1. Audiologic Rehabilitation for Children and Educational Audiology SPA 6581 – Spring 2015 Lecture Date: 03/16/15 AUDITORY VERBAL THERAPY

2. HTTP://WWW.UTDALLAS.E DU/~THIB/EARRINGFINAL/ EARRINGWEB_FILES/FRA ME.HTM

3.  Pollack, Goldberg, Caleffe-Schenck (1990)  Romanik, S. (1990)  Simser (1993)  Dickson, C. (1999)  Estabrooks (1998)  Cole and Flexer (2007)  Walker (1995, rev. 2010) CURRENT MODELS OF AUDITORY LEARNING

4.  Evaluations are done by many professionals  AuD  SLP  MD  Psychologist  Genetics  Therapy is typically provided by SLPs but is also provided by audiologists, early interventionists, and deaf educators  Therapist “fit” with patient depends on communication mode chosen and therapist’s skill/knowledge base WHO EVALUATES AND PROVIDES THERAPY?

5.  Cochlear Implant Age = length of time since CI “hook- up.”  A-V Age = length of time enrolled in Auditory-Verbal Therapy  Language Age = level of understanding and use of language IMPORTANT REVIEW OF TERMS

6.  John is an 11 month old boy whose moderately severe bilateral hearing loss was diagnosed at two months of age. He began wearing hearing aids at 3 months of age and began AVT at the age of 5 months.  What is John’s hearing age? What is his program (AVT) age? APPLICATION

7.  Auditory processing, neuroplasticity of the auditory system and a critical period for development of an auditory function  Normal Auditory Development  Speech Acoustics  Auditory-Verbal Strategies & Techniques  Assessment of Listening Skills KEEP IN MIND WHAT YOU NEED TO KNOW

8.  There are many approaches to working with our patients  SLPs goals are to improve or facilitate communication whether it be in sign language, augmentative alternative communication (i.e. PECS, technological devices),or, ideally, spoken language  It is the role of the family or the patient to determine what mode of communication is best for them WHAT TYPES OF THERAPY ARE OUT THERE?

9.  Facilitates optimal acquisition of spoken language through listening by infants, toddlers, and children who are deaf or hard of hearing.  Auditory verbal education promotes early diagnosis and state-of –the-art audiologic management and technology.  Parents and caregivers are involved to the fullest extent possible in their child’s language development and education.  Auditory-verbal educators promote mainstream education for students who are deaf or hard of hearing by supporting the development of audition, spoken language and vocabulary, reading and written expression throughout the teaching of academic material. AUDITORY VERBAL EDUCATION

10.  Auditory verbal educators provide parental support, support services to mainstreamed students and intensive intervention for students in self-contained placements for children who are deaf or hard of hearing.  Auditory-Verbal Education focuses on teaching listening and talking to various sized instructional groups to prepare children to enter mainstream education when they have the skills to do so successfully.  A Listening and Spoken Language Educator (LSLS Cert. AVEd) teaches children with hearing loss to listen and talk exclusively though listening and spoken language instruction.  The LSLS Cert. AVEd is guided by the Academy's Ten Principles of LSLS Auditory-Verbal Education and adheres to a professional code. AUDITORY-VERBAL EDUCATION…

11.  Auditory Verbal therapy facilitates optimal acquisition of spoken language through listening by newborns, infants, toddlers, and young children who are deaf or hard of hearing.  Auditory-verbal therapy promotes early diagnosis, one-on-one therapy, and state of the art audiologic management and technology.  Parents and caregivers actively participate in therapy.  Through guidance, coaching and demonstration, parents become the primary facilitators of their child’s spoken language development.  Ultimately, parents and caregivers gain confidence that their child will have access to a full range of academic, social, and occupational choices.  AVT must be conducted in adherence to the “Principles of LSLS AVT.” AUDITORY-VERBAL THERAPY

12.  Certified by the AG Bell Academy for Listening and Spoken Language  Listening and Spoken Language Specialist (LSLS)  Also can be certified as a LSLS – cert. AVEd (Auditory Verbal Educator)  There are many therapists who use the auditory verbal approach but are not officially certified WHO PROVIDES AVT? CONTINUED…

13. WHAT DOES IT TAKE TO BECOME AN AVT?

14.  1. Promote early diagnosis of hearing loss in newborns, infants, toddlers, and young children, followed by immediate audiological management and Auditory Verbal therapy.  2. Recommend immediate assessment and use of appropriate, state-of-the-art hearing technology to obtain maximum benefits of auditory stimulation.  3. Guide and coach parents to help their child use hearing as the primary sensory modality in developing listening and spoken language. PRINCIPLES OF LSLS AUDITORY- VERBAL PRACTICE...

