Peripatetic Teachers of the Deaf (1969)

This Survey was carried out by the members of HM Inspectorate and Medical Officers of the Department. (See also Survey 1 Units for Partially-hearing Children 1967.)

The complete document is presented in this single web page. You can scroll through it or use the following links to go straight to the various sections:

Historical Background (page 1)
Purpose and Scope of the Survey (3)
Statistics (5)
Work of the Service (17)
Priorities (27)
Observations and Conclusions (29)

Blank pages have been omitted.

The text of Peripatetic Teachers of the Deaf was prepared by Derek Gillard and uploaded on 5 April 2023.


Peripatetic Teachers of the Deaf
Education Survey 6

Department of Education and Science
London: 1969
Crown copyright material is reproduced with the permission of the Controller of HMSO and the Queen's Printer for Scotland.


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[title page]


Peripatetic Teachers
of the Deaf




Education Survey 6


Department of Education and Science







London: Her Majesty's Stationery Office 1969


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SBN 11 270031 4


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Foreword


Educational provision for children with impaired hearing in England and Wales is made in several ways: some children attend day or residential schools for the deaf or partially hearing; some are placed in special classes or units in ordinary schools and some attend the normal classes. All need in different degree the services which can be provided by specially qualified teachers of the deaf and partially hearing - who are in short supply.

The first publication of this series 'Units for Partially Hearing Children' dealt with the work of these teachers is special units and classes attached to ordinary schools. The present survey is concerned with the work of teachers known as peripatetic teachers of the deaf whose duties include assessing the needs of children with impaired hearing and visiting those who are in ordinary classes and who may fall behind in their work if their disability is not recognised and they are not given extra help. It was carried out by the members of HM Inspectorate and Medical Officers of the Department.





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Contents


page

Historical Background
1

Purpose and Scope of the Survey
3

Statistics
5

Work of the Service
17

Priorities
27

Observations and Conclusions
29


[page 1]

Historical Background


Provision for the education of children with impaired hearing in Great Britain has undergone rapid expansion in the present century. It was not until after the Elementary Education (Blind and Deaf Children) Act of 1893 that it became the duty of all school authorities to arrange for all deaf children to receive efficient and suitable education, either in schools that were newly established by local authorities or in already existing non-maintained schools. At the beginning of the century, therefore, the profoundly deaf, whose plight was obvious and who could not benefit from placement in ordinary schools, were separated from children, who could hear normally. The partially hearing and the hard-of-hearing were not, as such, included in the Act. Their special need was largely unrecognised and they remained either in the ordinary schools or in special schools for the deaf where their residual hearing was not exploited. They were taught as deaf pupils.

The progress of these pupils was the subject of an enquiry when, in 1934, a Departmental Committee of the Board of Education was established 'to enquire into and report upon the medical, educational and social aspects of the problems attending children suffering from defects of hearing, not amounting to total deafness'. In the Report of this committee, which was published in 1938, it was recommended that partially-deaf pupils should be educated separately from deaf pupils, and in the 1945 Regulations made under the Education Act 1944, there was for the first time a separate category of the partially deaf. This led to the provision of separate educational arrangements.

The 1938 report, together with the development of techniques for testing hearing and the provision of hearing aids in the days just prior to World War II, brought changes in attitudes.

As a first step, partially hearing children in the special schools were separated from the deaf into classes within these schools and group hearing aids for class teaching were made available for them. These early aids, however, tended to be unreliable and difficult to maintain at a high level of efficiency. Individual aids were heavy and bulky and were available only to the few. Consequently, specialised work for the partially hearing was not markedly successful in the early stages.


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Major changes occurred after World War II when the development of the science of electronics made it possible to improve group aids and to manufacture small individual aids for distribution as part of the National Health Service. Educational experiment followed and special units or classes for partially hearing children were opened in ordinary schools.

More accurate measurement of response to pure tones by means of audiometry brought to light many more schoolchildren than had been expected whose hearing was not within the range considered to be normal. Investigation showed that many of these children, although having only a partial hearing loss and appearing to make progress in school, were nevertheless under strain. In many cases their achievements did not correlate with their intelligence. The nature of the disability, which could easily become a handicap, was such that their teachers had not always been aware of their problems. Many children were in need of additional help.

Several authorities were concerned about these children and sought means to provide them with constructive help. A Deafness Aid Clinic, which concentrated on work with young children, was started at Golden Square Hospital, London, in 1948 when a teacher of the deaf was appointed to deal with the educational aspects of work with children not in special schools. At about the same time the Principal School Medical Officer for Lancashire instituted a peripatetic service designed to discover all school children with any significant impairment of hearing and to provide appropriate educational treatment.

The terms of reference of the first peripatetic teachers appointed were directed to the discovery of children with impaired hearing and organisation of additional help for those who were capable of remaining in ordinary schools. Since then duties have been extended in several directions and now have an audiological aspect as well as a teaching and guidance function. They can be concerned with all stages in the life of the child, from babyhood to the teenager entering work, and with any degree of hearing loss. It is generally agreed that the parents of young deaf children who cannot make natural progress in the development of speech and language need guidance and support. In many areas this work also is undertaken by the peripatetic teachers. Thus the field of duties extends far beyond what was originally envisaged and extends from the clinics to the children's homes, to their schools and on into employment.



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Purpose and Scope of the Survey


Experienced teachers of the deaf in the special schools have been attracted to peripatetic work and many have responded with enthusiasm to its demands. Nevertheless it is little understood and criticism has at times been heavy. This criticism has many facets, some relating to the nature of the work and some to the financial reward. Throughout the educational system there is an acute shortage of people qualified to help children with impaired hearing. There is urgent need to find out whether the peripatetic service is working to maximum efficiency and whether scarce resources are well used. It was therefore decided that HM Inspectors and Medical Officers should review the present situation and, by means of a survey, should investigate and evaluate the nature of the work and determine its priorities. The service has grown up empirically rather than logically; the teachers have received, in their training and previous experience, very little to fit them for their new responsibilities and it was therefore decided to consider also whether additional training is advisable. From investigation in depth it should be possible to make recommendations for improving the efficiency of the service.

