy student does not receive the [TDHH] support that he should because his primary designation is autism even though he is deaf as well. He deserves just as much support as a [deaf] student who only has one designation\u201d (SP06), \u201csometimes, if the secondary designation is F and the primary designation is A [physically dependent with multiple needs], C[moderate to profound intellectual disability], or D[physical disability or chronic health impairment], the student does not receive full services from the TDHH and instead receives consultative services\u201d (TD08), \u201cI wondered if meeting designation for an F has put my MID or LD kiddos at a disadvantage in gaining other supports\u201d (TD48), \u201cI've had school principals say to me, well, we're not claiming him as a student as a category F but claiming the student for autism because we get more and it's easier to get support\u2026for a profoundly deaf child with bilateral cochlear implants\u201d (AM10). As only primary designations are populated on the Ministry\u2019s form for funding purposes and any secondary designations \u201cdo not come up as part of MyEducation BC\u201d (TD22), \u201cmost people do not pay attention to giving the student a secondary designation once the funding is secured, (as) the secondary designation does not officially guarantee related professional services\u201d (TD01). Thus, there was disagreement between educators about the necessity of having secondary designations as mentioned above (see Table 5.3). While some educators believed that \u201cwithout the secondary designation, those other needs for d\/Dhh students definitely fall through the cracks\u201d (TD02), others responded that \u201cif DWD has already F designation, then [there is] no need for an additional designation\u201d as \u201cthe student's secondary designation does not play a role in the educational services our students receive\u201d (SP13).    136 Service provision between districts. Lastly, many educators considered practices in various school districts to be different under this one designation-based funding model. TD54 shared her experiences during the interview:  I've worked with so many different districts, so on the one hand, you'll get the district that says yes, all the support the better, and other districts that will say, oh no no, you know, there is a resource room, they're taken care of, they can use AACs, we don't need the deaf piece in there, you're just going to complicate things. So, everything in between, there doesn't really seem to be any consistent response from school districts about how to approach those situations. I think school districts get more and more autonomy about how they do things to make these decisions around support than they used to. And that the whole guidelines around criteria are kind of a little bit more wishy-washy now, as I found it more of a challenge actually to [follow].  This inconsistency seemed to bring confusion to practitioners regarding the decision about the kinds of support services for different needs. TD21 stated, \u201c[services] vary with the student and even from school to school.\u201d  TD55 added, \u201cthere doesn't seem to be a consistent 'flowchart'-type of actions or decisions and services depend on nature and awareness of need and administration.\u201d TD54 pointed out that personnel changes may affect service provision, \u201cYou have one district director that does things one way and then they retire and now you have a new director, and everything changes.\u201d   To answer the first research question, the data analyses revealed the following educators\u2019 perspectives about the identification and eligibility of DWD students: (a) assessments of DWD are challenging due to its complexity and lack of professionals, (b) the current designation-based funding model does not secure all necessary services to meet learners\u2019 needs, and (c) educational  137 services from specialized professionals were inconsistent throughout the province due to district autonomy. 5.3.1.3 Suggestions in Identification and Eligibility In regard to the considerations addressed, educator participants shared the following suggestions for better service provision to students who are DWD.    Comprehensive and timely assessment. Assessments of DWD students should take place comprehensively and in a timely manner. Comprehensive assessments should be conducted by \u201ca multidisciplinary team, which means everybody's involved: the teacher, special education teacher, case manager, EAs, parents, and everybody who has access to or who's providing services to the child\u201d (DS06). When psycho-educational assessments are done by professionals outside the school district, they should include the perspectives of the learner\u2019s TDHH or school team member(s) who have worked directly with the child. In addition, assessment reports should be asset-based including meaningful and practical strategies rather than deficit-focused. To shorten the waiting period for access to assessment, respondents suggested targeted funding be utilized for recruiting professionals, including school psychologists. Equitable support. Educators emphasized that equitable support should be provided based on students\u2019 needs and not by designations. AM03 insisted,  Whether or not a student is designated, if a child needs support, they should get the support, whether they meet the criteria from the Ministry's perspective or not. When I hear people in the district say, \u2018well, we have this kid, we were sure he has autism, and he really needs support, so we need to get them tested and you need to push the parent to get the child to the pediatrician.\u2019 My argument is NO. If the kid needs support, the kid needs support\u2026we shouldn't be waiting for them to fail.\u201d  138  CL10 also asserted, \u201cany student should be able to access support as they need them. They should be readily available, regardless of designation.\u201d A needs-based funding model. To ensure equitable support, educators suggested that the Ministry needs to adopt a needs-based model in which funding is provided for supporting all educational needs as well as a single set of processes that is consistent across the province. CL12 stated, \u201ca new system or structure needs to be used to determine support services and who can access them.\u201d TD60 seconded, \u201c[the province] needs to have a system of rules governing affairs of the school and district level for all children the right to inclusive education.\u201d To warrant services that are equitable and fair, AM03 asserted that:  Equitable funding [be made available] to support all options: full access to an accessible language as well as access to other needed supports [for DWD students]. I believe a student with two designations needs even more support than a student with one designation. One suggestion for improving the current system was to have MyEducation BC (the province\u2019s central repository of student information system) and IEPs include all needs (i.e., multiple designations, diagnosis, and unidentified needs) of a student so that relevant specialist support is pursued. TD01 insisted, \u201cin the student's IEP, the secondary designations (not only one but as many as identified) should be clearly listed.\u201d DS05 added that the system needs to \u201callow multiple designations and ensure IEP relates to ALL designations and needs.\u201d SP12 further mentioned that:  We need to improve the way that we put the diagnoses, and the clarification of the categories for the students so that regardless of what their category is, they receive the appropriate support\u2026 regardless of whether or not they're depending on the funding.   139 5.3.2 Educational Placement 5.3.2.1 Current Practices in Educational Placement Educational placement options. The most prevalent educational setting option available in the province for students who are DWD is a general classroom with or without EA support. Other educational setting options available for the students in their district or schools, in order of prevalence, are a resource room for students with disabilities, a learning support program for students with disabilities, a general classroom with an ASL interpreter, and a resource room for d\/Dhh students in a general education public school. Resource rooms for students with disabilities were almost three times more available than resource rooms for d\/Dhh students in school districts for students who are DWD. Less than 10% of respondents answered that a specialized school setting for d\/Dhh students was available in their district or school. A few respondents offered other setting options such as home school, d\/Dhh cohort classes, and alternate school (see Table 5.6). Table 5.6 Educational Placement Options Available in BC Question Responses (n) Percentage (%) Placement options available in district\/ school* 93    A general classroom with EAs 80 82.5   A general classroom with no support staff 51 52.6   A resource room for students with disabilities 46 47.4   A general classroom with ASL interpreter 30 30.9   A learning support program for students with disabilities 30 30.9   A resource room for d\/Dhh students 14 17.5   A general classroom in a specialized school for d\/Dhh students 9 9.2   A specialized school setting for students with disabilities 8 8.2   Others (e.g., alternate school, home school) 3 3.1 Note. *The percentage to this multiple-selection question is calculated by dividing the number of respondents who selected the option by the total number of the respondents to the question; thus, the total of the percentages does not add up to 100%.    140 Case managers. Respondents reported that 74.5% of the case managers for the learners were school-based special education teachers (e.g., Inclusive Team Teacher, Integration Support Teacher, Learning Support Teacher). Of those, 26.8% worked with TDHHs as co-case managers, while some respondents answered that it depends on what the primary designation is. Less than 10% answered that TDHH worked as a case manager (see Table 5.7). Table 5.7 Case Managers for d\/Dhh Students with Disabilities Question Responses (n) Percentage (%) Case manager(s) for DWD students 98    Special Education Teacher 54 55.1   Both TDHH & Special Education Teacher 19 19.4   Depends on the primary designation 16 16.3   TDHH 8 8.2   Others  1 1  Whether needs are being met. Table 5.8 shows educators\u2019 perspectives on whether their students\u2019 needs were being met in current educational settings with respect to three skill areas: language and communication, social and behavioral, and academic. Overall, the top three factors that determine success for each skill area are the same factors that when not present made the placement unsuccessful.           141 Table 5.8 Educators\u2019 Perspective on Meeting Educational Needs Questions Responses (n) Percentage (%) Needs met in language\/communication development  98    Strongly disagree 19 19.4   Somewhat disagree 33 33.7   Neither agree nor disagree 12 12.2   Somewhat agree 27 27.6   Strongly agree 7 7.1 Factors for language\/communication development* 32    Full language access  20.2   Sufficient professional services from the district  18.5   Efficient collaboration between team members  15.6   Sufficient opportunities for engagement with peers  14.5   Well-written and implemented IEP  13.7   Strong connection between home and school  13.5   Others  3.9 Factors against language\/communication development*  50    Insufficient professional services  20.8   Lack of language access  18.9   Inefficient collaboration between professionals   15.1   Insufficient opportunities for engagement with peers  14.6   Lack of connection between home and school  13.3   Poorly written and implemented IEP  11.8   Others  5.57 Needs being met in social skills development 97 100   Strongly disagree 16 16.5   Somewhat disagree 29 29.9   Neither agree nor disagree 17 17.5   Somewhat agree 29 29.9   Strongly agree 6 6.2 Factors for social skills development* 32    Sufficient opportunities for engagement with peers  19.9   Full language access overall  19.0   Sufficient professional services and school-wide support for social inclusion  16.3   Efficient collaboration with classroom teachers and EA  15.5   Strategies for social skills in the IEP well implemented  14.9   Strong connection between home and school  10.9   Others  3.6 Factors against for social skills development* 45    Insufficient professional services and school-wide support for social inclusion  20.8   Lack of language access overall  18.0   Insufficient opportunities for engagement with peers  16.3  142   Strategies for social skills in the IEP not implemented  14.4   Insufficient collaboration between IEP team members  13.5   Lack of home support and\/or connection with parents  12.1   Others  4.9 Needs being met in academic skills development 97    Strongly disagree 15 15.5   Somewhat disagree 23 23.7   Neither agree nor disagree 25 25.8   Somewhat agree 25 25.8   Strongly agree 9 9.3 Factors for academic skills development* 31    Full language access  20.6   Sufficient professional services from district and school  18.1   Well-written and implemented IEP  15.0   Skilled EAs  14.9   Efficient collaboration among the IEP team members  13.1   Strong academic support from home  10.8   Others  5.1 Factors against academic skills development* 36    Insufficient professional services from district\/school  18.7   Lack of language access  18.0   Difficult to find a skilled EA  17.9   Strategies for academic skills not implemented  14.5   Insufficient collaboration between team members  13.7   Lack of home support and\/or connection with parents  11.7   Others   5.7 Note. *This question requires respondents to rank (i.e., \u201cdrag and drop\u201d from the most pertinent to the least) the given factors by its importance from 1 to 7. The weighted average percentage is calculated to identify the most important factors out of the options.   Regarding language and communication skills, the three factors most selected by respondents were full language access, sufficient professional services from the district, and efficient collaboration between IEP team members. More than half of the respondents agreed that the educational needs of the learners were not being met in their current settings because these factors were absent. About 35% of educators felt that their learners\u2019 educational needs were being met because these factors were present. Approximately 10% of respondents neither agreed nor disagreed.  143 In social skills development, respondents reported full language access, sufficient professional services, school-wide support for social inclusion, and sufficient opportunities for social engagement with peers were the main factors for success. When these factors were missing, the social skill development was not successful. Almost half of the respondents disagreed that the students\u2019 social needs were being met in their current settings due to the absence of these factors. About 35% of the respondents agreed that their students\u2019 social needs were being met with these factors in place. Slightly more than 15% neither agreed nor disagreed. In academic skills development, the three factors for success were sufficient professional services from the district and school, full language access, and a skilled EA. About 40% of participants agreed that their students\u2019 needs were not being met due to a lack of these factors. A similar percentage of educators agreed that the learners\u2019 academic needs were met when these factors were fulfilled. A quarter of them neither agreed nor disagreed. Transitions between schools. As shown in Table 5.9, 54 respondents reported that their students had experienced transitions from a school or program to another school or program during their school years. The top two reasons for transition were parents or guardians\u2019 decision to change their child\u2019s educational settings and the family\u2019s move to a different location for other reasons. However, transitions also occurred by the school\u2019s recommendations, or to seek for better language access and\/or professional resources.        144 Table 5.9 Reasons for School Transitions Question Responses (n) Percentage (%) Reasons for school transitions* 65    Parents\u2019 decision to change the educational settings 32 49.2   Family\u2019s move to a different location for other reasons 31 48.0   Better language access 16 24.6   School\u2019s recommendations 16 24.6   Lack of professionals 12 18.5   Others (i.e., not applicable) 11 16.9 Note. *The percentage to this multiple-selection question is calculated by dividing the number of respondents who selected the option by the total number of the respondents to the question; thus, the total of the percentages does not add up to 100 %.   5.3.2.2 Considerations in Educational Placement The educators shared two concerns regarding educational placement: (a) a lack of educational setting options and (b) a challenging process for incidents of school transition. Inclusive classrooms with insufficient support. Educators were concerned that DWD students are being placed in inclusive classrooms without necessary support or alternate options to meet their learning needs. They addressed that there is a lack of sufficient teachers who are trained to meet the complex and diverse needs in inclusive classrooms. SP16 mentioned, \u201cthe classroom has too many needs for a teacher to successfully juggle individual needs all day, every day, all year. Same problem that all students face because of the imbalance between diverse learning needs and not enough teachers.\u201d  It is because \u201cstudents are added but additional personnel are not. This decreases the support we are able to provide to our other students\u201d (SP19). TD16 added, \u201cregular teachers do not have the skills and support to adapt or modify programs for these students, which is particularly true with the Covid-19 mandates\u201d and cautioned about the possibility of unmet learning needs in those classrooms:  At the same time, severely low academic students with hearing losses and no behavior problems can be overlooked in classes for many years\u2026 they are just part of the class  145 community in Math 9 but they can do work at Grade 2 level.  I call this abuse to the students, and it is not justifiable and equitable education. Teachers often feel traumatized or overwhelmed when trying to be inclusive to students with other disabilities along with the hearing loss.  Another example from SP19 raised the same concern:  This is not criticism towards the classroom teacher because the classroom teacher is brand new to this setting. So how can a teacher with no signing skills, and no experience in special education at all, serve the needs of deafblind students? Educators also shared that \u201cthe kids who have safety needs will end up taking priority for the EA support over the kids who have a hearing impairment or additional needs\u201d (SP12). Even if \u201c[DWD] students who are supposed to have an EA for academic support often don't see it as support is pulled to work with students who have behavior issues\u201d (TD05). She further added with details:  Our district also does not consider the category H student (i.e., severe behavior in Level 3) in their composition of the classes. So, what's happening in the district is a lot of the funding that's originally allocated to the student who has hearing loss ends up getting used towards students who are having issues in the classroom with self-regulation. That's unfortunate because there was a reason that these students are allocated to Level 2 funding there. They deserve it and they should have the interventions that are in place\u2026A lot of the students who are deaf and hard of hearing don't necessarily have those behaviors that are causing the red light, or we have to support them immediately as they're a flight risk. And as a result, they're sitting there and they're quietly fading away,  146 and they're stopping to wear their devices by the time they hit middle school, they don't feel like they belong anywhere. TD22 shared another example for the same issue:  I just feel like whatever the biggest behavior in the school is, or whatever the biggest need or the biggest issue is, it's deaf and hard of hearing children often who are being taken from, because learning disabilities, hearing loss, it's all there. There's flying under the wire there, the well-behaved, quiet kids, and the gaps can just grow so quickly and easily unless you're on it. And you can't teach the competencies without somebody being on top of it.   Educators noted that school districts tend to promote inclusion. TD54 mentioned that \u201cschool districts often do not support moves to \u2018segregated\u2019 programs as they view this as negative\u201d (TD54). SP 12 observed a similar perception in her district as well, \u201cI don't know if it's the city I live in or if it's the province, educators are extremely averse to any kind of pull-out whatsoever. They just think pull-out is the worst thing you can possibly do.\u201d  In this tendency, respondents expressed their concerns that the current practice of inclusion may not always be the best policy or decision for DWD students to meet their unique learning needs. TD57 cautioned that \u201cinclusion model can also take away valuable time to assist students with complex needs with their personalized goals\u201d as \u201c[they are] physically in the classroom in terms of placement. They kind of sit at the back together while the rest of the class goes about their lesson.\u201d TD24 supported, \u201cthe district mainstreams all the time; however sometimes the mainstream environment can be incredibly overwhelming for a student with multiple needs.\u201d  TD 57 concurred that \u201ca student's time may be more valuable learning how to communicate effectively  147 and independently on their AAC than being in some classes so that they can independently and clearly communicate post-graduation.\u201d SP12 expressed: It would be like for me going into a university Calculus class where I don't understand anything that's going on. I will sit still and quiet, very quiet. I'm not learning anything. It's not doing me any good. It's not doing them any good. It might feel nice to be around smart people, but maybe not all day, because I feel like it's really important to teach them what they need. TD14 summarized that \u201cabsolute inclusion does not always allow time to teach skills specific to students that will help them in a regular classroom.\u201d   Limited alternate placement options. Educators expressed limited alternate options available for DWD students in the province where their learning needs can be met. This is because: districts seem to be taking options away in favor of mainstreaming\u2026Our school district had that. xx Elementary had a Deaf and Hard of Hearing program and xx Secondary had a Deaf and Hard of Hearing program, and they were both shut down. (TD24)  Another reason stated by TD01 was that \u201cdistricts do not try to \u2018invent\u2019 an option within the district, but they rather recommend parents to find one out of the school districts.\u201d TD22 shared the same experience with her district, \u201cour district hasn't had the appetite to be open to listening to those different models yet.\u201d Instead, when \u201cit is determined that the best environment for access to ASL, the request or recommendation is made to the family to consider the School for the Deaf\u201d because \u201cdistricts do not have resources to provide students who need or would benefit from ASL access and support\u201d (TD35). TD54 expressed her perspective about these situations, \u201cthey (districts) don't want to admit that their supports were insufficient or that they somehow  148 were not able to meet the child's needs.\u201d Options for the learners are even scarcer in rural areas according to TD48. Due to a lack of options where unique learning needs can be met, \u201cit's then a difficult decision to prioritize between access to language and support for the additional disabilities\u201d (TD35). It seemed especially challenging to find a placement where the learners can have both access to language and support from professionals in developing their language. AM12 reported: We had an SLP started last year. She's not actually working with those students who might need AAC\u2026those kids aren't referred to her... If hearing kids can hear English, why do they need AAC if they have English? It's the same thing for me. If a child needs AAC, it's not because they don't need ASL. They need both.   TD54 pointed out, \u201ceven if the kid has complex needs, language is still held paramount.\u201d Here is an example from her during the interview:  I'll share with you about a child who has severe language deprivation. For whatever reasons there were barriers present and parents did not access early intervention services until the child was like three or four or five. And the child is profoundly deaf and has ASD, somewhere on the spectrum. And the child presents with no language. And then the school is saying, \u2018oh, actually, the child doesn't have any language so you can't prove that the child needs an ASL environment or that they would benefit from it. Because they don't have, they don't sign, whatever like.\u2019 Well, they don't sign because they haven't had access so that's what you need to do is to give them the access. So, to me it's like unfathomable that they would be in that position, especially if you can demonstrate that, you know, there is some understanding happening and some development happening.\u201d  149 A shortage of trained professionals. Meanwhile, educators expressed that there was also a lack of trained personnel with specialized skills to support DWD students across the province. AM10 brought an example,  I had a student with very significant behavior issues and referred him to the counselling service for the deaf\u2026 Because his needs were so great and they didn't have anyone to replace the person that was working with him. [Later] they referred him to the xxx services and somebody took over, and it was actually a disaster. They showed and told us to use stickers, sticker reward system. That just\u2026and it fell apart. SP19 added that students who transferred from other districts \u201cadd stress to our school that already has a lack of resources\u201d such as qualified TDHHs, special education teachers, and EAs with ASL. She continued, \u201cwe do not always have the right supports for secondary designations\u2026students are added but additional personnel are not. This decreases the support we are able to provide to our other students\u2026this makes the transition harder.\u201d Transition process between schools. The concern regarding DWD students who experience increased transitions to new schools or programs was that the referral and transition process can be challenging. TD15 felt, \u201cI'm currently working through one of these processes for a referral to xx [program]. It's quite time-consuming and complicated\u201d due to \u201cnot enough information and unclear communication (between) the placement programs\u201d (TD14). TD44 added, \u201cwhen a d\/DHH student with multiple challenges changes school districts or schools within one district, the transition time for staff to share the information regarding the student is often not [sufficient]\u201d TD35 perceived that, for some programs in the province, additional disabilities are likely to become \u201ca barrier for admittance as they have reported limited resources to support additional student needs.\u201d  150 Disagreements between parents\u2019 desires and schools\u2019 recommendations can further complicate the transition process. TD56 reported that \u201cneeding to convince parents what the best option for the child is [difficult] over what they have been told by doctors, specialists, audiologists, and SLPs that do not fully understand the value of fully accessible communication.\u201d TD14 listed other reasons for disagreements such as \u201ctransportation to ideal placement, not enough information, unclear communication of placement program, desire to have them go to same school as sibling(s).\u201d TD01 pointed out that \u201coften parents, especially whose English is not their mother tongue, do not have enough information about the possible placement options\u201d TD14 seconded, \u201cfamilies who do not speak English have more barriers to information and communication with staff working with their child.\u201d These issues may sometimes cause \u201cthe parents to pull their children out [from the current school] and did not allow them a transition time to their new school\u201d (TD04). Although it was about d\/Dhh students with disabilities, TDHHs reported that they were not always included in the decision-making and transition process. TD54 in Focus Group 1 shared:  When I was in a suburban city in BC, we all teachers of the deaf and hard of hearing often have these conversations about just being left out of the conversation when kids are in kindergarten transition... We were never invited to be a part of those conversations, and then we would ask, and then they'd be like, \u2018we'll let you know if we have any questions.  TD22 who participated in the same group agreed:  They (admin) didn't even think that we should be a part of that equation. Even though we were the ones doing the transition meetings from their preschools or their early  151 intervention agency into the school, so there's a real disconnect. Until I learned that that process happened, not taking no for an answer and being loud, then I started to be included. Furthermore, a lack of options and resources also led to multiple transitions during their school years, in which case, sometimes students and families decided to come back to their own school districts where they had started from. TD27 shared, \u201cI'm really concerned that if things don't go well at the program and my little one comes back who's adorable and sweet, I don't have the staffing [ASL interpreter] to support her. So that's a major barrier.\u201d  Here is another example from AM03:  I\u2019m thinking of a kid Nick (pseudonym) who started with our school district, went to a provincial program when he was a little guy. And then he came back [to our school district] because he was spending hours on a bus going to the program. Yeah, he went there for a year or year and a half, maybe two years\u2026This isn't good for kids to ping-pong them back and forth from one place to another.   To answer the second research question regarding the perspectives of educators towards educational placement, the analysis revealed that (a) participants reported DWD students are mostly being placed in general education classrooms without necessary support, (b) there is a lack of educational setting options across the province where the learners\u2019 educational needs are met, and (3) as a result, multiple transitions between placements during school years may occur, and the process is challenging and complicated for both educators and parents. 5.3.2.3 Suggestions in Educational Placement Educators suggested that more placement options be created where language accessibility is secured, social interaction is meaningful, and resources for disabilities are available. The  152 suggested options by respondents were across two themes: (a) to equip inclusive classrooms with more resources and (b) to create more \u2018cohort programs\u2019 where d\/Dhh students can be clustered.  