15.  4. Guide and coach parents to become the primary facilitators of their child's listening and spoken language development through active consistent participation in individualized Auditory-Verbal therapy.  5. Guide and coach parents to create environments that support listening for the acquisition of spoken language throughout the child's daily activities.  6. Guide and coach parents to help their child integrate listening and spoken language into all aspects of the child's life. PRINCIPLES OF LSLS AUDITORY- VERBAL PRACTICE...

16.  7. Guide and coach parents1 to use natural developmental patterns of audition, speech, language, cognition, and communication.  8. Guide and coach parents1 to help their child self- monitor spoken language through listening. PRINCIPLES OF LSLS AUDITORY- VERBAL PRACTICE...

17.  9. Administer ongoing formal and informal diagnostic assessments to develop individualized Auditory- Verbal treatment plans, to monitor progress and to evaluate the effectiveness of the plans for the child and family.  10. Promote education in regular schools with peers who have typical hearing and with appropriate services from early childhood onwards. PRINCIPLES OF LSLS AUDITORY- VERBAL PRACTICE...

18.  Think about the 2 year old and the hours that professionals have vs. parents  1 hour of therapy x 48 weeks a year = 48 hours  11 waking hours per day x 7 days a week = 77 hours x 52 weeks a year = 4, 015 hours  Think about the 9 year old who has the language of the typical 4 year old.  Parent sessions are not typically done in public school settings...a MUST for children with educationally significant language delays. GUIDING AND COACHING PARENTS = EFFICIENCY

19.  Parents actively participate in ALL sessions.  The parent is the primary student during therapy sessions.  The parent is the primary teacher in day-to-day life  Parent participation and parent involvement in all aspects of the child’s habilitation IN AN AUDITORY-VERBAL APPROACH

20.  80 hours of CEUs in the area of AVT  Minimum of 750 supervised therapy clock hours over a three to five year period  Minimum of observation 10 hours of at least two different LSLS Cert AVTs  Work with a LSLS-certified mentor for three to five years  Written examination after all of the above has been completed WHAT ARE THE REQUIREMENTS?

21. CRITICAL AREAS TO ASSESS  The speech and language assessment should include the “evaluation of the client’s speech perception abilities, understanding and use of spoken language, written and signed language as appropriate, voice skills, speech production and overall intelligibility, preferred method of communication, and any communication tactics used (Cooper, & Craddock, 2006).”  I would argue that it should include a few more areas to round out the assessment of “form, content, and use,” including: audition skills, pragmatic, and social skills.  Others you would include?

22.  Case History  Informal audiological assessment  Questionnaires regarding auditory behavior  Speech perception testing  Clinical and behavioral observations  Standardized and criteria based speech and/or articulation assessments  Standardized language assessments  Sign language tests (if needed) OVERVIEW OF THE SPEECH LANGUAGE EVALUATION

23. SLE PRIORITIES AND PROTOCOLS  Each center will develop their own protocols for evaluations. These should be evidence-based, and need to be flexible enough to adapt with changing criteria and/or technology.  Examples of protocols for the SLE:  USC protocol: page 1, page 2page 1page 2  UNC protocol: page 1, page 2, page 3, page 4page 1page 2page 3page 4  AVT protocol recommendations – A.G. Bell  Other Considerations:  What about the patients who don’t fit into the predetermined general protocol?

24. USC SLE PROTOCOL – PAGE 1

25. USC SLE PROTOCOL – PAGE 2

26. UNC SLE PROTOCOL PG. 1

27. UNC SLE PROTOCOL PG. 2

28. UNC SLE RECOMMENDATIONS PG. 1 AND 2

29. UNC SLE RECOMMENDATIONS PG. 3 AND 4

30.  Case History  Pregnancy, labor, delivery history  Medical history  Surgical history  Hearing history, amplification history  Developmental milestone acquisition  Communication mode  Educational history  Concerns regarding speech and language development THE SPEECH LANGUAGE EVALUATION

31. CASE HISTORY EXAMPLE QUESTIONS  Did the pregnancy progress to full term?  Were there associated complications?  Was there perinatal infection, such as _____________?  Did the child spend time in the neonatal intensive care unit (NICU)?  Were high oxygen concentrations needed?  Were there blood transfusions?