By agreement with the appointing bodies, questionnaires were sent out to all the peripatetic teachers in employment in the Spring of 1967, and all were completed and returned. Scrutiny of these revealed an enormous variety in organisation that related not only to the appointing bodies but also to the mode of procedure. Some teachers were in isolation; some worked in groups; some were in teams with a designated leader. Some teachers were part time; others combined their duties with teaching in units. There was variety, too, in the areas in which they worked. Some were in densely populated urban areas; some were in areas of scanty population that involved long distances of travel. In order to obtain a cross section of the provision, it was decided to spend time with representatives of all types and, in consequence, 94 of the 177 teachers were visited.


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Statistics


(i) Numbers in the Service

In March 1967 there were 177 peripatetic teachers of the deaf, 82 men and 95 women, variously employed in the country; eight other posts were unfilled. These figures refute the generally held opinion that more men than women undertake this work. It must however be noted that only 11 men, but 34 of the women, were employed part-time on this work. Some of the latter were housewives who found such an occupation and use of their skill congenial.

The work undertaken is very varied and frequently reflects either a teacher's own interests or those of the appointing body. Although there are other duties, development of the work with school children has followed three directions so that some are concerned solely with help in school, some are concerned with assessment of hearing and help in school, and some are so heavily loaded with assessment of hearing that help in school is almost precluded. Some teachers refer to this work as audiology. No present definition of the term gives a clear indication of its meaning and there is, in consequence, confusion of thought and practice. Clarification of terminology is needed.

Of the 177 teachers working in March 1967, 155 were appointed to the service of Local Education Authorities, 15 were part of a Health or School Health Department, 4 were appointed by Local Education Authorities and seconded to School Health, 2 were joint appointments between the Local Education Authority and the Regional Hospital Board and one was a joint appointment between a Local Education Authority and a School Health Department. The work of these variously appointed teachers can be expected to show marked differences and there is need to determine what, if any, advantage is to be gained from such variation.

Of the 162 counties and county boroughs in England and Wales, 83 employ one or more peripatetic teachers of the deaf while 79 do not. Some of those without such workers are small, some have special schools to which they look for assistance and others have plans for future development.

Dates of first appointment to the peripatetic service of teachers working in March 1967 ranged from 1951 to the Spring of 1967. Expansion of the


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service has been rapid in recent years: 16 appointments had been made in the first three months of 1967.

Table 1 Year of appointment

There were 126 teachers working in teams of two or more; the remaining 51 worked in isolation. 21 men and 9 women were leaders of teams. Some of them were appointed as organisers or leaders in order to investigate local needs and set up a service. Others, who were the first-comers in the area, had risen to these positions in the process of natural growth of local services. One woman part-timer was the leader of a team.

The teams varied in size from 2 to 11 but from most areas came pleas for additional workers to meet the demands of rapidly expanding services. Not all of these pleas would be valid if priorities were more realistically determined. The frequency of team meetings varied: 15 met once a week, 5 once a month, 6 once a term and 3 whenever it was deemed necessary. The remaining 'team' consisting of two people did not in fact meet.

Table 2 Size of teams

(ii) Qualifications

All but one of the teachers had obtained special qualifications as Teachers of the Deaf prior to appointment -

132 at Manchester University
1 at London University
36 through the National College of Teachers of the Deaf
7 by training overseas
1 without special qualification as a Teacher of the Deaf
177 Total

Of these teachers, 41 were graduates; several had continued their studies and obtained further degrees in education; 7 had completed the course in advanced audiology at Manchester University.


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(iii) Experience

Local Authorities have been advised, when establishing a peripatetic service, to appoint teachers who have had some length of experience both in special schools for the deaf or partially hearing and in ordinary schools. By their knowledge of standards in general education and of the limitations that are imposed when the disability of impaired hearing has become a handicap they should be able to give more constructive guidance both to the pupils and to the class teachers in the schools as well as to provide enlightened guidance and support for parents.

Full information was not available in all cases but in general it was evident that many had spent several years in special schools. Fewer had any similar length of experience in ordinary schools and at least 41 had none. Since many peripatetic teachers are expected to assess the educational capabilities of partially hearing children in ordinary schools and give recommendations for school placement, it is desirable that they should have such experience.

(iv) Salaries and Allowances

Since 45 of the teachers either were part time or combined other duties, such as teaching in units with their peripatetic work, figures concerning allowances were difficult to collate. The 148 that were obtained from the questionnaires (152) showed that nearly all were receiving an allowance in excess of that which would be paid to a qualified teacher of the deaf working in a special school for the deaf. The majority were receiving allowances of 300 per annum or more, the highest, as would be expected, being paid to senior teachers, leaders of teams and organisers. These payments were for the most part determined by analogy with special posts in ordinary schools. Thus there were:

2 paid as organisers receiving Soulbury Scale
1 paid as head teacher: Group I
2 paid as head teachers: Group III
1 paid as deputy head
32 paid as heads of department
15 paid as graded posts: Scale I
6 paid as graded posts: Scale II
24 paid as graded posts: Scale III
10 were known as 'senior' teachers
74 had no particular title
10 were paid at an hourly rate
29 did not give details of allowances
177 Total


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Table 3 Total Allowances (including payment for special qualifications)

(v) Clerical Assistance

Those teachers who were involved in assessment of hearing and educational attainment with the consequent responsibility of making recommendations for educational placement had heavy clerical duties. The variation in the provision was marked: 78 teachers, 9 of them leaders, had no help, whereas 2 had full time clerical assistance. It may be that the work of some teachers does not require such assistance, but on the whole and for the leaders in particular there would appear to be need for it. Arrangements varied but in some cases there was concern about the paucity or lack of such facilities. It was said that reports in manuscript tended not to have the impact and the recognition that would be afforded to typewritten documents and the teachers who were without access to a clerical service felt themselves to be at a disadvantage. It is no part of a teacher's duty to be able to type or to provide his own typewriter.

