Changed World for Hearing Loss. Facts of Hearing Loss

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1 Teletherapy for Children with Hearing Loss Cheryl Broekelmann, MA, LSLS Cert. AVEd Jeanne Flowers, MSDE, MS, CCC-SLP, LSLS Cert. AVEd Amy Knackstedt, MA, CED Mandy Eckelkamp, MS, CCC-SLP Michelle Graham, MS, CED, LSLS Cert. AVEd. Barbara Meyers, MAEd, CED Agenda 10 minutes Introduction and Disclosures 30 minutes Overview and Background 30 minutes Case Studies, Anecdotal Evidence, Questionnaire Results 20 minutes Conclusion, Wrap Up, & Questions Learner Outcomes Participants will recognize fundamental connections between auditory training and speaking in practices of Listening/Spoken Language intervention for children with hearing loss. Participants will distinguish the rationale and practices related to coaching of caregivers and educators from the rationale and practices of direct service provision in intervention for children with hearing loss. Participants will identify key aspects of a coaching model for supporting and educating, via online therapy, families and educators of children with hearing loss who receive listening and spoken language services. Participants will analyze examples of coaching model in practice. 1 2 Facts of Hearing Loss Changed World for Hearing Loss Each year in the United States, as many as 12,000 babies are born with hearing loss. 9 out of 10 children with hearing loss are born to hearing parents. It is estimated that there are 30 school children per 1,000 with hearing loss. In the United States, roughly 25,500 children have received a cochlear implant. Advances in technology Hearing Aids Bone Conduction Hearing Aid Cochlear Implant Early identification and intervention are proving that auditory-based intervention is enabling children with all degrees of hearing loss to have access to spoken language through listening. Warren Estabrooks 3 4 Technology is NOT correction: Cochlear implants do not restore normal hearing Hearing through a cochlear Implant is different from normal hearing Intense instruction in auditory skills helps children learn to listen and interpret what they hear through cochlear implants and hearing aids Developing Spoken Language through Listening We hear with the brain The problem with hearing loss It keeps sound from reaching the brain. (Cole & Flexor, 2007) Access auditory brain centers during time of maximum neuroplasticity Appropriate and consistent use of hearing devices Optimum listening environment Provide listening/language rich environment Audiological care and management Listening therapy in which auditory skills are systematically developed and practiced 5 6

2 Listening and Spoken Language Certification The professionals are committed to offering superior service to families wishing to utilize listening and spoken language for their child who is deaf or hard of hearing. The LSLS certificate signifies that an individual has achieved her or his education, practical knowledge and experience according to the highest standards and conducts listening and spoken language practice in accordance with the Academy s professional code of conduct. The designations of the LSLS certification are: LSLS Cert. AVEd (Certified Auditory-Verbal Educator) LSLS Cert. AVT (Certified Auditory-Verbal Therapist) (AG Bell Academy for Listening and Spoken Language, 2011) Implications of Hearing Loss Early identification and intervention can result in normal development by age 5 Early intervention impacts early childhood language development Incidental learning of language is poor Helps in development of age appropriate language Children need explicit, repetitive instruction, within context for it to have meaning 7 8 What does Early Intervention do? Coach parents to be a part of the habilitation process Educating children early in favorable signalto-noise ratio environments improves auditory brain development Focus on more than one year growth in listening, speech and spoken language Goal- to catch up with peers by school age Meeting the Needs of Children with Hearing Loss Lack of Specialist in Rural areas IDEA of 2004 authorizes appropriately trained paraprofessionals to assist in the provision of Special Education 9Section 612 *a+*14+*b+*iii What is ihear? A program to bring listening and spoken language therapy services to families and children regardless of where they live One-on-one auditory-verbal therapy LSLS trained staff (Listening and Spoken Language Specialist) Sessions designed to work directly with families or school districts using a coaching model Digital Lesson Plans Interactive, objective based lesson Flexible to meet the needs of the students and the school professional Each lesson has objectives related to:(iccares) Expressive Language Development Receptive Language Development Auditory Development Speech Development Cognitive Development Coaching Strategy for the School Professional 11 12

3 Internet Therapy Outcome Tracking System (itots) Systematic data collection from inception Upon acceptance, baseline data is gathered from referring partners or assessment is done with the ihear therapist. Reassessment is conducted every 6 months. Needs derived from norm-referenced assessments are applied to criterion-referenced tools to determine objectives. Objectives are embedded in the digital-lesson plans. Data is taken at each session on the child s ability to use the chosen objective. Therapy focuses on: Equipment functioning: Ling 6 sound check Auditory Training: Listening as a continuumdetection, discrimination, identification, comprehension Verbal responses- auditory feedback loop Language development- pre-linguistic skills Developing of receptive and expressive language for children with hearing loss Repair strategies Access to Curriculum Coaching is Coaching is an interactive, nonlinear approach to supporting another person in his or her attempts to refine knowledge and skills. It provides a structure for developing the competence and skills of family members and early childhood practitioners to support a child s participation in home and community settings in meaningful ways. Why the Coaching Model? Empowers families and educators to grow in confidence Collaborative strategy between the coach and implementer, parent or caregiver Supports the child to develop new skills using existing skills (Hanft, Rush, Sheldon p. 26) Coaching a Triadic Model Coaching is about Connections Professional Child Specialist When we work online, we do more than make the technology connect Working relationships Potentially as close or closer than they would be in other forms of service delivery Therapist, on-site facilitator (parent, caregiver, teacher, or para-professional), and child must all communicate about the process Sense of inter-dependence, building trust and educating the facilitator to check, implement, inform and engage fully in the process of working together online 17 18