Equipping inclusive classrooms. Respondents asserted that inclusive classrooms should be enriched with more resources (i.e., teachers or professionals) or could be modified with strategic pull-out support for DWD students. TD56 emphasized\/believed that \u201cstudents with additional designations are still able to be full time in a classroom with their peers. The level of additional support does not take away from classrooms.\u201d To make this happen, SP16 mentioned, \u201cmore in-class co-teaching with the enrolling teacher might be good so that both teachers can see how the integration is going and to make service more fluid. The TDHH shouldn\u2019t be a visitor; they should be an active part of the student\u2019s learning plan.\u201d TD05 also supported co-teaching, \u201cI would like to work with effective and efficient staff who are willing to use universal design strategies that would benefit both my student and the entire class.\u201d TD11 suggested altering physical space for improved inclusion, \u201cschool sites need to provide more accessible spaces if the ministry is really wanting inclusion to happen. Accessibility includes not just mobility, but visual, acoustical treatment to learning spaces, and so on.\u201d  Strategic pull-out can be used effectively and inclusively according to TD24, \u201cthere should be more options for what the \u2018least restrictive environment\u2019 is\u2026 Having a smaller program that a student attends part of the day could meet their needs and is arguably the \u2018least restrictive environment\u2019.\u201d This may include a combination of general classroom and resource room model as DS06 mentioned below:  I would say that combination of regular education and resource room is the best. But of course, we can always do, maybe 50% in the resource room and 50% in the classroom  153 depending on how the child can function effectively with his or her peers because eventually our goals for that child are to be socially engaged.  TD16 emphasized that \u201csupport and action plans can strategize the needs of these students and at the same time they need to be happy, safe and supported.\u201d  However, the respondents reported that the Ministry\u2019s targeted funding seemed necessary in order to achieve what they suggested. TD11 pointed out that \u201cif the Ministry wants successful inclusion, then they need to fund it properly\u201d because \u201cto address all the complex needs requires time to implement and collaborate with a transdisciplinary team.\u201d AM03 also emphasized \u201cequitable funding to support all options for full access to an accessible language -which is ASL- as well as access to other needed supports.\u201d Creating cohort programs. The other theme was to utilize a cohort program for d\/Dhh students, which could satisfy social and psychological aspects as it clusters students within a region with increased support for language accessibility and environmental modification. TD09 stated that \u201callowing students to be grouped and not forced to go to their home school\u201d might be an alternate option because \u201cthey ultimately have less overall support and lack peers with whom to connect with\u201d in their catchment schools. TD24 mentioned, \u201cI just feel like education is not a one-size-fits-all. The least restrictive environment maybe has some access to a Deaf and Hard of Hearing program within their home school district.\u201d AM03 and TD15 shared that their school district recently created a cluster model:  We have three or four (interpreters) there now. We put in one interpreter for the three kids that were all in one kindergarten class, but we also were able to ensure that the itinerant teacher had a lot more time at that site. We are able to get all of the audio equipment, sound field systems, and everything so that there was a really robust setup in  154 terms of equipment, which you know that's sort of one piece in terms of those resources. But I believe that the most important piece is that those kids are now interacting with other kids who are deaf or hard of hearing. You're able to use ASL with other kids that are deaf or hard of hearing. The language acquisition support workers go in there too.\u201d  Additionally, AM12 wondered \u201cabout trying to centralize services and trying to provide like a hub in Kelowna or in the Okanagan, and one in Prince George.\u201d TD22 supported that, \u201ccreating satellite locations for DHH programs in district zones could reduce travel for specialists (TDHHs, Signing EAs, VLIs) and maximize possible service.\u201d Respondents suggested that educational placement options be created in consideration of the unique needs of DWD students by providing more resources in classrooms or implementing strategic pull-outs. Cohort programs can be created by clustering students within a district or among regions in provision of language accessibility and professionals for disabilities. Informed decision-making by families. The importance of collaborative discussion between placements and family in the decision-making process was continuously emphasized by educators in different positions. DS07 stated that \u201ccollaborative discussion with the student's team and family regarding student's needs and for critical review of which setting meets those needs best\u201d should take place when considering students\u2019 transitions. SP19 suggested that decisions for transition be made based on \u201cholistic considerations of the child's age, current communication preferences, family support, and additional disability needs\u201d rather than \u201cpurely based on hearing status\u201d as \u201csometimes teachers\/parents focus on accessibility for D\/Dhh students but are not focused enough on other supports for secondary designations.\u201d AM10 added that sometimes \u201cthe degree to which the student's learning is impacted by the secondary designation\u201d could also guide recommendations when the student is transitioning.  155 One of the suggestions was to share a website about the student with the teams and parents. TD25 shared their experience:  When working with d\/DHH students with disabilities, I have found that having a digital communication and planning tool to be the most effective way to work with a large team in addressing the students\u2019 goals. Because there are often many support persons involved (i.e., classroom teacher, resource teacher, TDHH, SLP, EA, etc.) having a \u2018place\u2019 where information can be easily shared, observations noted, and overall progress reported ensures that all involved are aware of what the other is doing and can adjust their own teaching and\/or support of the child as needed.  DS10 seconded that they \u201chave a student website with gathered information to share\u2026prior to all school transitions with all professionals and people involved to gather information and identify student's individual needs.\u201d Furthermore, some respondents expressed a desire for a province-wide system for transitioning students to make the process more efficient. TD01 mentioned we need to \u201chave a clear, transparent system for transitioning between schools and school districts for the public including parents and teachers who help the families navigate.\u201d They wondered if \u201cthe ministry can develop a website to provide information for the families and teachers.\u201d   Respondents agreed that parents should be able to make informed decisions for transition when they are exploring a new placement. SP08 added that \u201cit is important to be open and honest with parents on why the placement is best for their child. They need to understand that the recommendation is being made for the best interest of the child\u201d as \u201cparents may have different opinions of where the best place or program for students is, (but) resources required may not be there\u201d (SP19). DS06 insisted that we \u201cinform parents of the level of specialized support they can  156 expect to receive well in advance.\u201d AM03 supported this, \u201cparents need to receive very specialized information from qualified professionals before making \u2018fully informed\u2019 education decisions regarding their child\u2019s educational planning\u201d (AM03). In addition, TD12 addressed that \u201cparents where English is not their first language need for professionals to translate school\u2019s ideas and concerns correctly so that there is sure understanding on both ends\u201d in the whole transition process. AM07 highlighted the importance of placement \u201cwhere they [the learners] will thrive the most with staff trained in the field.\u201d Concludingly, collaborative discussions between the teams of placements and parents are necessary for any student\u2019s transition to be fruitful. 5.3.3 Implementation of Strategies and Interventions 5.3.3.1 Current Practices in Intervention Professionals working with d\/Dhh students with disabilities. As shown in Table 5.10, more than 50% of respondents answered that school-based special education teachers, SLPs, occupational therapists, and psychologists were available for students who are DWD in their school districts or schools. Other commonly utilized specialists, such as ASL interpreters or specialists, behavior analysts, or autism specialists were also selected as available by fewer districts. Regarding the sufficiency of professionals to work with the students, almost two-thirds of the respondents disagreed strongly or somewhat that they have sufficient professionals who can optimally serve the learners. A quarter of the respondents agreed strongly or somewhat. Less than 10% neither agreed nor disagreed.      157 Table 5.10 Professionals available for d\/Dhh students with disabilities Questions Responses (n) Percentage (%) Title of professionals available in districts\/schools* 91    Special Education Teacher (school-based) 81 89.0   Speech Language Pathologist 80 87.9   Occupational Therapist 57 62.6   Psychologist 50 54.9   Physiotherapist 37 40.7   ASL specialist \/ ASL interpreter 33 36.3   Multicultural Worker \/ Spoken Language Interpreter 29 31.9   Behavior Analyst 25 27.5   Certified Autism Specialist or Consultant 23 25.3   Other (e.g., Intervenor, Child & Youth Worker) 22 24.2 Sufficiency of professionals  94    Strongly disagree 30 31.9   Somewhat disagree 30 31.9   Neither agree nor disagree 9 9.6   Somewhat agree 19 20.2   Strongly agree 6 6.4 Note. *The percentage to this multiple-selection question is calculated by dividing the number of respondents who selected the option by the total number of the respondents to the question; thus, the total of the percentages does not add up to 100%.   Challenging factors in intervention. When asked to rank what the most challenging factors are in implementing strategies and interventions, educators selected a lack of professionals who can consult practitioners with a comprehensive understanding of the learners, a lack of appropriate assessment and evaluation tools, and a lack of available resources and teaching materials as the top three challenges. Some of the educators identified a lack of communication and connection with parents as a challenging factor in implementing strategies. Their top reasons were language barriers for communication, cultural differences (e.g., in parenting, relationship with school staff), and different expectations regarding the child\u2019s progress. This corresponds with the concerns of working with parents who are multilingual\/multicultural for students\u2019 transitions (see Table 5.11).    158 Table 5.11 Challenging Factors in Intervention Questions Responses (n) Percentage (%) Challenges in intervention* 90    Lack of professionals for consulting practitioners  21.4   Lack of appropriate assessment and evaluation tools  18.1   Lack of available resources and teaching materials  16.8   Insufficient collaboration between team members  14.4   Inefficient IEP planning and implementation  13.9   Lack of communication and connection with parents  10.2   Others  5.2 Challenging factors in communication with parents* 64    Language barriers for communication  19.9   Different expectations toward child\u2019s progress  19.6   Cultural differences (e.g., parenting, relationships)  19.1   Lack of parents\u2019 understanding of deafness\/ disabilities  17.9   Insufficient time to communicate with parents   17.3   Others   6.2 Note. *This question requires respondents to rank (i.e., \u201cdrag and drop\u201d from the most pertinent to the least) the given factors by its importance from 1 to 7. The weighted average percentage is calculated to identify the most important factors out of the options.   Collaboration. Regarding collaboration with their team members and\/or outside professionals, approximately half of the respondents reported that their collaboration was efficient while the other half considered it inefficient. Factors that made collaboration successful were, in order of importance, efficient communication between professionals, leadership of the case manager or educational consultant, and sufficient time for collaboration. On the other hand, factors that made collaboration difficult were insufficient time to collaborate, different perspectives about the student\u2019s needs between professionals, and a lack of understanding of the student\u2019s needs and progress (See Table 5.12).      159 Table 5.12 Collaboration Questions Responses (n) Percentage (%) Collaboration within team and outside professionals 94    No or few collaboration 4 4.3   Mostly inefficient 11 11.7   Somewhat inefficient 30 31.9   Somewhat efficient 30 31.9   Mostly efficient 19 20.2 Factors for successful collaboration* 46    Efficient communication between professionals  20.2   Leadership of case manager or consultant  18.9   Enough time given for collaboration  16.5   Excellent implementation by teacher and EA  16.4   Strong connection with home  12.3   Great support from administrators   11.7   Others  4.0 Factors made collaboration difficult* 42    Insufficient time to collaborate  22.4   Different perspectives about student\u2019s needs  18.4   Lack of understanding of student\u2019s needs and progress  17.9   Lack of support from administrators   13.4   Difficulty in communication with parents  12.0   Language barriers between professionals  11.5   Others   4.6 Note. *This question requires respondents to rank (i.e., \u201cdrag and drop\u201d from the most pertinent to the least) the given factors by its importance from 1 to 7. The weighted average percentage is calculated to identify the most important factors out of the options.   Teachers\u2019 preparedness. Table 5.13 shows educators\u2019 perspectives regarding their preparedness for teaching students who are DWD. Approximately half of all respondents agreed that they were able to develop educational programming to provide appropriate instruction for the learners. About a third of the respondents disagreed strongly or somewhat. Nearly 20% neither agreed nor disagreed.       160 Table 5.13 Teacher Preparedness Questions Responses (n) Percentage (%) Development of educational programming 94    Strongly disagree 6 6.38   Somewhat disagree 24 25.5   Neither agree nor disagree 18 19.2   Somewhat agree 36 38.3   Strongly agree 10 10.6 Knowledge and skills to meet students\u2019 needs  84    Strongly agree 13 15.5   Somewhat agree 42 50   Neither agree nor disagree 10 11.9   Somewhat disagree 13 15.5   Strongly disagree 6 7.1 Resources to provide appropriate instruction 84    Strongly agree 8 9.5   Somewhat agree 21 25   Neither agree nor disagree 18 21.4   Somewhat disagree 28 33.3   Strongly disagree 9 10.7 Sources for resources or consultation* 74    Colleagues within district  23.7   Online resources  22.7   Colleagues or professionals outside district  18.6   Books or materials from previous training  17.8   Administrators (e.g., Inclusive Learning Directors)  11.9   Others  5.3 Note. *This question requires respondents to rank (i.e., \u201cdrag and drop\u201d from the most pertinent to the least) the given factors by its importance from 1 to 7. The weighted average percentage is calculated to identify the most important factors out of the options.   Two-thirds of TDHH respondents and allied professionals perceived that they themselves have the knowledge and skills to meet the needs of DWD while less than 25% disagreed strongly or somewhat. More than 40% of TDHHs and allied professionals disagreed strongly that they have the resources to provide appropriate instruction for DWD students while about a third considered that they have sufficient resources for instruction  The results for these two questions, however, should be carefully interpreted as the scale was flipped over (i.e., agree to disagree)  161 compared to the other questions of the same type throughout the whole survey (i.e., disagree to agree) due to the researcher\u2019s mistake. TDHHs and allied professionals reported that they obtained resources or consultation for teaching their d\/Dhh students mainly from colleagues within the same district, online, or colleagues out of the district. Intervention strategies frequently used. As shown in Table 5.14, the most frequently used educational practices for language and communication improvement were visual supports, labeling with words or signs, augmentative and alternative communication devices, language experience activities, peer modelling, and picture exchange communication system. None chose environmental or curricular modification for language and communication instruction. To improve social and\/or behavioral skills for DWD students, in order of frequency, respondents used social stories, peer modelling, positive behavioral support, and coaching. None chose small group interventions and environmental or curricular modification for social skill development. For the enhancement of academic skills, the respondents listed a variety of strategies they used. In order of prevalence, they mentioned using direct instruction, one-on-one EA support (and training EAs), discreet technology for interactive software programs and accessibility (e.g., speech-to-text or text-to-speech program), and peer coaching. Additionally, adapting materials to their level, creating experiential learning opportunities, and providing a predictable structure were suggested by several respondents.       162 Table 5.14 Interventions and Strategies Frequently Implemented by Professionals Questions Responses (n) Percentage (%) Strategies for language\/communication development* 83    Use of visual supports 78 94.0   Labeling with words\/signs 63 75.9   Augmentative and alternative communication devices 53 63.9   Language experience activities 49 59.0   Peer modeling 49 59.0   Picture exchange communication system 44 53.0   Naturalistic teaching strategies 32 38.6   Video modeling 29 34.9   Repeated viewing of a text in ASL 21 25.3   Functional communication training  15 18.1   Environment modifications (e.g., seating, acoustics) 0 0   Curricular modifications  0 0   Others  4 4.8 Strategies used for social\/ behavioral skills* 79    Social stories 61 77.2   Peer modeling 53 67.1   Positive behavioral support  39 49.4   Coaching 38 48.1   Video modeling 24 30.4   Functional communication training 12 15.1   Milieu communication training 1 1.3   Small group interventions (e.g., Circle of Friends) 0 0   Use of visual supports 0 0   Environmental modifications 0 0   Curricular modifications  0 0   Others (e.g., social games, adult mentoring).  6 7.6 Note. *The percentage to this multiple-selection question is calculated by dividing the number of respondents who selected the option by the total number of the respondents to the question; thus, the total of the percentages does not add up to 100 %.   Assessment and evaluation. TDHHs and allied professionals reported (in an open-ended question) that they evaluated and monitored their DWD students\u2019 needs and progress in language (i.e., expressive and receptive), literacy, auditory, social-emotional, and advocacy skills. The majority of them used a combination of informal assessments such as the student\u2019s language sample, work sample, collaborative observations, and\/or anecdotal notes from the school-based  163 team. Assessment information about a student was gathered by different professionals on the team (i.e., school psychologist, LST teacher). They also modified currently available standardized assessment tools or utilized teacher-made assessments such as rubrics, checklists, or communication matrices. Students\u2019 progresses were evaluated based on the learning goals of the IEP and targeted skills were monitored and tracked over time collaboratively.   5.3.3.2 Considerations in Intervention When implementing strategies and interventions, participants expressed concerns about educators\u2019 lack of understanding about the complexities of language acquisition for some students who are DWD. There was also a concern regarding the provincial-wide shortage of professionals who have been trained to work with DWD students. Challenges in collaboration between members and with parents were also expressed. Lack of understanding of language development. Respondents were concerned about the lack of understanding of language acquisition and deprivation some DWD students experience, from other professionals they collaborate and work with. TD54 stated, \u201cschool staff do not understand the significance of language and\/or language deprivation in identifying student needs and correlations to other \"issues\" that may present such as behavioral.\u201d TD09 added, \u201cmany of the additional service providers have no idea about hearing loss and have difficulty communicating effectively with our d\/Dhh students.\u201d The lack of understanding of language development led to confusion or disagreement among the team members (or practitioners), especially in the usage of augmentative and alternative communication systems (AAC) over ASL by DWD students. TD54 stated:  School staff will turn to interventions such as augmentative communication devices as a primary need over sign language, particularly in kids with additional disabilities... I think  164 a lot of it comes down to an understanding of language and how we access language, right? They're pushed for AAC over sign language, but AAC is a communication tool, it's not a language. If we have a language, then we know how to use the tool, but they don't understand that. AM12 addressed that concern as well:  They need access to the language. It's just like the kid with AAC has English. If hearing kids can hear English, why do they need AAC if they have English? It's the same thing for me. If a child needs AAC, it's not because they don't need ASL. They need both. Educators who directly work with DWD students do not always have a good understanding of their language acquisition and how to support their language development. Lack of skill sets. Many Educator participants expressed they felt unequipped with the appropriate skill sets in teaching DWD students, although it seemed to vary depending on the personnel\u2019s role, education, and experiences. TD02 mentioned that \u201cI'm not confident in teaching D\/hh that have additional disabilities, if they are mild in nature that is not a problem, but if it is severe in nature then I feel that is out of my expertise.\u201d Another TDHH shared: Primarily, my concern about identifying service needs comes from my relative inexperience as a TDHH and haven't the field experience that comes from encountering varied needs of students. Further, needs can be complex and multi-faceted or ill-defined due to communication problems associated with hearing loss (TD55).  A lack of skills can cause retention issues for resource room teachers, as SP19 shared: We strive for inclusion, but there are a few students that need kind of a separate classroom. And that classroom (for deaf students with disabilities) has had new teachers every year. For the past two years, it'll be a sort of temporary teacher and the teachers  165 come in and they're like completely stressed out, feeling so unprepared to be in a classroom with students with such high needs, and then they leave after that year. AM10 expressed her concern as an administrator in terms of recruitment of TDHHs, \u201cwhen you think about these students who have disabilities in addition, it is already hard enough to get a teacher of the deaf but then do even narrow specialization? It\u2019s like asking too much.\u201d   The same concern was addressed regarding the skill sets of special education teachers and EAs who provide DWD students with direct support more often in schools than itinerant service providers. School-based special education teachers often take on the role of case manager for DWD students, as described by SP21, \u201cunless a case manager understands a student\u2019s needs and reaches out for support, the student may not get any or the right support.\u201d Some special education teacher participants did not perceive themselves as sufficiently trained in supporting DWD students. SP19 shared her own experience:  As a new learning support teacher, I had to really stop my feet to say I need support too because I don't have the skills or qualifications to support the students either. Who can I talk to at a district level that's available to help me? That took a really long time to have any sort of relationship with someone to set up.  SP16 also was concerned about the skills of LSTs: The fact is that [Learning Support] teachers don\u2019t always get to work with h\/Dhh students. Our skill set and experience with those needs is quite low; it may not come automatically\u2026We\u2019re not as familiar with d\/Dhh kids. There\u2019s little time for the teacher to successfully and consistently implement, monitor, evaluate and adjust d\/Dhh strategies while doing the same for all the other students and needs in the class.  SP10 seconded:   166 With the dual diagnoses of hard of hearing, as I said before, it makes it a bit tricky for us to help him with that diagnosis, just because we don't have the training and don't see the hearing resource teacher enough. She's really doing her best and trying to email us, but we just don't have that consistency to ask questions on the fly.  TD52\u2019s experience working includes:  I see too often students not having the direct, effective instruction they need to develop communication skills because the staff working with them (EA or teacher) isn\u2019t trained effectively to include their needs or they are in classes (secondary) that don\u2019t always meet their needs or support plan.   The skill sets of EAs who work with DWD students were also commented on by participants. AM12 pointed out:  I actually think that the EA support is a big deal. To be honest I think they're not trained. Even if they sign, they don't necessarily have the EA training. Again, it's hard to find people. But even the people here, the EA don't have a lot of background... they don't have a lot of understanding of hearing loss. SP19 expressed: We just don't have the staffing, we haven't somebody who's done her Braille course last year working with our other deafblind student who is a Braille user with unilateral hearing loss, but we have her in the deafblind category because she definitely has severe communication needs, so finding the right person and the right personality to be an intervener (is challenging). It's the EA specialty - whether it's intervener, signing EA, or braille-est.  167 CL04 seconded, \u201cwe do not have enough qualified Education Assistances to even take any specialized training to support my d\/Dhh student.\u201d In addition, TD22 was concerned about frequent EA changes and indicated that \u201ca lot of support staff are not adequately trained. I find that when I train people, especially the support staff, they get moved around frequently.\u201d TD16 further expressed frustration regarding EA allocation:  District administrators usually collaborate with the team involving DHH students with other challenges, but the ultimate decision is usually based on the budget, particularly with the shortage of EAs who are used for pulling away service, reallocate or re-assignment throughout the school year. Changes in their support sometimes occur without informing the TDHH. Lack of trained professionals. In fact, a majority of respondents expressed a concern over the provincial shortage of professionals who have been trained to work with DWD students, including TDHHs, special education teachers, and supporting staff. This coincides with the result addressed in the current practice section. AM10 stated, \u201cthere's a general shortage of people across the board who are working in the fields that are the most necessary.\u201d TD02 also mentioned that \u201cmy district has an extreme shortage of all these services; therefore currently, D\/hh students in my district with additional needs are NOT getting their needs met even if they have [F as] a secondary designation.\u201d AM12 furthered, \"for example, when it comes to a deaf-blind child, my thing was, \u2018Do they have access to that visual language? and how are we going to provide that access?\u2019 We don't have any teachers who are resource teachers or special education teachers.\u201d This overall shortage of staff resulted in educators having larger caseloads than they can adequately support all d\/Dhh students including those with complex needs.   168 TDHHs reported that, due to their large caseloads, DWD students often miss out on direct services from a TDHH. TD22 stated:  The biggest issue I see is a lack of staffing and over-the-top caseload numbers for the TDHH's. We can't see all of our students regularly as it is and the students with additional needs can lose out because they are at least being seen by someone so they may not see us as often as we would like.  When a TDHH\u2019s FTE is based on the number of students whose primary designation is F, districts \u201cdo not always take into account that we [TDHHs] are providing service to students with other designations as well\u201d (TD08). TD27 pointed out, \u201cthis leads to inflated caseloads that do not accurately reflect the time needed to support ALL students with hearing loss.\u201d TD27 further shared their concern with more details during a focus group interview:  In our district, the secondary diagnosis is not \u2018counted\u2019 in our TDHH numbers\u2026I don't have a lot of time for my students with additional needs. I have 35 students on my direct service caseload. And that doesn't include those 10 deaf with disabilities, so my ability to support them is very limited... Just to be fully honest, for my students with autism with hearing loss, essentially, (what I do) is equipment support and minimal communication support, unless there is an issue that schools really struggling with communication.  The same concern was addressed regarding large caseloads of school-based staff (i.e., Learning Support Teacher, EA) and district specialists. TD27 shared: One of the best resource teachers in one of our schools had 20 kids on her caseload to help manage, but only two days a week in that role as a resource teacher. She was like, nope, so she just left the position and now she's an amazing grade 1 teacher. Yeah, so it's really hard to (keep them in the positions).   169 AM03 concluded that \u201cthe issue is large caseloads and staff who do not have the skills required to support students.\u201d Relating to DWD students\u2019 language access, specific concerns arose regarding the shortage of specialized educational staff with suitable skill sets for supporting DWD students, such as signing EAs, ASL interpreters, and intervenors. CL01 mentioned, \u201cour district does not have staff that know ASL. No training in ASL is encouraged let alone provided for those who work closely with deaf or hard-of-hearing students. Deaf Mentor Teacher was not fluent in ASL and was a requirement.