In one area there were part-time clerical assistants whose secretarial duties were limited to making appointments for children to attend the clinic for hearing tests. Their main task, for which they were trained by the peripatetic teachers, was to screen the hearing of school entrants. In a contrasting area, the teacher was accompanied by a secretary at all sessions so that reports and appointments could be kept up-to-date. In some places clerical assistance was obtainable on a shared basis in the clinics and education offices.

A small number of teachers spent one afternoon a week on clerical work. This could be deemed expensive use of skilled teacher time. Others regarded their work with the children as of prime importance and were unwilling to set aside much time for clerical activities. They depended instead upon time gained when appointments for hearing tests were not kept. It may be for this reason that in many cases children's records did not contain enough information and registers of visits were not well kept. There was evidence that the teachers had not had much guidance in maintenance of records and administration but had devised their own methods through personal experience.

Table 4 Hours of clerical assistance


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(vi) Work in Clinics and Centres

The wide variation in the number of clinics and centres which the teachers attended clearly demonstrated the differences in their function. Some were concerned entirely with schools and had no contact with clinics; some worked at only one clinic to which school children came and parents brought young children for testing and guidance; others worked at many clinics. The majority of the latter were teachers on a School Medical Officer's staff, who were engaged for the most part in the assessment of hearing and had little time to spare for actual guidance and regular tutorial work with individual children and their parents. This was wasteful of the skills of teachers who had been specially trained to help children and parents with their educational difficulties and, for some, presented an unrewarding if not impossible task.

Table 5 Number of clinics and centres at which work is done

Good conditions for working with hearing-impaired children include acoustic efficiency, warm bright rooms suitable for the display of attractive materials, good storage facilities and waiting space and adequate sanitary provision. These were found in those clinics where a special room had been allocated to the peripatetic teacher. Usually, however, the teacher was a transient visitor and even in the purpose-built clinics and health centres, conditions were poor for the type of work to be done. In some of the latter the repetitious sounds of adjacent plumbing militated against intensive listening for the tiny sounds of audiometric testing. Little children can be frightened and therefore unresponsive when faced with the paraphernalia of optical instruments or the equipment for physiotherapy. These conditions obtained when the teacher was obliged to seek temporary working space in specialist rooms in clinics that were over-pressed and constantly occurred in areas where the work was chiefly assessment of hearing.

(vii) Visits to Schools

Included with the figures for schools visited were play groups, nurseries and junior training centres.

Just as the variation in number of clinics and centres attended by different teachers pointed to difference of emphasis in their work, so the number of schools that they visited regularly reflected the bias of their duties. 27 teachers did not visit schools; a few of these were part-timers concerned solely with


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guidance to parents of young children in their homes. Some of the teachers who worked in close collaboration with school medical officers were unable to preserve a balance between the educational side of their duties and the time demanded for conducting tests of hearing; they tended to visit few schools.

Regular visits to schools were made once a week or once in two weeks: very few were more frequent and many were less.

In several county areas surveys were in progress and visits were being made to all schools in order to ascertain how many children were in need of additional help. In these cases there were no regular visits and it was impossible to estimate an eventual regular figure.

Table 6 Number of schools visited regularly

(viii) Visits to Homes

The majority of teachers visited both homes and schools, but, as Tables 6 and 7 show, fewer regular visits were made to homes than to schools. The children seen at home were usually very young and likely to be very deaf or to have additional handicaps. Some teachers visited twice a week but once a week, once a fortnight or once a month was more usual. Rather than interrupt lessons in school a few teachers visited older children at home out of school hours. The wide divergence precluded calculation of a realistic national average number of visits made.

Table 7 Number of homes visited regularly

(ix) Case Loads

Some of the teachers were unable to provide case load figures which distinguished between regular visits and casual visits to follow up screening tests and the issue of hearing aids. The balance between these duties was often difficult to maintain.


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Although there was general agreement about the needs of very young children and their parents, not all peripatetic teachers had responsibility for them. Of the 177 teachers, 97 did no work with young children under 2 years of age, 76 had fewer than 10 on their books and 3 had between 10 and 20.

The numbers of children under five were also small, the heavy influx of cases coming at school entry. Screening at this age brought to light many with slight impairment caused probably by catarrhal infections. Numbers tended to drop off towards school leaving age. Teachers did not usually retain pupils on their books after they had left school except in special cases of need when young people went on to some kind of further education.

Table 8 Numbers and ages of children recorded on the teachers' registers

One teacher saw children only as required

(x) Frequency of Visits

The overwhelming numbers that some teachers had on their registers were explained when they were related to the frequency of visiting. The very few who were seen twice per week were very young children with special needs. A rather larger number were seen once per week or once per fortnight, but the majority were seen less often. The frequency of visits was in inverse proportion to the number of children for whom the individual teachers were responsible. It affected the type of work that could be done with profit and called for thought in determining priorities. (See table 9 on page 12.)

(xi) Children Whose Needs Were Not Met

Many of the teachers were hard pressed and in consequence they were concerned about children to whom they could not give enough attention.


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Table 9 Frequency of visits

(175 teachers answered this question and 2 did not)

The number of children with additional handicaps indicates a need for better provision. Some children were in need of nursery provision but none was available; some who should have been full time in units for the partially hearing could not be given such placement because there were none in the area (there were 66 such areas). Others, with additional handicaps, were difficult to place in school. The number (740) who needed more help was small in relation to total population but it was nevertheless significant. Only 57 of the teachers felt that they were able to give all the children for whom they were responsible the attention that they needed.

Table 10 Children who needed more help

(Nine teachers did not answer this question)


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(xii) Duties

The teachers' duties covered a wide field and each of them had developed the pattern of his work according to his own situation, terms of appointment and interests. Observation of the work and subsequent discussion with the teachers gave clear evidence that some duties are fundamental whereas others are peripheral. The central function of the service as it has developed and as agreed by the teachers appears to be guidance for parents of young children and for teachers in ordinary schools. (Work with children under the age of two and in audiology clinics, although desirable, does not always come within the peripatetic teacher's orbit).