4 Coaching Model vs. Traditional Therapy Model Traditional Therapy Directed by therapist, with varying levels of client/family involvement Likely to be decontextualized, using materials and activities targeting skills. Coaching Model for Therapy Collaborative: goals and activities are established by therapist based on assessment, but are also responsive to family/educator/client preferences and functional needs in ways that are likely increased by family/educator involvement during sessions. Contextualized by the situation of session taking place at a distance, but open to varying levels along Coaching and the Adult learning Model 1. Joint Planning 2. Observation 3. Action 4. Reflection 5. Feedback Outcome: Generalizing knowledge and applying to other situations Baseline Data Questionnaire was developed to determine the needs of the school professionals working with children with hearing loss Experience with children who have hearing loss Knowledge of hearing devices Knowledge of audiogram Knowledge of how well the child uses the device Knowledge of speech and language development Case Study: Coaching Strategies Mom brings toys to the session that are of interest to the child Mom is coached on using the previously discussed skills while she is playing with the child Big sister is incorporated into the sessions Cooking as a way to build audition and language Repetitive nature of the activities VERY motivating! Mom brings her questions/concerns to the sessions Case Study of a School-Age Child 10- year-old boy Bilateral Cochlear Implants, with FM system Bilateral hearing aids at 30 months; initial cochlear implant 3 years; second cochlear implant at 6 years Attends third grade in mainstream school; works with speech implementer in both classroom and in pull-out Demonstrates difficulties with receptive and expressive language as well as auditory memory. Five 30-minute online sessions a week (speech, language, audition). Case Study: Coaching Strategies IEP goals in speech, audition, and language were written by online therapists, in consult with the implementer. Online therapists provide regular homework and instruction in teaching vocabulary through techniques emphasizing auditory training, with written, auditory, and kinesthetic support. Implementer communicates regularly with online therapists to provide classroom vocabulary and other information per current functional needs

5 Case Study: Seize the Moment Student hears school-wide announcement, refers to it as office and girl (principal) Teach vocabulary ( announcement, principal ) Coaches implementer to introduce student to principal Student and implementer visit school office, meet principal Student learns principal s name and observes her making an announcement For contact information visit ihearlearning.org Jeanne Flowers, MSDE, MS, CCC-SLP, LSLS Cert. AVEd jflowers@sjid.org Amy Knackstedt, MA, CED aknackstedt@sjid.org Cheryl Broekelmann, MA, LSLS Cert. AVEd cbroekelmann@sjid.org References Alexander Graham Bell Academy for Listening and Spoken Language. (2011). Retrieved November 8, 2011, from American Speech-Language Hearing Association. ( ).LPAA Project Group (Chapey, R., Duchan, J.F., Elman, R.J., Garcia, L.J., Kagan, A., Lyon, J.& Mackie, N.S.). Life participation approach to aphasia: A statement of values for the future. Retrieved November 7, 2011 from American Speech-Language Hearing Association. (2005). Speech Language Pathologists Providing Clinical Services in Telepractice: Position Statement. [Position Statement]. Available from American Speech-Language Hearing Association. (n.d.). Practice Portal Professional Issues: Telepractice. Retrieved March 25, 2014, from the American Speech-Language Hearing Association Website: Cole, E.B. & Flexer, C. (2007). Children with hearing loss: Developing listening and talking. San Diego, CA: Plural Publishing. Easterbrooks, S.R. & Estes, E.L. (2007). Helping deaf and hard of hearing students use spoken language: A guide for educators and families. Thousand Oaks, CA: Corwin Press. Estabrooks, W. (2006). Auditory-Verbal therapy and practice. Washington, DC: Alexander Graham Bell Association for the Deaf and Hard of Hearing. Fey, M.E. (1986). Language intervention with young children. Newton, MA: Allyn & Bacon. Fey, M.E., Catts, H.W. & Larrivee, L.S. (1995). Preparing preschoolers for the academic and social challenges of school. In M.E. Fey, Windsor, J., Warren, S.F. (Eds.), Language intervention: Preschool though the elementary years volume 5 (pp ). Baltimore, MD: Paul H. Brookes Publishing Company. References (continued) Hanft, B.E., Rush, D. D.& Shelden, M.L. (2004). Coaching families and colleagues in early childhood. Baltimore, MD: Paul H. Brookes Publishing Company. McLuhan, M. ( 1994). Understanding media: The extensions of man. Cambridge, MA: The MIT Press. (Original work published 1964). Sharma, A., Martin, K., Roland, P., et al. (2005). P1 latency as a biomarker for central auditory development in children with hearing impairment. Journal of the American Academy of Audiology, 16, (2013). St. Joseph Institute Auditory Therapy Guide. St. Louis, MO:. World Health Organization. (2001). International classification of functioning, disability and health. Geneva: World Health Organization. Ylvisaker, M. & Holland, A. (1985). Coaching, self-coaching, and rehabilitation of head injury. In D. F Johns (Ed.), Clinical management of neurogenic communication disorders (pp ). Boston, MA: Little, Brown & Company