\u201d SP19 added about their school situation:  Educational assistants with ASL skills are also very limited. School districts do not offer training for hearing EAs to learn ASL. Experienced ASL interpreters with higher-level interpreting skills choose to work for other companies and get paid more. Many educational interpreters are fresh graduates and do not have the adequate skills to interpret advanced high school courses.  TD27 shared their concern for difficulty in finding an ASL interpreter in a suburban city: The only one I have who has some sign language is on maternity leave, so I'm really concerned that if things don't go well at the school (where the student was recently transitioned to in a different district) and my little one comes back who's adorable and sweet, I don't have the staffing to support her. So that's a major barrier.  An additional layer of this concern was that there was no substitute when the staff (i.e., interpreters, intervenors) is absent, which means the students do not have access to language and instruction for the duration of absences. SP10 shared:  170 We only have one EA who signs. And there was one day that she was absent, and the student had nobody to sign him through classes. He has some strategies like lip reading but with the mask on, he can't read lips.  SP19 was concerned, \u201cI just think of those days when those intervenors are sick, or if in the future or next year one of them were to retire, I really feel like we'd be stuck.\u201d AM03 noticed the need of replacement, \u201cif they were absent, they would say no replacement was required. When I asked about that, I was told that there was nobody on the spare board. To which I said, there needs to be.\u201d  Respondents also reported difficulties in accessing qualified specialists (i.e., autism specialists, SLPs, Board Certified Behavior Analyst [BCBA]) for DWD students due to extreme shortages across the province. AM10 pointed out, \u201cI think one of the biggest challenges is finding professionals who are experts in other areas of special needs.\u201d SP19 wrote on the survey, \u201cvisual Impairment teachers are extremely limited. SLPs have very limited time with students on their caseload. Autism specialists are hard to find and book. There is an overall lack of specialists available to work with d\/Dhh students.\u201d SP21 seconded, \u201cThere are too many needs and not enough specialists to consult with case managers or spend time with students in classes to understand their situation and provide advice beyond general information on how to support a student.\u201d Not to mention, it is harder to find specialists for schools in rural areas. AM07 shared: In a rural setting, it is hard to obtain the services of specialists in specific fields. Even if the district has a specialist, they have many schools and miles to cover so it is very limited on the services we receive SLPs, and educational psychologists, right? So, for any special role, they'll come here for the first year or two, and then as soon as they have some experience, they immediately will move somewhere to a more desirable location.  171 Furthermore, TD02 was \u201cconcerned with the lack of awareness or experience that OTs, SLPs and school psychologists with not having much experience or understanding the needs of d\/Dhh students.\u201d Lack of development opportunities. Although a lack of skill sets and need for training of professionals were present, respondents expressed that there are scarce professional development opportunities in the province to expand knowledge and acquire skills to work with DWD students. SP21 insisted, \u201cteachers need training when it comes to having d\/Dhh students in their classes as well as the other diverse needs in their classes. There is virtually NO PROFESSIONAL DEVELOPMENT for teachers when it comes to inclusion and support needs.\u201d Overall, there is a province-wide shortage of professionals and supporting staff who have been trained to work with DWD students, which brings about too large caseloads for educators to adequately support DWD students. Lack of collaboration. Another concern was a lack of team collaboration. As reported in Table 5.12, nearly half of respondents reported that their team collaboration is either inefficient or there is little to no collaboration in support of the learners. Given that none of the specialists or teachers possess all the skills to meet the needs of DWD students, evidently \u201ccollaboration is the key\u201d according to TD24. However, respondents stated it is challenging for itinerant specialists to collaborate with school-based staff on a regular basis. TD52 stated, \u201citinerant TDHHs may miss day-to-day conversations and plans for students and may not get adequate space at the table to weigh in on their concerns, ideas, and specialized knowledge to support students.\u201d TD57 concurred, \u201cthe bigger the support team, the harder and more time it can take to connect and communicate information, which can be challenging for an itinerant TDHH with high caseload numbers.\u201d TD 24 regarded that:   172 Collaboration is not valued enough by districts. SLPs\/OTs\/PTs\/TDHH are all itinerant. The ability to meet and collaborate together and with the school team is limited. We often only see each other once a year, and that's at the IEP meeting where we are all discussing goals that have mostly been predetermined. TD48 summarized that \u201cthe itinerant model has become very consultative with rising caseloads. This puts our d\/hh students with disabilities at a great disadvantage.\u201d  TD27 attributed insufficient time to the lack of collaboration:  I'm thinking that barriers to implementing support are time and time. Time is one of the biggest barriers - time for the whole team to get together and make decisions, and also even time to work with the family at home if we are moving towards using some sign and gesture for the student.  SP12 agreed, \u201cI think for us, there's a major time constraint for any of the specialized teachers, for them to be able to connect with classroom teachers.\u201d She further explained:  District TDHH has close to 75 kids on her caseload and 30 odd schools. And if you're trying to wrangle that in a week, plus the assorted emails, after-school in-service, and parent phone calls, there's just no way of connecting with that many different people.  SP10 expressed her desire for collaboration if sufficient time is allowed: \u201cit would have been nice to have more time with the hearing resource teacher to collaborate. I think that's what we're really missing to complete the student's program.\u201d  Respondents reported that insufficient collaboration brought about inefficient implementation of interventions. SP16 pointed out that \u201cthere\u2019s little time for the teacher to successfully and consistently implement, monitor, evaluate and adjust d\/Dhh strategies while doing the same for all the other students and needs in the class.\u201d TD08 shared:   173 Educational Assistants have told me they are sometimes overwhelmed by the number of interventions they have been given by the TDHH, SLP (home and school), behavior consultant (home and school), Learning support teacher, and sometimes the TVI or POPDB consultants.  A lack of collaboration with parents was addressed as well. TD27 shared her experience during a focus group interview: I had a student in Grade 4 with autism who was recently diagnosed with hearing loss. I find it challenging to have enough time to talk to the parents. The hearing aids aren't just for school, right? So, kind of trying to teach them [parents] about hearing loss. I've kind of said you can ask the provincial services for the deaf and hard of hearing, but the family was not interested in that.  Some administrators commented that some parents appear to be passive in collaborating with educators. AM12 remarked: It's actually odd. I guess I think there's a false idea in some ways that we [teachers] have some kind of magic... we definitely need their [parents\u2019] input and we definitely need their support. Maybe part of this is because some families don't speak English, so that's kind of a complicated process, but it's true in all schools, so I don't know. It was a weird thing to have parents not ever call us out. It is just a weird thing that no one (parents) ever came in and said to us, \u2018How am I going to get my kid that part?\u2019 \u2026No one ever came in and said to us.  AM10 seconded in the same group interview:  I know, I find the same thing. It's a weird thing. Except that we recommend that this child needs to learn ASL and that's really their path. Other than that, families trust us  174 implicitly. It's like, \u2018I don't know, you tell me, I'll do whatever you (say)\u2019 except for that one thing. Yeah, it's the same. It's the same with us. I feel like they trust us sometimes too much, (but) they should call us up, they should say.  For the third research question, three themes are emerged from the data about implementation of strategies and interventions for DWD students: (a) lack of understanding among educators regarding language acquisition and deprivation; (b) provincial-wide shortage of professionals who have been trained to work with DWD students; and (c) inefficient and insufficient team collaboration. These themes may contribute to inadequate practices to meet complex needs students who are DWD. 5.3.3.3 Suggestions in Intervention The respondents made suggestions corresponding to the concerns they addressed above. A student-centered approach, manageable caseloads, and efficient collaboration were the key factors that educators recommended in support of DWD students. Student-centered approach. Educators suggested taking a student-centered approach when implementing strategies and interventions for DWD students. TD55 stated that \u201cstudents with hearing loss and other disabilities are unique\u201d so we need \u201cto do a lot of observation and recording and spend time in varied settings\/situations in order to understand their needs and abilities, and how to help them grow.\u201d TD11 highlighted that it is important to \u201calways have the expectation that all students can learn - it will be at a different rate and different amount.\u201d This approach may require educators to \u201chave higher expectations for students, value the importance of varying forms of communication, and get the training or access [for the students] to be able to communicate independently where possible by graduation\u201d (TD52). It is because \u201call students  175 deserve an equitable and equal access to information, socialization, and curriculum studies\u201d (TD16). In this approach, educators emphasized adapting teaching activities to an individual student\u2019s interests, building students\u2019 advocacy skills, and including social goals in the planning. SP19 stated that \u201cit is important to tailor lessons and activities to students' individual interests to get the most student engagement.\u201d TD15 suggested that educators \u201cget to know the student's particular needs first and remain flexible\u201d as well as \u201cbuild student capacity slowly for their self-advocacy skill development.\u201d SP21 highlighted that \u201csupportive peers and teachers who are the \u2018right\u2019 fit is also important in pre-planning for students\u201d as \u201cthey [DWD students] also want friends and fun, and to belong but maybe they don't know how\u201d (TD30). TD16 concurred, \u201csupport and action plans can strategize the needs of these students but at the same time they need to be happy, safe, and supported.  They also need to have social interaction with the regular and challenged students.\u201d CL14 also added that \u2018meaningful collaboration with peers\u2019 is needed in developing social relationships in the classroom. TD55 summarized that \u201cit is very important to understand each student well (ALL facets) in order to ensure the best plan is made for the student.\u201d To create a student-centric approach, respondents were in consensus that it is necessary to \u201ceducate\u201d people (including administrators, classroom teachers, special education teachers, EAs, parents, peers, and so on) in the learning environment of DWD students. DS06 insisted:  I believe it starts with the education of everybody in the environment. There are three parties that we have to educate in the environment itself: not only the teachers but also the peers of the students, and, of course, whoever is working with them has to be educated about the child.  176 Administrators are to be one of them as TD55 stated, \u201cit's important for administrators and other decision-makers to have a deeper understanding of hearing loss and its impact on education and access to information, and how this challenge exacerbates other disability needs\u201d AM03 further added the ministry to the list, \u201cI think it's a matter of educating, the public educating the ministry, educating principals, but even educating the teachers that are doing that work.\u201d Education should not be limited to school staff but also include professionals who conduct assessment and diagnosis. AM10 highlighted, \u201ceducation is important. I also think people who are doing the diagnosis like psychologists need that background information and education to understand that these kids have very specific needs as learners and that their language needs are quite varied.\u201d TD56 seconded that we should \u201cprovide a fuller, more in-depth education to doctors and specialists that is more inclusive to developing children as a whole, rather than as a diagnosis to be fixed or treated.\u201d Furthermore, some respondents recommended that we educate parents about the possibility of independence and success of their child. SP12 insisted: We need to empower the parents who feel like where else they can go then. If they can't access speech therapy in the school system because of this system being what it is, then what else can they do? Can they go to a third charity? Can they find a way of getting them access to a different source of funding? Because I feel like they're left sort of high and dry on their own. That really isn't fair. Recruiting professionals for manageable caseloads. Educators strongly claimed that more professionals should be available in the province for DWD students. Respondents voiced that smaller caseloads with more staffing could be used to provide adequate support. TD36 wrote on the survey, \u201cReduce caseload size! I think when people have a more manageable caseload, they have more time to help some of those students.\u201d TD57 also insisted that \u201cmore staffing [is  177 required] to lessen the LARGE caseloads and better support students.\u201d TD16 echoed that \u201cwe need to negotiate the appropriate means for caseloads. The district needs to hire more specialists to provide assessments, action plans, collaboration, etc.\u201d SP06 specified the need for trained TDHHs and EAs who can work directly with DWD students, \u201cthese students need more support from trained EAs who are fluent in sign language and more time with the teacher who is specialized in working with students who are deaf or hard of hearing.\u201d TD14 concurred that \u201cwe need more trained TDHHs and education staff to sufficiently support students.\u201d In addition, in order to receive suitable support in the classroom or school, DS07 insisted that we have \u201cmore in-school case managers so that there can be better oversight of what is happening in the classroom, to ensure recommendations and strategies are being implemented, and educational needs of the student are being met.\u201d SP21 added a need for \u201cmore specialists in the school district.\u201d TD05 summarized that overall \u201cthe team members need more FTE or more people need to be hired to properly meet their needs.\u201d To bring in trained professionals in a broad range of services and resources, respondents addressed that targeted funding is necessary. AM03 contended that DWD students need more funding from the Ministry to access language at school:  Other administrators say, \u2018you only get funded 20 plus thousand dollars (per student with F designation), so they either don't have them [professionals or specialists] or they'll have them part-time.\u2019 To that I say, \u2018but the kid isn't deaf half the day, the kid is deaf all day. You're basically eliminating their ability to access education for half the day if that is their mode of communication. So, I think money is the biggest piece and retention you [need to] get people that actually know how to do the job.  178  TD09 seconded that the extra funding should target \u201cfor direct in-class support so that the student has full-time access to Visual Language Interpreters, signing EA's, etc.\u201d  TD38 listed her suggestions on the survey:  Allot funding specifically for the DHH student and distributed for the needs of that student only, release funds from Ministry of Education to the principal of Inclusive education who with the recommendations of the TDHH, distribute extra funding in a broad range of service and resources, e.g., ASL development, OT, PT, TDHH support, SLP support etc.  TD11 summarized that \u201cif the Ministry wants successful inclusion, then they need to fund it properly.\u201d Furthermore, educators proposed that districts offer incentives for recruiting and training professionals (TD14). DS01 stated, \u201cwe need more trained professionals. If districts would provide incentives, it might be more desirable to get training (for example: pay for masters in DHH education and for ASL learning)\u201d SP19 suggested the school districts \u201cpushing for incentives for us to have more training or to learn sign language for teachers\u2026 If the district kind of promotes it, then maybe there'd be more teachers that would be intrigued and interested in it.\u201d For the districts in rural areas, AM07 also insisted that professionals \u201cneed to be enticed with pay and that doesn't seem to happen. I wish I had an answer for this never-ending problem.\u201d A couple of examples of incentives were shared:  Our district does a 5% salary bonus for a signing EA, and they get a six-hour day, which I fought for. Interpreters are getting a seven-hour day, so I am fighting that. We should also get a seven-hour day because there's a lot of prep and planning when we're having sign language interpreters. (TD27)   179 Recruitment and retention, of courses, is an issue. I increased the hours that they work per week. There was nothing in their collective agreements for prep time but EAs had language in their collective agreements for prep time. Well, interpreters need proper time. (AM03) Given that it is supporting staff (i.e., signing EAs, intervenors) who spend most of the school time with DWD students, respondents asserted that incentives should also be given to them to promote their training and consistency in their job placement. TD14 suggested that districts \u201coffer incentives to train EAs for work with DHH and disabilities in classrooms.\u201d TD22 furthered that districts need to \u201chire EAs who can be specifically trained to work with DHH students so that they aren't changing, and new ones put in place who lack understanding and are not able to intuitively address needs proactively.\u201d TD38 supported, \u201cEAs who bid on DHH students with additional disabilities should be expected to follow the student throughout the grades\/programs. Furthermore, SP19 suggested:  Districts provide incentives for professionals, EAs, teachers, and interpreters to learn ASL. Or provide incentives for those who do know ASL to advance their skills. I know of EAs who sign but choose to work in a hearing school and with hearing students as their additional skills are not recognized and compensated financially. We need more counsellors, SLPs, and teachers who sign, however, ASL classes are generally at the expense of the individual. SP10 summarized that \u201cthere are needs to offer high incentives\u201d for recruitment and retention of professionals and supporting staff. Increasing professional development opportunities. To increase professional development opportunities for the school teams (i.e., teachers, EAs, LSTs), respondents  180 suggested regular in-service training. TD57 proposed that it is necessary to have \u201ccommunication and in-service for staff about challenges and resources for d\/Dhh students with disabilities\u201d SP12 furthered:  I think any teacher who has a student with a diagnosis of deaf or hard of hearing should have an in-service afternoon at the beginning of the year where they can just connect, get to know what that means, what it looks like how you can support, and then periodically throughout the year. Some special education teachers highlighted that \u201cprofessionals working with students who are deaf MUST learn strategies to work with students who are deaf AND who have autism, etc.\u201d (SP06). SP21 summarized that \u201cmore training for teachers to understand different needs and support options. Proactive rather than reactive support.\u201d Moreover, \u201ctraining of support staff to work with students who are d\/Dhh and with disabilities\u201d (TD57) was emphasized and regarded as an essential part of the implementation of strategies and interventions. DS06 pointed out: Since I am not there most of the time in my job, training whoever is working with a child on that basis is the best part because you would want this goal to be achieved in a certain term. And if you don't train the EAs or the teachers, then at the end of the year, the student will still be the same, he or she doesn't progress anyway. So training the support personnel is the second best part that we need to make sure. SP10 added, through offered professional development, \u201cEAs can better deliver programs and advocate for adaptations in class and implement recommendations.\u201d AM06 suggested \u201conline course or webinars for support staff on working with students with d\/Dhh, similar to that of POPARD or POPFASD.\u201d TD56 more specified that \u201cincreased fluency in ASL would be  181 preferred in EAs supporting students as well as a greater understanding of how to communicate visually (ASL or pics or drawing or gestures or whatever).\u201d Increasing collaborative practices. Efficient collaboration was regarded as a \u201cmust-do\u201d solution by respondents. All acknowledged that the education of a DWD student \u201crequires a team approach\u201d for successful inclusion (TD48), which can be either \u201ca multidisciplinary team, which means everybody's involved: the teacher, special education teacher, case manager, EAs, parents, and everybody who has access to or who's providing services to the child\u201d (DS06) or \u201ca transdisciplinary team to address all the complex needs that requires time to implement and collaborate with\u201d(TD11). Especially for the additional challenges or disabilities, TD39 recommended to \u201creach out to the professionals that work with the student and are qualified in the area of the student\u2019s additional exceptionality\u201d in the team as \u201cconsulting with the professionals in the field of the other disability\u201d is necessary in implementing strategies (TD09). TD14 highlighted that members should \u201ctrust in all sides of the equation and know that everyone is trying their best (parents, staff, EAs, teachers). More emphasis was placed on the collaboration of TDHHs with school-based special education teachers and classroom teachers. To \u201chave a close connection with the school's Integration Support teacher\u201d (TD09), TD25 suggested: More time needs to be given to TDHH and Student [Learning] Service or Resource [Room] teachers for co-planning the strategies, accommodations, and learning plans for d\/DHH students with disabilities to ensure that each person has a solid understanding of how the different diagnoses interact and impact the child's learning. TD11 seconded, \u201cregular communications between the TDHH and the classroom teacher and resource teacher need to happen so that TDHH can support the learning that is happening in the  182 class, as this will help support inclusion.\u201d Given the limitation of having an itinerant case manager, TD48 recommended co-case management of both TDHH and LST for DWD students:  When a student's need is beyond hearing and language, it is imperative that kids have a school-based co-manager to advocate for their other needs, as we [itinerant TDHHs] do not have the depth of knowledge a resource teacher or learning assistance teacher might have about their specialty area or the programming available at the school\u2026collaboration is the key. Having a \"co-case manager\" would offer the best of both worlds.   TD22 supported the idea and pointed out then \u201cit is important to identify who is responsible for what... TDHH for X and LST for Y.... etc.\u201d  as \u201cLSTs know more about affiliated resources i.e. SET-BC, or ARC-BC and have varying experience with augmentative communication or writing programs i.e., Clicker.\u201d Collaboration between TDHHs and classroom teachers also was emphasized, especially by school-based special education teachers: \u201cI would like more time for the enrolling classroom teacher to meet with and consult with the HRT\u201d (SP16), \u201cCollaborate with HRT and classroom teacher together to come up with classroom strategies that best fit student and teacher\u201d (SP21). SP05 shared a picture of team collaboration for a DWD student on the survey: I rely heavily on the Teacher of the Deaf and Hard of Hearing as the 'expert' in this field. It is the TDHH who ensures all of their hearing needs are met. I work collaboratively with the TDHH, classroom teachers, and EAs to ensure the adaptations are implemented and necessary resources are provided. We work together as a team and communicate regularly. For sufficient collaboration, TD22 stressed that time for regular team communications should be secured: \u201cyou need regular time to touch base [with your team] like weekly or  183 biweekly, where you're going to set aside 30 minutes to just sit down and hammer out the new things that pop up.\u201d TD28 seconded that \u201cI should be able to meet with the teachers regularly without them having to give up personal time to meet.\u201d TD13 asserted that \u201cadministrators and case managers need to understand that more time is needed for consultation with other team members.\u201d As shown in the survey results the most critical factor that made collaboration difficult was insufficient time, respondents accordingly expressed a need for \u201crelease time that should be given to ALL staff working with the child including classroom teacher (TD24)\u201d to be able to do \u201cfrequent checks in with other professionals who work with the student to see who is targeting which skills and how\u201d (TD08). Extra release time should be given for planning the success and progress of the students, including \u201cBEFORE the IEP\u201d (TD24), \u201cconsultation and in-servicing\u201d (DS07), and meetings with parents (TD16). Another collaboration suggested was with outside professionals, including provincial resources (i.e., POPDHH, POPDB). TD19 suggested \u201ctrying to access professionals from outside agencies and work closely with parents to receive a diagnosis to help in developing individualized programs.\u201d TD01 states, \u201cdon't feel bad about reaching out to others such as those in POPDHH and your other Deaf and Hard of Hearing teachers in the province.\u201d SP20 added their experiences, \u201cservices from Canadian Deaf-Blind are extremely useful in understanding how to support d\/Dhh students with additional support needs.\u201d There were expectations from school-based staff that TDHHs would connect professionals to support outside of their districts. SP08 expressed: I think it is important for itinerant or specialist teachers to have an awareness of what supports are out there for students, whether the supports come from school districts or  184 outside agencies.  In my role [as Learning Support Teacher], I do not have the ability to know every support available for every designation but if the itinerant teacher had a good understanding of the supports that are out there, that would be great. CL04 also wondered regarding possible outside resources \u201cif there can be outreach given to specialized groups such as these that could give strategies and advice on how to work with Dhh children.\u201d According to respondents, collaboration should include families to ensure continuity and advocacy. \u201cBuilding connections and relationships with families\u201d (TD17) should be achieved by consistent \u201cdiscussion with parents about their goals and the reality of what the school district can do to support\u201d (TD31). TD24 pointed out the importance of the parents\u2019 role in ensuring adequate services, I've honestly found that especially with the deaf plus students, the number one predictor of how much support students are going to get is parents. It doesn't matter what I say. It doesn't matter what the psycho-evaluation says or whatever, it's the parents. The parents have to be a squeaky wheel, and I get parents that are sometimes apologetic; I'm like, no, be louder.  SP04 summarized that \u201cit [collaboration] works if the team is altogether on the same page; The parents help that piece.\u201d In conclusion, respondents suggested a student-centered approach with high expectations, increasing the number of trained professionals, targeted funding, incentives, and increased opportunities for professional development. Efficient collaboration was regarded as the key factor in providing appropriate education for DWD students.  185 5.3.4 Summary of Results The themes that emerged to answer the first research question included the identification of disabilities as challenging due to its complexity and lack of qualified professionals to complete psychoeducational assessments. This ties to the second theme surrounding the current funding models and highlights the deficit-based model the current funding system has that requires disabilities be identified before the delivery of services. Only primary designations are eligible for supplementary funding, which creates disparity in the way services are allocated to students, another theme that emerged from the Results.  To answer the second research question, the analysis of the data revealed a theme of concern that many DWD students are being placed in general education classrooms without the necessary support and limited alternate placement options are available. And educators find the process of transition is challenging and complicated. Only half of the educators felt that they were able to develop educational programming to provide appropriate instruction for DWD learners.  Themes that emerged from the final research question include that almost half of the respondents did not see their students\u2019 needs in language, communication, and social skills development being met in their current educational settings due to lack of language access, as well as professional services for disabilities. A theme emerged that a large number of educators were not equipped with the appropriate skill sets for teaching the learners. They were concerned about the extreme, provincial-wide shortage of professionals and support staff who are trained to work with these learners. And finally, nearly half of the participants regarded their team collaboration as inefficient due to a lack of time and differing perspectives toward the student\u2019s  186 needs and progress. All themes provided in-depth information to answer the three research questions investigated and the Results will be further expanded within the Discussion section. 