Another fundamental duty is to test the hearing of those children who are known to have a hearing loss, in order to determine whether this loss constitutes an educational hazard, to follow tests up with auditory and speech training and when possible to provide suitable additional help with school work. Several of the teachers tested and serviced hearing aids and made insert moulds when necessary.

Assessment of educational attainment may involve the teachers in recommendations for school placement or transfer: for this to be successful, they need to be in close liaison with schools of all kinds. In some areas there was growing awareness of the needs of older children. In these areas liaison with social workers, welfare officers, and youth employment officers was developing into schemes for follow up into employment.

Several team leaders acted not only as directors of their teams but also as advisers to their local authorities; they gave lectures to health visitors and students and organised courses for teachers and parents. Some of them also took an active part in the partially hearing units and were involved in the extension of the service as a whole.

In the light of these many duties and the heavy case loads carried by the majority of the teachers, it was not surprising that only 95 said that they were able to carry out their programmes satisfactorily: 24 could not and a further 57 were not satisfied with their work. Amongst many others, the main reasons for this dissatisfaction were heavy case loads, shortage of staff, undue time spent in travelling, in teaching in partially hearing units and in clerical work. Administration was a problem in many cases.

(xiii) Areas Covered

The areas covered by the teachers included 60 described as densely populated, 25 sparsely populated and 92 which were a mixture of both. The


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majority of the teachers used their own cars, 7 were provided with a car by the Authority for which they worked, 1 had a mobile audiology van and 19 used public transport. Some of the daily journeys in the sparsely populated areas were very long but journeys in cities and places where traffic was congested were also time consuming and frustrating and likely to upset the programme.

Those who travelled by public transport were, in general, able to claim their fares. In one case, an allowance of 20 per annum was made. Users of private cars were variously reimbursed, 24 different scales being recorded; 16 received payment on the National joint Council Scale; mileage rates ranged from 11¾d. to 3d. but some who were paid at the lowest rates had additional monthly allowances.

Table 11 Miles travelled per week

(xiv) Stock Allowances

Many teachers received supplies of equipment and materials on request and reported no problem. For the rest, there was wide divergence in arrangements; whereas 15 teachers had no allowance and 4 received theirs in combination with units or schools, others were very differently situated. Those in receipt of large amounts (580, 355, 250 and 200 per annum) were expected to include replacement and maintenance of equipment in the expenditure. The most usual allocations appeared to be between 25 and 60 per annum. In all, 37 teachers complained about difficulty in obtaining equipment and 20 others about the supply of materials. Those who worked with children of wide age and ability range needed a variety of books and materials that called for a more generous allocation of money.

(xv) Equipment

The special equipment used in peripatetic work is of considerable value. The majority of the teachers carried their equipment in their cars but, because of the policy of the local authorities, in only 76 cases was it insured. Those who did not have large equipment in their own possession were, for the most part, able to obtain it on loan or find it available for use at the clinics, 12 of which were fully equipped. Very few had free field audiometers, a fact that probably related to the small number of teachers dealing solely with very young children.


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Some teachers were not able to obtain a supply of spare hearing aids and problems were created by the lack of them. Three teachers carried kits for making ear moulds and inserts in emergencies.

A number of authorities provided speech training units for loan to parents and schools. It was encouraging to see how successfully many were being used, even in the difficult conditions prevailing in some infants' schools.

Table 12 Equipment and Materials carried

Audiometers105
Speech Training Units145
Sound Level Meters45
Tape Recorders81
Spare Aids132
Spare parts for aids152
Books148
Play and Testing Materials142
Files117
Stationery30
Typewriter2

(Separate tapes for recording the speech of individual children were carried by a few teachers.)

(xvi) Books, Pamphlets and Notes of Guidance

At several clinics and centres there were good collections of books and pamphlets for loan to parents, teachers and other people interested in children with impaired hearing. These made a valuable contribution to the work. (Where there are no central collections that are scrutinised regularly and to which additions are made as they are published, care should be taken in recommending pamphlets for reading since a number are now considered out-of-date.) Many teachers had prepared notes of guidance for distribution; to parents by 82 of them; to teachers in ordinary schools by 96; to health visitors by 27. Not all health visitors need notes of guidance: those who have been trained in techniques of hearing testing either at Manchester University or by their medical officers have their own notes for reference.

(xvii) Other Personnel Concerned with the Children

Many people shared the interest and concern of the teachers in the well-being of the children. Those who appeared to take the greatest part were head teachers of ordinary schools, educational psychologists and school medical officers. Otologists, health visitors and education officers were less frequently involved, head teachers of schools for the deaf and partially hearing and local authority inspectors of schools hardly ever. Paediatricians, speech therapists and social workers played some part but very few of these


[page 16]

people met regularly as a group in case conferences. Their association was usually on an individual basis, sometimes by letter, as need arose. Case conferences were more likely to be held in special audiology clinics.

In discussion the teachers mentioned education officers and local authority inspectors of schools much less often than otologists and school medical officers. This does not necessarily suggest lack of interest on the part of the former, but it may account to some extent for the confusion that has arisen in the development of a service that is mainly educational.





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Work of the Service


The duties of peripatetic teachers take them into hospitals, ENT and child health clinics, children's homes, schools and junior training centres. Each demands a different approach and different skills. Although not every teacher has responsibilities in every field, nevertheless many of them cover several. It cannot be expected that every individual will be equally skilled in them all; gifts and interests differ. Each field of work is considered separately below.

(i) Work in Hospitals

Several teachers of the deaf were employed by Regional Hospital Boards in Ear, Nose and Throat Departments as educational advisers. Although these people were not peripatetic teachers in the sense used in the survey and were not included in the investigations, their opinions were sought because they had a valuable contribution to make and their work affected that of the peripatetic teachers in the neighbourhood. Their main duties appeared to be assessment of the hearing of young children, preparation of audiograms for the otologists and consultants with whom they worked, early training of young children in communication skills and guidance of parents as well as advice about eventual school placement. In order to give useful and realistic advice it is essential for the teachers not only to know the home conditions in which the children live but also to have up-to-date knowledge of the available educational facilities in the area. Liaison with the local education authority is very important. This did not exist in every case.

