Language is learned through interaction. Deaf and hard of hearing individuals using spoken English can work with instructors to jointly construct meaning. This type of activity gives them opportunities to formulate ideas and improve their spoken and written English. Instruction that links oral and written literacy appears to help students employ certain linguistic structures both in their written and spoken communication. Mediated learning strategies may be used to help students create comprehensible utterances that correctly convey their communicative intent.

Students engage in analyzing their own discourse via a visual presentation of their texts. This places students in the role of receiver, enabling them to utilize metacognitive strategies to determine whether their utterances convey what they mean. Students can modify utterances or they can progressively build utterances that accomplish their intended meaning.