5.4 Discussion A province-wide survey combined with focus group interviews was conducted to explore the perspectives of educators who work with students who are DWD regarding identification and eligibility for service provision, educational placement, and interventions. From this mixed-methods study, current practices, considerations, and suggestions for the education of DWD students were reported.  5.4.1 Strengths-based Approaches to Assessment Educators who participated in this study were concerned that most psychological assessments are deficit-driven, which provides neither a comprehensive picture of the learners\u2019 needs nor any guidance for the educators\u2019 practices. The assessment reports are \u201cbasically documenting things he [the child] couldn\u2019t do\u201d mainly for diagnosis purposes (AM12), are \u201cdone completely in isolation outside of a school setting\u201d (TD22), do not provide educators with guidance for placement and instruction, and do not support students to get what they actually need (AM10). Epstein (2000) also highlights that many assessment scales are deficit-oriented, indicating little has changed in the practice of assessment during the last two decades. When d\/Dhh learners with or without disabilities continue to be perceived through a medical lens, deficit-based perceptions and decisions will remain rampant throughout service provision (Wanis, 2018). Wehmeyer (2020) asserts that the shift (i.e., from deficit-based to strength-based) should start with assessment, as perspectives towards abilities and disabilities of students affect (a) \u2018what to measure\u2019 for determining educational services, (b) \u2018what to focus on\u2019 in assessment, and (c) \u2018how to measure\u2019 student\u2019s progress.   187 Including assessments measuring strengths. Assessments that focus on a learner\u2019s strengths, interests, or passions should be utilized to gain a comprehensive picture of the learner. Although some of the respondents state that direct instruction should be designed \u201cto what interests the student\u201d (TD03) and lessons and activities should be tailored \u201cto student's individual interests to get the most student engagement\u201d (SP19), respondents reported assessment tools that  measure mainly academic achievement or language and literacy skills of learners (e.g., Wechsler Individual Achievement Test, Reading Benchmark, Peabody Picture Vocabulary Test, Clinical Evaluation of Language Fundamentals, ASL Receptive Skills Test, ASL Expressive Skills Test). No respondents mentioned assessments used to measure other domains (e.g., interpersonal skills, social-emotional) or type and variety of assessment (e.g., formative, summative; observation, work samples, language samples, video sample) to gain a holistic view of the learner. An example of such an assessment is the Behavioral and Emotional Rating Scale 2nd Edition (BERS-2) which aims to provide an overall index of a child\u2019s strengths and competencies from three perspectives: the learner, parent, and teacher (Epstein, 2004); however, there are not many instruments available that comprehensively measure a student\u2019s strengths (Buckley & Epstein, 2004). Thus, it is needed to develop and validate more assessments that focus on strengths and interests (Wehmeyer, 2019) as a balanced assessment will lead to the greatest gains in student learning (Cooper, 2022).  A Learner\u2019s Profile. The evidence for students\u2019 progress, or the effectiveness of instruction, should be measured in multiple domains and in multiple ways. Responses throughout the survey show that observations, such as \u201ccheck-ins\u201d or anecdotal notes, are the methods most often used to assess and monitor the progress of students who are DWD. However, it was not reported how the observation notes were being shared and validated as evidence with their team  188 members. In the determination of quality services, it is essential to create a profile of each learner\u2019s strengths and weaknesses to determine areas where they may require support needs. Support needs can be defined as \u201cthe pattern and intensity of supports necessary for a person to participate in activities linked to normative human functioning\u201d (Thompson et al., 2009, p.135). Thompson and his colleagues (2016) created the Supports Intensity Scale \u2013 Children\u2019s Version (SIS-C) that looks at the intensity, type, and frequency of support needs of a learner for school participation, school learning, health and safety, social activities, and advocacy activities as well as home living and community\/neighborhood activities. This measures what supports are needed for an individual to be successful across multiple typical contexts through interviews and conversations with people involved in the education of the learner. Developing a learner profile across environments helps the family and educators understand the whole picture of the child. Thus, this measure has potential applicability for all learners including students who are DWD when IEP teams determine necessary educational services.  In conclusion, strengths-based approaches to assessment should measure the learner\u2019s strengths and interests. A learner\u2019s profile across multiple environments will help educators to gain a comprehensive picture of the learner and determine quality services.  5.4.2 Equitable Services Participants assert that the current BC funding system is situated in a medical, deficit-based model. This funding model is perceived as \u201cflawed\u201d (TD38) as it does not generate equitable services for DWD students and can even become a barrier for these learners. Reasons for this are (a) students need to wait for services until eligibility is determined, (b) substantial educational difficulties that are linked to hearing loss is a criterion for eligibility (The Ministry, 2016), and (c) funding for services is based on the primary eligibility designation without  189 consideration of educational needs attributed to co-occurring disabilities. The Report of the Funding Model Review Panel (the Panel, 2018) from the Ministry admits \u201cthe current funding model does not comprehensively support inclusive education principles, contributing to poor student outcomes\u201d (p.21). The BC Teachers\u2019 Federation (2019) indicated that the funding flowing from the Ministry to school districts for special education covered only 58% of what school districts ultimately spent on special education. This lack of financial resources largely impacts the shape and sustainability of inclusive education practice in BC. Then what changes are necessary to deliver equitable services to students who are DWD?  Revision of the eligibility. At the ministry level, the eligibility criteria for students who are d\/Dhh should be revised to be based on only the hearing status. The current deficit-based eligibility (see p.130) implies that a student must experience substantial educational difficulty as a criterion for assessing specialized services. However, research shows that learners with mild, moderate, severe, and profound hearing losses may require educational services, as any barrier to language access can have an impact on educational progress (Marschark & Knoors, 2012). Atlantic Provinces Special Education Authority (n.d.) provides an example of an eligibility criterion that is solely based hearing status: \u201cStudents, age birth-21, eligible for services shall have a diagnosis from a licensed audiologist within the last 12 months as having at least one of the following: slight hearing loss or greater in the better ear which is not reversible in a reasonable period of time and amplification is prescribed; or single-sided deafness\u201d (p.2). This revision will allow educational services \u201cto become proactive rather than reactive\u201d (SP21).  Targeted funding for recruitment of professionals. To provide equitable services, respondents also emphasized that strategic, targeted funding is necessary to recruit professionals who have suitable skill sets for supporting students who are DWD. Responses show that a  190 critical shortage of specialized professionals has contributed to increased caseload size and a dilution of service among existing professionals, including TDHHs, educational interpreters, EAs (especially those fluent in ASL), SLPs, ASL instructors, counsellors, BCBAs, autism specialists, etc. Most of all, efforts for recruitment of TDHHs should be prioritized as all students who are d\/Dhh, regardless of having a disability or not, should be able to receive services from a TDHH (Jackson et al., 2017; Luft, 2022). In addition, knowledgeable and experienced professionals who can consult with practitioners working with DWD students are in demand (see Chapter 2). Needs-based funding model. Several survey participants (e.g., AM03, SP03) assert that the entire funding system should be needs-based, not designation-based, to provide equitable services to students who are DWD. As demonstrated in AM03\u2019s comment, \u201cif a child needs support, they should get the support, whether or not they meet the criteria from the Ministry\u2019s perspective,\u201d the basic premise underlying a needs-based service delivery model is that \u201cthe needs of students are more important in determining programming and essential supports than are the categorical labels of disabilities\u201d (Saskatchewan Ministry of Education, 2015, p.6). This approach involves \u201ca comprehensive evaluation of the holistic needs of individual students and their families, the identification of concerns and priorities, and the coordination of appropriate supports through an efficient use of resources\u201d (p.6). While actualizing the delivery model, the Saskatchewan Ministry ensures that the approach recognizes that students have different needs that change over time; thus, they require responsive support to meet their particular needs and to enhance their individual strengths and abilities. Considering the BC Ministry (2016) aims to \u201cenable the equitable participation of students with special needs\u201d (p.6), a needs-based funding system may better align with the purpose. Continuous efforts should be made to actualize a  191 needs-based funding model to support students with disabilities including DWD students, as the Panel of BC Ministry (2018) indicated that a needs-based assessment approach is underway within the Ministry and school districts.    In summary, BC\u2019s current funding system is a medical, deficit-based model, which does not support students who are DWD to receive adequate educational services. Revision of the eligibility criteria for d\/Dhh students is necessary. A needs-based funding system may allow students who are DWD to access more equitable educational services. Strategic targeted funding for recruitment of specialized professionals who work with d\/Dhh students with and without disabilities should be prioritized. 5.4.3 Equipping an Educational Placement Regarding current educational placement, participants were concerned that DWD students are being placed in inclusive settings without consideration of their unique needs in language accessibility and professional resources for disabilities. There are limited alternate options available for the learners in the province where their learning needs can be met. When options are scarce, educators and parents often have to choose a placement based on prioritizing what they view as the greatest need. This may result in more transitions for DWD students than others between placements during school years. Researchers note that the alternating educational placements may result in limited or slower growth over time in academic, language, and behavioral development (Borders et al., 2017; Guardino & Cannon, 2022).  Furthermore, participants suggested that more placement options with language access, meaningful social interaction, and professional resources for disabilities be created. This is well supported in the literature as these three elements will increase accessibility to learning  192 opportunities for DWD students (Hagger & Aceves, 2017). Recommendations on how to achieve these elements in educational placement are discussed below. Language access. Educators need to have a strong understanding of the language development of students who are DWD, as it may impact decisions made for their educational placement. Respondents emphasized that full language access is the key factor not only for language and communication development but also for the social and academic skill development of DWD students. However, as shown in the example that TD54 brought to the interview (see p.145), educators\u2019 lack of understanding might become a barrier for a child to access a language-rich environment. Language access should be secured for d\/Dhh children in educational settings (Marschark & Knoors, 2012), regardless of their intellectual and\/or physical disabilities. Social interaction with peers. To build an environment with meaningful social interaction, researchers highlight that the implementation of strategies and interventions involving social interactions should involve both learners with and without disabilities (Antia & Kreimeyer, 1996; Borders et al., 2022; Fees et al., 2014). TD30 states that learners who are DWD \u201cwant friends and fun and want to belong but maybe they don\u2019t know how.\u201d Similarly, peers, at young ages, often do not know how to interact with DWD learners either, which may lead them to remain spectators. According to respondents, social stories and peer modelling are the most commonly used strategies to develop the learner\u2019s social skills. Social stories may also be taught to the entire class; however, the effectiveness of the intervention to increase social interaction varied (see Chapter 4). More evidence-based practices are to be sought in creating learning contexts where the learners and peers have meaningful interaction and build friendship and belongingness (Crowe, 2018).  193 Professional resources for disabilities. An educational environment for DWD students should be equipped with professionals who have been trained to work with the learners. AM12 addresses that educators need to consider \u201cwhether we have the resources to support a child whatever disability it has.\u201d However, the critical shortage of professionals who have been trained to work with DWD students is the highest barrier to providing adequate services to the learners, according to respondents. Solving this problem may require a strategic plan through partnerships with universities and government departments. An example is Maryland School for the Deaf (n.d.). Through a partnership with the Maryland State Department of Education and the State Department of Health, the school has been equipped with staff for DWD students including BCBAs, school psychologists, counsellors, social workers, language development specialists\/functional communication therapists, etc., who are fluent in ASL and have experiences working with d\/Dhh students. Student support specialists and counsellors, along with school psychologists, provide positive behavior support and intervention, as well as consult and train staff and families through ongoing assessment and data collection. Equipping a school or program for the d\/Dhh with special education resources should be feasible through collaborative partnerships. \u201cCluster\u201d programs as alternate options. As an effort to provide a range of educational options and supports for students who are DWD, participants recommended creating specialized \u201ccluster\u201d programs in cohort schools within a district or among regions. Currently, in the province, there are four cohort schools for d\/Dhh students that have been created by the Surrey School District (CSP, 2023; Schmidt, 2021). The cohort schools may provide the learners with an environment that is equipped with the three elements educators suggested earlier by extending ASL instruction to all students in the cohort schools and utilizing district specialists for special  194 education services. Additionally, the CSP (2023) suggests that such program options for d\/Dhh learners should be increased not only at the school district level but also at the Ministry level (i.e., provincial programs) as not many districts and programs can be expected to possess the level of requisite expertise. To summarize, respondents were concerned DWD students are being placed in inclusive classrooms without adequate support. There are limited alternate options available in the province. Suggestions as to how an educational placement can be better equipped when seeking language access, meaningful social interactions, and professional services for their disabilities are provided. As well, cohort programs initiated by school districts or the province might be alternatives to expand feasible educational placement options for d\/Dhh learners with or without disabilities. 5.4.4 Strengths-based Approaches to Planning and Implementation Respondents emphasized that educators need to take a student-centered approach when planning and implementing strategies and interventions, which is one of the guiding principles for student success set by the Ministry (2022). The strategies and interventions mentioned by the respondents included those aimed to improve individual students\u2019 skills through direct instruction from adults. To bridge the gap between the learner\u2019s capacity and the environment demands (Wehmeyer, 2019), however, it is recommended that strategies and interventions be implemented not only (a) to enhance a student\u2019s strengths and capacities, but also (b) to reduce the barriers in the environment and (c) to educate \u201cpartners\u201d (i.e., people in the environment). Enhancing strengths through student involvement. To enhance a learner\u2019s strengths and capacities, promoting students\u2019 involvement and strengthening their self-determination skills is essential (Burke et al., 2020; Hart & Brehm, 2013; Patall & Hooper, 2018; Wehmeyer & Zhao,  195 2020; Wehmeyer, 2019). The importance of student involvement was recognized by several respondents using related terms such as self-assessment, self-identity, self-reflection, and self-advocacy. TD22 strongly recommended involving students to increase self-determination and empower them to become problem solvers and advocates for their learning and audiological needs. This is in line with the heart of BC\u2019s competency-based pedagogical approach: to nurture self-determination within \u201call\u201d learners (Cedillo & Schnellert, 2021). When the learners have ownership for their learning through flexibility and choices of how, when, and where their learning takes place, they will eventually thrive as unique and curious individuals in the \u2018real world\u2019 (Zhao, 2012). Reducing barriers in the environment. Strategies to reduce the barriers in the environment should also be utilized when practicing student-centered approaches. The importance of the environment on the learning of students who are DWD is highlighted by Hauser\u2019s comment (Scarlett\u2019s Park Conference, 2021), \u201cDo not automatically assume there is something wrong with the child. There could be something wrong or missing from the environment.\u201d However, strategies related to environmental modifications are rarely used in classrooms, according to respondents. This reveals there is little awareness or considerations in regard to reducing the barriers in the environment for student\u2019s success. Guardino and Antia (2012) recommend examining the physical arrangement in general education classrooms to reduce visual and auditory distractions and to enhance students\u2019 academic engagement. Changes in their physical environment may benefit not only students who are DWD but also other students in the classroom.   Providing opportunities for professional development. When practicing student-centered education, or strengths-based approaches, respondents insisted that professionals should  196 be continuously educated through professional development opportunities. Wehmeyer (2019) states that the \u201ceducation\u201d should start with shifting perspectives toward the learners, as perspectives influence educational practices for students with disabilities. Thus, professional development should include efforts to reframe the perspectives of educators from the deficit-focused of disability to strength-focused.  Although continuous professional learning for practitioners (i.e., teachers, specialists, EAs) is crucial to better serve DWD learners (Hyte, 2017; Kewanian, 2021; see Chapter 2), professional development opportunities in the province are scarce according to respondents. Creating such opportunities may require extensive collaborative work with provincial programs (i.e., POPDHH, POPARD, POPDB, Inclusion Outreach) or universities. One of the recommendations from the field is a provision of virtual professional development opportunities (Guardino, 2015), such as a series of webinars and interactive workshops in partnership with the Ministry of Education. For example, Guardino and Cannon (2022), in partnership with the Georgia Department of Education, created eight webinars, followed by interactive workshops, as a professional development opportunity for educators in the state. Each webinar consists of theories and practical strategies for teaching DWD students. Another example of a virtual learning opportunity is to partner with a local university to create an undergraduate course, entitled \u201cEducation of d\/Dhh students with Disabilities.\u201d This course could be open to any educator, without prerequisites, who is currently or may possibly work with DWD learners.  Furthermore, TD01 suggested having \u201ca club to discuss and promote the education of d\/Dhh students with disabilities (e.g., how to help their inclusion, how to help parents advocate their children)\u201d in the survey. An example of such teachers-initiated professional development opportunities can be seen in the work of Bruce and colleagues (2008). A small community of  197 teachers at Horace Mann School for the Deaf in Boston contacted a faculty member in the Severe Disabilities and Deafblind program at Boston College for professional development. They wanted to expand their knowledge and skills about educating DWD students as they felt unequipped for the increasing number of DWD students enrolling into the school. Through a three-year strategic plan that consisted of in-service sessions on teacher-selected topics and individual support in the teachers\u2019 classrooms, approaches, and strategies for instruction on how to best include DWD students in their classrooms and school were shared. Such an intensive professional development opportunity can be replicated in the province by a committed group of teachers in partnership of a local university. Without a coherent plan for teacher training in the educational needs of children with disabilities, attempts to appropriately serve this population is challenging (Avramidis & Norwich, 2002; Kewanian, 2021).   In summary, student-centered approaches should be taken when implementing strategies and interventions for students who are DWD. Students\u2019 involvement should be increased in the process of learning. Application of environmental strategies should be implemented as well as strategies to enhance students\u2019 strengths and capacities. Professionals need to be educated to shift their perspectives from deficit-oriented to strengths-focused. Various professional development opportunities could be created through partnership with the Ministry and universities. 5.4.5 Collaborative Practices Interprofessional collaborative practices. Respondents highlighted that collaborative work is necessary to understand the unique learning characteristics of learners who are DWD and discuss strategies to support their success. They also reported that collaborative practices are challenging when perspectives of professionals in the educational team are incongruent regarding the student\u2019s needs and progress and when there is a lack of understanding of the  198 learner as a whole person. Nelson and Bruce (2019) suggest educational teams for DWD learners exercise interprofessional collaborative practices through which a professional\u2019s skills, knowledge, and roles are adapted to complement those of other professions while acknowledging different viewpoints. This is specifically known to be beneficial for team members when addressing the complex needs of individuals with severe disabilities and making decisions (Bruce & Bashinski, 2017; Erickson, 2017; Feiler & Watson, 2010; Horn & Kang, 2012; Ogletree, 2017), including learners who are DWD (Isarin et al., 2015; Nelson & Bruce, 2019; Zaidman-Zait et al., 2015). Co-teaching in inclusive classrooms. In the survey, collaboration among TDHHs, special education teachers, and classroom teachers was highly emphasized. One of the collaborative practices suggested was in-class co-teaching by TDHHs and general education teachers. SP16 and TD05 addressed that TDHHs should be an active part of the inclusive classroom, rather than remaining as visitors or consultants, to benefit the entire class. Luckner (1999) reported the effectiveness of co-teaching by a TDHH and general education teacher in an inclusive classroom as it increases d\/Dhh students\u2019 opportunities for cooperative learning experiences, social interaction, and communication skills; enables hearing students to interact and develop friendships with their d\/Dhh peers by learning another way to communicate; and enhances a sense of belonging for all in the community. Successful co-teaching may require (a) sufficient time for structured planning for all personnel involved (Scruggs et al., 2007; Solis et al., 2012; Stein, 2016), (b) teachers with strong interpersonal skills and a commitment to the relationship (Ploessl et al., 2010; Trent et al., 2003), and (c) administrator\u2019s support and feedback to the professionals (Luckner, 1999; Scruggs et al., 2007). The active involvement of the school-based special education teachers, who often function as case managers, may increase the  199 efficiency of the co-teaching partnership as they may create more shared planning time and oversight.  Strengthening partnership with families. Participants selected three factors that made the collaboration with families difficult: language barriers, cultural differences, and different expectations toward the children. This implies that educators may find it more challenging when working with families with multilingual\/ multicultural backgrounds, whose children are DWD. Respondents indicate that barriers in communication with parents may result in uninformed decisions for educational placement, discontinuity of school learning at home, and eventually low expectation toward their children\u2019s achievement. It is recommended in Chapter 2 that educators provide culturally and linguistically responsive practices, including providing language and communication support through interpretation and translation (e.g., progress report in the family\u2019s home language, visual evidence of assessment, and\/or relay interpreters for communication with d\/Deaf teachers while respecting their cultural values and cultivating their strengths. These practices will enable parents to have equal access and invitations to participate in the decision making of their child\u2019s education plan (Bowen & Baker, 2022; Thompson et al., 2010).   Another way to strengthen the collaborative partnership with parents is to provide resources related to deafness and other special education services. An online network or a parent support group, where families and caregivers can share experiences and information, ask questions, and receive support, can be created and opened to any parents across the province (or the nation) whose children are DWD. The Provincial Deaf and Hard of Hearing Services (PDHHS) in BC can be also resourceful for the families, as their Family Navigators function as the key contact person to facilitate and ensure the delivery of supports and services for families  200 whose children are DWD (BC Ministry of Children and Family Development, 2022). Empowering parents is one of the effective ways to promote learner\u2019s success (Goldstein, 2016; Whicker et al., 2019). 5.4.6 Limitations  There are some limitations to this study that may have affected the interpretation and generalization of the outcomes. Practices and considerations reported in this study may not be representative of all teachers who work with students who are DWD in the province with following reasons: First, the total sample size of 123 of participants should be taken into consideration. They were not obligated to complete the survey or answer all the questions. As some questions were designed for certain titles of professionals (i.e., administrators, TDHHs, specialists), the number of responses for each question varied. Depending on their response (e.g., \u201cyes\u201d or \u201cno\u201d), the number of questions given to a participant differed as well. For example, while 121 participants answered a question regarding the ways of identifying students\u2019 additional disabilities, there were only 32 participants who answered a question about factors for social skills development as the question was only generated for respondents who agreed that their students\u2019 needs in social skills development were being met in the current placement. Another limitation is the use of purposeful sampling. The survey invitations were emailed to listservs of organizations across the province (e.g., school districts, independent schools, provincial programs) and posted on social media. However, some professionals in the province may not have received the survey invitation email, especially general education teachers and district specialists who are not automatically recognized as professionals working with d\/Dhh students, as well as educators who work in private schools. In addition, there is a possibility that  201 a higher number of participants came from certain districts as those districts showed more interest in this research and distributed the invitation district-wide. Third, the research cannot verify if the perspectives shared through the survey came from educators with diverse hearing differences as the survey did not include a question asking the participant\u2019s hearing status. There was no d\/Deaf educator in group interviews. Therefore, findings might be biased by educators with typical hearing level (i.e., normal hearing) and their experiences. Next, as the survey encompassed the population of students who are DWD, some considerations and suggestions educators shared may not be applicable to certain students who are DWD (e.g., strategies for deaf students with autism vs. ones for hard of hearing students with ADHD). The survey invitation only indicated the learners as \u201cstudents who are d\/Deaf and hard of hearing (d\/Dhh) with disabilities (e.g., intellectual disabilities, autism, learning disabilities)\u201d although the population of students who are DWD is extremely heterogeneous and there is a wide range of abilities and disabilities of the learners. Thus, cautions are required when applying suggestions from the study to students that they are currently working with. Lastly, the results may not be generalized to the other provinces in the country or other countries due to the inherently diverse settings in which educators work, the qualifications of professionals who serve the learners, provincial legislation, and the financial infrastructure used to support students who are DWD. Therefore, the results are not intended for direct application to schools and programs for the learners. Rather, outcomes in this survey may be groundwork on which professionals (i.e., TDHHs, administrators, classroom teachers, special education teachers, district specialists) can build and extend with their practice.  