Authors: Anna Kell, Cindy Corbett, Donna M. Kazemi, Stephen Fitzmaurice, Robin M. Dawson
Categories: Regular Article, Deaf and hard of hearing, Scoping Review, Transition experiences
Source: Health Care Transitions
Authors: Anna Kell, Cindy Corbett, Donna M. Kazemi, Stephen Fitzmaurice, Robin M. Dawson
Adolescence is a crucial time of transition in all aspects of life. Transition experiences for culturally Deaf individuals and individuals who are deaf or hard of hearing often differ from the mainstream population. The purpose of this scoping review was to examine and synthesize the existing literature surrounding transition experiences for culturally Deaf and deaf and hard of hearing populations through the lens of Meleis’ Transitions Theory.
Using PRISMA-ScR guidelines, a scoping review of literature related to transition experiences for culturally Deaf individuals and individuals who are deaf or hard of hearing was conducted. The scope of the review was limited to articles focused on the United States and Canada published in the past ten years.
After the screening process, 46 sources related to transition experiences remained. The following transition periods were postsecondary education transitions, early childhood transitions, other education transitions, vocational transitions, social transitions, independent living transitions, and health-related transitions. Additional concepts from Meleis’ Transitions Theory, such as transition types and transition conditions, were identified and included in the thematic analysis.
Existing literature primarily focused on educational and vocational transitions during adolescence and young adulthood. However, most quantitative studies were secondary analyses of the National Longitudinal Transition Study (NLTS2). Future research should focus on intervention work and other relevant transitions, such as health care transitions.
Transition experiences occur throughout the lifespan for all individuals. Typically, developmental transitions are marked by key milestones, including aspects like adequate employment, social acclimatization, changing family roles, and academic accomplishments.^1^ For individuals who are culturally Deaf and individuals who are deaf or hard of hearing, these transitions can be complicated by population-specific factors such as language and cultural barriers, the availability of resources, and access to appropriate accommodations. According to the National Deaf Center on Postsecondary Outcomes,^2^ the primary goal of transition planning is to prepare students for life after high school.
The general population often views deafness as a medical condition or disability; however, many members of the Deaf community view their deafness as part of their cultural heritage.^3^ For this reason, deaf (designated with a lower-case d) will be used when speaking of the disability, medical condition, or individuals with hearing loss who do not identify as culturally Deaf; Deaf (designated with a capital D) will be used to refer to the Deaf community and those who identify as culturally Deaf.^4^ Additionally, individuals who identify as part of the Deaf community view their deafness as part of their cultural identity and choose to use the term “Deaf” over person-first language, such as “individuals with hearing loss” or “persons who are deaf”.^5^
This scoping review was conducted through the lens of Meleis’ Transitions Theory. As a middle-range theory with multiple uses with diverse populations, Meleis’ transitions theory provides an appropriate framework for presenting and interpreting the results of a literature review on transitions for culturally Deaf individuals and individuals who are deaf or hard of hearing.^6^ Meleis’ transitions theory has a broad application beyond health-related transitions, focusing on the elements of transitions from one stable state to another. The theory accounts for numerous elements related to themes associated with transitions applicable to any population and situation.
Previously conducted scoping reviews have included some emphasis on transition experiences for individuals who are deaf or hard of hearing.7, 8, 9, 10, 11, 12 Two existing scoping reviews focused on parental experiences and support in the early intervention years.7, 8 We also identified multiple scoping reviews that did include deaf and hard-of-hearing populations but focused on broader categories of disabilities.9, 10 While some previously conducted scoping reviews did examine the transition experiences of individuals who are deaf or hard of hearing, the aims of these reviews were directed toward a specific transition experience or developmental period.11, 12 In reviewing related scoping reviews, none were identified that looked specifically at the transition experiences throughout the lifespan specific to the Deaf population.
The overarching purpose of this scoping review was to examine and synthesize the existing literature surrounding transition experiences for culturally Deaf and deaf and hard of hearing populations. Specifically, our goals in this scoping review were (1) identify the transition types and subtypes addressed in the existing literature; (2) assess the study designs, methods, and measurement tools most commonly used in transition research; and (3) explore the various conditions that facilitate and inhibit transition among culturally Deaf, deaf, and hard of hearing populations.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) Checklist was used to conduct a literature review.^13^ Given the expansion of the Americans with Disabilities Act in 2009, we elected to include articles published from January 2009 to the time of this literature search in February 2024. All included articles were quantitative and qualitative research articles published in English, including dissertations and theses. We included articles that focused on deafness exclusively and excluded articles that focused on multiple disabilities or individuals with multiple disabilities. We limited the inclusion criteria to US and Canadian populations, excluding studies conducted outside North America, as Deaf culture and community experiences differ significantly between regions. Additionally, we excluded articles not published in English.
After consultation with a university librarian, we conducted a literature search based on the prior inclusion criteria using the following PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), American Psychological Association (APA) PsychInfo, and Education Resources Information Center (ERIC). The above databases were selected based on their relevance to disciplines traditionally involved in transition planning. We searched the above databases using Medical Subject Heading (MeSH) terms or equivalent subject headings and key terms related to deafness and transitions. In PubMed, we used the following MeSH deafness; persons with hearing impairment; education of hearing disabled; health transition; rehabilitation, vocational. Related subject headings and terms were searched as appropriate in other included databases. Table 1 displays an overview of the subject headings used for select databases. To account for possible gray literature, we followed the recommendations outlined by Paez.^14^ We searched two additional databases, ProQuest Dissertation and Theses Database and Web of Science, including dissertations and theses in our results to ensure a comprehensive overview of transition-focused literature.Table 1Summary of Subject Headings.Table 1DatabaseSubject HeadingPubMedDeafness; persons with hearing impairment; education of hearing disabled; health transition; rehabilitation, vocationalCINAHLDeaf culture; deaf education; deafness; hearing loss, partial; transitional programs; rehabilitation, vocationalAPA PsychInfoDeafness, hearing loss, college transition, school readiness, school transition, school to work transition, transition planning, vocational education, vocational rehabilitationERICDeafness, hearing impairment, career readiness, school readiness, college readiness, individualized transition plans, transitional programs, vocational education, vocational rehabilitation
We completed the initial search with the university librarian, which included a total of 1986 articles. We identified and removed 941 duplicate records using EndNote, followed by a manual review. Following the removal of duplicates, two authors participated in the remaining rounds of article review. By reviewing titles alone, we excluded 676 articles. After reviewing the abstracts, we determined that an additional 291 articles did not meet the inclusion criteria. The remaining 78 reports were assessed for eligibility. We excluded 32 articles for the following 1.Focusing on the transition experiences of another population, such as parents (two articles);2.Focus on multiple disabilities or primarily on individuals with multiple disabilities (two articles);3.Lack of focus on transition defined by Meleis^6^ as moving from one stable state to another stable state (15 articles);4.Not a research study (four articles); and5.Population of focus outside the US and Canada (nine articles)
There were no disagreements between reviewers regarding the selected articles. Additional citation searching did not reveal any other articles meeting the inclusion criteria. The identification and screening process is outlined in the PRISMA figure below.(Fig. 1).Fig. 1PRISMA Table.Fig. 1
Following the identification of articles that met inclusion criteria, we extracted the following initial information from each article as applicable based on the PRISMA-ScR study purpose, theoretical framework, study design and methodology, measurement tools, participant number, population of interest, location, and years for data collection. We also extracted and charted the transition type and conditions based on Meleis’ Transitions Theory and divided these variables into subtypes.^6^
During the initial screening process, after all inclusion and exclusion criteria were applied, 46 articles remained, including 29 quantitative, 12 qualitative, and five multimethod studies. Reviewing the included studies, we identified all four types of transitions in Meleis’ situational, developmental, health/illness, and organizational.^6^ Additionally, we identified seven subtypes of transitions dealing with specific transition postsecondary education transitions, early childhood education transitions, other education transitions, vocational transitions, social transitions, independent living transitions, and health-related transitions. Using the transition conditions (facilitators and inhibitors) concept from Meleis’ Transitions Theory, we also identified other variables, including personal, community, and societal factors.