Isolation from the educational system was seen to be a source of difficulty. In a hospital clinic it is possible, through enthusiasm and through incomplete knowledge of homes and schools, to make over-optimistic prognoses, to retain children on the books under clinic supervision for too long and to fail to pass on essential information to the education authorities whose responsibility they will eventually be. Because of this, local authorities are sometimes unaware of the presence of handicapped children in their areas; if such children come late to the notice of the peripatetic teachers outside the hospitals, suitable provision is difficult to arrange for them. Joint appointments by Regional Hospital Boards and Local Education Authorities largely avert this difficulty but are not without their attendant problems. Pressure from the otologists for the services of the teachers in preparing audiograms


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and reports and following up children with significant hearing losses can upset the balance between the two sides and hospital duties may take precedence over work in homes and schools.

(ii) Work with Young Children in Clinics and Centres and at Home

Clinics outside hospitals were of two kinds: those which were set up for the one purpose of hearing assessment and which were frequently connected with special schools, and those which were part of the local authority's child and school health services. The former had the advantages of concentration of equipment in usually ideal clinic conditions and the proximity of a school with which the parents could become familiar. Work in local authority clinics afforded different advantages: it provided easy access to doctors and other medical staff and also gave the opportunity to discuss problems with health visitors, speech therapists and educational psychologists. Conditions in clinics varied; some were purpose-built, others were in old houses. Islanded amongst rickety card tables and the signs and smells of the previous night's social club activities, teacher and child in one 'clinic' managed to dismiss their surroundings from their minds in the concentration of intensive listening.

These clinics were attended both by young children brought by their parents and by children of school age. Some very young children who had failed screening tests were referred by health visitors: others were sent by otologists at local hospitals. Those children who were found early were likely either to be very deaf or to have disorders of communication or learning. The quality of reports upon such children and the information contained in them varied; as the teachers rely on them when, after re-testing, they undertake guidance of the parents and begin their home visits, it is important that they should contain full and accurate information. Re-testing the hearing of very young children is often difficult; through lack of special training, not all the teachers had sufficient skill and the results could be unreliable, especially when handling unresponsive children. Many teachers were concerned about children whose response was erratic or even lacking and who were later found not to be deaf. It was debatable whether they should have been included in their case loads. Many teachers had only limited knowledge of child development and needed additional training. In assessing the potential of children it is important to consider the whole child in his environment and learn to observe closely and record faithfully. Those who had attended the course in Advanced Audiology at Manchester University and who were also teachers of young children showed the value of their training.

In some cases guidance for parents was given only in the clinics. This no doubt saved travelling time for the teacher but it also had disadvantages:


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if not handled with care the session could become a teaching period for the child rather than guidance for the mother. One grandmother who deputised for her daughter, was heard to say of a two year old. 'I've brought Tommy for his lesson'. It has to be made clear that these sessions are for the purpose of helping the parents of young children to understand the nature of their child's disability and its effects which include lack of normal means of communication. The teacher's role lies in convincing the parents that since facility in spoken English follows progressive stages and can be developed, they have an active part to play. Through purposeful guidance over a period parents can be encouraged to accept increasing responsibility for this growth of oral language and to make fewer demands upon the teacher's time. In this way, twice-weekly visits might be reduced to once a week and eventually perhaps to once a month. When this is achieved home visits might be replaced by sessions held at a clinic. It was seen to be much more difficult to achieve the right atmosphere in the clinic than in the homes where the children were surrounded by their own playthings and the mothers could be shown how to use the life of the home as a learning situation. Yet work in the homes was much more demanding: the mothers were more at ease in their own domains where the disciplined approach possible for the teacher in a clinic could not be enforced in the same way.

There were teachers who tended to 'teach' children rather than to help parents to develop their own skills. Some of them were conscious of their own lack of training and concerned that some of the mothers were unable to profit from guidance sessions. These mothers were living in over-crowded conditions, their families were large and noisy, they had other young children, or they could not grasp the significance of the advice. (Immigrant parents without an adequate knowledge of the English language were a particular problem). A mother who, on opening the door to the teacher, said 'Come in, sit down and keep quiet. You watch me this time' must have been like a bright star in a gloomy sky. She had accepted the guidance with understanding and knew her role.

Other factors also affected the time-table. Regular visits by men teachers to homes in some areas could be regarded with suspicion by unkind neighbours and lead to hurtful gossip. In these cases it was necessary to call in the evening; although this meant dealing with young children tired after an active day and upset the teacher's normal working hours, it had the advantage that other members of the family were at home and could be involved.

Home visiting with its purposeful guidance for parents can be the focal point of work with children whose hearing is seriously impaired. Since parents are usually in a highly emotional state and the peripatetic teacher's hand is the first to be extended in constructive help, his responsibility may


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be very heavy. It is not an easy task to lead parents towards accepting a handicap that is so difficult to understand.

(iii) Work with School children in Clinics and Centres

Some teachers were concerned only with children of school age. The number of clinics and centres at which they worked influenced the pattern of their work. Only those who had one definite base with office, telephone, secretarial help and amenities for display and storage were able to make their rooms attractive to the children who came there. Others worked from many centres - one from as many as seventeen - and conditions were often far from good. Co-operation with medical officers at the clinics varied.

Teachers who were employed by or seconded to a school health service had some advantages, such as access to clerical help and their own accommodation in the school clinics. Perhaps because the appointment cards sent to parents were directives from the Principal School Medical Officer, the rate of failure to attend appeared to be low. Regrettably it seemed to be more difficult to make the service known and appreciated in the schools.

Children of school age as well as young children were referred to the teachers by some otologists; in one or two areas, it was evident that the otologists were using the teachers to provide themselves with a service. This was useful in some ways but the work involved could upset the general balance. Again, the quality of relationships and exchange of information between the teachers and the otologists and local authority medical officers was important. Some teachers were despondent about the lack of co-operation and complained of the paucity of information they received about children under treatment and those issued with hearing aids.

