Coaching: Listening/Spoken Language Teletherapy for Children with Hearing Loss

Coaching: Listening/Spoken Language Teletherapy for Children with Hearing Loss

Cheryl Broekelmann, MA, LSLS Cert. AVEd Victoria L. Carlson-Casaregola, MA, CCC-SLP Jeanne Flowers, MSDE, MS, CF-SLP, LSLS Cert. AVEd Michelle Graham, MS, CED, LSLS Cert. AVEd. Amy Knackstedt, BA, CED Barbara Meyers, MAEd, CED

Agenda 5 Minutes Introduction and Overview 15 Minutes Background 15 Minutes Coaching Strategies 15 Minutes Case Studies 10 Wrap-Up and 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.

Disclosure of Proprietary Interest As therapists, educators, and developers of curricular and technological materials for online therapy for children with hearing loss, we have a professional and financial interest in our topic.

SJI: A Tradition Of Innovation

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)

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

Coaching is about Connections When we work online, we do more than make the technology connect and the computer work properly in order to reach clients. We form working relationships connections that are potentially as close or closer than they would be in other forms of service delivery because therapist, on-site facilitator (parent, caregiver, teacher, or paraprofessional), and child must all communicate about the process in detail, with the facilitator implementing and monitoring student progress closely and providing the therapist with necessary information about the child s work outside of the session. The therapist must work with a sense of inter-dependence, building trust and educating the facilitator to check, implement, inform and engage fully in the process of working together online.

Coaching Model vs. Traditional Therapy Model Traditional Therapy Directed by therapist, with varying levels of consideration of client/family preference (assuming incorporation of evidence-based practice paradigm); Likely to be decontextualized, using materials and activities targeting skills. Continuum of naturalness= Continuum of Intrusiveness vs. Nonintrusiveness? (Fey, Catts, Larrivee, 1995) 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 continuum of naturalness. The nature of this new model for online coaching is evolving.

New Coaching Paradigm: Larger Influences in Speech Language Pathology International Classification of Functioning, Disability and Health (ICF): emphasis on health of whole person functioning in community, not simply on treatment of disability or disorder (World Health Organization, 2001) Early Intervention coaching model of empowering families Other areas of practice: aphasia therapy connection with life coaching (Ylvisaker & Holland, 1985) and statement of coaching as a valid clinical role (ASHA, LPAA Group, 1997)

Technology = Change, Challenge, Opportunity, New Ways to Provide Services, Adapted Practices We become what we behold. We shape our tools and thereafter our tools shape us. (McLuhan,1994, 1964) Telepractice, teletherapy, Internet-based, or online therapy, opens up many new professional opportunities in the Global Village envisioned by media theorist McLuhan in the mid-twentieth century. Therapists have new technology and with it comes the need for adaptations of methods and developments of new techniques to achieve best practices. Our tools do indeed shape us and our professional practices.

Tele-Intervention Overview ASHA defines telepractice as the application of telecommunications technology to delivery of professional services at a distance by linking clinician to client, or clinician to clinician, for assessment, intervention, and/or consultation. (ASHA, 2005)

ASHA Position Statement ASHA s position is that telepractice is an appropriate model of service delivery for the professions of speech-language pathology [and audiology]. Telepractice may be used to overcome barriers of access to services caused by distance, unavailability of specialists and/or subspecialists, and impaired mobility. Telepractice offers the potential to extend clinical services to remote, rural, and underserved populations, and to culturally and linguistically diverse populations. The use of telepractice does not remove any existing responsibilities in delivering services, including adherence to the Code of Ethics, Scope of Practice, state and federal laws (e.g., licensure, HIPAA, etc.), and ASHA policy documents on professional practices. Therefore, the quality of services delivered via telepractice must be consistent with the quality of services delivered face-to-face. (ASHA, 2005)

Typical Interactions of Therapist and Parent/Educator Parent/Educator: Checking Sound Signal Parent/Educator: Checking Child s Production Therapist: Expanding interaction with child to include teachable moment for the on-site coach Therapist: Modeling therapy techniques in naturalistic context, then directing the on-site coach to try the technique Parent/Educator: Encouraging the on-site coach and the child to continue to work on strategies.