The majority of selected studies focused solely on culturally Deaf students and recent graduates or students and recent graduates who are deaf or hard of hearing.15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42 A single study focused on preschool children exclusively.^43^ One study focused exclusively on parents of children who are deaf and hard of hearing,^44^ while three additional studies focused on both parents and professionals.45, 46, 47 Two studies focused on the experiences of students and parents.48, 49 One study focused on Deaf community stakeholders.^50^ Another study focused on Deaf adults who identified as part of the LGBTQ+ community.^51^ Hinz^52^ studied a combination of professionals and Deaf individuals, while Luft^53^ studied specific types of secondary Deaf education programs. The remaining studies focused on other professions related to the Deaf community, including teachers of the deaf, school administrators, allied health professionals, and vocational rehabilitation counselors.54, 55, 56, 57, 58, 59, 60
Sample size varied considerably between studies based on design. Of the eight studies with strictly qualitative methods, sample sizes ranged from four^16^ to 24.^32^ One qualitative study, a five-site study with community conversation events, did not specify sample size.^50^ Sample sizes of the quantitative, mixed-method, and multimethod studies ranged from 19^46^ to 1345.^59^ Many of the studies based on secondary analysis of existing data did not include specific participant numbers.18, 19, 23, 25, 27, 35, 40, 43, 57
As noted in the inclusion criteria, all selected studies were conducted within the United States (US) and Canada. Two studies focused on populations across Canada,45, 54 while five studies were conducted throughout Ontario.16, 32, 48, 49, 55 An additional Canadian-based study focused on western Canada.^47^ The remaining studies focused on US populations. Swenson’s^42^ study of Deaf recent college graduates was limited to those residing in California, while Porter-Vaughn^38^ and Rugg and Donne^46^ limited their studies to the Northeast area. Chevalier^21^ focused on the Deaf community in the Denver metro area. Three studies were conducted in the District of Columbia (DC) area, a region known for a higher population of culturally Deaf individuals.17, 24, 51 Luft and Huff^30^ surveyed students in the Midwest, and Appelman et al.^15^ focused on the northwestern US. Additional studies included state-specific populations in New Jersey, New York, Texas, Arizona, Tennessee, and Ohio.22, 31, 37, 41, 60 The other 23 studies were either unspecified cities or across the United States.18, 19, 20, 23, 25, 26, 27, 28, 29, 33, 34, 35, 39, 40, 43, 44, 52, 53, 56, 57, 58, 59, 61
Nineteen studies mentioned a specific theoretical framework or approach.16, 21, 25, 26, 28, 29, 37, 38, 41, 42, 45, 48, 50, 51, 54, 58, 60, 61 Overall, sixteen different theoretical frameworks, models, and approaches were mentioned, with several studies (primarily dissertations) including multiple theories. Wehmeyer’s functional self-determination theory was the most utilized, being used in three studies.25, 26, 60 Tinto’s themes for inquiry on retention served as the framework for two studies.21, 38 Porter-Vaughn^38^ also used Perry’s student development theory and Bandura’s self-efficacy theory. Two studies were guided by an ecological model.45, 54 One study had a community-based participatory research approach.^50^ Two studies were guided by the social cognitive theory, with Johnson et al.^28^ also including the expectancy-value theory in guiding their research28, 37. Jun^29^ used the self-determination theory, Palmer et al.^61^ used capital theory, and Swenson^42^ used Farrington’s five noncognitive factors. Blair^16^ utilized the self-efficacy theory, while Schlossbert’s Transition Theory guided Shaginaw’s^41^ dissertation research. DuBois^48^ used entrainment theory, and Mauldin and Fannon ^51^used feminist disability studies as their research approach. Two additional models were identified in the included The Model Transition Process for Deaf and Hard of Hearing Youth and the Social-Psychological Model37, 58. The remaining 27 studies did not identify a guiding theory, model, or approach.
Eight qualitative studies had descriptive designs.24, 45, 49, 50, 51, 54, 55, 56 Researchers for three additional qualitative studies, all dissertations or theses, used a case study design.16, 29, 52 Three studies were phenomenological.38, 42, 60. Researchers for one study used a grounded theory approach.^32^ All the strictly qualitative studies used interviews or focus groups for data collection.16, 24, 29, 45, 49, 50, 51, 52, 54, 55, 56 For the qualitative component of two multimethod studies and one mixed-method study, researchers used either focus groups, interviews, or a combination of both.41, 46, 59 In contrast, researchers for the other multimethod studies used open-ended survey questions as part of a qualitative component.17, 53, 57
Researchers most commonly used secondary analysis of an existing national dataset or previously conducted study.18, 19, 20, 22, 23, 25, 26, 27, 28, 31, 34, 35, 39, 40, 61 Of the 15 secondary analysis studies, 13 were based on the same dataset – the National Longitudinal Transition Study-2 (NLTS-2), a 10-year study conducted from 2000–2010 focusing on the transition from adolescence to young adulthood for students in special education.18, 19, 20, 23, 25, 26, 27, 28, 34, 35, 39, 40, 61 For the remaining secondary analysis studies, Meinzen-Derr et al.^31^ used data from the Ohio Early Hearing Detection Intervention Program, and Convertino, Marschark and Sapere^22^ used data from previous studies.
Eight quantitative studies had a cross-sectional design where researchers used surveys for data collection.15, 21, 30, 33, 37, 44, 47, 58 While most researchers did not specify which survey tools they utilized, several specific measurement tools were mentioned in the literature. Pearson^37^ used the outcome expectation and career-related parent support scales. Appelman et al.^15^ developed a survey based on the NLTS2 data. Luft and Huff^30^ used the Transition Competence Battery, while Myers and Takayama^33^ used a knowledge, skills, and abilities questionnaire in their study of recent graduates. A national needs assessment survey, which was noted to have a poor response rate of ∼14 %, was used.^44^
Researchers for the five multimethod studies and one mixed-methods study all used a cross-sectional descriptive design for the quantitative component, using surveys for data collection.17, 41, 46, 53, 57, 59 Luft^53^ used the transition services survey, and Shaginaw^41^ used the college mattering inventory. No specific survey instruments were mentioned in the remaining multimethod studies and mixed method study.17, 41, 46, 53, 57, 59
One additional non-experimental study used a longitudinal design.^43^ In this longitudinal study, researchers used three specific surveys to measure school the Clinical Evaluation of Language Fundamentals-Preschool, Wechsler Preschool and Primary Scale of Intelligence, and the Bracken Basic Concept Scale–Receptive.^43^ The surveys were administered using a pre-test followed by a single post-test.
Only one study included any intervention work.^48^ DuBois^48^ used a quasi-experimental design to assess the effectiveness of a music-based 12-week intervention with preschoolers. Using pre-test and post-test surveys, DuBois^48^ assessed child participants for two interventions and one control group in the following phonological awareness in rhyming, social skills, motor skills, and language skills.
Meleis^6^ identified four types of transitions – developmental, situational, health/illness, and organizational. All four types of transitions were identified in the reviewed literature, with situational and developmental being the most common. The majority of included studies addressed multiple types of transitions simultaneously.15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 37, 38, 40, 41, 42, 43, 44, 45, 47, 48, 49, 50, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61 In addition to the broad categories of transition types, we identified the following transition periods in the postsecondary education transitions, early childhood education transitions, other educational transitions, vocational transitions, social transitions, independent living transitions, and health independence transitions.
Forty-three studies addressed some developmental transition.15, 16, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 37, 38, 39, 40, 41, 42, 43, 44, 45, 47, 48, 49, 50, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61 However, no single study addressed developmental transition alone. Developmental transitions were seen most commonly in combination with situational transitions.15, 16, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 33, 34, 35, 37, 38, 40, 41, 42, 43, 44, 45, 47, 48, 49, 50, 52, 53, 54, 56, 57, 58, 59, 60, 61 However, three studies included both developmental and health/illness transitions.29, 32, 55 In addition to focusing on health/illness and developmental transitions, Jun^29^ included aspects of organizational transition type.
The overwhelming majority of the studies that included developmental transition focused on the transition from adolescence to young adulthood.15, 16, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 32, 33, 34, 35, 37, 38, 39, 40, 41, 42, 44, 48, 49, 50, 53, 55, 56, 57, 58, 59, 60, 61 These studies focused on a variety of periods of transition, including vocational and post-secondary education as well as independent living. The remaining developmental transition studies focused on younger years, looking at early intervention and early elementary years.31, 43, 45, 48, 54
As previously mentioned, developmental and situational transitions heavily overlapped. Of the 44 studies that mention some type of situational transition, forty-one of them also include a developmental transition.15, 16, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 33, 34, 35, 37, 38, 40, 41, 42, 43, 44, 45, 47, 48, 49, 50, 52, 53, 54, 56, 57, 58, 59, 60, 61 Two situational transition studies included health/illness transition types, and two included organizational transitions.17, 29, 59 Two studies focused on situational transitions alone, including experiences specific to the Deaf community, such as finding a Deaf identity and transitioning between spoken and signed language.46, 51
Most studies on situational transition types focused on post-secondary education or vocational transitions. Twenty-five studies mentioned post-secondary transitions.15, 16, 18, 19, 21, 22, 23, 24, 26, 27, 28, 29, 30, 34, 35, 37, 38, 40, 41, 42, 44, 46, 50, 53, 58, 60, 61 While some overlap is present with situational transition type studies that addressed both post-secondary and vocational outcomes, eighteen studies mentioned vocational transitions.19, 20, 23, 25, 26, 27, 30, 33, 34, 38, 44, 52, 53, 56, 57, 58, 60, 61
Only two studies included organizational transition types, both in combination with other transition types.17, 59 Cawthon et al.^59^ studied the organizations and professionals that assisted in post-secondary transitions for individuals who are deaf or hard of hearing. Bowman and Crowe^17^ looked at the organizational factors surrounding the abrupt transition to online learning during COVID-19 among college students who are deaf or hard of hearing.