The main duties with children of school age were two-fold: assessment of hearing and improvement of performance in school. In most areas the hearing of all school entrants was tested; only eight teachers reported that this was not done. Screening and referring children to the teacher was done by specially trained nurses, health visitors, audiologists and clerical assistants.

A working group on 'the early detection and treatment of handicapping defects in young children' which was appointed under the World Health Organisation and met in November 1966 defined screening systems as implying the application to all children, 'of certain procedures which can be carried out in a short time by the less specialised members of the staff and which will give an indication of the presence or absence of certain disabilities. Some of these procedures may give a definite indication that the child either has the disability or cannot possibly have it. Others are less definite, indicating only


[page 21]

that the child may have a disability. If the result is positive, indicating the actual or probable presence of the disability, the child is referred for specialist investigation and care. If the result is negative, no further investigation is carried out.'

Screening of school entrants brought to light many children with slight hearing losses due to catarrhal conditions which might clear up in the normal process of growth. Indiscriminate follow-up of all these children involved teachers in much work that was not profitable use of their time. One teacher was reported to have 1,370 children on his register. Such a case-load precluded work in schools. The priorities determined by teachers with very large case loads were usually assessment of hearing (which they carried out at the request of otologists and school medical officers) and follow-up of screening tests. So many children were referred for assessment, following routine or selective medical inspections or after screening, that very little time remained for tutorial or remedial work. One teacher devoted nine sessions per week to assessment and one to school visits. This was in great contrast to the brief laid down at the commencement of the service in that area.

Children whose hearing loss constituted an educational hazard were referred back to the medical officers and otologists for further attention and possible supply of hearing aids and were kept under review. Those whose speech was poor and whose attainments indicated retardation were accepted for tutorial work in speech, auditory training and development of communication skills. Such work could be with individuals or with groups, in the clinics or in schools. Many other children, particularly those who lived in industrial areas, had intermittent periods of hearing loss which, although not severe at any one time, were nevertheless significant in total and gave rise to retardation in school work. These children are properly the responsibility of the ordinary teachers, who require information from the peripatetic teachers in order to understand the educational need in such conditions. Working in the clinics often afforded valuable opportunity for collaboration with speech therapists and educational psychologists. It saved travelling time but it tended to be divorced from the schools and normal educational practice. Where the significance of the work was not realised either by the family or by the school, it sometimes resulted in spasmodic attendance at tutorial sessions.

Related duties included recommendations for school placing and change of school. This demanded a knowledge of local and regional provision which not all teachers had; in some areas closer links between the peripatetic teachers and the schools, both special and ordinary were needed. Many children who were linguistically retarded required more help than the teachers had time to give. Many of the teachers were urging their local authorities to set up


[page 22]

units for the partially hearing, but in the present shortage of qualified teachers of the deaf to staff them, such pleas can be unrealistic.

The relationship of the peripatetic teachers with children admitted to partially hearing units varied. In some areas connection ceased when the children were admitted. In others, the teachers continued in an advisory capacity and maintained interest in the children's progress and their future school careers. For this kind of relationship it is essential that the function of the service is understood, that the peripatetic teachers are diplomatic, tactful and persuasive and that their status is accepted by the headteachers. That many of them possess such qualities was evident in those areas where relationships between them and the headteachers were good. The units are integral parts of schools and although the work done in them may be outside the experience of the heads, they come under their authority. For the peripatetic teacher whose status is not determined, giving guidance to inexperienced teachers in the units might be regarded by the heads as interference.

The same qualities are called for when recommending placement in special schools. There were very few instances of disagreement between peripatetic teachers and special schools or of parental objection to special school placement.

(iv) Work in Schools

The majority of children with impaired hearing had been identified through screening tests at the time of entry to school but some who had missed the screening tests in their early school life or whose deafness was later in onset were referred by school medical officers. On-going assessment was continued but, with the passage of years, duties became mainly educational with older pupils. Teachers were seen at work in nursery, infant, primary, secondary and special schools and in junior training centres. Each type of school set its own problems.

By virtue of their organisation, nursery, infants' and progressive primary schools appeared best able to use the service provided by the peripatetic teachers, although finding space for working was not always easy. Good co-operation with clear desire to give maximum help to the children was evident in many, and some peripatetic teachers were able to spend valuable time in the classrooms talking to the teachers and observing the children at work. In many schools where co-operation was unstinted, over-crowded conditions, noise and poor facilities for testing were unfortunate obstacles.

Since the visits made by teachers with heavy case-loads are likely to be infrequent, the value of time spent in tutorial work is doubtful. Half an hour per week (a generous allocation) is small in relation to a 25 hour school


[page 23]

week. It is important, therefore, that there shall be opportunity to talk to the class teachers and advise them about the disability and the handicap it can impose and about hearing aids, their uses, their limitations and their maintenance. In many schools, where classes were large and teachers were over-pressed, it was often difficult to find opportunity to talk in this way. The advisory function of the peripatetic service is carried out in some areas by means of one-day conferences to which groups of teachers from ordinary schools are invited. Such conferences should be arranged regularly and frequently in order to keep pace with staff changes.

Work in secondary schools presented the greatest difficulties. Pupils were taught by many different teachers, not all of whom were interested in the special needs of minorities, and opportunities for meeting those most involved were not easy to arrange. It was seldom that one teacher had responsibility for the handicapped pupils in general or for those who wore hearing aids. Additional help was needed in many subjects. For work of value to be done, this called for liaison with different specialist teachers in each school and demanded wide interests and knowledge. In large schools, some of which spread over several buildings on an extensive campus, there was the task of finding the pupils, finding a space in which to work and fitting the session into the peripatetic teacher's and the pupil's time-table. Much precious time was consumed in this way. It is doubtful if the services of peripatetic teachers, who are in short supply, are used economically in such remedial work in secondary schools. Part-time teachers interested in remedial work might be an alternative source of help.