202 5.4.7 Future Research  Future research could be conducted to explore other stakeholders\u2019 perspectives on practices and considerations in the education of students who are DWD. Most of all, parents' or caregivers\u2019 perspectives could be investigated, regarding (a) their understanding of deafness and accompanying disabilities, (b) consideration of factors in educational placement, (c) support needs of families for continuity of children\u2019s learning at home, and (d) resources and\/or support networks. EAs is another stakeholder whose voice could be heard with more weight.  5.4.8 Conclusion Through a province-wide exploration of the education of DWD students, current practices and considerations were examined along with suggestions from educators. Currently, identification of accompanying disabilities of DWD students is challenging due to lack of available professionals. Furthermore, the Ministry\u2019s designation-based funding model does not guarantee all the services necessary to meet the needs of DWD students. To acquire a comprehensive picture of the learners, strengths-based approaches to assessment through identifying students\u2019 strengths, interests, and competencies is recommended. To achieve equitable services, revision of the eligibility criteria and a new service delivery model that responds to students\u2019 needs are required. Educators are concerned that DWD students are being placed mostly in inclusive classrooms and without adequate support. There is a lack of placement options where the learners can access language, have meaningful social interactions, and receive services from professionals in special education. Such program options for d\/Dhh learners should be increased across the province.  203 There is also an overall lack of understanding among school educators regarding both language acquisition and deprivation in d\/Dhh students, which contributes to inadequate teaching practices in the classroom. Ongoing professional development and efficient collaboration are key recommendations. Strengths-based approaches can be practiced across the whole learning process, empowering students to own their learning and be actively engaged in it.   204 Chapter 6: Discussion The overall purpose of this dissertation is to examine considerations in the education of DWD students to gain a better understanding of how to effectively support the learners, families, and schools. Study 1 (Chapter 2) and Study 2 (Chapter 3) explore the experiences of a DWD learner, their family, and their educators through an intrinsic case study. Study 3 (Chapter 4) is an experimental research study conducted in three different general education classes across three different schools to examine the effectiveness of an intervention to improve social interaction between DWD students and their peers. The last study further extends the exploration province-wide to investigate practices and considerations from the perspective of educators who worked with DWD learners. The results from the four investigations presented in this dissertation provide theoretical and practical implications for educators who work with DWD students. The objective of Chapter 6 is: to synthesize the research findings presented in the four studies and discuss the strengths of the dissertation; discuss the novel contributions and implications of the research; outline study limitations; and provide a series of potential directions for further research. 6.1 Synthesis of the Research Findings The findings presented in this dissertation fall into three main categories: (1) educational considerations for DWD learners; (2) educational considerations for their families; and (3) educational considerations for the school (i.e., educators, peers). Utilizing different methodologies, each study is also able to make suggestions in the areas of identification and eligibility, educational placement, and intervention by looking at practices not only from the field of DWD education but also from adjacent fields.   205 6.1.1 Considerations for d\/Dhh Learners with Disabilities  Throughout the four studies in this dissertation, the diversity of DWD learners is discussed. Their learning characteristics are unique. The support needs they require, to thrive as a learner, are exceptional. The studies in this dissertation find that DWD learners require: strengths-based approaches to assessment to identify their strengths, potentials, and growths of their learning in multiple contexts with multiple means (Studies 2 & 4);  an educational placement where secured language accessibility, meaningful social interaction, and professional resources for disabilities are present (Studies 1, 2, & 4); and trained \u201cpartners\u201d in their environment (i.e., family, educators, peers) to enhance their skills and abilities (Studies 1, 2, 3, & 4) as learning is \u2018a shared process\u2019 in a responsive social context (Vygotsky, 1978). Furthermore, the learners should be empowered to own their learning through active engagement (Study 4).  This dissertation continuously recommends educators have a holistic view of the learner to understand their learning characteristics and support needs. To achieve it, some practical suggestions are made including compiling a language profile of DWD learners encompassing three components (Study 2) and creating a learner\u2019s profile of support needs across multiple contexts (Study 4). Most importantly, a shift of partners\u2019 perspectives from a deficit focus to a strengths-based focus toward the learners is accentuated as their perspectives influence educational practices for students with disabilities.  6.1.2 Considerations for the Families In addition, to understand the unique support needs of DWD learners\u2019 families, within this dissertation, parents of a DML-D learner were interviewed (Chapters 2 & 3). Their struggles in the search for adequate educational services, appropriate educational placement, and effective interventions were also shared from the educators\u2019 viewpoint. Both of the studies find that the  206 new immigrant, hearing family had neither language proficiency to facilitate their child\u2019s ASL learning at home nor to understand professional discussions and advocate for their child in English. Furthermore, they lacked a good understanding of their child\u2019s disabilities and of the school system in Canada. Due to the language limitation, they felt isolated from and incongruent with the Deaf (ASL users) and hearing (English speakers) communities that surrounded them. Overall, linguistic and cultural barriers prevented them from being equal partners when collaborating with school educators.   The results of this parental interview directed me to suggest educators use culturally and linguistically responsive practices, including utilizing a multicultural and multilingual worker or consultant to assist parents in navigating the advocating process for their children (Study 2) and providing translated school documents in parents\u2019 own language as well as visual, non-linguistic resources when sharing strategies (e.g., video-recorded examples) (Study 3). Interestingly, the survey results in Chapter 5 reveal that educators also find it challenging to collaborate with multilingual and multicultural families due to language barriers and cultural differences. Educators indicate that barriers in communication may result in parental uninformed decisions for educational placement, discontinuity of school learning at home, and eventually low parental expectations toward their children\u2019s achievement.  6.1.3 Considerations for Schools Perspectives of educators gathered from eight educators who participated in the case study (Chapters 2 & 3) were consistent with the findings from 123 educators who participated in the province-wide survey and focus group interviews (Chapter 5). Common themes arise in the areas of service provision, educational placement, and interventions. Those studies find that: (a) there is a lack of assessment tools and assessment providers that can inform educators of a  207 comprehensive understanding of the learners and of a direction for implementing interventions; (b) it is challenging to find an educational placement where the learners can access language, meaningful social interaction with peers, and special education services for disabilities; (c) there is an extreme shortage of professionals who have been trained to work with the learners; and (d) efficient collaboration requires sufficient time and interprofessional collaborative practices. Additionally, Study 4 (Chapter 5) reports collective suggestions from educators, especially in terms of eligibility for service provision. To serve the learners equitably requires revision of the eligibility for students who are d\/Dhh, targeted funding for recruitment of professionals, and a needs-based service paradigm in which services can be provided according to the needs of students, not by the categorical labels of disabilities. The study also introduces examples of professional development opportunities that can be replicated in the province through partnerships with the government and universities.   6.1.4 Strengths of the Research There are several noteworthy aspects of the research. One strength of this research is that the four studies included in this dissertation were conducted consecutively in an attempt to achieve the ultimate goal of investigating considerations of DWD learners, families, and schools. Findings from Studies 1, 2, and 3 provide a repository in preparation for Study 4 (i.e., compiling the questionnaire). As Studies 1 and 3 were published before writing the manuscript of Chapter 5, the early ones function as solid references when discussing the outcomes in Chapter 5.  An additional asset of the dissertation includes using diverse methodology and data. I conducted an intrinsic case study (Baxter & Jack, 2008: Stake, 1995) due to my interest in understanding a particular DWD learner. I was then able to build upon that to understand a larger population of learners. The results were triangulated through a semantic, thematic analysis  208 (Braun & Clarke, 2006) of the interview transcripts. To investigate the functional relation between the intervention and the students\u2019 social behaviors in Study 3, I employed a non-concurrent multiple baseline design across participants (Ledford & Gast, 2018). The frequency of four communicative social behaviors and the duration of social engagement with peers were recorded for each participant during the data collection period.  Lastly, an anonymous online survey using Qualtrics, and focus group interviews were used for the province-wide investigation. A mixed methods approach (Saga, 2009) was taken to analyze both qualitative and quantitative data. The two types of data were integrated into reporting results and discussion.  Another notable strength of this research is that a theoretical foundation was utilized to enhance this research. Vygotsky\u2019s sociocultural theory on learning and development, introduced in Chapter 1, guides this dissertation. In the theory, social exchanges between parent-child, teacher-student, and child-peer are central for learning and development. This perspective provides this dissertation with two insights, which have been reflected in shaping the studies and discussing the results: first, the three partners of DWD learners (i.e., parents, teachers, and peers) should be strengthened through education for better outcomes of the learners; second, it is necessary to understand a DWD learner as a whole person and to see beyond the disability(ies).  Furthermore, each study also employs a practical framework influenced by the theoretical foundation (i.e., Vygotsky\u2019s sociocultural theory), which makes it applicable to the education of learners with disabilities. In Study 1 (Chapter 2), I introduced the Tenets of Effective Practice for Learners who are d\/Deaf or hard of hearing with Disabilities framework (Guardino & Cannon 2022). The Tenets, encapsulated by UDL and Vygotsky\u2019s sociocultural theory, guides Study 1 and 4 with emphasis on collaboration and linguistically culturally responsive practices when working with families whose children are DML-D. In Study 2 (Chapter 3), examining language  209 learning characteristics of a DML-D child through the Tri-focus Framework (Siegel-Causey & Bashinski, 1997) allows me to determine the language and communication factors across all the components: the learner, partner (i.e., the family, educators, peers), and the environment (Chapter 2). In addition, this framework enables me to direct educators to take strengths-based approaches in planning and implementing interventions in Study 4 (Chapter 5) (i.e., enhance the learner\u2019s capacity, educate personnel through professional development opportunities, and reduce barriers in the environments). Lastly, Social Interactionism Theory (Chapter 1), which attempts to explain children\u2019s language acquisition and development influenced by Vygotsky (McLeod, 2018; Paul, 2009), leads me to design the intervention examined in Study 3 (Chapter 4). Through the lens of the theory, increasing social interactions requires reciprocal efforts; thus the whole class community learned from the intervention how to interact and communicate. As such, the application of the foundation and frameworks makes this dissertation more able to provide theoretical implications to the field of special education.  6.2 Novel Contributions of the Research Although, currently, research is steadily increasing in the education of DWD students, there is an ongoing need for resources and strategies to effectively meet the needs of the learners in the cycle of assessment, identification, educational placement, and instruction (Guardino & Cannon, 2022). This series of studies represent the first effort in the province and the nation to examine considerations for DWD learners, families, and educators.  With regards to Study 1 and 2 of a DWD learner who comes from an immigrant family (i.e., DML-D), the findings assist in building a repository of information where parents and professionals can gain a better understanding of how to effectively meet these learners\u2019 needs. Study 1 is the first publication in the field pertaining to students who are both DML and DWD  210 (i.e., DML-D). Furthermore, the Study 2 manuscript has been submitted to a special issue of American Annals of the Deaf whose theme is \u201cLanguage, Literacy, and Culture in East Asian Communities.\u201d The edition has been planned in response to the sparseness of extant research on DWD learners from Asian immigrant families. The findings from Study 2 about exclusive experience of a Korean immigrant family in Canada whose child is DWD will be added to the edition along with other studies sharing the experiences of families with d\/Dhh children from other Asian countries such as the Philippines, Hong Kong, Taiwan, Cambodian, and Singapore.  In regard to Study 3, it is important to note that the study is the first social story intervention conducted with students who are d\/Dhh-ASD (i.e., DWD) and their peers in a general education classroom settings. Due to a lack of evidence-based practices, modifications of the intervention (i.e., incorporation of ASL vocabulary, inclusion of peers in implementation) were necessary to suit the unique needs of DWD learners as suggested by the field (Borders et al., 2016; Borders et al., 2022; Bruce & Borders, 2015). While the results may not indicate a clear treatment effect across the three classes, possible confounding variables were discussed to consider when implementing a class-wide intervention strategy, including students\u2019 readiness levels in social interactive skills and school environmental factors.  Based on the findings from the case study and the single-case experimental study, a questionnaire was compiled for Study 4 to examine the practices and considerations province-wide along with focus group interviews. This study is the first attempt in the province and the nation that explored practices and considerations, as well as suggestions for DWD learners in K-12 school systems. To acquire a more comprehensive understanding, the study invited any school educators who have been involved in the education of DWD learners (e.g., TDHHs, administrators, classroom teachers, special education teachers, and district specialists) to  211 participate. Moreover, the large number of educators that participated in the survey strengthens the representation of the outcomes.   6.3 Limitations of the Research Despite the contributions of the research presented within this dissertation, limitations also exist and should be recognized. While the unique limitations of each study are outlined in the individual chapters, one broad limitation corresponds to the number of case studies included in this dissertation as groundwork for the province-wide investigation. Although the case study provides me with information about considerations of each component, findings from one specific case do not necessarily represent the population as a whole; rather, it presents a picture of one case out of many diverse DWD learners. More case studies of the DWD learners would enrich the repository of information about the learners, families, and schools.  This dissertation reports more about educators\u2019 perspectives when examining the considerations of the three components; thus, the findings, especially from Study 4, can be biased. To gain a more comprehensive, balanced picture of the practices and considerations in service provision, educational placement, and implementation of instruction (e.g., continuity at home), the province-wide investigation could have included parents of the learners. Additionally, this dissertation does not incorporate any attempt to gather the learners\u2019 own perspectives when exploring considerations about the learners. Multiple means, such as interviews or visual questionnaires, could be creatively utilized to include the learners\u2019 voice in the examination.  There is a limitation in the analysis of qualitative data in Studies 1, 2 and 4. To validate the qualitative data collected for each study, the results were triangulated through a semantic, thematic analysis (Braun & Clarke, 2005). I invited two university professors to search for convergence among the collected data (i.e., interview, documents, survey open-ended comments)  212 and reported the themes overlapped across the three investigators with rich detailed descriptions and quotes. Further credibility measures could have been utilized, such as member checks or peer debriefing (Brantlinger et al., 2005; Gast & Ledford, 2018), in the process of analysis. Another limitation across the four studies corresponds to the contextual level through which I explored. This is specifically related to the findings and discussions in Study 4 (Chapter 5). For example, considerations on eligibility for service provision and educational placement addressed are only relevant to the context of BC. With respect to the generalizations or applicability of the findings to different contexts (e.g., diverse abilities\/disabilities of DWD learners, other provinces), a cautionary approach is warranted for external validity and potential variables that might interact with their practices. 6.4 Future Directions First, there is a need for longitudinal studies of DWD or DML-D children (Guardino, 2008). There are only a limited number of longitudinal studies about d\/Dhh learners (Galloza-Carrero, 2018); the majority of which are associated with language acquisition of d\/Deaf individuals without disabilities. No longitudinal studies currently exist for DWD learners. For example, in case of Jimin (Chapters 2 and 3), several years after my case study was conducted, the learner\u2019s environment and support needs may have drastically changed; however, based on the limited studies, the information available to support the learner, family, and school may now be insufficient. He will be Grade 7 in the coming school year, and his parents and the educational team may need to start his transition process to secondary school. What assessment tools are being utilized to identify the support needs of Jimin and his family? What educational placement options are available for him in his neighborhood or in the district for his secondary education? What strategies or interventions might be useful for him and his new school? Furthermore, what  213 should be the IEP goals during the secondary years? A longitudinal study can provide educators with a comprehensive picture of a DWD individual and their family when exploring the nature of the lifelong learning process through relationships (Arciuli & Torkildsen, 2012).  Second, as briefly mentioned earlier in the limitation of the study, the perspective of parents whose children are DWD (including DML-D) should be further explored province-wide in order to have a balanced understanding of the education of DWD students. What Studies 1 and 2 provide is a glimpse of the whole picture, considering that there is a high level of diversity among DWD learners, even in the DML-D populations. The parents\u2019 input may add different layers to the findings, especially regarding barriers to accessing appropriate service provision and educational placement, and factors that make collaboration with school challenging. Suggestions from their perspectives may provide educators with a great source of how to coordinate with the families and empower them as fair partners for students\u2019 success (Akamatsu & Cole, 2003; Bowen & Baker, 2022, Cole, 1998; Jackson et al., 2015). Third, more efforts to find evidence-based practices for DWD learners have to be made to effectively teach language and communication and to create an inclusive school environment. There is a need to modify interventions that have been found to be effective with students with certain disabilities (e.g., ASD) for d\/Dhh students who also present those specific disabilities (i.e., d\/Dhh-ASD). Furthermore, specific examples of how the UDL framework can be utilized into lessons and intervention planning in inclusive educational settings should be shared and accessible through publications.  Lastly, research on collaborative practices is also warranted. Efforts of collaboration can be made not only between the team members (e.g., TDHH and general education classroom teacher) but can also be extended to one between a school and the provincial programs (e.g.,  214 POPDHH, PDHHs, POPARD) to increase a DWD learner\u2019s engagement in the school community or to a local university to create professional development opportunities. For example, Rain in Study 3 might benefit from the collaboration between the school team and Inclusion Outreach which assists students with multiple and complex disabilities within BC schools. Efficient collaboration is the key.   6.5 Conclusion In conclusion, the studies embedded in this dissertation explore the considerations for the learner, family, and school in the education of students who are DWD. A synthesis across four chapters within this dissertation substantiates the support needed for learners, families, and schools to adhere to a strengths-based approach when collaborating with one another for the learner\u2019s success. In the strengths-based approach, shifting the focus from the learner to the entire framework (i.e., partners, environment) is essential in the process of learning. The stronger the partners\u2019 skill sets, the more the learner\u2019s capacities will be enhanced. The delivery of equitable services requires a commitment to respond to the support needs of the learner, their family, and educators by adopting a needs-based funding system. It takes the whole school community to build an accessible learning environment for every student including learners who are DWD. When taken together, the studies presented in this dissertation provide theoretical and practical implications for the field as well as an empirical basis for researchers for the learners, families, and schools in the education of students who are DWD.  215 Bibliography Akamatsu, C. T. & Cole, E. (2003). Deaf immigrant and refugee children: A different kind of multiculturalism? In C. Ester & J.A. Siegel (Eds.), Effective consultation in school psychology (2nd ed., pp. 296-321). Hogrefe & Huber. Allgood, M. H., Heller, K. W., Easterbrooks, S. R., & Fredrick, L. D. (2009). 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Retrieved from National Clearinghouse for English Language Acquisition website: http:\/\/www.ncela.us\/files\/rcd\/BE021195\/pol icy_report.pdf    257 Appendices  Appendix A   Case Study A.1 Parent Consent Form for Interview    Consent Form \u2013 Parents  A Case Study of a Deaf Multilingual Learner with Disabilities:  Diagnoses, Educational Placements, and School Services    Principal Investigator: Dr. Joanna E. Cannon Assistant Professor Department of Educational and Counselling Psychology, and Special Education University of British Columbia  Co-Investigator: Eun Young Kwon M.A., M.Ed., Ph.D. student  Department of Educational and Counselling Psychology, and Special Education University of British Columbia   Purpose: You are invited to share your stories and perspectives regarding your child\u2019s education. The purpose of the study is to better understand learners who are deaf with additional disabilities and come from homes where their parents neither speak English nor use American Sign Language as their primary mode of communication.   Study Procedures: In this study, you and some of the educators who work with your child would be interviewed at a pre-arranged, convenient time. You would be interviewed twice; each interview would last about 90 minutes. Both interviews could take place either at your home or at a private, quiet place of your choice. You would be interviewed by a native speaker of your preferred language and the Department of Educational and Counselling Psychology, and Special Education Faculty of Education  2125 Main Mall Vancouver, BC Canada V6T 1Z4  258 interview would be audio-recorded so we can later transcribe and analyze your responses. You would receive the interview questions ahead of the interview time. The other participants would include teachers, educational assistants, and administrators who have worked with your child. They would also be interviewed in their school offices or at a private place of their convenience.   Potential Risks: There are no known or suspected risks associated with participating in this study. If you decline to participate in this study or decide to stop participating in the study there would be no negative consequences for you or your child. No information about your participation would be shared with anyone. In case you do not feel confident or comfortable expressing your ideas or thoughts in English, you would be given the option for the interview to be conducted by a native speaker of your preferred language.   Potential Benefits: You would have opportunities to share your experiences and thoughts with an interested, neutral party who is not directly associated with your child\u2019s educational services. The information you would share with us could help educators understand how to better support other children like your child. Furthermore, your input may benefit the field of deaf education, where there has been minimal research conducted that specifically focuses on this population.   Confidentiality: All documents would be assigned an identification number and kept in a locked filing cabinet. Data on any electronic devices, including audio recordings, would be locked with a password and encrypted. The data would be de-identified prior to being made publicly available in any reports of the completed study.   Remuneration or compensation: You would be compensated for your time with a $50 gift card upon completion of the interviews.   Contact for information about the study: If you have any questions or desire further information with respect to this study, please contact Dr. Joanna Cannon or Eun Young Kwon.   Contact for concerns about the right of the research participants: If you have any concerns or complaints about your rights as a research participant and\/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Services at 604-822-8598 or if long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598  Consent: Participation in this research is voluntary. You do not have to be in this study. If you decide to be in the study and change your mind, you have the right to drop out at any time. If you decide not to participate in this study, there would be no interviews of you or any stakeholders related to your child\u2019s education. Whatever you decide, your child would not lose any benefits to which they are otherwise. Once the data is made publicly available, however, you would not be able to withdraw your input.   259  Your signature indicates that you are one of the parents\/guardians who will be interviewed, and you have received a copy of this consent form for your own records. Please keep this copy of the consent form for your records and return the signature page attached.  Signature Page Your signature indicates that you give consent to participate in this study.     ____________________________________________________ Parent or Guardian Signature     Date     260 A.2 Parent Consent Form for Interview in Korean   \ubd80\ubaa8 \ub3d9\uc758\uc11c  \uc774\ubbfc\uc790\uc758 \ub18d\uc911\ubcf5\uc7a5\uc560\uc544\ub3d9 \uc0ac\ub840\uc5f0\uad6c: \uc9c4\ub2e8, \ud559\uad50 \ubc30\uce58, \ud559\uad50 \uc11c\ube44\uc2a4    \uc8fc \uc5f0\uad6c\uc790: Dr. Joanna E. Cannon \uad50\uc721 \uc0c1\ub2f4 \uc2ec\ub9ac\/ \ud2b9\uc218\uad50\uc721\uacfc \ubd80\uad50\uc218 University of British Columbia  \uacf5\ub3d9 \uc5f0\uad6c\uc790: \uad8c\uc740\uc601 \ud2b9\uc218\uad50\uc721\ud559 \uc11d\uc0ac, \uccad\uac01\uc7a5\uc560 \uc804\uacf5 \ubc15\uc0ac\uacfc\uc815 \uad50\uc721 \uc0c1\ub2f4 \uc2ec\ub9ac\/ \ud2b9\uc218\uad50\uc721\uacfc University of British Columbia   \uc5f0\uad6c \ubaa9\uc801: \uc5ec\ub7ec\ubd84\uc758 \uc790\ub140\ub97c \ud0a4\uc6b0\uc2dc\uba74\uc11c \uac00\uc9c4 \uacbd\ud5d8\ub4e4\uacfc \uc0dd\uac01\ub4e4\uc744 \ub098\ub204\uc5b4 \uc8fc\uc2dc\uae30 \uc6d0\ud569\ub2c8\ub2e4. \uc774 \uc5f0\uad6c\ub97c \ud1b5\ud574 \uc800\ud76c\ub294 \ub18d\uc911\ubcf5 \uc7a5\uc560\ub97c \uac00\uc9c0\uba74\uc11c \ub3d9\uc2dc\uc5d0 \ubd80\ubaa8\uc758 \uc8fc \uc5b8\uc5b4 \uc218\ub2e8\uc774 \uc601\uc5b4\ub098 \uc218\ud654\uac00 \uc544\ub2cc \uc544\ub3d9\ub4e4\uc744 \ub354 \uc798 \uc774\ud574\ud558\uae30 \uc6d0\ud569\ub2c8\ub2e4.   \uc5f0\uad6c \uc808\ucc28: \ubcf8 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\uc608\uc0c1\ud558\uace0 \uc788\uc2b5\ub2c8\ub2e4. \uadf8 \ubd84\ub4e4\uc758 \uc778\ud130\ubdf0\ub294 \ud559\uad50 \uc0ac\ubb34\uc2e4\uc774\ub098 \ud3b8\uc758\uc5d0 \ub530\ub77c \ub3c5\ub9bd\uc801\uc778 \uacf5\uac04\uc5d0\uc11c \uc9c4\ud589\ub420 \uac83\uc785\ub2c8\ub2e4.  \uc7a0\uc7ac\uc801 \uc704\ud5d8: Department of Educational and Counselling Psychology, and Special Education Faculty of Education  2125 Main Mall Vancouver, BC   Canada   V6T 1Z4  261 \uc774 \uc5f0\uad6c\uc5d0 \ucc38\uc5ec\ud568\uc73c\ub85c\uc368 \ud30c\uc0dd\ub418\ub294 \uc5b4\ub5a0\ud55c \uc704\ud5d8\ub3c4 \uc54c\ub824\uc9c4 \ubc14 \uc5c6\uc2b5\ub2c8\ub2e4. \uc5ec\ub7ec\ubd84\uc774 \uc774 \uc5f0\uad6c\uc5d0 \ucc38\uc5ec\ud558\uc2dc\uae30\ub97c \uac70\uc808\ud558\uac70\ub098 \uc911\uac04\uc5d0 \uba48\ucd94\ub354\ub77c\ub3c4 \uc5ec\ub7ec\ubd84\uc774\ub098 \uc790\ub140\uc5d0\uac8c \uc5b4\ub5a0\ud55c \ubd80\uc815\uc801 \uacb0\uacfc\ub3c4 \uc5c6\uc744 \uac83\uc785\ub2c8\ub2e4. \uc5ec\ub7ec\ubd84\uc758 \ucc38\uc5ec\uc640 \uad00\ub828\ub41c \uc815\ubcf4\ub294 \uadf8 \uc5b4\ub290 \ub204\uad6c\uc640\ub3c4 \uacf5\uc720\ub418\uc9c0 \uc54a\uc744 \uac83\uc785\ub2c8\ub2e4. \uc601\uc5b4\ub85c \ud45c\ud604\ud560 \ub54c \uc788\uc744 \ubd88\ud3b8\ud568\uc744 \ub300\ube44\ud574 \ud55c\uad6d\uc5b4\ub85c \uc778\ud130\ubdf0\ub97c \uc9c4\ud589\ud558\uace0\uc790 \ud569\ub2c8\ub2e4.   \uc7a0\uc7ac\uc801 \ud61c\ud0dd: \ubcf8 \uc5f0\uad6c\uc758 \uc778\ud130\ubdf0\ub294 \uc5ec\ub7ec\ubd84\uc758 \uacbd\ud5d8\uacfc \uc0dd\uac01\ub4e4\uc744 \uc5ec\ub7ec\ubd84\uc758 \uc790\ub140 \uad50\uc721\uacfc \uc9c1\uc811\uc801 \uad00\ub828\uc774 \uc5c6\ub294 \uc81c 3\uc790\uc640 \ub098\ub20c \uc218 \uc788\ub294 \uae30\ud68c\uac00 \ub420 \uac83\uc785\ub2c8\ub2e4. \uc5ec\ub7ec\ubd84\uc774 \uc81c\uacf5\ud558\ub294 \uc815\ubcf4\ub4e4\uc740 \uc5ec\ub7ec\ubd84\uc758 \uc790\ub140\uc640 \uac19\uc740 \uc0c1\ud669\uc5d0 \uc788\ub294 \ud559\uc0dd\ub4e4\uc744 \uc774\ud574\ud558\ub294 \ub370 \ub3c4\uc6c0\uc774 \ub420 \uac83\uc785\ub2c8\ub2e4. \ub354 \ub098\uc544\uac00 \uc774\ubbfc \uc790\ub140\uc774\uc790 \ub18d\uc911\ubcf5\uc7a5\uc560\ub97c \uc9c0\ub2cc \ud559\uc0dd\ub4e4\uc5d0 \uad00\ud55c \uc5f0\uad6c\uc5d0 \ud070 \ud61c\ud0dd\uc744 \uc8fc\uc2e4 \uc218 \uc788\uc2b5\ub2c8\ub2e4.   \uac1c\uc778 \ube44\ubc00 \uc815\ubcf4 \uc720\uc9c0: \ubaa8\ub4e0 \ubb38\uc11c\ub4e4\uc740 \uac01\uac01 \uace0\uc720\ubc88\ud638\uac00 \ub9e4\uaca8\uc9c4 \ud6c4 \ud30c\uc77c\ub9c1 \uce90\ube44\ub137\uc5d0 \ubcf4\uad00\ub420 \uac83\uc785\ub2c8\ub2e4. \uc778\ud130\ubdf0 \ub179\uc74c \ud30c\uc77c \ubfd0 \uc544\ub2c8\ub77c \ucef4\ud4e8\ud130\ub85c \uc800\uc7a5\ub41c \ubaa8\ub4e0 \uc790\ub8cc\ub4e4\uc740 \ube44\ubc00\ubc88\ud638\ub97c \uc785\ub825\ud574\uc57c\ub9cc \uc811\uc18d\uc774 \uac00\ub2a5\ud560 \uac83\uc785\ub2c8\ub2e4. \uc544\uc6b8\ub7ec \uc774 \uc5f0\uad6c \ubc1c\ud45c\uac00 \uacf5\uc801\uc73c\ub85c \uc774\ub8e8\uc5b4\uc9c0\uae30 \uc804\uc5d0 \uc790\ub8cc\uc5d0 \uc788\ub294 \ubaa8\ub4e0 \uc0ac\ub78c\ub4e4\uc758 \uc774\ub984\ub4e4\uc740 \ud310\ub3c5\uc774 \ubd88\uac00\ub2a5\ud558\uac8c \ucc98\ub9ac\ub429\ub2c8\ub2e4.  \uac10\uc0ac\uc758 \ud45c\uc2dc: \ub450 \ubc88\uc758 \uc778\ud130\ubdf0\uc5d0 \uc751\ud574 \uc8fc\uc2e0 \ubd80\ubaa8\ub2d8\uaed8\ub294 \ucd1d 50 \ub2ec\ub7ec \uc0c1\ub2f9\uc758 \uc120\ubb3c \uce74\ub4dc\uac00 \uc99d\uc815\ub429\ub2c8\ub2e4.   \uc5f0\uad6c\uc790 \uc5f0\ub77d\ucc98: \uc5b4\ub5a0\ud55c \uc9c8\ubb38\uc774 \uc788\uc73c\uc2dc\uac70\ub098 \uc774 \uc5f0\uad6c\uc5d0 \uad00\ud574 \ub354 \ub9ce\uc740 \uc815\ubcf4\ub97c \uc6d0\ud558\uc2dc\ub2e4\uba74 Dr. Joanna Cannon \ub098 \uad8c\uc740\uc601\uc5d0\uac8c \uc5f0\ub77d\uc8fc\uc2ed\uc2dc\uc624.   \uc5f0\uad6c \ucc38\uc5ec\uc790\uc758 \uad8c\ub9ac\uc5d0 \uad00\ud558\uc5ec:  \ub9cc\uc57d \uc774 \uc5f0\uad6c\uc758 \ucc38\uc5ec\uc790\ub85c\uc11c \uc5f0\uad6c \uacfc\uc815 \uc911\uc5d0 \uc5b4\ub5a0\ud55c \ubd88\ub9cc\uc774\ub098 \ubd88\ud3b8\uc0ac\ud56d\uc774 \uc788\uc73c\uc2dc\uba74 UBC Office of Research Services \ub0b4\uc5d0 \uc788\ub294 Research Participant Complaint Line ( 604-822-8598)\ub85c \uc5f0\ub77d\uc8fc\uc2ed\uc2dc\uc624. \uba3c \uc9c0\uc5ed\uc5d0 \uacc4\uc2e0 \ubd84\uc740 RSIL@ors.ubc.ca \ub85c \uc774\uba54\uc77c\uc744 \ubcf4\ub0b4\uc2dc\uac70\ub098  toll free 1-877-822-8598 \uc804\ud654\ub97c \ud558\uc2dc\uba74 \ub429\ub2c8\ub2e4.  \uc5f0\uad6c\uc5d0 \ub3d9\uc758: \uc774 \uc5f0\uad6c\uc5d0 \ucc38\uc5ec\ub294 \uc790\ubc1c\uc801\uc785\ub2c8\ub2e4. \uad73\uc774 \uc774 \uc5f0\uad6c\uc5d0 \ucc38\uc5ec\ud558\uc9c0 \uc54a\uc73c\uc154\ub3c4 \ub429\ub2c8\ub2e4. \uadf8\ub9ac\uace0 \uc5b8\uc81c\ub4e0 \ucc38\uc5ec\ub97c \uc911\ub2e8\ud558\uc2e4 \uc218 \uc788\uc2b5\ub2c8\ub2e4. \ub9cc\uc57d \ubd80\ubaa8\uc778 \uc5ec\ub7ec\ubd84\uc774 \uc778\ud130\ubdf0\ub97c \ud558\uc9c0 \uc54a\uae30\ub85c \uacb0\uc815\ud558\uc2e0\ub2e4\uba74 \uc800\ud76c\ub294 \uc5ec\ub7ec\ubd84 \uc790\ub140\uc758 \uad50\uc721\uc5d0 \uad00\ub828\ub41c \uc5b4\ub5a0\ud55c \ub2f4\ub2f9\uc790\ub3c4 \uc778\ud130\ubdf0\ud558\uc9c0 \uc54a\uc744 \uac83\uc785\ub2c8\ub2e4. \uc5b4\ub5a0\ud55c \uacb0\uc815\uc744 \ud558\uc2e0\ub2e4 \ud558\ub354\ub77c\ub3c4 \uc5ec\ub7ec\ubd84\uc774\ub098 \uc790\ub140\uac00 \ubc1b\uc744 \ud61c\ud0dd\uc774 \ub2ec\ub77c\uc9c0\uc9c0\ub294 \uc54a\uc744 \uac83\uc785\ub2c8\ub2e4. \uadf8\ub7ec\ub098 \uc77c\ub2e8 \uc790\ub8cc\uac00 \ubc1c\ud45c\ub41c \uc774\ud6c4\uc5d0\ub294 \uc5b4\ub5a4 \ubc29\ubc95\uc73c\ub85c\ub3c4 \uc5ec\ub7ec\ubd84\uc774 \ub098\ub208 \uc815\ubcf4\ub97c \ub418\ub3cc\ub9b4 \uc218\ub294 \uc5c6\uc2b5\ub2c8\ub2e4.   \uc5ec\ub7ec\ubd84\uc774 \uc544\ub798\uc5d0 \uc11c\uba85\ud558\uc2dc\uba74 \ubcf8 \uc5f0\uad6c\uc758 \uc778\ud130\ubdf0\uc5d0 \ucc38\uc5ec\ud558\uc2e0\ub2e4\ub294 \ub73b\uc73c\ub85c \uac04\uc8fc\ub429\ub2c8\ub2e4. \uc544\uc6b8\ub7ec \uc800\ud76c\uac00 \uc774 \ub3d9\uc758\uc11c\ub97c \uc5ec\ub7ec\ubd84\uc5d0\uac8c \ub4dc\ub838\ub2e4\ub294 \uc758\ubbf8\ub3c4 \ud3ec\ud568\ub429\ub2c8\ub2e4. \ubcf8 \ub3d9\uc758\uc11c\ub294  262 \uc5ec\ub7ec\ubd84 \uac1c\uc778\uc758 \uc790\ub8cc\ub85c \uac00\uc9c0\uace0 \uacc4\uc2dc\uace0 \uc544\ub798\uc758 \uc11c\uba85\uc774 \ud3ec\ud568\ub41c \ud398\uc774\uc9c0\ub294 \uc800\ud76c\uc5d0\uac8c \ub3cc\ub824\uc8fc\uc2dc\uae30 \ubc14\ub78d\ub2c8\ub2e4.    Signature Page  \ub098____________\ub294 \uc774 \uc5f0\uad6c\uc5d0 \ucc38\uc5ec\ud560 \uac83\uc744 \ub3d9\uc758\ud569\ub2c8\ub2e4.    ____________________________________________________ Parent or Guardian Signature     Date    263 A.3 Educator Consent Form   Consent Form \u2013 Teachers\/ Educational Assistants\/ Administrators  A Case Study of a Deaf Multilingual Learner with Disabilities:  Diagnoses, Educational Placements, and School Services   Principal Investigator: Dr. Joanna E. Cannon Assistant Professor Department of Educational and Counselling Psychology, and Special Education University of British Columbia  Co-Investigator: Eun Young Kwon M.A., M.Ed., Ph.D. student  Department of Educational and Counselling Psychology, and Special Education University of British Columbia  Purpose: The purpose of the study is to better understand learners who are deaf or hard of hearing with additional disabilities and come from homes where their parents neither speak English nor use American Sign Language as their primary mode of communication. You are invited to share your experiences and thoughts in educating a learner with these characteristics.    Study Procedures: In this study, you have been contacted because you have worked with a deaf student with disabilities whose home language is neither English nor ASL. The parents of the student have agreed to participate in this study and have given us permission to contact you. We would like to interview you at pre-arranged, convenient time. You would be interviewed once for approximately 90 minutes either in your school office or at a private, quiet place of your choice. The interview would be audio-recorded, with your permission, so we can later transcribe and analyze the interview responses. If you prefer, however, the interviewer can take notes during the session instead. You would receive the interview questions ahead of the interview.  Potential Risks: There are no known or suspected risks associated with participating in this study. If you decline to participate in this study, there will be no negative consequences for your employment or in your relationship with the Investigators.  Department of Educational and Counselling Psychology, and Special Education Faculty of Education  2125 Main Mall Vancouver, BC Canada V6T 1Z4  264  Potential Benefits: You would have opportunities to share your experiences and thoughts as an educator in serving deaf multilingual students with disabilities. The information you would share with us may help other educators who work with this population. Furthermore, your input may benefit to the field of deaf education, where there has been minimal research conducted that specifically focuses on this population.   Confidentiality: All documents would be assigned an identification number and kept in a locked filing cabinet. Data in any electronic devices including audio recordings will be locked with a password and encrypted. The data will be de-identified prior to being made publicly available in any reports of the completed study.   Remuneration or compensation: You would be compensated for your time with a $25 educational gift card upon completion of the interviews.   Contact for information about the study: If you have any questions or desire further information with respect to this study, you may contact Dr. Joanna Cannon or Eun Young Kwon.   Contact for concerns about the right of the research participants: If you have any concerns or complaints about your rights as a research participant and\/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Services at 604-822-8598 or if long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598  Consent: Participation in this research is voluntary. If you decide to be in the study and change your mind, you have the right to drop out at any time. If you decide not to participate in this study you will not lose any benefits to which you are otherwise entitled. Once the data is made publicly available, however, you would not be able to withdraw your input. Your signature below indicates that you are one of the educators who will be interviewed, and you have received a copy of this consent form for your own records. Please keep this copy of the consent form for your records and return the signature page attached.  Signature Page Your signature indicates that you give consent to participate in this study.    ____________________________________________________ Signature     Date       265 A.4 Parent Interview Questions Interview Questions for Parents\/Caregivers  Title: A Case Study of a Deaf Multilingual Learner with Disabilities: Diagnoses, Educational Placements, and School Services  Principal Investigator: Dr. Joanna Cannon Co-Investigator: Eun Young Kwon  Background Information & Family Culture 1.  What is your relationship with your child? 2.  What is the primary language spoken in your home? 3.  Which country does your family come from? 4. How many children do you have? How old are they? 5. Where were your children born? 6. Describe your family\u2019s culture or background?  7. How many people currently live in your home? 8.   Are there other adults who care for your child? If so, who are they? 9. Who works in the family? Please briefly describe their work and the extent they work (i.e., working full-time, part-time, not employed). 12. What is your goal as a parent? (or your parenting philosophy) About your child 1. What is your goal(s) for your DML child? 2. What makes your child happy?  3. What are your child\u2019s strengths and challenges in the following areas? (a) Social skills (e.g., initiations, response, engagement with peers) (b) Communication (e.g., non-verbal, Verbal, Visuals, PECS, ASL or signs, AAC)  (c) Behaviors (e,g., aggression toward others, self-injurious behaviors, tantrum) (d) Emotional functioning\/self-regulation 4.   Please specify any other strengths or challenges that your child presents at school or home. Diagnosis of hearing loss 1.     At what age was your child identified as deaf or hard of hearing? How? 2.     What was the cause of your child\u2019s hearing loss? 3.     What is your hearing status? What is his biological father\u2019s hearing status? 4.     What is the level of your child\u2019s hearing loss? (i.e., mild, moderate, severe, profound) 5.     Does your child use amplification (i.e., HA, CI, BAHA, FM)? If so, at what age did the child first use amplification?  6.     Has the amplification choice changed over time? (i.e., started with HA, now has CI) 7.     What type of amplification is currently used at home? at school? 8.     What was the first organization or professional you were introduced to, or you found for consulting regarding your child\u2019s hearing loss?  \u25cf How did you meet them?  \u25cf Describe the meeting?  o What did they tell you?   266 o How did you feel? o How was your communication with them?  o Was there a professional who assisted with the communication between you and the representative who consulted with you about your child\u2019s hearing level (i.e., interpreter or multicultural worker or cultural broker)?  \u25aa If yes, did you ask for them or was it provided? \u25aa If no, do you wish there was an interpreter or cultural broker?  9.   Did you previously have experience with deaf individual? If so, in what capacity?  10. What was your reaction to your child\u2019s deafness? 11. What was the response from other family members (i.e., partner or older sibling) when you shared information about the child\u2019s deafness?  Diagnosis of co-occurring disability 1.    At what age was your child diagnosed with the second disability? 2.    Please describe the process of obtaining the second diagnosis?  \u25cf Who initiated the assessment for a secondary disability? \u25cf If you initiated the process, how did you know what to do? 3. Were there challenges or difficulties with the assessment process? If so, please describe. 4. After the assessment, who shared with you that your child was diagnosed with a second disability? \u25cf How did you feel?  \u25cf Was an interpreter provided when they shared the results of the assessment?  \u25cf Was your interpreter skilled with the terminology needed to clearly relay the information to you and your family members? o If you did not understand their recommendations or terminologies, what did you do? 5.     What was the most challenging part for you? For your family? For your child? 6.     What\/Who was the most helpful for you and your family?  EI services across all disabilities 1. Did your child receive EI services?  If so, please describe. \u25cf Who provided the services? \u25cf Was communication between you and the service provider clear and comprehensible?  \u25cf What were the recommendations?  o Did you have challenges implementing the recommendations? o Were there successes when implementing the recommendations? 2. When you had questions, how did you get answers? And from whom? 3. What other resources were available to you?  \u2022 At home?  \u2022 At school? 4. Did you have opportunities to meet with other parents with children with disabilities?  \u25cf If yes, how did that impact you and your child?  \u25cf If not, do you think this would have benefitted you and your child? How? 5.  During the first year after diagnosis, what were the greatest challenges? Successes? 6.  Did the second diagnosis change your criteria for choosing EI services? If so, how? 7.  How could the EI process been improved to meet your needs? Your child\u2019s needs?  Communication and Language Development  267 1. What communication modalities and\/or languages have you tried? 2. What is the child\u2019s current mode of communication, for receptive\/expressive language?  3. Is the communication mode or language different between school and home?  4.   Do you speak\/use your home language with all of your children? If not, why? 5.   Does your child use your family\u2019s home language? If so, how often? 6.   Please describe your ability to communicate with your child? 7.  Did you need to learn a new language or communication mode in order to better communicate with your child (i.e., ASL, English, PCS)? If so, what\/who has helped you to improve your skills? 8. What do you think would facilitate communication with your child? 9. Describe your child\u2019s ability to communicate with others (i.e., the other family members, familiar neighbors, teachers, peers)? 10.  Describe your communication with service providers regarding your child\u2019s language development?  \u25cf How often? How did you communicate with them? (e.g., emails, meetings) \u25cf What would facilitate communication between you and your child\u2019s service providers? 11. What is your goal\/wish for your child\u2019s language and communication development? 12. Who works with your child to develop his\/her language and communication skills at home? At school? Educational Services and Placements 1. Please describe the transition from EI to Kindergarten\/grade level (depending on educational history)?  \u25cf What professionals were involved?  o Were you offered a cultural broker or interpreter for the transition meeting? \u25cf When did the process begin? \u25cf Were you given information about placement options and services prior to the meeting? Was this information available in your first language?  \u25cf Do you feel you were part of the process? That your input was regarded as important? \u25cf Do you think the professionals understood and considered your child\u2019s dual exceptionality and cultural needs thoroughly? o If so, why or how?  o If not, why?  2. Did this diagnosis of the co-occurring disability impact your child\u2019s educational program\/placement? 3. What was the result of the transition meeting? 4. Do you agree with the placement your child was assigned? \u25cf If yes, why? \u25cf If not, what alternative placements should have been considered? 5. Do you agree with the services your child received? \u25cf If yes, why? \u25cf If not, what other services should have been considered? 6. What could have improved the transition to K-12? Educational Placement and Services (Current) 1. What kind of services is your child currently receiving (i.e., behavioral consulting, Speech, Counselling, respite, adapted sports programs)  268 \u25cf At home? In the community?  2. What kind of supports are your child receiving from school?  (e.g., One-to-one EA, PT, OT, SLP, TDHH, LST\/IST\/MST) \u25cf How often does your child receive services from each provider? \u25cf Do the service providers share with you what they are working on with your child?  o If so, how often? Is this information shared in your native language?  o If not, do you understand the materials and information that is shared with you? \u25cf Do the service providers share strategies that you can use at home to continue developing your child\u2019s skills?  o If so, is this information shared in your native language?  o If not, do you understand the materials and information that is shared with you? 3. Do you feel comfortable communicating with your child\u2019s service providers?  \u25cf If yes, what makes you feel comfortable? If not, why? \u25cf What could be changed to facilitate communication between you and the service providers?  4.    Are you satisfied with your child\u2019s current educational placement? Why or why not? \u25cf What do you think can be done to improve your child\u2019s educational placement?  \u25cf Do you have a plan to advocate for changes in the current setting? \u25cf Do you have an advocate (e.g., teacher, counselor, aid, administrator) who can help you advocate for the changes you think are needed? 5.    Are you satisfied with the services your child receives? Why or why not? Implementation of IEPs 1.     Please describe your experience before your child\u2019s annual IEP meetings.  \u25cf Does someone from the school contact you? \u25cf Are materials or a draft of the IEP sent home prior to the meeting? \u25cf Are these materials translated into your native language? If not, do you understand the language within the documents? \u25cf Are you offered an interpreter, parent advocate, or cultural broker to attend the meeting with you? 3. Please describe your experience during the IEP meeting. \u25cf Does anyone attend the IEP meeting with you?  \u25cf Do you bring an interpreter?  \u25cf Without an interpreter, how much do you understand during the meeting?  \u25cf Do you feel the IEP team members understand you when you communicate your thoughts and perspective at the meeting?  4. How do you communicate with your school regarding the progress of IEP goals?  5. Do you understand your role in the implementation of the IEP? How do you use IEP at home?   6. What is the most challenging aspect of the IEP process (i.e., understanding the conversation during the meeting, keeping track of the progress with the school during the year, understanding your role)? 7.  Are you satisfied with your child\u2019s current IEP? If no, why not? 8.  What do you think can be done to improve the IEP process? Closing: Are there any final thoughts you would like to share with us today?    269 A.5 Educator Interview Questions Interview Questions for Teachers \/ Educational Assistants\/ Administrators  Title: A Case Study of Deaf Multilingual Learners with Disabilities: Diagnoses, Educational Placements, and School Services  Principal Investigator: Dr. Joanna Cannon Co-Investigator: Eun Young Kwon  1.     What are your roles and responsibilities in the child\u2019s education? 2.     How long have you been working with the child? The family? 3.     What are your goals (beyond the IEP) for the child? Family? 4.     How much time do you have to work toward those goals?  \u25cf Do you feel this allotted time is sufficient for working toward these goals?  5.    What would you consider the child\u2019s strengths? 6.    What do you consider the child\u2019s challenges? 7.    How often do you spend time with the student?  \u25cf Where do you see them?  \u25cf What activities do you conduct with them? \u25cf What kind of support do you provide when serving the child? 8.   What strategies have been successful? What strategies did not work and had to be changed? 9.   What do you think could be implemented to better support for this student?  \u25cf Are those services available at your school?  \u25cf In your district? 10.  Do you think the current educational placement is serving the needs of this child? \u25cf If yes, why? \u25cf If no, what may be a better placement? 11.  How does the referral process work for a new educational placement?  \u25cf Are there specific eligibilities for each possible program for this child?  \u25cf Does the family understand this process? 12.  How do you communicate with the child? The child\u2019s family? 13.  What could facilitate communication between you and them?  14.  What other professionals do you communicate with regarding the child\u2019s progress and\/or challenges?  \u25cf How often?  \u25cf Does your team have similar ideas and understanding toward the child\u2019s needs?   Closing: Are there any final thoughts you would like to share with us today?     270 A.6 Parent Consent Form for Document Release   Consent Form \u2013 Parents  A Case Study of a Deaf Multilingual Learner with Disabilities: Assessment and Educational Implications at the School Level  Principal Investigator: Dr. Joanna E. Cannon Assistant Professor Department of Educational and Counselling Psychology, and Special Education University of British Columbia  Co-Investigator: Eun Young Kwon M.A., M.Ed., Ph.D. student  Department of Educational and Counselling Psychology, and Special Education University of British Columbia  Purpose: You are invited to share documents regarding your child\u2019s education. The purpose of the study is to better understand learners who are deaf with additional disabilities and come from homes where their parents neither speak English nor use American Sign Language as their primary mode of communication.   Study Procedures: In this study, you will be asked to mail copies of educational documents (e.g., (psychoeducational assessment, IEP reports, assessment data, student work) you wish to share with the researchers.   Potential Risks: There are no known or suspected risks associated with participating in this study. If you decline to participate in this study or decide to stop participating in the study, there will be no negative consequences for you or your child. No information about your participation will be shared with anyone. In case you do not feel confident in understanding the purpose of the study or use of the documentation in English, you will be given the option for communication with a native speaker of your preferred language.   Potential Benefits: Department of Educational and Counselling Psychology, and Special Education Faculty of Education  2125 Main Mall Vancouver, BC Canada V6T 1Z4  271 The information you will share with us might help educators understand how to better support other children like your child at the school level. Furthermore, your input may benefit the field of deaf education, where there has been minimal research conducted that specifically focuses on this population.   Confidentiality: All documents will be assigned an identification number and kept in a locked filing cabinet. Data on any electronic devices will be locked with a password and encrypted. The data will be de-identified prior to being made publicly available in any reports of the completed study.   Contact for information about the study: If you have any questions or desire further information with respect to this study, please contact Dr. Joanna Cannon or Eun Young Kwon.   Contact for concerns about the right of the research participants: If you have any concerns or complaints about your rights as a research participant and\/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598  Consent: Participation in this research is entirely voluntary. You do not have to be in this study. If you decide to be in the study and change your mind, you have the right to drop out at any time. The copies of the documents will be returned to you and not used for the study. If you decide not to participate in this study, the case study will not include any part of your child\u2019s educational document. Once the data is made publicly available, however, you will not be able to withdraw your input.   Your signature indicates that you will provide your child\u2019s educational documentation to the researchers, and you have received a copy of this consent form for your own records. Please keep this copy of the consent form for your records and return the signature page attached.  Signature Page Your signature indicates that you give consent to participate in this study.     ____________________________________________________ Parent or Guardian Signature     Date    272 A.7 Parent Consent Form for Document Release in Korean   \ubd80\ubaa8 \ub3d9\uc758\uc11c  \uc774\ubbfc\uc790\uc758 \ub18d\uc911\ubcf5\uc7a5\uc560\uc544\ub3d9 \uc0ac\ub840\uc5f0\uad6c: \uc9c4\ub2e8 \ud3c9\uac00\uc640 \ud559\uad50 \uad50\uc721\uc5d0 \ubbf8\uce58\ub294 \uc2dc\uc0ac\uc810   \uc8fc \uc5f0\uad6c\uc790: Dr. Joanna E. Cannon \uad50\uc721 \uc0c1\ub2f4 \uc2ec\ub9ac\/ \ud2b9\uc218\uad50\uc721\uacfc \ubd80\uad50\uc218 University of British Columbia  \uacf5\ub3d9 \uc5f0\uad6c\uc790: \uad8c\uc740\uc601 \ud2b9\uc218\uad50\uc721\ud559 \uc11d\uc0ac, \uccad\uac01\uc7a5\uc560 \uc804\uacf5 \ubc15\uc0ac\uacfc\uc815 \uad50\uc721 \uc0c1\ub2f4 \uc2ec\ub9ac\/ \ud2b9\uc218\uad50\uc721\uacfc University of British Columbia  \uc5f0\uad6c \ubaa9\uc801: \uc774 \uc5f0\uad6c\ub294 \uce90\ub098\ub2e4\uc5d0\uc11c \ub18d\uc911\ubcf5\uc7a5\uc560\ub97c \uac00\uc9c0\uba74\uc11c \ub3d9\uc2dc\uc5d0 \ubd80\ubaa8\uc758 \uc8fc \uc5b8\uc5b4 \uc218\ub2e8\uc774 \uc601\uc5b4\ub098 \uc218\ud654\uac00 \uc544\ub2cc \ud559\uc0dd\ub4e4\uc758 \uad50\uc721\uc801 \ud544\uc694\ub97c \ub354 \uc798 \uc774\ud574\ud558\uae30 \uc704\ud574 \uc2e4\uc2dc\ud558\uace0 \uc788\uc2b5\ub2c8\ub2e4. \ubcf8 \uc5f0\uad6c\ub294 \uc5ec\ub7ec\ubd84\uaed8\uc11c 2019 \ub144\uc5d0 \ucc38\uc11d\ud558\uc2e0 \uc0ac\ub840\uc5f0\uad6c\uc758 \uc77c\ud658\uc73c\ub85c \uc5ec\ub7ec\ubd84\uc758 \uc790\ub140\uac00 \ud559\uad50\ub098 \uad50\uc721 \uae30\uad00\uc73c\ub85c\ubd80\ud130 \uc9c0\uae08\uae4c\uc9c0 \ubc1b\uc544\uc628 \uc9c4\ub2e8\ud3c9\uac00\ub4e4\uacfc \uad50\uc721 \uc11c\ube44\uc2a4\uc640 \uad00\ub828\ub41c \uc790\ub8cc\ub4e4\uc744 \uc218\uc9d1\ud558\uace0\uc790 \ud569\ub2c8\ub2e4.   \uc5f0\uad6c \uc808\ucc28: \uc774 \ud6c4\uc18d \uc5f0\uad6c\uc5d0\uc11c \ud544\uc694\ub85c \ud558\ub294 \uc790\ub140\uc758 \uad50\uc721 \uad00\ub828 \uc790\ub8cc\ub4e4\uc744 \uc800\ud76c \uae30\uad00\/\uc5f0\uad6c\uc6d0\uc5d0\uac8c \uc6b0\ud3b8\uc73c\ub85c \ubcf4\ub0b4\uc8fc\uc2dc\uba74 \uac10\uc0ac\ud558\uaca0\uc2b5\ub2c8\ub2e4. \uc608\ub97c \ub4e4\uba74 \ubcd1\uc6d0\uc2ec\ub9ac\uc9c4\ub2e8 \ud3c9\uac00\uc11c, \ud559\uad50 IEP \uc640 \uc544\ub3d9\uc758 \ubc1c\ub2ec \ubc0f \ud559\uc2b5 \uc9c4\uc804\uacfc \uad00\ub828\ub41c \uad50\uc0ac \ud3c9\uac00\uc11c, \ud559\uc0dd \uacfc\uc81c \uc0d8\ud50c\ub4e4\ub85c \ubcf8 \uc5f0\uad6c\uc6d0\ub4e4\uc774 \uadc0\ud558 \uc544\ub3d9\uc758 \ud559\uc2b5 \ubc1c\ub2ec \uacfc\uc815\uacfc \uc0c1\ud0dc\ub97c \uc9c4\ub2e8\ud558\uace0 \ud310\ub2e8\ud558\ub294\ub370 \ub3c4\uc6c0\uc774 \ub418\ub294 \ubaa8\ub4e0 \uc790\ub8cc\ub4e4\uc774 \ud574\ub2f9\ub429\ub2c8\ub2e4.   \uc7a0\uc7ac\uc801 \uc704\ud5d8: \uc774 \uc5f0\uad6c\uc5d0 \ucc38\uc5ec\ud568\uc73c\ub85c\uc368 \ud30c\uc0dd\ub418\ub294 \uc5b4\ub5a0\ud55c \uc704\ud5d8\ub3c4 \uc54c\ub824\uc9c4 \ubc14 \uc5c6\uc2b5\ub2c8\ub2e4. \uc5ec\ub7ec\ubd84\uc774 \uc774 \uc5f0\uad6c\uc5d0 \ucc38\uc5ec\ud558\uc2dc\uae30\ub97c \uac70\uc808\ud558\uac70\ub098 \uc911\uac04\uc5d0 \uba48\ucd94\uc2dc\ub354\ub77c\ub3c4 \uc5ec\ub7ec\ubd84\uc774\ub098 \uc790\ub140\uc5d0\uac8c \uc5b4\ub5a0\ud55c \ubd80\uc815\uc801 \uacb0\uacfc\ub3c4 \ubbf8\uce58\uc9c0 \uc54a\uc744 \uac83\uc785\ub2c8\ub2e4. \uadf8\ub9ac\uace0 \uc5ec\ub7ec\ubd84\uc774 \uc81c\uacf5\ud574\uc8fc\uc2e0 \uc790\ub8cc \uc815\ubcf4\ub294 \uadf8 \uc5b4\ub290 \ub204\uad6c\uc640\ub3c4 \uacf5\uc720\ub418\uc9c0 \uc54a\uc744 \uac83\uc785\ub2c8\ub2e4. \ubcf8 \ud6c4\uc18d\uc5f0\uad6c\uc758 \ubaa9\uc801\uc774\ub098 \uc790\ub8cc \uc0ac\uc6a9\uacfc \uad00\ub828\ud558\uc5ec \ud655\uc2e4\ud558\uc9c0 \uc54a\ub294 \ubd80\ubd84\uc774\ub098 \uc9c8\ubb38\uc774 \uc788\uc73c\uc2e0 \uacbd\uc6b0 \ud55c\uad6d\uc5b4 \ud1b5\uc5ed\uacfc \ubc88\uc5ed\ub3c4 \uc544\uc6b8\ub7ec \uc81c\uacf5\ub429\ub2c8\ub2e4.  Department of Educational and Counselling Psychology, and Special Education Faculty of Education  2125 Main Mall Vancouver, BC Canada V6T 1Z4  273 \uc7a0\uc7ac\uc801 \ud61c\ud0dd: \uc5ec\ub7ec\ubd84\uc774 \uc81c\uacf5\ud558\ub294 \uc815\ubcf4\ub4e4\uc740 \uc5ec\ub7ec\ubd84\uc758 \uc790\ub140\uc640 \uac19\uc740 \uc0c1\ud669\uc5d0 \uc788\ub294 \ud559\uc0dd\ub4e4 (\ub18d\uc911\ubcf5\uc7a5\uc560\ub97c \uc9c0\ub2cc \uc774\ubbfc\uc790\ub4e4\uc758 \uc790\ub140)\uc758 \uad50\uc721 \ud544\uc694\ub97c \uc774\ud574\ud558\uace0 \uc5f0\uad6c\ud558\ub294 \ub370 \ud070 \uae30\uc5ec\ub97c \ud560 \uac83\uc785\ub2c8\ub2e4.   \uac1c\uc778 \ube44\ubc00 \uc815\ubcf4 \uc720\uc9c0: \ubaa8\ub4e0 \ubb38\uc11c\ub4e4\uc740 \uac01\uac01 \uace0\uc720\ubc88\ud638\uac00 \ub9e4\uaca8\uc9c4 \ud6c4 \uc11c\ub958 \ubcf4\uad00\ud568\uc5d0 \ubcf4\uad00\ub420 \uac83\uc785\ub2c8\ub2e4. \ucef4\ud4e8\ud130\uc5d0 \uc800\uc7a5\ub41c \ubaa8\ub4e0 \uc790\ub8cc\ub4e4\uc740 \ube44\ubc00\ubc88\ud638\ub97c \uc785\ub825\ud574\uc57c\ub9cc \uc811\uc18d\uc774 \uac00\ub2a5\ud55c \uc0c1\ud0dc\ub85c \uc7a0\uae08\ub429\ub2c8\ub2e4. \uc544\uc6b8\ub7ec \uc790\ub8cc\uc5d0 \uc788\ub294 \ubaa8\ub4e0 \uc0ac\ub78c\ub4e4\uc758 \uc774\ub984\uc740 \ud310\ub3c5\uc774 \ubd88\uac00\ub2a5\ud55c \uc0c1\ud0dc\ub85c \ucc98\ub9ac\ub420 \uac83\uc785\ub2c8\ub2e4.   \uc5f0\uad6c\uc790 \uc5f0\ub77d\ucc98: \uc5b4\ub5a0\ud55c \uc9c8\ubb38\uc774 \uc788\uc73c\uc2dc\uac70\ub098 \uc774 \uc5f0\uad6c\uc5d0 \uad00\ud574 \ub354 \ub9ce\uc740 \uc815\ubcf4\ub97c \uc6d0\ud558\uc2e0\ub2e4\uba74 Dr. Joanna Cannon \uc774\ub098 \uad8c\uc740\uc601\uc5d0\uac8c \uc5f0\ub77d \uc8fc\uc2ed\uc2dc\uc624.   \uc5f0\uad6c \ucc38\uc5ec\uc790\uc758 \uad8c\ub9ac\uc5d0 \uad00\ud558\uc5ec:  \ub9cc\uc57d \uc774 \uc5f0\uad6c\uc758 \ucc38\uc5ec\uc790\ub85c\uc11c \uc5f0\uad6c \uacfc\uc815 \uc911\uc5d0 \uc5b4\ub5a0\ud55c \ubd88\ub9cc\uc774\ub098 \ubd88\ud3b8\uc0ac\ud56d\uc774 \uc788\uc73c\uc2dc\uba74 UBC Office of Research Ethics \ub0b4\uc5d0 \uc788\ub294 Research Participant Complaint Line ( 604-822-8598)\ub85c \uc5f0\ub77d \uc8fc\uc2ed\uc2dc\uc624. \uba3c \uc9c0\uc5ed\uc5d0 \uacc4\uc2e0 \ubd84\uc740 RSIL@ors.ubc.ca \ub85c \uc774\uba54\uc77c \ubcf4\ub0b4\uc2dc\uac70\ub098  toll free 1-877-822-8598 \uc804\ud654\ub97c \ud558\uc2dc\uba74 \ub429\ub2c8\ub2e4.  \uc5f0\uad6c \ucc38\uc5ec\uc5d0 \ub3d9\uc758: \uc774 \uc5f0\uad6c\uc5d0 \ucc38\uc5ec\ub294 \uc790\ubc1c\uc801\uc785\ub2c8\ub2e4. \uc6d0\ud558\uc2dc\uc9c0 \uc54a\ub294\ub2e4\uba74 \uad73\uc774 \uc774 \uc5f0\uad6c\uc5d0 \ucc38\uc5ec\ud558\uc9c0 \uc54a\uc73c\uc154\ub3c4 \ub429\ub2c8\ub2e4. \uc5b8\uc81c\ub4e0 \ucc38\uc5ec\ub97c \uc911\ub2e8\ud558\uc2dc\uae30 \uc6d0\ud558\uc2e0\ub2e4\uba74 \uc54c\ub824\uc8fc\uc2dc\uae30 \ubc14\ub78d\ub2c8\ub2e4. \uc81c\uacf5\ud558\uc2e0 \uc544\ub3d9 \uad50\uc721 \uc790\ub8cc \uc815\ubcf4\ub294 \ubd80\ubaa8\ub2d8\uc5d0\uac8c \ub2e4\uc2dc \ub3cc\ub824\ub4dc\ub9b4 \uac83\uc774\uba70, \uc790\ub8cc\uc758 \uc5b4\ub5a4 \ubd80\ubd84\ub3c4 \uc5f0\uad6c\uc5d0 \uc0ac\uc6a9\ub418\uc9c0 \uc54a\uc744 \uac83\uc785\ub2c8\ub2e4. \ud558\uc9c0\ub9cc \uc77c\ub2e8 \uc790\ub8cc\uac00 \ucd9c\ud310\/ \ubc1c\ud45c\ub41c \uc774\ud6c4\uc5d0\ub294 \uc5b4\ub5a4 \ubc29\ubc95\uc73c\ub85c\ub3c4 \uc5ec\ub7ec\ubd84\uc774 \ub098\ub208 \uc815\ubcf4\ub97c \ub418\ub3cc\ub9b4 \uc218\ub294 \uc5c6\uc2b5\ub2c8\ub2e4.   \uc5ec\ub7ec\ubd84\uc774 \uc544\ub798\uc5d0 \uc11c\uba85\ud558\uc2dc\uba74 \ubcf8 \uc5f0\uad6c\uc758 \uc778\ud130\ubdf0\uc5d0 \ucc38\uc5ec\ud558\uc2e0\ub2e4\ub294 \ub73b\uc73c\ub85c \uac04\uc8fc\ub429\ub2c8\ub2e4. \uc544\uc6b8\ub7ec \uc800\ud76c\uac00 \uc774 \ub3d9\uc758\uc11c\ub97c \uc5ec\ub7ec\ubd84\uc5d0\uac8c \ub4dc\ub838\ub2e4\ub294 \uc758\ubbf8\ub3c4 \ud3ec\ud568\ub429\ub2c8\ub2e4. \ubcf8 \ub3d9\uc758\uc11c\ub294 \uc5ec\ub7ec\ubd84 \uac1c\uc778\uc758 \uc790\ub8cc\ub85c \uac00\uc9c0\uace0 \uacc4\uc2dc\uace0 \uc544\ub798\uc758 \uc11c\uba85\uc774 \ud3ec\ud568\ub41c \ud398\uc774\uc9c0\ub294 \uc800\ud76c\uc5d0\uac8c \ub3cc\ub824\uc8fc\uc2dc\uae30 \ubc14\ub78d\ub2c8\ub2e4.   \ub098____________\ub294 \uc774 \uc5f0\uad6c\uc5d0 \ucc38\uc5ec\ud560 \uac83\uc744 \ub3d9\uc758\ud569\ub2c8\ub2e4.    ____________________________________________________    274 Appendix B  Experimental Study B.1 Parent Consent Form    Consent Form \u2013 Parents  Investigating interventions that increase social interaction for learners who are deaf or hard of hearing and experience autism spectrum disorder   Principal Investigator: Dr. Joanna E. Cannon Associate Professor Department of Educational and Counselling Psychology, and Special Education University of British Columbia  Co-Investigator: Vicki Knight Assistant Professor Department of Educational and Counselling Psychology, and Special Education University of British Columbia  Co-Investigator: Eun Young Kwon M.A., M.Ed., Ph.D. student  Department of Educational and Counselling Psychology, and Special Education University of British Columbia  Purpose: You are invited to have your child participate in a research study. The purpose of the study is to investigate how social stories improve social interaction between deaf or hard of hearing students with Autism Spectrum Disorders and their peers in inclusive settings.   Study Procedures: This study consists of three phases: baseline (3-5 observations, one week before the intervention), intervention (6 sessions and observations for two weeks), and follow-up (3 observations, two weeks after the intervention). A 15-minute intervention session includes reading a social story to the class and teaching them 5 American Sign Language vocabulary Department of Educational and Counselling Psychology, and Special Education Faculty of Education  2125 Main Mall Vancouver, BC Canada V6T 1Z4  275 words from the story. Ms. Kwon will conduct the intervention in your child\u2019s classroom. Then she will observe your child with his\/her peers for 20 minutes each time during lunchtime and recess in the classroom and\/or on the playground from a distance.   Potential Risks: In this study, your child will not have any more risks than he\/she would in a normal day at school. There are no apparent risks for his\/her participation in the current study. If you decline to have your child participate, there will be no negative consequences for your child. The information your child would provide pre\/post and during the intervention is similar to the information your child shares with his\/her teacher(s) during any typical day at school.   Potential Benefits: It is expected that the stories may provide your class with positive communication strategies to increase social interactions between your child and his\/her peers.  If you decide to participate in the study, your child may benefit from exposure to the social stories that may help increase: (a) communicative behaviors towards his\/her peers; and (b) social engagement with his\/her peers during lunchtime or recess.  In addition, the class as a community may have opportunities to: (a) gain knowledge and understanding about hearing loss and Autism Spectrum Disorders; (b) learn some basic American Sign Language vocabulary that helps them communicate with your child; and (c) grow positive social behaviors and communicative strategies with their peers.   Confidentiality: All documents would be assigned an identification number and kept in a locked filing cabinet. Data in any electronic devices will be locked with a password and encrypted. The data will be de-identified prior to being made publicly available in any reports of the completed study. No video would be recorded during the observation, and you would be provided with a copy of the results upon completion of the study.  Remuneration or compensation: You will not receive compensation for having your child participate in this study.   Contact for information about the study: If you have any questions or desire further information with respect to this study, you may contact Dr. Joanna Cannon or Eun Young Kwon.   Contact for concerns about the right of the research participants: If you have any concerns or complaints about your rights as a research participant and\/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Services at 604-822-8598 or if long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598  Consent: Participation in this research is voluntary. Your child does not have to be in this study. If you decide you want your child to be in the study and change your mind, you have the right to have your child drop out at any time. If you decide not to participate in this study, this study will not be  276 conducted in your child\u2019s classroom. You may stop your child\u2019s participation at any time. Whatever you decide, your child will not lose any benefits to which they are otherwise entitled or be in jeopardy at school or in your relationship with the Principal Investigator. Once the data is made publicly available, however, you will not be able to withdraw your child\u2019s data.  Your signature indicates that you are the parent \/guardian and able to give consent and that you give consent for your child's participation in this study. Once you give us consent, you will be asked to fill out the background form attached here. Some of the information regarding your child\u2019s performance at school and related school services may be collected from the teachers.   In addition, your signature below indicates that you have received a copy of this consent form for your own records. Please keep this copy of the consent form for your records and return the signature page attached.   Signature Page Your signature indicates that you give consent for your child to participate in this study.     ____________________________________________________ Parent or Guardian Signature     Date  ____________________________________________________ Child\u2019s Name           277 B.2 Assent Consent Form   Participants Assent Form  Study Title: Investigating interventions that increase social interaction for learners who are deaf or hard of hearing and experience autism spectrum disorder  Principal Investigator: Dr. Joanna E. Cannon Associate Professor Department of Educational and Counselling Psychology, and Special Education University of British Columbia  Co-Investigator: Vicki Knight Assistant Professor Department of Educational and Counselling Psychology, and Special Education University of British Columbia  Co-Investigator: Eun Young Kwon M.A., M.Ed., Ph.D. student  Department of Educational and Counselling Psychology, and Special Education University of British Columbia   Participants in this study will range in age from 5 to 9 years old. They are deaf or hard of hearing and have been diagnosed with autism spectrum disorders. Since the students use American Sign Language (ASL), the researcher will use ASL as well as speak orally to communicate the following script prior to the observation and intervention sessions.  The assent procedures for this study will be as follows:   1. The Researcher will state the following to the participant:   \u201cI have a story to read to your class today and then I want to stay for lunch and recess with your class.  Would you like me to read a story to your class, teach them some signs, and stay for lunch and recess? Department of Educational and Counselling Psychology, and Special Education Faculty of Education  2125 Main Mall Vancouver, BC Canada V6T 1Z4  278 2. If the student responds \u201cYes\u201d, the researcher will say, \u201cOkay, let\u2019s start reading a story.\u201d The researcher then will print the student\u2019s name on this assent form to indicate that the student understood the researcher and gave assent to participate in the study.  3. If the student responds \u201cNo,\u201d the researcher will say, \u201cOkay, then I am not going to read a story with your class today.\u201d The researcher will make three attempts to receive assent from the student and if the student still refuses to participate or appears upset the student will not be asked again that day. If this happens three consecutive sessions, the student will not be included in the study.    Participant Name ______________________________________________  Date ________________________________________________________     279 B.3 Letter to Teachers and Educational Assistants    Letter to Teachers\/ Educational Assistants    Principal Investigator: Dr. Joanna E. Cannon Assistant Professor Department of Educational and Counselling Psychology, and Special Education University of British Columbia  Co-Investigator: Vicki Knight Assistant Professor Department of Educational and Counselling Psychology, and Special Education University of British Columbia  Co-Investigator: Eun Young Kwon M.A., M.Ed., Ph.D. student  Department of Educational and Counselling Psychology, and Special Education University of British Columbia   Dear Teachers and\/or Educational Assistants.  My name is Dr. Joanna Cannon, and I am an Associate Professor in the Department of Educational and Counselling Psychology and Special Education at the University of British Columbia. I am writing this to inform you about a study titled \"Investigating interventions that increase social interaction for learners who are deaf or hard of hearing and experience autism spectrum disorder.\u201d In the process of recruiting participants who are deaf or hard of hearing (d\/Dhh) with autism spectrum disorders and their classes, I would like to ask for your consent to conduct this study in your classroom and for you to complete the social validity questionnaire attached to this letter. The questionnaire will ask about your thoughts regarding the social importance and outcomes of the study. You will be asked to complete the same questionnaire twice, during and after the study. There is no need for you to conduct any assessments or intervention for the students during the study.    Department of Educational and Counselling Psychology, and Special Education Faculty of Education  2125 Main Mall Vancouver, BC Canada V6T 1Z4  280 This study consists of three phases: baseline (3-5 observations, one week before the intervention), intervention (6 sessions and observations for two weeks), and follow-up (3 observations, 2 weeks after the final intervention session). A 15-minute intervention session includes reading a social story to your class and teaching them 5 American Sign Language vocabulary words from the story. Ms. Kwon, a doctoral student at UBC will conduct the intervention in your classroom. Then she will observe the d\/Dhh student with their peers for 20 minutes each time during lunchtime and recess in the classroom and\/or on the playground.   There will not be any more risks than the students would have in a normal day at school. None of the participants in this study will be identified. No video would be recorded during the observation and you would be provided with a copy of the results upon completion of the study. All the data will be password protected and encrypted. If there is any student who does not want to read the social stories, you may provide them with a different activity.   The possible benefits from this study are that the d\/Dhh student may increase: (a) communicative behaviors towards his\/her peers; and (b) social engagement with his\/her peers during lunchtime or recess. The class as a community may have opportunities to: (a) grow positive social behaviors and communicative strategies toward their classmates including the d\/Dhh student; and (b) learn some basic American Sign Language vocabulary that helps them communicate with the student.  Participation in this research is voluntary. If you decide you want your class to be in the study and change your mind, you have the right to have your class drop out at any time. If you decide not to participate in this study, this study will not be conducted in your classroom. By agreeing to complete the questionnaire, you are consenting to participate in this research. If you have any concerns or complaints about your rights as a research participant and\/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Ethics at 604-822-8598 or if long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598.\"      Dr. Joanna E. Cannon Associate Professor Department of Educational and Counselling Psychology, and Special Education University of British Columbia 604-822-1645     281 B.4 Six Social Stories and ASL Vocabulary  Story 1. We are Different  There are many people in our school and community. People have different skills and talents. Some people are good at spelling or science. Others might be good singers or good at sports. We all have things we enjoy doing or that we do really well. Each of us are different and special.  People also have different challenges - things that they find hard to do. Some of our classmates may find learning math takes them longer than it takes their friends. Others might have a hard time riding a bicycle or playing soccer. Some people wear glasses to see better. Some people wear hearing aids to hear better. Sometimes these challenges can be small, and people work hard to improve at the things they find difficult.  Some people have autism, which means that their brains work differently than others. They are good at many things. They see, hear, and feel little things that some people might not even notice. Some like to make things tidy. They like routines because they know what to expect. Some have a hard time making friends because they don\u2019t always know what to say or do. Sometimes they have a hard time communicating. They are not wrong. They are just different in some ways - and we have already seen that being different is okay!  When we feel different, we hope that people will treat us nicely, by being a friend, lending a hand, being patient, not laughing at us, and helping us feel better. This means we will also take time to understand and be kind to our friends when they feel different.  It is nice to give a complement to our friend about things that make him or her unique, such as \u201cI like your red hair,\u201d or \u201cGood work\u201d, or \u201cYou are really good at signing.\u201d It can also be more general like, \u201cYou always treat your friends kindly.\u201d Everyone likes hearing nice things from others. It is nice to know that the people like each other because we are different. It is a good thing that we all are different.   Story 2. Let\u2019s Communicate  The first thing we do at school is to say \u201cHi!\u201d or \u201cGood morning!\u201d to our friends or teachers. This makes us happy when we start a new day at school. We like to talk with one another. Even just smiling is a good way to greet each other. We have conversations in the classroom, in the hallway, and on the playground for every day. We like to have conversations. When we have a conversation, we take turns talking and listening. If both people talk at the same time, they can\u2019t hear what the other person says. Taking turns works better. Listening is hearing words and thinking about what they may mean. When it is our turn to listen, we try to hear the words people say.  There are lots of different ways to communicate with people other than talking, such as drawing pictures, facial expressions, making eye contact, or hand gestures. Some people use sign language. They sign because they understand much better when they use sign language. When we use signs for a conversation, we take turns. While watching other\u2019s signing, people think about what the signs may mean. Once the person finishes signing, the others will take a turn to sign back what they think about the topic.   282 Some people understand better when rules are explained using simple words and pictures. They often say or sign repeatedly, such as \u201ceat lunch\u201d for \u201cI want to eat lunch now.\u201d Rather than asking WHY questions, we can ask simple questions.  They also tend to think words mean exactly what they say. For example, when someone says, \u201cThat is so cool!\u201d we know they are not talking about the temperature of something. It might be hard for people with autism to understand when we use words in a way that is different from their exact meaning. People who try to learn a new language may feel the same.  Whether we talk or sign to people, it is important we use good manners. When we ask for what we want, it is nice to say \u201cPlease,\u201d and \u201cThank you\u201d when it is given. When we have conversations, we listen, watch, think, and try to understand what others say with respect.    Story 3. Senses and Feelings   People use their senses to experience the world. The five senses are seeing, hearing, smelling, tasting, and touching. Sometimes we can feel overwhelmed by our senses. A bright light can hurt our eyes. A loud noise might surprise us and make us jump. Going in a place where people are crowded can make us feel dizzy. Everybody feels different things every day and each of us senses in different ways. Some friends see a lot of small things other people do not notice. They may look every single color and object in the classroom. They may notice how many desks or chairs are in the room. When something is out of place, they may feel confused or become upset. They might cry or do some things that look strange, like flap their hands, twist their bodies, or tap on a desk. They may do these things to communicate they are unhappy or to make themselves feel better.  Comfortable may mean that we feel good inside. When we know what to do and how to do it, we feel comfortable. Some of us like surprises while others like to have a schedule or a routine so they know what is going to happen next. We may get nervous, upset, or frustrated when things change or surprise us. Some of us may find that humming or listening to music makes us feel more relaxed.  To feel calmer, some people might work on a puzzle, go into a corner to be alone, or make sounds to help themselves calm down. Sometimes they will do something over and over again to make themselves feel more comfortable. Everyone feels uncomfortable sometimes. We can be frustrated, worried, or scared. When people around us are using words or expressions we don\u2019t understand, we might get confused or upset. Sometimes we do not know how to express how we feel; but when others recognize our feelings and try to understand the way we express our emotions, we feel calmer and comfortable. There are friends who look differently from us or act differently than we do; the best thing to do is try to understand and accept them.  Story 4. Making friends   School is fun because we have friends with whom we can learn and play. To have a lot of fun, we all learn to treat others with respect. We will treat our friends as equals. We will make our classroom a safe place.  We all enjoy playing. Some friends prefer to move and run during recess. Others prefer games with words and numbers, or like playing with puzzles or computers. Some friends use  283 their imagination. Others are much better at thinking about things that are real than things that are pretend, but we all like to spend time with friends.  We are excited when other people agree to play games or do things we enjoy. We, however, sometimes feel left out when our friends are playing games we don\u2019t like or aren\u2019t good at. How do you feel when someone asks you to play a new game, and teaches you with patience? What if your friends ignore you the whole time or got impatient with you? What would you do when you see a friend is left out and you know he doesn\u2019t know how to ask, \u201c(Do you) want to play (with me)?\u201d  We can invite any of our friends in the classroom to play. They might say or sign \u201cYes.\u201d We can help friends understand the game and show them how to play with patience. If someone is not doing a good job of sharing with us, or not letting us have our turn, it is ok to tell him, \u201cWait, it is my turn.\u201d  Even if some of our friends sit and play with us but do not talk much, we know that they like it when we spend time with them. Our friend may repeat what we say or sign. It means they are just stuck. We know that they are not teasing or mimicking us. They might say or sign \u201cNo.\u201d to us when they need a quiet time or some personal space as we all do sometimes. It is okay. We will listen. It always makes us feel good to hear compliments from friends. A compliment is a nice and friendly thing to say to someone. There are lots of compliments we can give people such as, \u201cI like to play with you.\u201d or \u201cYou are fun to play with.\u201d The important thing is to smile and use friendly words or signs. When we see our friends struggling to say something or getting upset, we will encourage them by \u201cGood try!\u201d \u201cLet\u2019s try it together.\u201d In this way, our classroom will be a comfortable and fun place to everyone.   Story 5. Play Inside  Our favorite times during a school day are lunchtime and recess. While we have lunch or eat snack, we can ask our friend what he wants to play. Our friend can choose an activity and we can choose an activity, too. We should decide what we want to play first. When we talk or sign to our friend, it is important to turn our shoulders toward the friend and look at his face. When our friend does not look at us, we should get closer to the friend, tap her on the shoulder and ask her to play. It is important to watch and listen to our friend if we want to have fun together.  When we talk and play, we can get to know things about our friend. We can ask our friend questions: What games do you like to play? What are your favorite subjects in school? (or do you like music or gym?) What sports do you enjoy?  (or do you like swimming?) What is your favorite thing to do on the playground? (or do you like slide or swing?) Then, we will get to know our friend better. Good friends know a lot about each other.  How do we get our friend to join a game? Some friends do not like eye contact. When our friend is facing us, it may be a good time for us to start a conversation with him. They may really want to play with our group but may not know how to ask. Others may come close by and not know how to say what they want. They do have a desire to make friends. We will not ignore them even if we think they do not notice us. We will try to find common interests together or share something we both like to do.   284 Some friends prefer games with words and numbers like Bingo. Others like to play games which have simple and visual rules, such as Jenga or Uno. We might make a craft with a small group of friends in a quiet corner when we have an inside day.  It is good to remember that sitting too close may be annoying to some friends. An elbow length away makes us feel comfortable. Even if our friend doesn\u2019t talk or seems to ignore our feelings, we will say it is okay because we know he likes to play with us. Sometimes our friends like to play near us but do their own thing. That\u2019s ok too, as long as they know they are included.  We can use signs if they use sign language to communicate with people. When we do not know the right sign, we can use gestures or pictures, or point to the area we would like them to go to together. We will wait for a response from them. We will see if they are happy and excited. We can encourage them to try new things because sometimes they may be afraid to try new stuff. They may learn a new game if we show them the steps one by one. They will want to play the game again and again and might sign, \u201cThank you. You are nice.\u201d We will say to our friend, \u201cGood work. Thank you\u201d too.    Story 6. Play Outside   Recess is a wonderful time for us to play outside with friends. What is your favorite place on the playground? We might play chase, dig in the sandpit, throw a ball, or something else. We often feel recess time is very short because we have a lot of fun. Even when we are having fun, we know we will take care of each other.  When we are leaving the classroom for recess, we look at each other and talk about the things we want to do outside. When we walk with our friend, we walk beside them. We do not walk ahead of our friend. We do not walk behind our friend. We walk with our friend side by side. There might be recess buddies or playground pals on the playground. Buddies or pals help some of our friends play well with others. We can be a recess buddy once a week with a friend in our class who would like to play with us. We can show our friend how to swing independently. We can listen and wait while they choose other activities. It is important to stay together with our buddy on the playground. Recess buddies are fun. Some games are tricky to learn or teach. We know not all people can run as quick as some people do. For example, the game \u201cIT\u201d is fun to play but we do not want to be the IT all the time. We will not ask a friend to be the IT all the time either. How can we play fairly? Another example is dodge ball. Usually we are not allowed to throw a ball at friends. When we play dodge ball, we are allowed to throw the ball at friends but not at the face and only under the neck. This rule can be confusing to some of our friends. What games will be good for our friends to join? We can make a new game and repeat them every day. Our friends will learn and enjoy our new game.  Some friends may be sensitive to touch. They might not like to be surprised by someone\u2019s touch. Before we touch them, we ask them if it is ok. If our friend never likes to be touched, do not touch them. We can still play with them. If our friend is playing too rough, we can tell them, \u201cPlease do not touch me. You are hurting me.\u201d If they continue to be rough, ask an adult for help. Some friends do not understand how we are feeling inside by looking at our facial expressions or hidden thoughts, so we need to use our words or sign to help them understand.  285 When recess is over and the bell rings, we will say, \u201cThanks for playing with me.\u201d to our friends. We can say, \u201cI like the way you put the ball back where it belongs.\u201d  Recess is a good time for us to make friends and play. We love who we are. We love who our friends are.    286 B.5 Social Validity Questionnaire  Social Validity Questionnaire  (For classroom teachers and educational assistants) Please put a checkmark in your answers to the following questions using a 1 to 5 scale.   (1=Strongly Disagree   2=Disagree   3=Neutral   4=Agree   5=Strongly Agree)  1 (strongly disagree) 2 (disagree) 3 (neutral) 4 (agree) 5 (strongly agree) Social Importance of the Goals      1. This intervention is a useful way for me to know the social and communicational needs of the student who is d\/Dhh with ASD in my class.      2. This intervention is a useful way for my entire class to increase social interactions with the student who is d\/Dhh with ASD.      3. This intervention is a useful way for the student who is d\/Dhh with ASD to be socially inclusive in the school setting.      Acceptability of the Procedures      4. This intervention procedures are clear and acceptable to all the participants.      5. The language used in the social stories is appropriate.      6. The duration of the intervention is appropriate and not interrupt the class functioning.       Social Importance of the Outcomes      7. I noticed that student who is d\/Dhh with ASD\u2019s social behaviors have improved during \/after the intervention sessions.      8. I noticed that my entire class\u2019s attitude and social behaviors towards the student who is d\/Dhh with ASD have improved      9. I would consider using social stories (with or without ASL) as an instructional method in the future.      Additional Comments      aThis social validity measure is written based on the recommendation by Wolf (1978; recited from Gast & Ledford, 2018). Some of the questions are adapted from the work of Chan (2008) and Tomasini, Basurto, Garcia, Villegas (2015).    287 Appendix C  Mixed-Methods Study  C.1 Survey Invitation Letter        UBC Survey Invitation  Dear Educators,  Our research team is investigating practices and considerations in the education of d\/Dhh students with disabilities (e.g., autism spectrum disorder, learning disabilities, intellectual disabilities) in the province. We would like to learn more about your experiences and perspectives of teaching the students.   If you are currently working as a professional in a school and have been involved in working with d\/Dhh students with disabilities (e.g., TDHHs, administrators, special education teachers, classroom teachers, allied professionals), please click the link below to start the survey. Also, please share this link (email) with your administrators, teachers, or allied professionals who work for the students so that they can participate in the survey as well.  https:\/\/ubc.ca1.qualtrics.com\/jfe\/form\/SV_9XdLp3jcTlUsosK  The survey will be anonymized, taking about 20-25 minutes to complete. Once you open the link, you may opt-out at any time during the survey. You can also leave and come back to the survey to complete as long as the link is available. You will have the option to be entered into a draw for one of four $50 gift cards to an educational website whether you complete the survey or not.  Thank you in advance for your assistance in this research. We really appreciate your input. Please contact us if you have any questions or concerns.  Joanna E. Cannon, Ph.D. Associate Professor, Educational Counselling, Psychology, and Special Education The University of British Columbia  Eun Young Kwon, M.A., M. Ed., Ph.D. Candidate  Educational Counselling, Psychology, and Special Education The University of British Columbia   Department of Educational and Counselling Psychology, and Special Education Faculty of Education  2125 Main Mall                                     Vancouver, BC Canada V6T 1Z4  288 C.2 Survey Questionnaire  Survey Questionnaires  Education of students who are deaf or hard of hearing with disabilities in British Columbia: Identification, eligibility, placement, and Interventions  I. Introduction \/ The Initial Page  Dear Educators,   Welcome! As a professional who works with students who are d\/Deaf and hard of hearing (d\/Dhh) with disabilities (e.g., intellectual disabilities, autism, learning disabilities), your input will help us better understand how to best serve students in your school settings. The following information is provided to make sure that you understand the purposed of this study and your rights as a participant.  