Ellen A. Rhoades, Ed.S., Cert. AVT, CED
When I served as executive director of two different auditory-verbal
nonprofit centers from 1977 through 1999, I took each of the center's
total annual budgets and then divided it by the number of children we
served for each of those years. The resultant figure was how I arrived
at the average cost to provide auditory-verbal intervention services for
a child. During the 1980s and 1990s, those costs were fairly consistent;
that is, the cost per child ranged from $4,000 to $5,000 at that time.
Moreover, it should be noted that I expected each child to be
professionally released from auditory-verbal intervention services when
they attained morpho-syntactical adult-like language which occurs by
four years of age for normally hearing children. This means each child
should achieve a four-year-level of oral language skills as demonstrated
on formal norm-referenced diagnostic tests of language (e.g., SICD,
OWLS, CASL) that have been standardized on normally hearing children.
Therefore, I am able to determine that the typical child will be
professionally released after receiving approximately four years of
effective auditory-verbal intervention services. Given this information,
I took the $5,000 cost per child and multiplied that by the average four
years of intervention to arrive at the $20,000 figure that it cost to
“create” a functionally hearing child who is ready for assimilation into
the mainstream of school and community.
However, just as we must recognize that there is great variability from
child to child, it must be similarly noted that this "cost per child"
will vary from program to program, depending on the program’s expenses
and extent of services rendered. Moreover, the cost may be dramatically
different when computed by auditory-verbal clinicians in private
practice, in hospital settings, or within public school settings. For
example, one private clinician’s fees may be $200 per session, whereas
another’s may be $75 per session. Finally, it should be noted that there
is often much variability in the quality of auditory-verbal services
provided by professionals, regardless of whether or not the
auditory-verbal clinicians are certified.
My research findings (Rhoades & Chisolm, 2001; more data is forthcoming)
with the children that were served under my administration demonstrate
the following outcomes:
(1) The typical child with significant hearing loss can progress in
their language skills at an average rate of progress equivalent to the
growth rate of normally hearing children.
(2) Some children demonstrated rates of language growth that surpass the
typical 100% rate of growth; these children “caught up” with normally
hearing peers. In other words, these auditory-verbal children closed the
gap between their Language Age and their Chronological Age, regardless
of whether they were hearing aid or cochlear implant users.
(3) Children who are prelingually deaf can attain communicative
competence in their parent’s native spoken language, which in the case
of these studies, is English.
(4) The average chronological age at initiation of high-quality
auditory-verbal intervention was 44 months.
The children in this study were all using effective hearing prostheses,
either hearing aids or cochlear implants. For additional information on
these findings, one can also go to this page on my web site:
http://www.auditoryverbaltraining.com/resources.htm
In order to compare the $20,000 cost per child to how other programs
serve children with hearing loss, one must attempt to equalize the
situation and this can prove difficult. For example, because my “cost
per child” was based on budget devoted exclusively to serving children,
I then located another program also devoted exclusively to serving
similar children, i.e., a local residential school for children with
hearing loss. I was able to determine the annual budget for that school
as well as the number of children they served. At that time, the annual
cost was then demonstrated to be $45,000 to $50,000. I also learned from
annual demographic studies provided by Gallaudet Research Institute that
the average deaf child remains in self-contained classroom for an
average of ten years. Therefore, $50,000 X 10 = $500,000. It was at this
point that I could compare my $20,000 figure to the half-million dollar
cost for educating a child who is deaf, irrespective of pedagogy
employed within the residential school.
Unfortunately, there is nothing published other than this document on
www.AuditoryVerbalTraining.com because this figure will vary from
situation to situation and from year to year, given our economic times
and budgets. However, regardless of intervention setting, there is one
key point to keep in mind when it comes to cost-effectiveness: Assuming
an auditory-verbal therapist provides one session for each child per
week, that therapist can serve twenty (20) children over the course of
any given year. How can this be the same cost as a teacher of the deaf
who provides services for a classroom of four to eight children over the
period of a year?
Reference:
Rhoades, E. A. & Chisolm, T. H. (2001). Global language progress with an
auditory-verbal approach for children who are deaf or hard of hearing.
The Volta Review, 102 (1), 5-24.
SICD: Sequenced Inventory of Communication Development
OWLS: Oral and Written Language Scales
CASL: Comprehensive Assessment of Spoken Language