32. CASE HISTORY CONSIDERATIONS  The SLP may identify a patient in need of further evaluation, and may be the initial point of referral to the CI team.  Audiological  Were they appropriate?  Were they timely?  Need to know the results for NBHS, recommendations for appropriate management  Were the appropriate referrals made?  Were recommendations followed?  Results of testing? (ABR…)  Others?  Have they seen an ENT?  Sample case history for children with hearing loss:  http://www.asha.org/docs/html/GL2004-00002-F1.html

33.  Informal audiological assessment  Depends on access to sound  Cochlear Implant – unilateral, bilateral, length of implantation, frequency use, how bonded to the device is the patient  Hearing aids – unilateral, bilateral, power aid, benefit from aid/aids  Behavioral responses to noise makers and/or speech THE SPEECH LANGUAGE EVALUATION

34.  Informal audiological assessment continued  Ling 6 sound test – detection  Informal VRA  Conditioned play  Ling 6 sound test – identification  Imitation using hand cue  Imitation without any cueing (usually older children and/or adults) THE SPEECH LANGUAGE EVALUATION

35.  Questionnaires regarding auditory behavior  Infant Toddler – Meaningful Auditory Integration Scale (IT-MAIS) and Meaningful Auditory Integration Scale (MAIS)  Can be administered by AuD or SLP  The IT-MAIS is -for children 4 and younger and the MAIS is for children 5 years and older  IT-MAIS was derived from the MAIS THE SPEECH LANGUAGE EVALUATION

36.  IT-MAIS and MAIS continued…  Both contain 10 questions with answers on a scale of 0 – 4  Caregiver interview designed to assess a child’s spontaneous responses to sound in his/her everyday situations  Assesses 3 main areas  Vocal behavior  Alerting to sound  Deriving meaning from sound THE SPEECH LANGUAGE EVALUATION

37.  LittlEars  a parent questionnaire that evaluates all types of auditory behavior which are observable as a reaction to acoustic stimuli  35 questions  Hierarchically structured as to follow the auditory development of children from newborn hearing screening to 24 months of age or hearing impaired children with cochlear implants or hearing aids with a hearing age of 24 months THE SPEECH LANGUAGE EVALUATION

38.  Speech Perception Testing  Different from the testing done in the audio booth  Loudness of stumuli is not controlled or set at specific decibel level when completed by SLP  Done auditory only but visual cues can be given after pt is unable to answer correctly  Helpful information can be gleaned when a pt can only answer correctly with visual cues THE SPEECH LANGUAGE EVALUATION

39.  Speech Perception Testing  Early Speech Perception Test (ESP)  Can be done by AuD or SLP  Two versions  Low-Verbal  Standard  Closed Set  Hierarchically structured  Pattern Perception  Spondees  Monosyllabic words THE SPEECH LANGUAGE EVALUATION

40.  Speech Perception Testing  ESP Low Verbal Version  Toys that correspond to the target words  Example for the “Pattern Perception” subtest would be a toy ball, an airplane, hamburger  Set of 4 toys out on the table at a time  ESP Standard Version  Colored pictures that correspond to the target words  Set of 12 pictures per card  1 card for each subtest THE SPEECH LANGUAGE EVALUATION

41.  Auditory Perception Test for the Hearing Impaired (APT-HI)  identifies specific auditory perception and processing deficits across the continuum of listening from awareness to open-set comprehension  Used with children 3 yrs or older THE SPEECH LANGUAGE EVALUATION

42.  Clinical and behavioral observations  Social skills – dependent on age  Eye contact, awareness of environment, communicative intent, joint communication, initiation of communication  Mode of communication  Nonverbal  Sign language, gestures, gestures + vocalizations, home signs, activating others, AAC  Verbal THE SPEECH LANGUAGE EVALUATION

43.  Clinical and behavioral observations continued…  Attention and/or behavioral concerns  Communication frustration vs. true behavioral concerns  Family dynamics  Family’s expectations for child and understanding of the implant process and time requirements involved THE SPEECH LANGUAGE EVALUATION

44.  Standardized and criteria based speech and/or articulation assessments  Goldman Fristoe Test of Articulation – 2 (GFTA-2)  Standardized articulation assessment  Requires child to label pictures and sometimes may not be appropriate for children with delayed language skills  Assesses a child’s production of all English consonants in most contexts (initial, medial, final, blend) THE SPEECH LANGUAGE EVALUATION

45.  Speech assessments continued…  Identifying Early Phonological Needs in Hearing Impaired Children (IEPN-HI)  Not standardized  Assesses most phonemes in most contexts, including vowels  Assesses child’s production of phonemes based on manner, place, voicing THE SPEECH LANGUAGE EVALUATION

46.  What’s the manner, place, and voicing for these phonemes?  /G/  /M/  /S/  What’s the frequency information for these sounds? QUICK LITTLE SPEECH QUIZ!