Researchers from four different studies mentioned some type of health and illness transition.17, 29, 32, 55 Two studies focused on developmental changes related to adolescents transitioning to self-management of hearing healthcare and adult hearing healthcare services.32, 55 The other two studies focused more on situational and health care transitions, with researchers studying the effects of the COVID-19 pandemic.17, 29, 32, 55
Postsecondary education transitions were the most commonly found in the literature. Twenty-eight studies included some focus on postsecondary education transitions.18, 19, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 34, 35, 37, 38, 40, 41, 42, 44, 50, 52, 53, 56, 58, 59, 60, 61 However, many researchers focused on vocational and post-secondary transitions simultaneously due to the experiences often being interrelated.19, 23, 25, 26, 27, 30, 34, 38, 44, 52, 53, 56, 58, 60, 61
Researchers from two studies found a strong relationship between parental expectations and postsecondary school attendance,19, 28 echoing earlier findings regarding parental expectations of post-secondary education.27, 37, 44 Johnson et al.^28^ found that while only half of the parents surveyed expected their children to attend postsecondary education, over 75 % of youth expected to attend at least a two-year postsecondary school. Parental expectations were also found to have a statistically significant impact on autonomous actions related to post-secondary education and subsequent vocational outcomes.^25^
In an interview by Dorminy,^24^ one participant reflected upon how his parents’ involvement built the foundation for developing his self-advocacy “My parents were always very motivated to go to Individualized education program (IEP) meetings; they always wanted to stay on top of things. As I got older, I developed the ability to talk with the teachers myself.”^24^ ^(p98)^ However, professionals noted that transition planning often lacks parental support.^60^
When culturally Deaf recent college graduates and recent graduates who are deaf and hard of hearing were asked about factors contributing to their postsecondary success, many mentioned themes related to intrinsic motivation, self-confidence, self-effort, and learning experience engagement.16, 42 Individuals who had completed post-secondary education were found to have higher levels of self-advocacy and personal autonomy.^27^ Self-determination attitudes and behaviors were critical transitional skills for post-secondary enrollment and success.23, 29, 52
Self-advocacy was associated with greater access to postsecondary settings and activities,^59^ with 55.6 % of participants noting that instruction in American Sign Language (ASL) made for smoother integration into higher education.^21^ Porter-Vaughn^38^ identified common themes in the postsecondary transition experience for culturally Deaf students and students who are deaf and hard of hearing, including the need for appropriate accommodations in order to succeed. Many students interviewed described miscommunication and misunderstanding of accommodations and how to access resources as significant barriers to self-advocacy and success in postsecondary education settings.^38^ One of the vocational rehabilitation counselors interviewed by Schoffstall et al.^56^ noted that, for postsecondary students, “What we like to see, is that the students themselves are aware of the resources that they have. What organizations they can contact if they need assistance.”^56^ ^(p543)^.
In Garberoglio et al.’s^50^ study of Deaf stakeholders, many noted the need for increased transition planning and better access to programs and services as strategies to improve the transition to postsecondary education for culturally Deaf students and students who are deaf and hard of hearing. Academic success was found to be most dependent on preparation and transition planning that occurred prior to enrollment in post-secondary education.^22^ Increased transition planning was found to be related to higher odds of enrolling in postsecondary education.^28^ However, interagency collaboration was vital to a successful transition.^58^
Additionally, increased course-taking, typically related to increased course offerings, increased the likelihood of enrolling in post-secondary education.^35^ However, even when taking more courses, deaf and hard of hearing students earned fewer academic credits on average.^34^ Overall, residential schools for the deaf were found to have more robust transition services, although residential schools had no differences in post-school preparation compared to non-residential schools.^53^ Culturally Deaf recent graduates and recent graduates who are deaf and hard of hearing were more likely to come from households with incomes > $50k, identify as White, have parents with at least a bachelor’s degree, and not use a signed language in the home.^61^
Six studies focused on the transition to early childhood education for Deaf children and children who are deaf or hard of hearing, primarily from the perspective of parents, early interventionists, and educators.31, 43, 45, 47, 48, 54 Curle et al.^54^ focused on administrators and system-level processes that facilitated and inhibited the transition process. The researchers reported that interagency document exchange and providing introductory opportunities for the parents and children to meet the school community helped facilitate the transitions.^54^ Limited placement options, inadequate prep time, and an overall lack of resources hinder the transition from an organizational level.^54^ Administrators reported that communication between early interventionists, early childhood educators, and teachers of the deaf helped ease the transition. However, Curle et al.^45^ found that this communication was often one-sided, with TODs lacking routine communication back to early interventionists.
Parents reported that a lack of guidance on what to expect during the transition from early intervention to early childhood education hindered the transition.45, 47 Additionally, parents expressed concerns about the level of support children receive in the classroom and their children’s academic ability.^47^ However, parents had little concern over their children’s ability to be separated from their parents and their relationship with teachers.^47^
Three additional studies examined factors affecting kindergarten readiness.31, 43, 48 DuBois^48^ reported higher scores in phonological awareness, social skills, motor skills, and language scores for deaf and hard of hearing preschoolers who participated in a music-based intervention. Additionally, students who started early intervention services sooner had improved school readiness and language scores.31, 43
Researchers with three studies looked at educational transitions that could not be categorized as post-secondary or early childhood transitions.17, 46, 49 Bowman and Crowe^17^ looked specifically at the educational experiences of Gallaudet University students during the COVID-19 pandemic, examining the challenges and social implications of abrupt online learning. The remaining two studies centered on transitioning between school types.46, 49 Rugg and Donne^46^ looked at the transition between schools for the deaf and mainstream school settings. They found that most students were adequately prepared and maintained academic standing following the transition. Similarly, Tropea^49^ found that while students and parents expressed transition concerns, they also identified aspects that facilitated transition, including support, accommodations, and parental and self-advocacy.
For many students choosing not to pursue postsecondary education, vocational transitions begin during the high school years, with planning sometimes beginning as early as middle school.^30^ Compared to non-deaf students, culturally Deaf students and students who are deaf or hard of hearing completed more high school credits on average, especially in vocational training.^34^ At a specific school for the Deaf in the northwestern US, graduates were found to have more successful vocational transitions compared to the NLTS2 data for individuals who are deaf or hard of hearing.^15^ However, Cawthon et al.^20^ found that the NLTS2 data did not show a significant effect of enrollment in vocational training courses on employment outcomes for culturally Deaf students and students who are deaf or hard of hearing. Parental expectations for independent living also increased the likelihood of employment.19, 44 Garberoglio et al.^25^ found that while student autonomy significantly impacted both job wages and job advancement, parental expectations did not significantly influence either variable. Self-advocacy for culturally Deaf individuals and individuals who are deaf or hard of hearing was also identified as an integral part of the vocational transition experience.26, 56 Specifically, adequate skill assessments and communication skills were necessary for a successful transition.33, 52, 56
Concerning vocational transition preparation, residential schools offered more transition services than general education schools.^53^ Students and recent graduates who participated in agency-supported transition programs or completed some postsecondary education were likelier to have successful postsecondary employment.23, 61 However, some professionals were unaware of the referral process or the role of vocational rehabilitation in supporting successful transitions.^57^ Additionally, interagency collaboration was critical in promoting a successful transition.^58^
Many social transitions mentioned in the reviewed articles overlapped with postsecondary and vocational transitions. Cawthon et al.^18^ found that parental ratings of social skills improved the likelihood of graduating from postsecondary education. Students who received self-advocacy training during their secondary school or who attended postsecondary school were more likely to be engaged in their community.39, 61 Recent college graduates also associated successful social transition, such as the ability to collaborate and cooperate with peers, with being successful in postsecondary education.^42^ Several researchers also focused on the development of Deaf identity and belonging as part of social transition, primarily at the postsecondary education level. 24, 30, 41, 51
Three studies focused on the transition to independent living.19, 30, 40 Parental expectations were a statistically significant predictor of independent living and employment.^19^ When looking at transition competence beginning in late middle school, 85 % of students had insufficient knowledge of independent living skills such as money management, health management, and home responsibilities.^30^ However, involvement in extracurricular activities during high school significantly predicted independent living later in life.^40^
Researchers with two studies examine healthcare-related transitions, specifically with adolescents and young adults learning self-management skills.32, 55 Using a qualitative approach, Meston^32^ explored health care transitions with adolescents who are deaf and hard of hearing specific to hearing healthcare, finding that successful transition was related to self-advocacy and building knowledge. Olds et al.,^55^ who also used a qualitative approach, looked at similar factors specific to cochlear implant users, finding that differences in service delivery models and communication play significant roles in the transition along with social supports.