Title: Education of students who are deaf or hard of hearing with disabilities in British Columbia: Identification, eligibility, placement, and interventions  Principal Investigator: Dr. Joanna Cannon, UBC  Co-Investigator: Eun Young Kwon, UBC, PhD Candidate  The purpose of this study is to investigate practices and considerations in the education of d\/Dhh students with disabilities (e.g., autism, learning disabilities, intellectual disabilities) from the perspective of educational professionals.   Possible participants for the survey will be educators (e.g., teachers, administrators, allied professionals) who are (1) currently working in school settings in BC, and (2) have been involved in educating d\/Dhh students with disabilities.   The survey data will be de-identified. All of the information you give us is confidential. Your name will not be attached to any of the information you give us. No identifying information will be published or released. All electronic data will be password-protected and encrypted.   This survey will take about 20-25 minutes for you to complete. Please answer as many questions as possible. Your participation in this study entirely voluntary.  Regardless of your completion of this survey, you will have the option (1) to be entered into a draw for one of the four $50 gift cards and (2) to take part in focus group discussions at a later time. If you have questions or would like more information about this study, please contact us by emails.   If you have any concerns or complaints about your rights as a research participant and\/or your experiences while participating in this study, contact the Research Participant Complaint Line in  289 the UBC Office of Research Ethics at 604-822-8598; e-mail RSIL@ors.ubc.ca; or call toll free 1-877-822-8598. The ethics ID Number of this study is H21-00264.  By clicking the NEXT button to take the survey, you are providing your consent to us. You may close this survey if you do not wish to participate.  (NEXT button will be shown right under this sentence on the right side.)  II. Demographics & Backgrounds  1. Where do you teach? (Select all that apply) - Rural  - Suburban - Urban  - Public School  - Independent School - Private School  2. What type of educational setting do you work in? - General education classrooms with district specialists (both public & private schools) - School settings for students who are d\/Deaf and hard of hearing (e.g., British Columbia School for the Deaf, Children's Hearing and Speech Centre) - Resource classrooms for students who are d\/Dhh - Resource classrooms for students with disabilities (e.g., autism, developmental delays) - Any other? Please specify.  3. What is the job title for your current position?  - Teacher of the Deaf and Hard of Hearing (TDHH) - School-based administrator (i.e., principal or vice-principal) - Administrator at the school district level - Administrator at the provincial level (e.g., Ministry of Education) - Director or coordinator of a related school setting  - Classroom teacher - Special Education Teacher (e.g., Resource Room Teacher, Learning Support Teacher) - District Specialist or others (e.g., SLP, ASL Specialist, Behavior Analyst)  4. How many years have you worked in this position? - Less than 2 years - 3-5 years - 6-10 years - 10-20 years - More than 20 years   III. Identification and Eligibility   290 1. How do you or your team identify d\/Dhh students\u2019 additional special needs or disabilities? (Please select all that apply) - Assessments by the School Team, including school psychologist - Assessment results from outside the public school system (e.g., Sunny Hill Hospital)  - Requests from parents - Requests and\/or referrals from classroom teachers - Data from Response to intervention (RTI)\/ Multi-tiered systems of support (MTSS) frameworks in your school - Any other?  2. Who makes the decision of what disability should be regarded as primary (or the Ministry of Education designation)? - School psychologist - Case Manager - School-based team - Administrators at the district level - Any other? Please specify in the box below:  3. In your school district, are some students recognized as having primary AND secondary designations for special education services? - Yes - No  4. What are the criteria for determining primary and\/or secondary designations when both disability categories provide the same amount of supplement funding? - F (deaf or hard of hearing) is always considered primary when co-occurring with others - C (profound intellectual disabilities) is always considered primary - D (physical disability or chronic health impairment) is always considered primary - G (autism spectrum disorder) is always considered primary - It varies depending on the case or up to administrators. - Any other criteria used? Please specify.   5. When a d\/Dhh student presents additional special needs that are specified as a Level 3 disability (i.e., H or R \u2013 requiring behavior intervention or \/ mental illness, K - mild intellectual disabilities, Q - learning disabilities), how are these needs met? - A professional in the area will work directly with the student once a secondary designation is determined. - A professional in the area will provide consulting to the team once a secondary designation is determined. - Any staff available in the current placement will provide related services no matter if the student has a secondary designation for the additional needs. - It is rare for the student to receive related services if a secondary designation is not determined for their additional special needs. - Any other? Please specify in the box below.  291 6. In your experiences, does having a secondary designation affect the educational services that d\/Dhh students with disabilities receive? (e.g., amount and\/or kind of services) - Yes - No - It varies depending on each student\u2019s needs. - Not applicable to me  7.  (Given to only respondents who selected \u201cyes\u201d or \u201cit varies\u201d) Please comment on how the secondary designation affects the educational services that d\/Dhh students with disabilities receive.   8. (Given to only respondents who selected \u201cno\u201d to Q6) Why do you think the secondary designation does not affect the educational services the students receive?   9. (Given to only respondents who selected \u201cno to Q3) If so, how do the students with multiple identifications access other educational services to meet their needs?  - The case manager or school-based team will contact district professionals for additional services.  - The classroom teacher will ask the principal for more educational support. - The students might not have access to other educational services. - Any other? Please specify in the box below:   10. Do you agree that your d\/Dhh students with disabilities have received enough services from you and other professionals to meet their educational needs?  - Strongly disagree - Somewhat disagree - Neither disagree nor agree - Somewhat agree - Strongly agree  11. What issues or concerns do you have in providing special education services to d\/Dhh students with disabilities?  12. What suggestions or recommendations do you have to make services more accessible for d\/Dhh students with disabilities?  <Questions for TDHHs Only> 13. Approximately what percentage of the d\/Dhh students on your caseload present disabilities or additional educational needs (e.g., autism, intellectual disabilities, learning disabilities, requiring intensive behavioural intervention) regardless of having identifications or designations?  - Less than 5% - 5-20 % - 20-40% - 40-60%   292 - More than 60%  14. Approximately what percentage of your d\/Dhh students have been identified\/diagnosed as having more than one disability?  - Less than 5% - 5-20 % - 20-40% - 40-60%  - More than 60%  15.  Approximately what percentage of your d\/Dhh students have a secondary designation?  - Less than 5% - 5-20 % - 20-40% - 40-60%  - More than 60% - Not applicable   16. To whom do you provide your regular services (i.e., work with the student on a regular basis such as weekly or bi-weekly)? - Only d\/Dhh students whose primary designation is F (deaf and hard of hearing) - All d\/Dhh students as long as they have F (no matter it is primary or secondary) - Any d\/Dhh student \u201cwho has a medically diagnosed hearing loss that results in a substantial educational difficulty\u201d (Ministry of Education, 2016) even if they do not have F designation  17. As you provide regular services only to d\/Dhh students whose primary designation is F, how do you support d\/Dhh students whose primary designation is not F?  - I do not provide any support to those students - I provide consulting services only to their school staff (e.g., case manager, educational assistant) - I provide consulting services to those students AND their school staff - This question is not applicable to me  <Questions for Administrators Only>  18. How many d\/Dhh students does your program\/school\/district serve per year including itinerant students? - More than 200 - Between 100 and 200 - Between 50 and 100 - Between 10 and 50 - Less than 10  293  19. Among the d\/Dhh students in your program\/school\/ district, what percentage of the students present additional special needs or disabilities? - Less than 5% - 5-20 % - 20-40% - 40-60%  - More than 60% - Not known  20. How was your data collected regarding the number\/percentage of students who are d\/Dhh with disabilities out of the total number of d\/Dhh students (i.e., to answer the previous question)? Please state briefly in the box below.   21. To whom do your teachers of the deaf and hard of hearing provide regular services? (i.e., work directly with the student on a regular basis such as weekly or bi-weekly)  - Only d\/Dhh students whose primary category is F - All d\/Dhh students as long as they have F (no matter it is primary or secondary) - All d\/Dhh students \u201cwho has a medically diagnosed hearing loss that results in a substantial educational difficulty\u201d (Ministry of Education,2016) even if they do not have F designation   <Questions for Allied Professionals only>  22. How many d\/Dhh students with disabilities have you worked with for the last three years (all together)? - More than 10 students - Between 5 and 10 students - Between 3 and 5 - One or two students  23. What ministry designation(s) do your d\/Dhh students with disabilities have? (Select all that apply) - The students have only F designation (deaf or hard of hearing). - The students have F as primary AND another designation as secondary. - The students have F as secondary designation. - Dents have one or two designations but neither of them is F.  IV. Educational Placement   1. What educational setting options are available for d\/Dhh students with disabilities in your district? (Select all that apply) - A general classroom with a certified ASL interpreter  294 - A general classroom without any support staff - A general classroom with an educational assistant - A Resource Room for d\/Dhh students  - A Resource Room for students with disabilities (e.g., autism, developmental delays) - A general classroom in a specialized school setting for d\/Dhh students (e.g., British Columbia School for the Deaf, Children's Hearing and Speech Centre) - A specialized school setting for students with disabilities (e.g., autism) - A learning support program or classroom for students with disabilities (e.g., GradQuest, Modified Academic Classroom)  2. Who is usually the case manager for those students in your district? - Teacher of the Deaf and Hard of Hearing - Special Education Teacher (e.g., Inclusive Team Teacher, Learning Support Teacher) - Both Teacher of the Deaf and Hard of Hearing and Special Education Teacher as co-case mangers - It depends on what the primary designation is. - For others, please specify their title in the box below:   3. Do you agree that those students\u2019 educational needs in language and communication development are being met in their current educational settings?  - Strongly disagree  - Somewhat disagree - Neither agree nor disagree - Somewhat agree - Strongly agree  4. (Given to respondents who agreed) What makes the placement work well for the students to develop language and communication skills? (\u201cdrag & drop\u201d in order from the most pertinent to the least) - Full language access  - Sufficient professional services from the district - Well written & implemented IEP - Efficient collaboration between IEP team members - A strong connection between home and school - Sufficient opportunities for social engagement with peers - Any other reasons? Please specify.   5. (Given to respondents who disagreed) What makes the placement not work well for the students to develop their language and communication skills? (\u201cdrag & drop\u201d in order from the most pertinent to the least  - Lack of language access  - Insufficient professional services (e.g., TDHH, SLP, BCBA) - Poorly written and implemented IEP  - Inefficient collaboration between professionals - Lack of connection between home and school - Insufficient opportunities for social engagement with peers  295 - Any other? Please specify.   6. Do you agree that the educational needs of d\/Dhh students with disabilities in social skills development are being met in their current educational settings?  - Strongly disagree - Somewhat disagree - Neither agree nor disagree - Somewhat agree  - Strongly agree  7. (Given to respondents who agreed) What makes the placement work well for the students to develop their social skills? (\u201cdrag & drop\u201d in order from the most pertinent to the least)  - Full language access overall - Sufficient professional services and school-wide support for social inclusion - Strategies for social skills in the IEP are well-implemented  - Efficient collaboration with classroom teachers and educational assistant - A strong connection between home and school and\/or home support - Any other? Please specify.   8. (Given to respondents who disagreed) What makes the placement not work well for the students to develop their social skills? (\u201cdrag & drop\u201d in order from the most pertinent to the least) - Lack of language access  - Insufficient professional services and school-wide support for social inclusion  - Strategies for social skills development in the IEP are insufficient and not implemented - Insufficient collaboration between IEP team members - Little connection of parents with the school and other parents - Insufficient opportunities for social engagement with peers  - Any other? Please specify.   9. Do you agree that those students\u2019 educational needs in academic skills development are being met in their current educational settings?  - Strongly disagree - Somewhat disagree - Neither agree nor disagree - Somewhat agree  - Strongly agree  10. (Given to respondents who agreed) What makes the placement work well for the students to develop their academic skills? (\u201cdrag & drop\u201d in order from the most pertinent to the least) - Full language access  - Sufficient professional services from the district and school - Well-written and implemented IEP  - Efficient collaboration among the IEP team members  296 - Skilled educational assistant - Strong academic support from home - Any other? Please specify.    11. (Given to respondents who disagreed) What makes the placement not work well for the students to develop their academic skills? (\u201cdrag & drop\u201d in order from the most pertinent to the least) - Lack of language access  - Insufficient professional services from the district and school - The IEP includes few strategies for academic skills and they are not implemented - Insufficient collaboration between the IEP team members including classroom teacher - Difficult to find a skilled educational assistant(s) - Lack of home support and\/or connection with the school - Any other? Please specify.   12. Have your d\/Dhh students with disabilities experienced transitions from a school or program to another school or program during their school years? If yes, what were the reasons for their school transitions? (Select all that apply)  - Better language access - School\u2019s recommendations - Parents or guardians\u2019 decisions to change their child\u2019s educational settings - Family\u2019s move to a different location for other reasons - Lack of professionals who provide services to students with multiple needs - Any other? Please specify.  13. What issues or concerns have you had in the process of transitioning and\/or in making decisions for educational placement? Please briefly describe below.  14. What suggestions or recommendations do you have for providing better educational placement options and the process of deciding a placement? Please briefly describe below.  (There are no specific questions for each group in Educational Placement section.)  V. Strategies and Intervention   1. How strongly do you agree or disagree with the following statements? - Strongly disagree - Somewhat disagree - Neither agree nor disagree - Somewhat agree - Strongly agree   \u2022 We have developed educational programming to provide appropriate instruction for d\/Dhh students with disabilities.  297 \u2022 We have sufficient professionals who can optimally serve d\/Dhh students with disabilities.  2. What are the challenges in implementing strategies or interventions for d\/Dhh students with disabilities? (\u201cdrag & drop\u201d in order from the most pertinent to the least) - Lack of appropriate assessment and evaluation tools  - Lack of professionals who consult practitioners with a comprehensive understanding of the learners - Inefficient IEP planning and implementation  - Inefficient or insufficient collaboration between the IEP team members  - Lack of available resources and materials for teaching - Lack of communication and connection with parents\/guardians - Any other? Please specify.  3. If one of your responses in the previous question was \u201clack of communication with parents\/guardians,\u201d what makes it the most difficult? (\u201cdrag & drop\u201d in order from the most pertinent to the least) - Language barriers for communication - Cultural difference - Different expectations toward the child\u2019s progress - lack of parents\u2019 understanding about deafness or co-occurring disabilities - insufficient time to communicate with parents for collaboration - Any other? Please specify.  4. What professionals do you work with to meet with your students\u2019 needs? (Select all that apply) - Special Education Teacher (school-based) - Speech-Language Pathologist - Occupational Therapist - Physiotherapist - Board Certified Behavior Analyst (BCBA) - Certified Autism Specialist or consultant - Psychologist  - Multicultural worker\/spoken language interpreter - American Sign Language Specialist\/ American Sign Language Interpreter - Any other? Please specify.  5. How would you rate the collaboration with the school team, parents, and\/or professionals outside the school system for your d\/Dhh students with disabilities? - There was no or few collaboration - Mostly inefficient - Somewhat inefficient - Somewhat efficient - Mostly efficient   298 6. (Given to respondents who answered \u201cefficient\u201d) What made the collaboration successful? (\u201cdrag & drop\u201d in order from the most pertinent to the least) - Enough time was given for collaboration (certain amount time was committed) - Efficient communication between professionals - Case manager or educational consultant led the team well  - Excellent implementation by the teacher and their educational assistant  - Great support from administrators - Strong connection with home  - Any other? Please specify.  15. (Given to respondents who did not answer \u201cefficient\u201d) What made the collaboration difficult? (\u201cdrag & drop\u201d in order from the most pertinent to the least) - Insufficient time to collaborate - Language barriers between professionals - Different perspectives about the student\u2019s needs between professionals - Lack of understanding of the student\u2019s needs and progress - Lack of support from administrators  - Difficulty in communication with parents\/guardians - Any other? Please specify.   <Questions for TDHH and Allied Professionals Only>  16. How strongly do you agree or disagree with the following statements?* - Strongly agree - Somewhat agree - Neither agree nor disagree - Somewhat disagree - Strongly disagree  \u2022 I have the knowledge and skills to meet the needs of d\/Dhh students with disabilities. \u2022 I have the resources to provide appropriate instruction for d\/Dhh students with disabilities  17. Where do you usually get the resources or consultation for teaching those students? (\u201cdrag & drop\u201d in order from the most pertinent to the least) - Online resources - Books or materials in my professional training - Colleagues within the district  - Colleagues or professionals out of the district  - Administrators (e.g., Inclusive Learning) - Any other? Please specify.  18. Which of the following educational practices have you used to improve language and communication for students who are d\/Dhh with disabilities? (Select all that apply) - Functional Communication Training - Augmentative and Alternative Communication (AAC) devices  299 - Picture Exchange Communication System (PECS) - Language experience activities - Video modeling - Peer modeling - Use of visual supports - Labeling with words\/ signs - Naturalistic teaching strategies (NATS) - Repeated viewing of a text in American Sign Language - Environmental modifications (e.g., strategic seating, organizing materials, acoustics)  - Curricular modifications (e.g., having a test read\/signed to them) - Anything else? Please specify.  19. What interventions or strategies have you used to improve the social and\/or behavioral skills for d\/Dhh students with disabilities? (Select all that apply) - Positive Behavioral Support (PBS) - Functional Communication Training - Social Stories  - Video modeling - Peer modeling - Coaching - Small group interventions (e.g., Circle of Friends) - Use of visual supports (e.g., visual contingency map, visual schedule) - Environmental modifications (e.g., strategic seating in classroom) - Curricular modifications (e.g., having a test read to them) - Anything else? Please specify.  20. What interventions or strategies have you used to improve the academic skills for students who are d\/Dhh with disabilities? Specify 2-3 strategies (e.g., direct instruction, interactive software program)  21. What assessment tools have you used for those students? How do you evaluate and monitor your students' needs and progress? Specify 2-3 main assessment tools or methods you have used.   22. What suggestions or recommendations do you have for teaching d\/Dhh students with disabilities in your position? (Note: This is the last question for you in the survey)    (There are no specific questions for administrators in this section.)  V. The Closing Page  Thank you! You have finished completing this survey. Your response has been recorded.   1. If you would like to enter into a draw for one of the $50 gift cards, please provide us with your contact information (e.g., email address, contact number).  300  _________________________________  2. You are invited to participate in a Focus Group to provide more in-depth information about your practices and considerations. A Focus Group will be about 60-minute long, facilitated by one of the researchers, with 4 to 6 participants who are in the same educator group (i.e., teacher of the deaf and hard of hearing, administrators, allied professionals). To protect confidentiality, all participants will be advised to use a pseudonym and turn off their camera.  Yes, I consent to send me an invitation to a focus group through the email I provide here: _______________________  For any questions or concerns about this research (both survey and Focus Group), please contact Dr. Cannon or Eun Young Kwon.    301 C.3 Focus Group Interview Consent Form    Consent Form \u2013 Focus Group Interview  Education of Students Who are Deaf or Hard of Hearing with Disabilities in British Columbia: Identification, Eligibility, Placement, and Interventions   I. Who is conducting the study?  Principal Investigator:  Dr. Joanna E. Cannon Associate Professor Department Educational and Counselling Psychology, and Special Education, UBC Faculty of Education  Co-Investigator:  Eun Young Kwon Ph.D. Candidate, M.A., M.Ed. Department of Educational and Counselling Psychology, and Special Education, UBC Faculty of Education  II. Why are we doing this study?  The purpose of this study is to investigate practices and considerations in the education of deaf or hard of hearing (d\/Dhh) students with a disability (or disabilities) from the perspective of their educational professionals.   III. What happens if I say \u201cyes, I want to participate in the study\u201d?   You are invited to participate in a focus group to share your experiences and perspectives in the education of d\/Dhh students with disabilities in school settings as you have completed the online survey (the first part of this study) and indicated you are willing to take part in a focus group.  There will be between 4 to 6 participants in your focus group. During the focus group, a member of the research team will ask participants a series of questions. These questions relate to special education provisions, educational placement, and interventions of the d\/Dhh students with disabilities in school settings.   The focus group will take up to 60 minutes via an online platform called Zoom. All the focus groups will be recorded. The UBC Zoom server is located in Canada, and Zoom stores users\u2019 names and usage data. Therefore, you may choose not to share certain information about your Department of Educational and Counselling Psychology, and Special Education Faculty of Education  2125 Main Mall Vancouver, BC   Canada   V6T 1Z4  302 experiences. In a focus group, we cannot completely protect your identity in the group but will ask everyone to keep all information confidential and deidentify all data during the transcription process. To increase confidentiality, you will be advised to use a nickname instead of your real name, and turn off your camera.   IV. What are we going to do with study results?  The main study findings will be published in academic journal articles and presented at academic conferences. We will also create a public report of the study findings and are happy to provide you with a copy if you would like one. In Section XI, there is a space for you to indicate your intention and provide your contact information (email address) if you would like us to send you a copy of the public report.  Some academic journals ask researchers to make their data available. In this study, \u2018the data\u2019 are the focus group transcripts. Making the data publicly available may increase participant risk. All identifying information will be removed. Once the data are made publicly available, however, it cannot be removed.  V. Is there any potential risk by participating in this study?   We do not think there is anything in this study that could harm you or be bad for you. Some of the questions we ask may seem sensitive or personal. You do not have to answer any questions if you do not want to. You may also leave the session at any time.  VI. Is there any potential benefit by participating in this study?  We do not think taking part in this study will help you directly or immediately. Indirect benefits may come through dissemination of results in publication or presentation form. Responses may help develop guidelines for supporting professionals who work with d\/Dhh students with disabilities. However, in the future, you and others may benefit from what we learn in this study.  VII.  How will your identity be protected?  Only research team members will have access to the documents and recordings from the study. All documents will be identified only by code number and kept in a locked filing cabinet. All recordings will be encrypted, password-protected, and stored on a secure server. Dr. Cannon will keep the documents and recordings for at least five years. After that time, the documents will be shredded and the recordings will be deleted. The data will be de-identified prior to being made publicly available in any reports of the completed study.   VIII. Will you be paid for taking part in this research study?   You will be compensated for your time with a $20 gift card for participating in the focus group even if you choose to leave during the session.  IX. Who can you contact if you have questions about the study?   303  If you have any questions or concerns about what we are asking of you, you may contact the study investigators. Their names and telephone numbers are listed at the top of the first page of this form.   X. Who can you contact if you have concerns about the right of the research participants?  If you have any concerns or complaints about your rights as a research participant and\/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Services at 604-822-8598 or if long distance e-mail RSIL@ors.ubc.ca or call toll free 1-877-822-8598  XI. Participant Consent and Signature Page  Participation in this research is voluntary. If you decide to be in the study and change your mind, you have the right to pull out of the study at any time without giving a reason and without any negative impact.   Your signature below indicates that you consent to participate in this study and you have received a copy of this consent form for your own records.    ____________________________________________________ Signature     Date       If you would like us to send you a copy of the study\u2019s public report, please provide contact information below (email address):  _____________________________________________________     304 C.4 Focus Group Guiding Questions  Focus Group Guiding Questions  Titles: Education of students who are deaf or hard of hearing with disabilities in British Columbia: Identification, eligibility, placement, and interventions   Principal Investigator: Dr. Joanna E. Cannon Co-Investigator: Eun Young Kwon  The questions for the focus group relate to experiences and perceptions of how deaf or hard of hearing students with additional disabilities receive special education services, in what educational settings they receive these services, and what interventions teachers have found effective.   1. What issues or concerns do you have in the identification and eligibility of d\/Dhh with disabilities? (with concrete examples if possible)  2. What suggestions\/ recommendations do you have to make services more accessible for d\/Dhh students with disabilities?  3. What issues or concerns do you have about the educational placement of d\/Dhh students with disabilities? (with concrete examples if possible)  4. What suggestions\/recommendations do you have for providing better educational placement options and the process of determining a placement?  5. What issues or concerns do you have about implementing strategies and interventions? (with concrete examples if possible)  6. What suggestions\/ recommendations do you have in implementing strategies and interventions for d\/Dhh students with disabilities in your position?  7. Any overall comments?  ","attrs":{"lang":"en","ns":"http:\/\/www.w3.org\/2009\/08\/skos-reference\/skos.html#note","classmap":"oc:AnnotationContainer"},"iri":"http:\/\/www.w3.org\/2009\/08\/skos-reference\/skos.html#note","explain":"Simple Knowledge Organisation System; Notes are used to provide information relating to SKOS concepts. 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