47.  Standardized language assessments  Consider child’s age and language abilities  Consider communication mode to determine appropriate test  Spoken language vs Sign language  Overall language tests  Vocabulary tests THE SPEECH LANGUAGE EVALUATION

48.  Infants and Toddlers  Most often assessment is completed via parent questionnaire and clinical observations  Clinician’s must use their knowledge of development and clinical instinct to sometimes accurately score these, as parents may under or over-estimate a child’s abilities  Birth to Three Developmental Assessment and Inventory Scale  Receptive Expressive Emergent Language Test -3 rd Edition (REEL-3) THE SPEECH LANGUAGE EVALUATION

49.  Preschool overall language tests  Preschool Language Scale – 5 th Edition (PLS-5)  Clinical Evaluation of Language Fundamentals – Preschool 3 rd Edition (CELF-P3)  Oral and Written Language Scales – 2 (OWLS-2) THE SPEECH LANGUAGE EVALUATION

50.  School age overall language tests  Oral and Written Language Scales -2 (OWLS-2)  Clinical Evaluation of Language Fundamentals -4 th Edition (CELF-4)  Test of Language Development – 4 th Edition (TOLD -4)  Primary and Intermediate Editions THE SPEECH LANGUAGE EVALUATION

51.  Vocabulary testing  Different from language in that it does not involve syntax, semantics, morphology  Receptive and expressive vocabulary testing  Completed via picture labeling or identifying THE SPEECH LANGUAGE EVALUATION

52.  Vocabulary testing continued…  Receptive One-Word Picture Vocabulary Test (ROWPVT) and Expressive One-Word Picture Vocabulary Test (EOWPVT)  Peabody Picture Vocabulary Test (PPVT) and Expressive Vocabulary Test (EVT)  Sign language vocabulary test  Carolina Picture Vocabulary Test (CPVT) THE SPEECH LANGUAGE EVALUATION

53.  Impressions and Recommendations are clearly stated in reports so that it can be understood and implemented in various environments (private therapist, school therapist, school teacher, home, etc)  Recommendations for CI candidacy, strength of candidacy, and why  Recommendations for possible change in amplification  Recommendations for educational placement, school accommodations (preferred seating, FM system)  Recommendations include speech, language and auditory goals  Further testing if needed (i.e. psychoeducational) THE SPEECH LANGUAGE EVALUATION

54. Therapy is key! GETTING DOWN TO WORK!

55.  Positioning to Maximize Auditory Input  Attention Getters  Helps for PROCESSING through Audition  IF you must…  Helps for Confident Listening  Other Strategies AUDITORY-VERBAL STRATEGIES AND TECHNIQUES

56.  Optimal distance is  Within 6 inches of the HA microphone  Within 6 inches of the CI microphone  Where should you be seated, etc. POSITIONING TO MAXIMIZE AUDITORY INPUT

57.  The Environment  Quiet room  High chair, little chairs and little table, or we play on the floor  Therapist sits on the side of the child, with the therapist’s chair slightly behind the child’s chair and directs the child’s attention in front using toys or redirection cues  Minimize distraction (toys, noise, etc…) AUDITORY BASED THERAPY

58. Attention Getters  The “Listen!” Cue  Audition FIRST  Not show and tell but Tell and Show  Why hearing first?  Sing What You Say/Parentese  Get Closer Helps for PROCESSING through Audition  CLEAR Speech  Speak at a slightly slower rate of speech  Acoustic Highlighting: more to less  Lowlighting/Whispering : Why? A-V STRATEGIES