Newman^60^ found that the transition to life after high school is highly individualized, whether to postsecondary education or a vocation. College readiness was predicted by high school academic skills, specifically in English, science, and math.^22^ Individuals with positive academic behaviors, such as motivation, learning engagement, and organization, reported being more successful in postsecondary education.^42^ The transition to college was accompanied by fear and worry, even if the student was academically ready.^41^ Readiness was also important for students transitioning from a school for the deaf to a mainstream setting. The primary method for identifying readiness was if the individual was not being challenged academically; however, some students still believed they were not ready to transition to a mainstream setting.^46^ For the transition from early intervention to kindergarten, higher early oral language scores were associated with better school readiness.^43^ Personal readiness was also identified as an important factor for individuals who are deaf or hard of hearing in the transition to adult hearing services.^55^
One’s motivation and determination were noted as powerful intrinsic motivators.21, 23, 52 Students who expected to attend postsecondary education were significantly more likely to enroll in a postsecondary education institution than those who did not have the same future expectations.^28^ Many postsecondary students felt self-determination behaviors are foundational transitional skills, especially in postsecondary and vocational environments.^29^ While self-expectations were not significantly related to employment outcomes, personal autonomy statistically impacted employment outcomes.25, 26 Self-advocacy was found to be a significant theme in the transition experience. Students often began developing self-advocacy skills as part of the transition from middle to high school.^49^ Cawthon et al.^59^ found that self-advocacy allowed for greater access to both formal postsecondary education settings and associated postsecondary activities. Those who had received self-advocacy training during secondary school had better community engagement later in life.^39^ Additionally, college-educated individuals had higher self-advocacy levels and more personal autonomy.^27^
In looking at the experiences of young adults who identified as deaf or hard of hearing, several qualitative studies included themes related to developing a Deaf identity.24, 38, 51 Finding a Deaf identity was related to finding a sense of belonging, establishing a cultural identity, and postsecondary academic success.24, 38, 51 Although some studies focused exclusively on oral-auditory communication styles, developing a Deaf identity was still identified as a critical theme.^32^
Myer and Takayama^33^ found that those with successful transitions from postsecondary education to employment had higher self-rated communication skills. Language and communication skills were found to be part of self-advocacy development.^56^ However, communication preferences and skills did not predict academic readiness.^22^ Individuals who obtained a postsecondary degree were more likely to come from households that did not use a signed language.^61^ For some students attending a signing university, postsecondary transitions were accompanied by language learning and a shift in communication styles.^24^ However, communication and language preferences varied widely among individuals who are deaf or hard of hearing.^27^
Parental expectations were found to influence transition experiences and outcomes.16, 18, 19, 25, 37, 44 Individuals whose parents also used ASL had a greater sense of family belonging and felt more supported by family, while incongruent communication preferences within the family were seen as a negative influence on transition.16, 44 Parents were among the most powerful extrinsic motivators of success in postsecondary and vocational settings.21, 25 Individuals with higher parental expectations were more likely to obtain a postsecondary degree.27, 28 Newman^60^ found that from the perspective of teachers of the deaf in Texas, transition support was lacking, especially parent support. However, in Swenson’s^42^ study of culturally Deaf recent college graduates and recent graduates who are deaf or hard of hearing, many identified familial support as a factor promoting success in postsecondary education. Parental involvement aided in the transition to self-advocacy in the postsecondary setting and in health care transitions occurring around the same age.24, 32, 55 Parental feelings of transition readiness and parental advocacy played important roles in transition timing for transitions occurring during primary and secondary education.46, 49
In early childhood settings, parents expressed concerns over their ability to advocate for their child’s needs.^47^ Parents felt uninformed during the early childhood transition process, while professionals noted that good parental support facilitated early childhood transitions.45, 54 Parental education level, specifically maternal education, played a significant role in kindergarten readiness and early enrollment in early intervention services.^31^
Former culturally Deaf postsecondary students noted that having a critical mass of Deaf students helped to foster their transition experience, allowing them to integrate into the postsecondary setting and giving them a sense of belonging.21, 38 At a mainstream university, students also reported increased belonging from peer, instructor, and advisor relationships.^41^ For non-signing students, initial contact with the Deaf community, such as attending a Deaf university, facilitated a sense of community, language learning, and integration into Deaf culture.24, 51 However, interpersonal relationships in college were disrupted and challenged by the academic transitions during the COVID-19 pandemic.^17^ Deaf stakeholders felt strongly that Deaf youth needed community to help facilitate post-secondary transition, as community empowerment helped improve self-beliefs.26, 50 Those who attended postsecondary programs were found to be more engaged in their community.^61^ For preschool-aged children, early socialization with other children who were deaf or hard of hearing improved social skills.^48^
Secondary school settings contributed to successful vocational and postsecondary transitions.^15^ At a specific school for the deaf in the northwest, attendees were found to have better transition scores than their counterparts in the NLTS2 survey data.^15^ Students who attended residential programs were often offered more transition support services, especially for employment preparation.^53^ Additionally, secondary school resources and support were necessary to transition into postsecondary education.^59^ Students with a transition planning goal of attending postsecondary education were more likely to attend postsecondary education, although supports were viewed as a “patchwork system”.28, 29
Direct instruction in American Sign Language (ASL) allowed for easier integration into the classroom setting.^38^ Students who identified as deaf or hard of hearing consistently scored lower than their hearing counterparts, regardless of language skills.^22^ Among students in mainstream postsecondary settings, many reported feeling “left behind and out” in the classroom setting, often missing comments and discussions from other students in the classroom^38^: "Overall, I felt rather isolated and alone as a student with a disability, and being on campus did not change any of this. I felt that this was a disadvantage as I did not feel as though I belonged."^(p85)^.
Although vocation-related course-taking during high school did not significantly impact employment outcomes, vocational education, and work-study experience predicted enrollment in postsecondary education.23, 59 Students who were deaf or hard of hearing earned, on average, 1.7 more credits, primarily in career education courses^34^; however, completing more career education courses did not contribute to a higher likelihood of postsecondary enrollment.^35^ Agency involvement, such as vocational rehabilitation, predicted postsecondary employment outcomes.^23^ For those who attended higher education, postsecondary experiences positively impacted the transition from school to employment.^33^ Once transitioning to the workplace setting, communication, and subsequently belonging, became an ongoing “All Deaf kids, when they get out of school, they want to work with somebody else who’s Deaf. Why? Because I don’t want to be alone all the time…I want to have somebody to talk to.”^52^^(p125)^ Employers had issues with compliance with regulations related to the rights of individuals who are deaf or hard of hearing, mostly stemming from a lack of education.^56^
Misunderstandings surrounding the needs of individuals who are deaf and hard of hearing and the Deaf community and an overall lack of societal support were recurring themes throughout the literature.24, 49, 54 Parents, early interventionists, TODs, and school administrators all mentioned the lack of communication as a barrier to transition at the early childhood level.47, 54 Professionals working directly with transition-age students who identify as deaf or hard of hearing highlighted the need for strong interagency collaboration in promoting successful transition.^58^ At the postsecondary level, Deaf stakeholders noted a need for system change, improved partnerships, and improved access to programs and services.^50^ Teachers of the deaf in secondary settings reported feeling that students were not adequately informed about available options for transition support and noted their often-unofficial role in promoting postsecondary and vocational transitions.^60^ While school settings played an essential role in successful transition, schools were not always prepared for the needs of students who identify as deaf or hard of hearing.39, 46
In healthcare settings, communication and differences in pediatric and adult services impacted the transition to self-management of care.^55^ Additionally, healthcare professionals may be unaware of academic and vocational transition supports. Researchers found that 58 % of audiologists had inaccurate knowledge of vocational rehabilitation services and were unaware of the full role of vocational rehabilitation in supporting transitions.^57^
Accommodations in the postsecondary academic and vocational settings were identified in the literature as facilitators and inhibitors of transitions at the societal level.29, 31, 38, 56 Undergraduates and recent graduates mentioned that while accommodations enhanced information access, navigating the channels available to request accommodations could be challenging.^38^ Vocational rehabilitation counselors reported that the need for accommodations extends into the workplace, with culturally Deaf individuals and individuals who are deaf and hard of hearing individuals often needing to advocate for their rights in vocational settings where employers may not be knowledgeable of their responsibility in providing reasonable accommodations.^56^ Postsecondary academic policies and procedures related to COVID-19 were found to hinder the transition to postsecondary education.^29^ Concerning healthcare, Meinzen-Derr et al.^31^ found that children who are deaf or hard of hearing who are covered by private insurance are more likely to be on track with language and literacy scores when beginning kindergarten.
