communities in the United States. Its original goal
was to reduce infant mortality by 50 percent through
community-driven strategies that provided direct, in-
novative prenatal services and health system service
changes. Permanently authorized through the Chil-
dren’s Health Act of 2000 (PL 106-310), the Healthy
Start Initiative is involved in over ninety communities
and focuses on three programs:
- Assuring access to and use of comprehensive
services for Healthy Start participants through
direct safety net services involving outreach,
case management, and health education. - Strengthening local health systems through de-
velopment and implementation of a biannual
system development plan. - Bringing a consumer/community voice to im-
prove maternal and infant health through the
use of local consortia.
In addition, the Healthy Start Initiative has now
broadened its developmental focus to address the
health of mothers and infants from conception
through two years postpartum, including attention to
maternal depression and interconceptional health.
This newer focus should help better integrate public
health pregnancy and birth outcome oriented pro-
grams with child and parent development programs,
which often serve the same families.
See also: EARLY INTERVENTION PROGRAMS
Bibliography
Healthy Start National Resource Center (HSNRC). In the National
Center for Education in Maternal and Child Health (NCEM-
CH) [web site]. Arlington, Virginia, 2001. Available from
http://www.healthystart.net; INTERNET.
Milton Kotelchuck
HEARING LOSS AND DEAFNESS
About 1 in 1,000 children demonstrates hearing loss
to a level considered deaf or partially hearing and in
need of special educational support. Severity of hear-
ing loss may differ in one ear compared to the other
and will vary greatly for different children.
Levels of Hearing Loss
Hearing loss is measured in decibels (dB) and is
generally subdivided into three major groups. A loss
greater than 55 dB is considered severe to moderate.
Hearing loss is termed severe if it averages between
70 and 90 dB. Averaged across all frequencies, a hear-
ing loss in the better ear of 90 dB or greater is consid-
ered profound. A child with mild loss of less than 40
dB may still be able to hear speech and have only
moderate difficulties. With a loss between 40 and 55
dB some children can still hear some speech sounds,
and these children may get a boost from a hearing
aid.
In addition to the degree of hearing loss, the fre-
quency range that is affected profoundly influences
hearing ability. A child with mild hearing loss across
the frequencies used for producing speech may have
more difficulties. Speech will sound quite distorted
and less intelligible for a child with 55 dB loss, who
will hear more vowels than consonants, since vowels
are transmitted at higher frequencies. A complete au-
diometric assessment of a child’s hearing loss must,
therefore, provide information for each ear, across a
range of frequencies.
Additional problems suffered by hearing im-
paired children are: brain damaged (8%), cerebral
palsy (7%), heart disorder (6%), perceptual-motor dif-
ficulties (10%), emotional and behavioral problems
(19%), and visual deficits (18%)’’ (Harris 1990, p.
208).Sign Languages
In the mid-1700s, Charles-Michel de l’Epée, a
French cleric, observed that twin girls who had grown
up together used fluent gestures to communicate with
each other, and it occurred to him that this gestural
language might already be equipped with syntax. He
proposed to extend the native sign language of the
deaf with supplementary methodical signs until this
sign language became the intellectual equivalent of
any spoken language. Today there are many sign lan-
guages based on hand signs and they differ widely in
different countries and are not mutually intelligible
for a deaf person. American Sign Language (AM-
SLAN or ASL) is a true language with syntactic and
morphological rules different from those of spoken
English. ASL signs are distinguished from one anoth-
er by hand shape, movement, location in space, orien-
tation of the hands during signing, and facial
expression. In a book published in 1979, Edward
Klima and Ursula Bellugi provided specific descrip-
tions of ASL grammar and rules.
Some signing systems have added artificial signs
for English morphemes such as verb tense markers
and ‘‘is.’’ Signed English, Seeing Essential English
(SEE), and Cued Speech are a few of the manual
forms developed. SEE was developed to represent
spoken English literally, so that a signed sentence
would be as complete as the spoken one. When the
syntactic language skills of deaf children of deaf
parents who used either ASL or SEE were analyzed,HEARING LOSS AND DEAFNESS 177