59. MORE AUDIBLE (for a beginning child) PROGRESSING TOLESS HIGHLIGHTING (for a child who is listening well) No background noise Increased background noise 6” from hearing aid or cochlear implant Increased distance from hearing aid or cochlear implant Slightly slower rate Normal rate Increased pitch variation (sing what you say) Normal rhythm Clearer enunciation (use of “clear” speech) Less clear and/or unfamiliar voice Increased repetition No repetition Greater acoustic contrast (vowel variation, rhythm contrast, number of syllables) Less varied (minimal pairs, same syllables, similar rhythm) Simpler language with shorter phrases Complex sentences Emphasis on key words No emphasis on key words Emphasis on unaccentuated words (prepositions, articles, verb tenses, pronouns) No emphasis Word position in sentence: End of sentence Middle of sentenceBeginning of sentence Closed set Open set AUDITORY BASED THERAPY

60.  WAIT Time + Expectant Look  The younger the child, the more wait time needed  The Expectant Look says...  Repetition: Why?  Pause before challenging word/s  Word position in sentence  Give a choice  What DID you hear? AV-STRATEGIES HELPS FOR PROCESSING

61. AV-Strategies IF you must...  A-V-A Sandwich or “Put it back into hearing”  Give visual context for auditory input  Point to the picture/object  Natural gesture  Facial expression  Adjust set size Helps for Confident Listening  Modeling  Converse slightly above child’s linguistic level  Diagnostic Teaching, NOT testing  Known →unknown, audible →less audible A-V STRATEGIES

62.  The absent-minded therapist  Let child be the teacher OTHER A-V STRATEGIES

63.  Framework for the development of an auditory function  Based on the work of Simser, Romanik & Foreworks Curriculum  Comprehensive chart  Not an exhaustive list AUDITORY LEARNING GUIDE BETH WALKER, 1995, REV. 2010

64.  Establishing Goals  Planning therapy sessions  Documenting progress  Parent Education  Professional collaboration THE ALG IS USEFUL FOR...

65.  Therapist’s skill level/experience  Residual hearing/aided thresholds  Age at implantation  Perception vs. production ALG: CONSIDERATIONS

66.  DETECTION ONLY, “LOW LEVEL”  Begins with detection of ANY speech sound  Quickly progresses to detection of all sounds  Close range to distance  Includes detection of wide variety of environmental sounds at various distances  Some children, with optimal amplification, may complete work on all steps in one week ALG: SOUND AWARENESS

67.  Conditioned Response  Exposure/Modeling at 16 months  Most children consistent: ~24 months  Audiological Evaluations  More efficient  More reliable  More thorough  Ling 6 Sound Check  Daily checks help monitor:  Amplification  Middle Ear Status ALG: SOUND AWARENESS

68.  Examples:  Alternating vowels (dee-mo)  Identification of consonants varying in manner of production (ma-ma- boo-boo) ALG: PHONEME LEVEL

69.  Connected spoken language  Conversational context:  Discourse  Dialogue  Combine with Sentence and Word Level ALG: DISCOURSE LEVEL

70.  Develops auditory memory  MUST give child a communicative reason to respond  Use imitation as a strategy  After step 3? 6?, “work” at this level is often unnecessary  “Stimulus-response” context ALG: SENTENCE LEVEL

71.  Examples of Critical Elements  One: Where’s the kittycat?  Two: I need a red ball. Look under the table.  Three: Mommy wants two pretzels.  Four: Color the big star yellow and orange. ALG: CRITICAL ELEMENTS

72.  Word Level  Perception of individual words  Progression:  Acoustic features of the target  Word placement  In the context of phrases or sentences ALG: WORD LEVEL

73.  Word Level  Vocabulary Development Program- (NOT “skill-based” exercises with single words)  1.Learning to Listen sounds  2.Power Word list  3.Lexicon One  4.“Theme-based” units, Children’s Literature Units (Ling Basic Vocabulary & Language Guide) ALG: WORD LEVEL

74.  https://sites.google.com/site/rudhhvideo/home/grace-id-by- description https://sites.google.com/site/rudhhvideo/home/grace-id-by- description FUN WEBSITE

75.  Learning to Listen Sounds: Content  Suprasegmental features  Early developing vowels  Early developing consonants. LEARNING TO LISTEN SOUNDS: CONTENT

76.  Learning to Listen Sounds  Sound/object associations  More auditorily interesting and diverse in suprasegmentals for the beginning listener  What are suprasegmentals?  Used at the beginning to teach that speech is meaningful  Helps the beginning listener learn how to discriminate between sounds  “ahhhhh” for the airplane vs “puh-puh-puh-puh” for the boat AUDITORY BASED THERAPY