The above results represent the available research regarding transitions for culturally Deaf individuals and individuals who are deaf and hard of hearing individuals published since the expansion of the Americans with Disabilities Act in 2009. Through this scoping review, we aimed to examine the literature surrounding transition experiences for individuals who are culturally Deaf, deaf, or hard of hearing using Meleis’ Transitions Theory to aid in structuring the results and identifying knowledge gaps. We identified 46 sources that met the inclusion criteria. Of the 46 sources, 30 were peer-reviewed journal articles.15, 17, 18, 19, 20, 22, 25, 26, 28, 30, 31, 33, 34, 35, 40, 43, 44, 45, 46, 47, 50, 51, 53, 54, 55, 56, 57, 59, 61 The remaining 16 data sources were doctoral dissertations or master’s theses, representing the gray literature in this area of research.16, 21, 23, 24, 27, 29, 32, 37, 38, 41, 42, 48, 49, 52, 58, 60
Major concepts from Meleis’ Transitions Theory, such as transition types and transition conditions, were identified thematically in the literature. We identified all four types of transitions (developmental, situational, health/illness, and organizational) in the included studies. Developmental and situational transitions were most commonly identified and often occurred concurrently.15, 16, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 33, 34, 35, 37, 38, 40, 41, 42, 43, 44, 45, 47, 48, 49, 50, 52, 53, 54, 56, 57, 58, 59, 60, 61 All three types of transition conditions (personal, community, and society) were identified and could be subdivided into additional themes regarding types of social support during transitions. While we did not uncover any previous studies that used Meleis’ theory as a framework, the identified themes in the literature related to theory concepts show the theory’s applicability to transition research with populations who are deaf or hard of hearing.
The available literature heavily focused on postsecondary and vocational transitions among culturally Deaf adolescents and young adults and adolescents and young adults who are deaf and hard of hearing. The focus on postsecondary and vocational transitions in research is consistent with current priorities in transition support services.^2^ As transitions rarely occur in silos, it is essential to view the transition process as fluid and interconnected, especially for transitions occurring during adolescence and young adulthood. While postsecondary educational and vocational transitions are often viewed as the priority, these transitions occur alongside other significant life transitions we identified in the literature, such as health and independent living. Additionally, while the literature focused heavily on what is typically considered “transition age” (i.e., adolescence and early adulthood), many significant life transitions occur outside this time frame and must be considered.
The identified facilitators and inhibitors of transition primarily centered around types of social support. At the personal level, themes of self-advocacy and self-determination were identified throughout the literature, especially concerning post-secondary transitions.21, 22, 24, 25, 27, 28, 29, 32, 37, 39, 42, 49, 52, 56, 58 As expected, familial and peer support was essential in facilitating or inhibiting the transition.16, 17, 18, 19, 21, 23, 24, 27, 28, 29, 32, 37, 38, 40, 41, 44, 45, 46, 47, 48, 49, 51, 52, 54, 55, 58, 60 Congruence in communication modality in familial, academic, and community settings facilitated transitions, while differing preferred communication methods were seen as a hindrance.16, 21, 24, 27, 38, 43, 52 Communication in ASL was commonly mentioned alongside developing a Deaf cultural identity, often during the early young adult years.21, 24, 29, 38, 51, 52 At the societal level, organizational disorganization and lack of communication were seen as a significant barrier to transition.24, 29, 35, 38, 45, 47, 49, 54, 55, 58 However, policies like those found in the Americans with Disabilities Act and the Individuals with Disabilities Education Act helped facilitate transitions, although organizational non-compliance did occur.^40^
Much of the primary data research had small sample sizes or included populations beyond individuals who identify as deaf or hard of hearing (e.g., parents, transition support personnel), highlighting the difficulty in accessing and representing this historically marginalized population in research.15, 16, 17, 21, 29, 30, 32, 33, 37, 41, 42, 43, 44, 45, 46, 47, 48, 49, 51, 52, 54, 55, 56, 57, 58, 59, 60 Additionally, almost half of the research published since 2020 comes from dissertation works rather than peer-reviewed articles.29, 32, 38, 42, 48, 60 The dissertations primarily focused on smaller subsets of the Deaf community and deaf and hard of hearing populations.29, 32, 38, 42, 48, 60 In a brief secondary search of the literature, focused on the authors of the six included dissertations published since 2020, we did not identify any peer-reviewed journal publications based on their dissertation research. The dearth of emerging researchers in this field holds implications for developing evidence-based, tailored, and culturally sensitive interventions for this vulnerable population group.
All the studies focused specifically on the experiences of the Deaf community, individuals who are deaf or hard of hearing, and those directly involved in transition experiences at appropriate stages.15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61 Several studies used populations across the US rather than focusing on a specific state or region, making findings more representative.18, 19, 20, 23, 25, 26, 27, 28, 29, 33, 34, 35, 39, 40, 44, 50, 52, 53, 56, 57, 58, 59, 61 Given that most of the studies focus on the adolescent to young adult period, the available literature provides a diverse and robust description of this transition period and the events and factors surrounding it.15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 37, 38, 39, 40, 41, 42, 44, 46, 49, 50, 52, 53, 55, 56, 57, 58, 59, 60, 61 Considering that many of the qualitative studies have similar or overlapping aims, the results confirm the findings of the other studies.16, 24, 29, 38, 41, 42, 46, 49, 50, 53, 56, 59, 60
Only one study included any interventional aims,^48^ and measurement tools used in primary analysis studies, if mentioned specifically, had limited reliability and validity data.30, 33, 37, 41, 43, 53 Most quantitative studies used secondary analysis of the NLTS2 data collected from 2000–2009.18, 19, 20, 23, 25, 26, 27, 28, 34, 35, 39, 40, 61 Given these dates and today's drastically different academic climate, the study results may not represent current d/Deaf and hard of hearing students and their experiences. The quantitative studies that used primary analysis mostly had smaller sample sizes that did not allow for predictive analyses. 30, 33, 37, 41, 43, 48, 53 Concerning transition types, the available literature focuses heavily on education and vocational transitions and has limited data on other transition types, such as health-related transitions.
Given that the available research focuses heavily on educational and vocational transitions, future research should be expanded outside of these areas to include other transition types such as health care transitions. Health care transitions are a crucial part of the transition experience for culturally Deaf individuals and individuals that are deaf or hard of hearing, especially during adolescence and young adulthood. The included literature that focused on health care transitions was specific to hearing health.32, 55 Future research should also focus on interventions to improve academic and vocational transitions for culturally Deaf students and students who are deaf or hard of hearing based on the available previous descriptive and correlational research. Additionally, opportunities for future research should be expanded to include age ranges outside of adolescence and young adulthood, looking at transitions that occur outside of the traditional ages associated with transition. Given the sample size concerns likely related to the accessibility of the Deaf community, we recommend that researchers collaborate with key community stakeholders for future studies.
Although current research for health care transitions among culturally Deaf, deaf, and hard of hearing populations is limited, the available research highlights the communication challenges that may exist both among health care providers and between individuals and health care organizations.32, 55. While adolescents and young adults must take ownership of their own health experiences, the findings in the literature echo the need for establishing strong patient-provider relationships, developing self-advocacy skills, and parental involvement early on.32, 55 Additionally, the findings of the studies related to health care transition experiences parallel many of the postsecondary transition planning priorities outlined by the National Deaf Center on Postsecondary Outcomes.^2^ The transition themes identified in the existing literature across all types of transitions indicate that like postsecondary, vocational, and independent living transitions, health care transitions have the potential to be a time of high support needs. Given this, health care professionals should be aware of the potential for unique support needs among deaf and hard of hearing populations during transition planning.