Workers in teams were able to specialise in specific subjects or certain ages but then had to cover larger areas. Some members assumed charge of young children while others attended to the older group; some, at secondary level, provided help in specific subjects. The problems inherent in allocating duties spread over large areas are matters of deep concern. Demands were greatest upon teachers working in isolation, who would, of necessity, have to cover all stages, all levels and all subjects. An organiser in one county arranged meetings and weekend conferences for his assistants and planned to invite teachers from neighbouring areas to join them.

A number of teachers went into junior training centres, where they were welcomed. Conditions were often difficult but the contact was worthwhile.

Some teachers referred to problems that arose from the frequency of staff changes in the ordinary schools; the same cause gave rise also to difficulties in the peripatetic service. Teachers who had worked consistently in one area had built up the confidence of headteachers and teachers in local schools, and the degree of co-operation was high. Conversely, in an area where changes were frequent, a full establishment had been reached in


[page 24]

only two of the thirteen years of its existence. It was impossible, in the resulting situation, to give a reasonable service. Stability is essential if work of any value is to be done.

(v) Liaison with Parents

The size of case load held by the teachers was indicative of the kind of work with which they were faced. Although large numbers frequently included children who were seen only once, there were always some who needed continuous attention and whose parents appreciated guidance and support at all stages. Too often, guidance was given only when children were young. Parents, as well as their children, and the teachers, need to know about the use, value and maintenance of hearing aids. They need also to have contact with other parents similarly placed and to meet together to discuss their common problems. Those teachers who, along with parents, took active part in Parent/Teacher Associations and the National Deaf Children's Society and other appropriate organisations and those who organised day and weekend conferences were doing good work.

(vi) Liaison with other Services

The amount of liaison with other services differed according to the personality and opinion of individual teachers. Smooth-running services resulted when teachers pursued a firm policy of close co-operation with heads of special schools for the deaf and units for the partially hearing, with other kinds of special schools, with hospitals and with officials of the local authorities. It was unfortunate that in some areas where there was variety in provision and there could have been useful collaboration, liaison between the different workers was poor and opportunities for co-ordination were lost.

Children placed in boarding schools a long way from their homes are often lonely in the long summer holidays. Several peripatetic teachers, who had known boys and girls from the time when they were very young, organised social occasions for them and acted as a link between home and school. Knowledge of the background of pupils who live many miles distant can be very difficult to obtain and by way of this link with peripatetic teachers heads of special schools who understood the purpose of this aspect of the service were able to receive valuable information.

Since all except organisers had school holidays, such activities were not possible if the holiday periods coincided. Sometimes staggering of holidays allowed teachers still to be at work when the schools were closed. There


[page 25]

was, of course, no difficulty in Lancashire and parts of Yorkshire where school holidays coincide with Wakes weeks, which are staggered between towns.

From beginnings such as this, comprehensive organisations involving all services are slowly emerging.

(vii) Liaison with other Agencies

In a very few areas, liaison with other agencies was developing. Some of these agencies were part of the local authority health service: others were within the education department. Teachers who worked from health and school health clinics and were able to meet and discuss problems with medical officers, speech therapists, health visitors, social workers and personnel from child guidance clinics found this of great value. Others profited from their contact with educational psychologists and members of remedial teams. Each had a contribution to make in reaching decisions about suitable educational provision. Young people leaving boarding schools and entering employment needed support, advice and guidance on leisure pursuits and careers. Contact with Youth Club Leaders, Youth Employment Officers and Welfare Officers of the Deaf was useful. Several peripatetic teachers were becoming increasingly conscious of their role in maintaining contact with the young people until they were settled in their jobs. This applied not only to the leavers from boarding schools but also to those from day schools and units. Many pupils travel long distances to their day schools. In one case a peripatetic teacher ran a club which catered for their immediate needs and was fully appreciated.

Many young people leaving school had received no advice that they could understand as to how to find and pursue courses in further education and those peripatetic teachers who were knowledgeable and ready to guide them were fulfilling a valuable function.

In addition to their work with children and teenagers, many teachers were acting as advisers to local education authorities. This called for wisdom, vision, tact and knowledge. Not all had enough experience to develop these qualities or to give them the full knowledge of educational goals that are required for such responsible positions. Their plea was for enlightened leadership from people who understood not only the needs of children with impaired hearing but also the full extent of educational provision. Many of these general duties tended to be outside the scope of the normal hours of a teacher's working day and they called for a flexible time-table into which administration and clerical work could be fitted. The organisers were able to arrange their programmes according to demands; not all of them had case


[page 26]

loads. Their team members were differently placed: in many cases their duties had become too complex.

Peripatetic teachers cannot provide special educational treatment for all hearing-impaired children in their areas. They can only make recommendations for what they consider to be suitable provision and give definite help to a limited number whose handicap is not severe.





[page 27]

Priorities


Since the heavy demands imposed upon the teachers are not likely to be fully met by increased staffing for several years to come, it is necessary for appointing bodies as well as teachers to be clear about priorities. If there is to be full growth of this service terms of appointment must be related to the special skills of the teachers. Only in this way will maximum use be made of the teachers available.

Many case loads are unrealistic and the resulting services are a cause of dissatisfaction both to the teachers and to the local authorities employing them. Survey of the daily programmes, with their attendant problems, suggests that a redefinition of priorities is needed. The following are considered appropriate functions of a peripatetic teacher but the emphasis may vary according to local circumstances.