77.  Learning to Listen Sounds  Lings 6 Sounds are incorporated in the Learning to Listen Sounds  “Ahhh” for an airplane  “Mmm” for a cookie  “Shhh” for a baby  “Sssss” for a snake  “Eeee” for a police car or elephant  “Ooo” for a ghost AUDITORY BASED THERAPY

78.  Considerations  Age  Experience listening  Selection of sounds  Auditory Access  Suprasegmentals  Child must be able to imitate sounds that vary in duration, intensity, and pitch.  Let’s name sounds with:  Long duration  Brief interrupted duration  Loud intensity  Quiet intensity  High pitch  Low pitch  Varied pitch LEARNING TO LISTEN SOUNDS: CRITERIA FOR MASTERY

79. Child must be able to imitate two back vowels, two mid-vowels and at least one front vowel.  Let’s identify:  Back vowels  Mid vowels  Front vowels  Child must be able to imitate a nasal, fricative, and plosive.  Child must demonstrate spontaneous use AND identify Learning to Listen Sounds in a set of 10-12 LEARNING TO LISTEN SOUNDS: CRITERIA FOR MASTERY CONTINUED

80. More Up Mama, Daddy Go Stop Bye-bye No All gone Hot/cold Mine/me Off/on Look Blow Go away Move Open POWER WORDS

81.  First 30-60 words that young children acquire.  Need a core vocabulary before child can produce two-word combinations  First Lexicon includes nouns, pronouns, adjectives, verbs, position/location words and words to indicate denial and rejection FIRST LEXICON

82. DELAYED AND REMEDIAL LEARNERS CAN “CATCH UP” WITH FOCUSED LANGUAGE INTERVENTION THAT FOLLOWS A DEVELOPMENTAL SEQUENCE

83.  A typical session will address the following:  Device check  Auditory goals  Language goals  Receptive and Expressive  Speech/Articulation goals  Parent education, home carry-over program, goals for the week  Almost all therapy is play based…you can’t make an impact if they’re not engaged! AUDITORY BASED THERAPY

84.  Device check  A MUST at the beginning of each session  Parents don’t always do this and if a child is not bonded to his/her device, the child may not know if batteries are dead. (E.F.)  Bilateral - must check each device independently  Microphone check via monitor headphones for CI and listening stethoscope for hearing aids  Typically done if there are concerns AUDITORY BASED THERAPY

85.  Device check cont…  How is it done?  Ling 6 sounds –method chosen depends on child’s age and length of time with device  Conditioned play  Informal VRA  Imitation  What happens if it doesn’t go well?  Troubleshoot – listen to microphone, determine if it is equipment issue or a hearing issue AUDITORY BASED THERAPY

86.  Conditioned play  Many MANY hearing impaired children do not have this skill  It is a learned skill  Children who receive auditory based therapy or AVT learn this skill almost immediately, as it allows for more accurate programming of their device/s and allows audiologists to obtain more reliable information in the audio booth  Audiologists LOVE SLPs for this!! AUDITORY BASED THERAPY

87.  Areas typically covered:  Communication  Auditory Learning/Audiological Management  Language Development  Speech Development  Development of Inner Discipline/Behavior Management  Cognition/Pre-Academic skills/Pre-Literacy A-V: PLANNING THE PARENT PARTICIPATION SESSION

88.  1. Greeting & Review---Sessions begin with asking parent(s) specific questions about child’s progress and quality and quantity of home carry-over since the last session.  2. Goal 1 & Activity State the goal to the parent  - be brief  - use parent friendly language  - refer to the source of the goal  - tell why this goal is important  3. Goal 1—(continued) Model the strategies you want the parent to learn.  State the strategies that you want the parent to practice. FORMAT FOR A PARENT PARTICIPATION SESSION

89.  4. Guided Practice  Therapist takes two or three turns, then turns the activity over to the parent  Therapist takes a turn, parent takes a turn, therapist takes another turn, parent  Therapist uses target strategies in a play activity one day, parent does it the next  Give feedback- find something positive and “shape” the behavior from there  5. Independent Practice  Parent practices strategies until he/she is comfortable without prompting  6. Encourage positive self-evaluation FORMAT FOR A PARENT PARTICIPATION SESSION