This scoping review examines the literature surrounding transition experiences for culturally Deaf individuals and individuals who are deaf and hard of hearing over the past ten years. Using Meleis’ Transitions theory as a guide, we examined the 46 articles that met the inclusion criteria. We identified several common themes in the literature and categorized them based on the transition types and transition conditions described by Meleis. Overwhelmingly, the existing research focused on educational and vocational transitions, highlighting the need for future research surrounding health-related transitions.(Table 2).Table 2Summary of Articles Meeting Inclusion Criteria.Table 2**Authors (Year)PurposeTheoretical FrameworkDesignMethods/ Measurement Tools/Data SourceParticipants (#)****Country (state, region, province)****Appelman et a. (2012)**To report specific postsecondary outcomes regarding students who are deaf and hard of hearing who attend a specific programCross-sectionalSurvey based on the National Longitudinal Transition Survey-2 (NLTS2)High school graduates (46)US (northwest)**Blair (2015)**To analyze participants’ planned transitions from high school to postsecondary educationSelf-efficacy TheoryQualitative case studyInterviewsCulturally Deaf youth (4)CA (ON)**Bowman and Crowe (2023)**To determine how students at Gallaudet University were emotionally impacted by the change to online learning during COVID-19MultimethodOnline survey with some open-ended questionsd/Deaf, hard of hearing, and hearing college students (84)US (DC)**Cawthon & Caemmerer (2014)to explore parent expectations about postsecondary outcomes for their children and parent perspectives on transition planningCross-sectionalNational needs assessment surveyParents of children who are deaf or hard of hearing (56)USCawthon et al. (2015a)to investigate the relationship between social skills while in high school and later postsecondary outcomes for individuals who are deafSecondary analysisNLTS218–35-year-olds who are deaf or hard of hearingUSCawthon et. al (2016a)to (a) investigate professionals’ perspectives on the effectiveness of the transition process for individuals who are deaf or hard of hearing and (b) investigate the perspectives of professionals on their level of preparedness to serve individuals who are deaf or hard of hearingMultimethodOnline survey, interviews, and focus groupsProfessionals working with individuals who are deaf or hard of hearing (1345)USCawthon et al. (2015b)to investigate the potential role of parent involvement and parent expectation in postschool outcomes for individuals who are deaf and hard of hearingSecondary analysisNLTS218–35-year-olds who are deaf or hard of hearingUSCawthon et. al (2016b)to (a) describe intensive vocation-related course taking utilized by students who are deaf and (b) measure the impact of taking such courses on long-term employment outcomes.Secondary analysisNLTS218–35-year-olds who are deaf or hard of hearing (580)USChevalier (2015)**to examine former postsecondary Deaf students' perceptions regarding their postsecondary experiencesTinto’s Themes for Inquiry on RetentionCross-sectionalSurveyDeaf former postsecondary students (27)US (CO)**Convertino et al. (2009)**To examine predictors of postsecondary classroom learning among deaf and hard of hearing college studentsSecondary analysisData from previous studiesDeaf and hard of hearing college studentsUS (NY)**Coyle (2013)To determine which predictor variables in the NLTS2 had an impact on postsecondary and employment outcomes of deaf and hard of hearing studentsSecondary analysisNLTS2Adolescents and young adults who are deaf or hard of hearingUSCurle et al. (2017a)to investigate program administrators’ perspectives of the organizational policies, procedures, and guidelines that facilitate or hinder the transition from the early intervention system to the school system for children who are deaf or hard of hearingEcological Model and Dynamic Model of TransitionQualitative descriptiveSemi-structured interviewsAdministrators (10)CACurle et al. (2017b)to examine the communication that occurred among early intervention (EI) providers, parents, and teachers before and during the child’s first year of kindergartenEcological Systems ModelQualitative descriptiveSemi-structure interviewsParents (6), early intervention providers (11), and teachers of the deaf (6)CADorminy (2013)**To develop a theory of the experience of non-signing oral deaf and hard of hearing undergraduate students as they transitioned into a predominantly signing universityQualitative grounded theoryInterviewsCollege students at Gallaudet University (10)US (DC)**Dubois (2021)**To explore how to better support development of school readiness skills using musicEntrainment theoryQuasi-experimental12-week group session interventionPreschool children and their parents (15 pairs)CA (ON)**Garberoglio et al. (2020)to identify and synthesize themes related to strategies for community-level system change regarding post-secondary transition for Deaf and deaf or hard of hearing studentsCommunity-based participatory researchQualitativeFocus groupsDeaf stakeholdersUSGarberoglio et al. (2017)to investigate the role of autonomy in the developmental process for deaf or hard of hearing adolescents as they navigate the transition from adolescence to early adulthood and enter the workforceWehmeyer’s Functional Self-determination TheorySecondary analysisNLTS218–35-year-olds who are deaf or hard of hearing (580)USGarberoglio et al. (2014)to explore the role of self-beliefs in predicting postschool outcomes for deaf or hard of hearing young adults in transition from secondary settingsWehmeyer’s Functional Self-determination TheorySecondary analysisNLTS218–35-year-olds who are deaf or hard of hearing (580)USHarrington et al. (2012)To examine relationships between early childhood factors and school readiness skills among young children with hearing lossLongitudinalClinical Evaluation of Language Fundamentals-Preschool, Wechsler Preschool and Primary Scale of Intelligence, and the Bracken Basic Concept Scale–ReceptivePreschool-age children (8)USHebert (2012)To explore the attributes of successful college graduates in a sample of students who are deaf or hard of hearing using the NLTS2Social Cognitive TheorySecondary analysisNLTS2College graduates who are deaf or hard of hearingUSHinz (2013)To examine interpreter use for students who are Deaf in the public school systemQualitative case studyinterviewsProfessionals (16) and Deaf individuals (24)USJohnson et al. (2022)to determine the effects of expectations and transition planning goals on the postsecondary education enrollment of deaf or hard of hearing youthSocial Cognitive Theory and the Expectancy Value TheorySecondary analysisNLTS2Students who are deaf or hard of hearing (580)USJun (2023)to investigate the postsecondary transition process and the use of self-determination for seven deaf or hard of hearing college studentsSelf-determination TheoryQualitative case studyInterviewsDeaf undergraduate students (7)USLuft (2014)to identify differences between residential, large, and small public school transition offerings for transition planning for deaf or hard of hearingMultimethodTransition Services Survey with open ended response questionsDeaf programs (94)USLuft and Huff (2011)**To examine transition knowledge and skills of secondary school students who are deaf or hard of hearingCross-sectionalTransition Competence Battery surveyMiddle and high school students who are deaf or hard of hearingUS (Midwest)**Mauldin and Fannon (2021)**To explore Deaf identity and lived experienceFeminist Disability StudiesQualitative descriptiveinterviewsDeaf individuals who identify as LGBTQ+ (5)US (DC)**Meinzen-Derr et al. (2020)**To evaluate the impact of early intervention early versus later kindergarten readiness in children who are deaf or hard of hearingSecondary analysisOhio Early Hearing Detection Intervention Program dataStudents who are deaf or hard of hearing (417)US (OH)**Meston (2021)**To explore the transition for adolescents who are deaf and hard of hearing toward the self-management of their hearing healthcareQualitative grounded theoryInterviewsAdolescents with congenital or early diagnosed hearing loss and their parents/guardians and teachers (24)CA (ON)**Myers and Takayama (2019)To investigate the extent to which deaf and hard of hearing adult graduates were able to succeed in transfer of learning from their collegiate studies to their workplaceCross-sectionalKnowledge, Skills, and Abilities questionnaireRecent college graduates who are deaf or hard of hearing (19)USNagle et al. (2015)to investigate Deaf and deaf or hard of hearing students' opportunities in secondary school to acquire college and career skillsSecondary analysisNLTS213–16-year-old students who are deaf or hard of hearing (610)USNewman (2022)**to explore perceptions of teachers of the deaf about services delivered to students with hearing loss, how those services impact the Deaf and deaf or hard of hearing students' post-high school transition, and what training supports need to be provided to teachers so they can assist student access to the general education curriculumWehmeyer’s Functional Self-determination TheoryQualitative interpretive phenomenologySemi-structured interviewsTeachers of the deaf (15)US (TX)**Newman et al. (2017)to examine the relationship of postsecondary education preparation in terms of high school course taking with postsecondary enrollment of students who are deaf or hard of hearingSecondary analysisNLTS2Young adults who are deaf or hard of hearingUSOlds et al. (2012)**To identify factors important in the transition from pediatric to adult cochlear implant services from the perspective of service providersQualitative descriptiveFocus groupsProfessionals (8)CA (ON)**Palmer et al. (2020)to examine the employment and social outcomes of deaf or hard of hearing individuals after leaving postsecondary educationCapital TheorySecondary analysisNLTS2Postsecondary graduates who are deaf or hard of hearing (140)USPearson (2009)**to investigate how parental influence, career maturity, and self-efficacy affect perceptions of postsecondary outcomes among students who are deaf or hard of hearingSocial-psychological ModelCross-sectionalOutcome Expectation Scale, Career-related Parent Support ScaleStudents who are deaf or hard of hearing (53)US (TN and AZ)**Porter-Vaughn (2022)**to explore the livedexperiences