1. Collaboration
(a) with special schools and units catering for children with impaired hearing to provide a comprehensive service
(b) with other services
(c) with other agencies
2. Audiometric testing of hearing; sustained observation and assessment only of those children who are likely to need special education or additional help in school

3. Advice on educational placement based on full knowledge of the abilities and disabilities of each child under consideration and the facilities available in the area or region

4. Parent guidance as an on-going service

5. Training children in

(a) auditory discrimination that leads to optimum use of hearing aids in all situations
(b) auditory discrimination linked with improvement in speech and growth of language
(c) maintenance of hearing aids
6. Advice to teachers in ordinary schools

7. Remedial teaching that is closely linked to the work of the school and is limited to children whose need is for more specialised help than can be provided by an ordinary remedial service

8. Follow-up of children placed in schools and units remote from their homes.


[page 29]

Observations and Conclusions


The value of this service is evident. It can provide the focal point for the beginnings of education for children with all degrees of impaired hearing but it cannot provide a continuing full education for all of them. It can ensure that parents are given guidance in the early years when their emotional needs are at their height; it can give them continued support as their child enters each succeeding stage of development. It is a worthwhile service but is not as yet fulfilling the role of which it is capable. The following observations are offered as a means to further development.

1. The peripatetic teacher of the deaf holds a highly responsible position in relation to the educational provision that is made for children with impaired hearing. The children's future development can be determined by him. Continuity is an important factor in the establishment of a good service.

Appointments should be made with care and conditions of service should be such as to foster stability.

2. The superiority of a service in which medical and educational departments fulfil their roles in harmony is clearly evident. Liaison is much affected by quality of relationship and ease of communication between them. The peripatetic teacher has a significant part to play as the link between them.

In order to preserve the right balance between the two, the teacher appointed should have the personal qualities, the knowledge and the training needed for the post.

3. The advantages of a service in which peripatetic teachers have vital connections with colleagues, schools and other services and agencies are very marked. Work in isolation is frustrating and, in many cases, unsatisfactory and much time is wasted in travelling.

Area development is recommended, in which teachers work under the direction of a skilled leader or organiser, whose aims and personal qualities encourage positive linkage with other services.


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4. Frequent communication is needed between members of a profession whose work is done in comparative isolation. Deterioration in quality of work, and diminishing sense of purpose, can occur when there is no opportunity to share ideas.

In developing plans for regional organisation, facilities should be provided for regular meetings in a central place where there is a good supply of up-to-date literature and text books and from which the work can be directed.

5. Demands for additional staff are not always reasonable. The service, as it develops, is mainly advisory and in many cases further consideration of the duties undertaken will lead to re-organisation of the programme and more economic use of the skills particular to teachers of the deaf.

The pressures on the specially qualified teachers could be reduced by re-examination of the duties involved, collaboration with remedial services and the appointment of part-time teachers (who are not necessarily qualified teachers of the deaf) to help with remedial sessions, particularly at secondary level.

6. Screening procedures for babies and school entrants are now general in the country. Time spent in testing five and six year olds who will not need the special skills of peripatetic teachers of the deaf upsets the balance of their work.

A second more searching screening test, carried out by workers other than teachers, would result in more appropriate cases being referred to the peripatetic teachers. Some additional training for this work would be required.

7. In some areas, maintenance of hearing aids and supply of spare parts is taken over by the peripatetic teachers of the deaf.

While the reasons for undertaking maintenance duties are understood, it is no part of the teacher's duty to spend time in making moulds for inserts.

8. Conditions in clinics and schools are not always easy. Those arising from physical difficulties cannot often be changed and must be accepted. Others arise from lack of understanding.

The purpose of the service and the status of the teachers should be made clear.


[page 31]

9. The different aspects of administration, both medical and educational, are a frequent source of worry to the teachers.

Short courses of training in administration would be of value to many teachers.

10. Many teachers regard work with young children as fundamental to their duties but few are fully confident even after several years of experience. Because their knowledge of child development is insufficient to enable them to differentiate between the normal and the abnormal, they are often uncertain about their conclusions. Testing, assessment and diagnosis and the beginning of training in the development of communication skills all present difficulties that are sometimes excessive.

A scheme of training in all aspects of pre-school work is urgently required. Many teachers now in the field would benefit from such a course.

11. Parent guidance is frequently orientated in the wrong direction and emphasises teaching the child rather than guiding the family. It is a broadly based subject that demands knowledge of family structure and characteristics, the influence of environment and the study of sociology.

A scheme of training to include parent guidance and all the allied aspects of sociology is needed.

12. When accepting responsibility for recommending placement in school peripatetic teachers do not always have full information on local, regional and national facilities. Standards in ordinary schools can be estimated by teachers who have had several years' experience in them but conditions and methods change and schools assume different characteristics with changes of head and staff.

Peripatetic teachers need to be up-to-date in their thinking. They should be given opportunity both to attend courses and to visit those educational establishments to which children in their care may need to go. Valid recommendations for placement cannot be made without up-to-date knowledge of facilities.

13. When young people whose hearing is impaired first take up employment, they very often need more support than their parents and the schools they have left can give.

The peripatetic teacher of the deaf can fulfil a role in giving support in the early period at work. (The teacher who is knowledgeable about


[page 32]

local conditions and opportunities for employment that is suited to young people with hearing impairment can be of particular value to the school leaver who is not in direct contact with a welfare officer for the deaf.) It will be necessary to make the purpose of this aspect of the work clear to head teachers, welfare officers of the deaf and youth employment officers.

14. The survey has shown that the peripatetic service is the starting point of the education of hearing-impaired children. All other branches of provision develop from it. The survey has also shown the wide range of roles and duties of the peripatetic teacher of the deaf and the difficulties which may arise in such a service, especially when teachers are working in isolation. The special skills of such teachers, who are in short supply, are used to the fullest advantage when they are able to work in close co-operation with others concerned with the education of hearing-impaired children in ordinary schools as well as in special schools and classes.

There is an obvious need for the development of comprehensive and closely integrated educational provision for all children with impaired hearing in which peripatetic teachers of the deaf can play their part in close co-operation with others.






[insert]

[The following type-written note on a sheet of paper was inserted at the back of the document.]

NOTE

The leaflet ("Teach Deaf Children") has been prepared by a group of the organisations concerned, in order that the interest and possibilities of this work can be brought to the attention of young people contemplating a teaching career. This leaflet, which gives an up-to-date and succinct account of the opportunities for training and teaching, is being distributed to colleges and university departments of education and to youth employment officers.




[inside back cover]




Crown copyright 1968

Published by
Her Majesty's Stationery Office

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