90.  7. Repeat #2-3-5 for each goal and activity.  8. Closure (2-3 mins.)  If the parent has not yet recorded the goals and strategies, now is the time to do this.  Let’s think of some ways we can encourage the parent to record the information in writing.  9. Have the parent tell you what he will be working on this week.  “Why don’t you tell me what you’ll be working on this week so I can check to make sure I’ve made myself clear.”  “I want to check to make sure I’ve stated our goals clearly. Tell me your understanding of what you will work on this week with Julie.” FORMAT FOR A PARENT PARTICIPATION SESSION

91.  Last five minutes of weekly sessions (child plays independently)  At a separate time from weekly session (child is not with parent)  Use Parent Information Session Topics handout to insure all necessary info is covered  Use handouts, videos, audios, books, other parents, websites as resources PARENT INFORMATION SESSIONS

92.  Communication Options/The Auditory- Verbal Approach  Communication  Audiological Management/Hearing Aids/Cochlear Implants  Behavior Management/Developme nt of Inner Discipline/Effective Parenting  Speech Development  Language Development  Speech Development  Auditory Development  Literacy  Child Development PARENT CURRICULUM

93.  Expertise in the Auditory-Verbal approach  Skills in teaching parents  Question: “Am I skilled in teaching adults?”  Areas where we need more training:  Providing clear information Coaching  Providing specific feedback  Open to feedback from and dialogue with parents EFFECTIVE PARENT COACHING AND GUIDANCE REQUIRES....

94.  What do you know about adult learning from your own experience?  Think of something you learned as an adult that you are good at - how did you become competent?  Think of an unsuccessful learning experience - what went wrong? ADULT LEARNERS

95.  Characteristics of Adult Learners  Seek education that relates or applies directly to their perceived needs  Goal oriented  Learning must make sense  Self-directed  Learn best in a democratic, participatory and collaborative environment.  “Adults respond most favorably when they are actively involved in designing and implementing their own learning.”- Lowy, 1983 WHAT DO WE KNOW ABOUT THE CHARACTERISTICS OF ADULT LEARNERS FROM THE LITERATURE?

96.  Adults vary in their confidence level, intellectual ability, education level, personality, and cognitive learning style.  They learn at different rates and in different ways:  Right brain vs. Left brain (Rose and Nicholls, 1997)  Visual vs. Auditory vs. Tactile/Kinesthetic (Brandler and Grider)  Reflective, Creative, Practical and Conceptual Thinkers CHARACTERISTICS OF ADULT LEARNING

97.  Parents need…  Coaching and guidance that is relevant and clear to help them meet their goals  Working knowledge of the stages in listening, language, speech and cognition and strategies and techniques that promote the auditory learning of the child’s goals  Practice and repetition  Reinforcement  Intervention that fits their learning style  Active, consistent participation  To be shown respect. Practitioners are open to feedback from parents APPLICATION TO A-V PRACTICE

98.  As adults who are goal oriented and seek education that relates or applies directly to their perceived needs  parents will work toward weekly goals when they are CLEAR about what those goals are.  As adults who are self-directed  parents will use hierarchies of normal development to select goals WITH the therapist.  As adults who learn best in a democratic, participatory and collaborative environment  parents feel their abilities are valued when the professional provides feedback by pointing out a parent’s strength and then shaping the behavior from that point.  parents feel empowered to disagree with the professional.  parents will ask questions when they don’t understand. FAMILY-PROFESSIONAL PARTNERSHIPS

99.  As adults who vary in their confidence level, intellectual ability, education level, personality, and cognitive learning style parents will grow in their capacity to be the child’s primary teacher  if the professional does not feel that he/she must always be the one with the answers.  parents are guided to discover answers to questions.  If the professional asks questions to highlight the parents’ knowledge. FAMILY-PROFESSIONAL PARTNERSHIPS

100.  Poor planning and organization  Parents who are not given ample opportunity to practice during the session will find it difficult/impossible to integrate new strategies and techniques during daily activities  Unclear statements from the teacher about what parents need to do  Activities and materials are not age/stage appropriate  Emphasis on testing vs. teaching  Too much time devoted to counseling/talking with parent—not enough time spent on weekly goals  Parents who chose this approach because someone “convinced” them A-V was right for their child may resist participating in sessions or home follow through  No occupying toys  Interruptions—deliveries, neighbors, phone, siblings  Child is not ready for the session when therapist arrives OBSTACLES TO SUCCESSFUL PARENT PARTICIPATION SESSIONS