of deaf and hard-of-hearing college students regarding college preparation and accommodations for transitioning into employment in the northeastern region of the United StatesTinti’s Student Retention Theory, Perry’s Student Development Theory, Bandura’s Self-efficacy TheoryQualitative phenomenologyInterviews using a text-type chat mechanism in Facebook MessengerCollege juniors and recent graduates who are deaf or hard of hearing (7)US (northeast)**Rugg and Donne (2011)**To examine the perceptions of parents and teachers towards the transition process and preparedness of students who are deaf or hard of hearing from a listening and spoken language schoolMixed methodsInterviews and surveysParents and teachers of students who are deaf and hard of hearing (19)US (northeast)**Ryan et al. (2021)to examine the effect of self-advocacy and social and life skill trainings in secondary school settings on Deaf youths’ social engagement after high schoolSecondary analysisNLTS2Young adults who are deaf (∼300)USSchoffstall et al. (2016)To investigate a predictive relationship between extracurricular involvement and postschool outcomes for individuals who are deaf or hard of hearingSecondary analysisNLTS2Adolescents and young adults who are deaf or hard of hearingUSSchoffstall et al. (2015)to explore how vocational rehabilitation counselors promote the self-advocacy knowledge and skills of their Deaf and deaf or hard of hearing consumers within post-secondary employment and educational contextsQualitative descriptiveInterviewsVocational rehabilitation counselors (10)USShanginaw (2018)**to gather deaf student feedback and better understand if deaf students feel as though they matterSchlossbert’s transition theoryMultimethodCollege Mattering Inventory and interviewsRowan University students who are deaf or hard of hearing (24)US (NJ)**Swenson (2020)**to identify and describe the extent to which noncognitive factors influenced Deaf and deaf or hard of hearing graduates' ability to successfully attain their college degreeFarrington’s Five Noncognitive FactorsQualitative PhenomenologyInterviewsRecent college graduates who are deaf or hard of hearing (8)US (CA)**Tropea (2010)**To investigate the perspectives of parents of students who are deaf or hard of hearing who were ready to make the transition to secondary schoolQualitative descriptiveFocus groupsStudents who are deaf or hard of hearing and their parents (9)CA (ON)**Whicker et al. (2019)To explore audiologists’ knowledge, attitudes, and referral practice patterns regarding vocational rehabilitation for transitioning adolescents with hearing lossMultimethodSurvey with open ended questionsEducational audiologistsUSWright (2019)To explore the relationship between interagency collaboration in transition planning and successful postsecondary outcomes for adolescents who are deaf or hard of hearingModel Transition Process for Deaf and Hard of Hearing YouthCross-sectionalSurveyProfessionals (30)USZaidman-Zait et al. (2019)to describe parental concerns during their children's transition from early intervention to school, to describe practices available for families of Deaf and deaf or hard of hearing children, and to explore parents' and teachers' perspectives regarding practices that support a smooth transition to schoolCross-sectionalSurveysParents (40) and teachers (37) of children who are deaf or hard of hearing transitioning into kindergartenCA (western)Authors (Year)Transition TypeTransition PeriodTransition ConditionsKey FindingsAppelman et a. (2012)**Developmental, situational4, 5CommunityThe northwestern school graduates had better indicators of successful social and vocational transition compared to the NLTS2 national results.**Blair (2015)**Developmental, situational1Community, personalCommon themes included self-motivation and positive experiences in Deaf education as motivators for pursuing postsecondary education; Deaf identity positively influenced postsecondary planning; having parents who signed contributed to greater feelings of belonging.**Bowman and Crowe (2023)**Situational, health/illness, organizational3Community, societyStudents had high levels of self-efficacy and well-being but increased loneliness; the transition to online learning was viewed as beneficial but came with challenges especially with participation and interpersonal relationships.**Cawthon & Caemmerer (2014)Developmental, situational1, 4CommunityPositive ratings of individualized education program (IEP) experience associated with co-occurring disabilities and parents having deaf identity; the majority of parents expected post-secondary education and full-time employment; most parents reported a need for ongoing support for communicationCawthon et al. (2015a)Developmental, situational1, 5CommunityThere was a statistically significant relationship between higher parental ratings of social skills and improved odds of postsecondary graduationCawthon et. al (2016a)**Developmental, situational, organizational1Personal, communityAmerican Sign Language (ASL) proficiency, female gender, and years of experience were all predictors of IEP ratings. Self-advocacy allowed for a greater range of access to postsecondary settings and activities.**Cawthon et al. (2015b)**Developmental, situational1, 4, 6CommunityHigher parental expectations for independent living, employment, and post-secondary education improved child’s odds of achieving their respective goals.**Cawthon et. al (2016b)**Developmental, situational4CommunityThere were no significant effects of enrollment in vocation-related courses on employment outcomes for deaf students.**Chevalier (2015)**Developmental, situational1Personal, community55.6 % of participants indicated that direct ASL instruction enabled them to integrate into higher education courses. Parents were identified as the most powerful extrinsic motivator while students’ motivation was most powerful intrinsic motivator. A critical mass of Deaf students fosters students’ transition, assimilation, and integration.**Convertino et al. (2009)**Developmental, situational1Personal, communityCollege readiness testing scores were predicted by English, science, and math skills; communication preferences and skills were poor predictors for academic readiness; Deaf students consistently scored below hearing counterparts on academic assessments regardless of language skills; academic success was most dependent on preparation before starting post-secondary education.**Coyle (2013)**Developmental, situational1, 4Personal, communityObtaining a high school diploma, inclusion in general education, self-determination skills, parental satisfaction, vocational education, and work-study experience were all predictors of enrollment in postsecondary education; Agency involvement, high school diploma, general education inclusion, paid work, and parental satisfaction were all predictors of postsecondary employment.**Curle et al. (2017a)**Developmental, situational2Community, societyFacilitating categories included interagency document exchange, providing information and support to parents, children and parents meeting the new school community, and school personnel observing the child pre-transition; factors that hindered transition included stakeholders’ lack of knowledge of culturally Deaf and deaf or hard of hearing students’ needs, lack of resources, limited placement options, and lack of preparation time.**Curle et al. (2017b)**Developmental, situational2Community, societyCommunication between early intervention (EI) and parents is often one-sided. Communication between the EI professional and the teachers of the Deaf (TOD) occurred early in the transition process but TOD had little communication back to EI. There was an overall lack of routine communication pathways from schools to EI systems. Parents preferred face-to-face communication with their child’s teachers and expressed feeling uninformed prior to the start of school.**Dorminy (2013)Developmental, situational1, 5Personal, community, societyIdentified themes setting the stage for a sense of difference, passing for hearing, Gallaudet as a gateway to a new community and language, transitions, developing a positive Deaf identityDubois (2021)Developmental, situational2CommunityAll children who participated in the music and movement group had increased scores in phonological awareness rhyming; 71 % of music and movement participants had increased social skill and motor skills scores; 43 % had increased language scores; No scores were statistically significant when compared with controlsGarberoglio et al. (2020)**Developmental, situational1Community, societyCommon themes (a) engage in system change strategies; (b) improve partnerships and resource sharing; (c) strengthen transition planning; (d) build communities of support for Deaf, and deaf or hard of hearing youth; (e) strengthen youth skills; (f) support families; (g) improve access to programs and services; and (h) provide professional development.**Garberoglio et al. (2017)**Developmental, situational1, 4Personal, communityParental expectations had a statistically significant impact on autonomous actions. Increased parental expectations were associated with children having an increased number of jobs since high school. Student autonomy had a statistically significant impact on employment outcomes.**Garberoglio et al. (2014)**Developmental, situational1, 4Personal, communitySelf-expectations were not significantly related to any of the measured outcomes. Young adults who felt more empowered had higher self-beliefs about future achievements.**Harrington et al. (2012)Developmental, situational2PersonalA positive relationship existed between early oral language scores and later school readiness; a negative relationship existed between age at identification, age at early intervention, age at sensory device and later school readinessHebert (2012)Developmental, situational1,4Personal, communityAlmost all participants used some oral speech but communication preference varied greatly; those with higher parental expectations were more likely to attain a college degree; those with college degrees had higher levels of self-advocacy and better friend interaction; personal autonomy significantly higher among those with a degree; education scores higher among those with college degreesHinz (2013)Developmental, situational1, 4Personal, communityCommonly identified 1. the value of comfort; 2. a call to morph; 3. Segregation: it is pervasive but understandable; 4. the outlook is a predictor; 5. what is being used now and its effectiveness; 6. what is not working well; 7. paving the way for success; 8. what is answerable for results?; 9. the merit of equals; 10. intepreter opinions, views, and beliefsJohnson et al. (2022)**Developmental, situational1Personal, communityYouth who were deaf who expected to attend college or who had parents who expected that they would attend college had significantly higher odds of attending college. Youth who were deaf who had a transition planning goal of attending college were more likely to enroll in college.