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

Auditory Hierarchy Detection of sound Alerting to a sound Discrimination of sounds Recognizing that sounds are different Identification of sounds Knowing what sound is heard Comprehension of sounds Taking what is heard and doing something with the information

Strategies for Auditory Development Listen Talk to your baby!! Parentese Proximity to the child and the microphone of the hearing device Acoustic Highlighting Emphasizing a word or phrase Indicates to the child a key word Auditory Sandwich Auditory Discrimination Developing Auditory Memory Auditory Feedback Loop

Auditory Sandwich Listen - auditory only Watch - provide visual cues to help child understand Listen - auditory only

Auditory Discrimination Sound Object Association: Onomatopoeias Songs Very distinct in terms of pattern (duration, intensity, and pitch) Requires lots of repetition Minimal Pairs Discriminate the differences in two sounds within a word that are minimally differ in formant information

Auditory Memory Nursery Rhymes and Songs Expansion of Language Vocabulary Imitation Modeling Increase Mean Length of Utterance

Auditory Feedback Loop A child s ability to use their residual hearing to self monitor their own speech and language Competent language users are able to listen to what they are saying at the same time they are saying it Able to know when they make a speech or language error and are able to correct it. Teaches self-monitoring of speech and the ability to match productions to those of others

Case Study #1: Toddler 18 month old boy Bilateral Cochlear Implants Very few single word utterances, approximately 50 baby signs Rural community Speech Language Pathologist in his home town with no experience in auditory development 2-30 minute sessions per week Focus has been on auditory development and using the auditory channels to increase expressive language

Case Study #1: 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 #1 Standard Score Growth 120 PLS-4/PLS-5 Total Language Standard Score Standard Score (average=85-115) 110 100 90 80 70 60 50 40 30 20 10 82 92 0 5/18/2011 10/18/2011

Use of the Coaching Model to Improve Therapist s Intercultural and Linguistic Competency Working closely with the on-site facilitator or caregiver during the session, and depending on that partner for verification of sounds produced or exact response can also provide immediate guidance per student s cultural and linguistic differences. In auditory discrimination or speech tasks, therapist can check to see if phonemes do indeed sound different in typical productions of the child s regional or cultural variation of the spoken language.

Case Study #2: 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 #2: 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.

Case Study #2: Example of Coaching to Increase Participation in School Community During online session, student hears school-wide announcement, refers to it as office and girl (principal), does not demonstrate comprehension or appropriate vocabulary. Therapist teaches vocabulary ( announcement, principal ), coaches implementer to introduce student to principal in friendly meeting. Student and implementer visit school office, meet principal. Student learns principal s name and observes her making an announcement.

Questions?

For contact information visit ihearlearning.org

Cheryl Broekelmann, MA, LSLS Cert. AVEd cbroekelmann@sjid.org Victoria L. Carlson-Casaregola, MA, CCC-SLP vcarlson-casaregola@sjid.org Jeanne Flowers, MSDE, MS, CF-SLP, LSLS Cert. AVEd jflowers@sjid.org

References Alexander Graham Bell Academy for Listening and Spoken Language. (2011). Retrieved November 8, 2011, from www.agbellacademy.org. American Speech-Language Hearing Association. (1997-2011).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 http://www.asha.org/public/speech/disorders/lpaa.htm American Speech-Language Hearing Association. (2005). Speech Language Pathologists Providing Clinical Services in Telepractice: Position Statement. [Position Statement]. Available from www.asha.org/policy. 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. 24-29). 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, 564-573.. (2012 forthcoming). 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.243-266). Boston, MA: Little, Brown & Company.