**Jun (2023)**Developmental, situational, health/illness1Personal, community, societyFour common themes were (a) identity is related to self-perception, (b) postsecondary transition is a patchwork system of supports; (c) self-determination attitudes and behaviors are transitional skills, and (d) college post-transition is an evolving challenge.**Luft (2014)**Developmental, situational1, 4CommunityResidential programs offer more employment preparation transition services. Transition planning has a heavy focus on early and initial transition issues.**Luft and Huff (2011)**Developmental, situational1, 4, 5, 6PersonalTransition competence scores were insufficient (<85 %) in all areas for both middle and high school students. Area testing job seeking, work adjustment, job-related social and interpersonal, money management, health and home, and community awareness.**Mauldin and Fannon (2021)Situational5Personal, communityInitial contact with the Deaf community triggered life adjustment to integrate into Deaf culture; finding a Deaf identity was followed by developing Deaf prideMeinzen-Derr et al. (2020)**Developmental, situational2Community, societyChildren who started early intervention at younger than 6 months had an increased odds of kindergarten readiness compared to children who entered early intervention after 6 months; children who enrolled in early intervention before 6 months also had an increased odds of being on track with language and literacy scores with maternal college education and private insurance increasing those odds.**Meston (2021)Developmental, health7Personal, communityKey concepts including developing ownership of health through building knowledge and making own decisions; managing identity; developing advocacy; and doing it myselfMyers and Takayama (2019)**Developmental, situational4Personal, communityUniversity preparation positively impacted transfers from higher education to employment; respondents had high self-rated communication and teamwork skills.**Nagle et al. (2015)**Developmental, situational1, 4CommunityCulturally Deaf students and deaf and hard of hearing students earned an average of 1.7 more credits than the general population including more credits in vocational courses but earned less academic credits, especially in higher level courses; students in special schools earned more vocational credits than students in regular schools.**Newman (2022)**Developmental, situational1,4Personal, communityTransition support focuses on what students want to do after high school; it is an avenue to promote independence, but differs between students, and is lacking in some areas (especially parental support); TODs have a role in informing students and parents of available options and services.**Newman et al. (2017)**Developmental, situational1CommunityCompleting more academic credits significantly increased the odds of enrolling in college; completion of more career technical education courses did not contribute to a higher likelihood of enrolling in post-secondary education.**Olds et al. (2012)Developmental, health7Personal, community, societyKey differences in service delivery models between pediatric and adult health care settings; communication between pediatric and adults cochlear implant (CI) settings; establishing relationships with youth in the adult setting; youth readiness and needs; parental involvementPalmer et al. (2020)**Developmental, situational1, 4, 5Personal, communityPostsecondary graduates were more likely to be White and come from households with annual incomes > $50k with parents who had bachelor’s degree or higher who didn't use sign language in home. 87 % of postsecondary graduates were employed compared to 68 % of nonattenders. Those who attended postsecondary programs were more engaged in community.**Pearson (2009)Developmental, situational1Personal, communityThe following factors significantly differed from the normative parental expectations, career certainty (males only), career indecision; career certainty (females) and self-efficacy did not differ significantly from the normative populationPorter-Vaughn (2022)**Developmental, situational1, 4Personal, community, societyCommon themes left behind and out, determination to succeed, sense of belonging, and social integration; accommodations enhanced access to information and influenced academic outcomes.**Rugg and Donne (2011)Situational3Personal, community, societyThree subthemes related to transition initiation and the length of time for the process to occur, the transition meeting, and readiness characteristics; All parents and 6 out of 7 teachers felt that their students were adequately prepared to transition to mainstream classroom setting; 6 out of 7 students maintained or improved their GPA after transitionRyan et al. (2021)**Developmental, situational5Personal, community, societyDeaf youth who received self-advocacy training in secondary school were significantly more likely to be at least minimally socially engaged.**Schoffstall et al. (2016)**Developmental, situational1, 6Personal, community, societyParticipating in extracurriculars significantly predicted independent living and postsecondary education involvement.**Schoffstall et al. (2015)**Developmental, situational1, 4Personal, community, societyThere were 16 sub-themes identified as part of self-advocacy self-advocacy skills, language skills building, communication access, monitoring for comprehension, skills assessments, skill modeling, counseling, skills programming, developmental readiness, system-level opportunities for self-advocacy, access assessments, employer education, employers' compliance, and removing systemic barriers.**Shanginaw (2018)Developmental, situational1, 5Personal, communityMattering scores were on average higher than the general university population in the following perception of value, mattering to students, general college mattering, and mattering to advisors; scores were lower for mattering to instructors; qualitative results included feelings of fear and worry related to the initial transition to college, the need for support, gaining self-awareness and independence, and strategies for additional transition helpSwenson (2020)**Developmental, situational1, 5Personal, communityFive themes with associated subthemes were identified as contributing to college (a) academic behaviors (being motivated in college, organizational strategies, engaging in learning experience), (b) academic perseverance (intrinsic motivation, persistence), (c) academic mindsets (confidence in success, believing academic tasks had values, believing in growth with self-effort), (d) learning strategies (using strategies that worked for me, understanding and regulating how I learn), and (e) social skills (family and friend support, collaboration and cooperation with others).**Tropea (2010)Developmental, situational3Personal, community, societyThemes from the student focus group supports and accommodations; educational assistants as facilitators and barriers; parental advocacy; teacher characteristics; professional collaborations; peer interaction and socialization; new school concerns; and transition incidences. Themes from the parent focus group academic supports; education assistance and teacher of the deaf as barriers and facilitators; parental and self-advocacy; people skills/personality traits; professional collaboration; peer interaction and socializations; lack of options; and transition incidencesWhicker et al. (2019)Developmental, situational4Community, society85 % of audiologists had knowledge about general vocational rehabilitation (VR) services but knowledge was lacking about eligibility, educational services, and transition procedures; 58 % had inaccurate knowledge of VR services; respondents wanted more information about VR services, eligibility, staffing, and the referral process; audiologists reported facing challenges related to structural and procedural aspects of VRWright (2019)Developmental, situational1, 4Personal, community, societyParticipants strongly agreed that interagency collaboration was needed for successful transition; participants from schools with post transition or vocational training programs were more likely to agree that post transition programs are related to successful transition outcomes; most participants agreed that family involvement was related to successful transitionZaidman-Zait et al. (2019)**Developmental, situational2Personal, community, societyParents had concerns about child-related abilities, advocating for child's needs, following directions, communicating needs, level of support in classroom, academic ability, social skills, and peer relationships. The most common transition practices for teachers communication between TOD and EI and classroom teachers, meeting and communication with family prior to the transition, and determination of school placement and needed support.CA=Canada; US=United States1 =Postsecondary; 2 =Early childhood; 3 =Other education; 4 =Vocational; 5 =Social; 6 =Independent living; 7 =Health
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
The authors declare they have no conflicts of interest. This work is not human subjects research and therefore did not require an ethic review.
Cindy Corbett: Writing – review & editing, Writing – original draft, Methodology, Conceptualization. Anna Strickland Kell: Writing – review & editing, Writing – original draft, Methodology, Formal analysis, Data curation, Conceptualization. Robin Dawson: Writing – review & editing, Writing – original draft, Methodology, Formal analysis, Data curation, Conceptualization. Stephen Fitzmaurice: Writing – review & editing, Writing – original draft, Methodology, Conceptualization. Donna Kazemi: Writing – review & editing, Writing – original draft, Methodology, Conceptualization.
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.