The Dream Team - The Playbook for Partnering Parents and Professionals in

Early Intervention

Monique BakerMonique@Kyhandsandvoices.org

Jane MadellJane@janemadell.com

Sally Tannenbaum-KatsaggelosSallyt@uchicago.edu

IT’S A DREAM TEAM EFFORT

“Tell me and I will forget.Show me and I will remember.

Involve me and I will understand.Step back and I will act.”

A Chinese Proverb

The Dream Team: Shared & Collaborative Partnership

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IT’S A DREAM TEAM EFFORTTHE ROLE OF THE AUDIOLOGIST

• Have HIGH expectations• “Good enough” is not good enough

– Only the best auditory access is good enough• Listen to the people who work with the child daily. • Problem solve to make the necessary improvements

in access to auditory information• Over-amplification is a myth –

– Not perceiving auditory information is not a myth– It affects the ability to learn, communicate, and

to participate in the world

Audiology Basics

• Evaluate hearing • Select and evaluate technology

– Aided thresholds R and L– Ling Sound thresholds R and L– Speech perception

• Body parts and familiar words before standard testing

• Confirm that hearing is at the top of the speech banana• Monitor progress• Counsel family about test results and progress• Working cooperatively with other team members

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Appropriate Technology

Enriched Auditory Exposure

AUDITORY BRAIN DEVELOPMENT

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The Audiology Fruit

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Can We Call It The Speech Bean?

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IS TECHNOLOGY SET APPROPRIATELY

• The child needs to hear throughout the frequency range– 6000 and 8000 Hz really do matter– Missing high frequencies results in missing grammatical markers for

pluralization, possessives, and missing non-salient morphemes (e.g. morphemes that are not stressed during conversation such as prepositions)

• The child needs to hear at a soft enough level– Soft speech is about 35 dBHL.– If a child cannot hear soft speech, she will

• Not hear peers in the classroom or on playground• Not “overhear” conversation and will have limited incidental learning• Have reduced language and literacy skills

– Moeller (2011) reported that in her research 40% of children fit with hearing aids were underfit.

• Aided hearing at 0 dB is not the goal– It can cause distortion

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What Does the Audiologist Need to Know to Do a Good Job?

• Information needed from family, EI provider, SLP, LSLS, Teacher – Can the child hear all the Ling sounds? – What phonemes is he hearing, – What phonemes is he missing

• Distance at which child can detect and identify phonemes• Are language and auditory skills developing - one year’s

progress in one year’s time?• Do team members have concerns about development of

auditory skills? Other skills?• Where is child using his FM system? How many hours/day?

What does he hear with and without FM• In what situations is it difficult for the child to hear.

Using the Information

• If testing indicates hearing below optimal levels– Change settings – Try new technology– Consider CI

• Reports from other team members– Listen to the information– Modify technology settings to improve performance

• Continue to monitor performance • Continue to talk with team members

Teaching Parents to Check Technology

• When baby wakes up– Put on one HA– Repeat one Ling sound– Observe if baby responds– Observe distance baby can respond

• Next time test other ear• Next time test other Ling sounds• Keep records and share with audiologist and

therapist

If The Child Is Not Progressing As Expected

• Suspect technology first– Is the child hearing well enough with the technology?– Is the child hearing high frequencies

• Is the child wearing technology consistently?– If a child is using technology 4 hrs/day it will take 6 years for the

child to hear what a typically hearing child hears in one year.• Does the family have appropriate expectations?

– Are they requiring full time use of technology’– Are they providing auditory stimulation– Do they expect the child to listen and talk

• Do the clinicians working with the child have appropriate auditory expectations?

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IT’S A DREAM TEAM EFFORTROLE OF EI PROVIDERS

• Guide the family to help provide an enriched language environment – the power of PARENT TALK!

• Empower the parents through shared knowledge and experience

• Use daily routines and experiences to make it meaningful for the child and the family

• Be realistic and consider the family’s demands• Help the family become their child’s advocate

IT’S A DREAM TEAM EFFORTROLE OF EI PROVIDERS

• Have HIGH expectations• Expect the child to be able to use audition and

show the family how to provide auditory stimulation and a rich language environment

• Take a leadership role on the team – bringing everyone together

• Share with the medical team/audiologist what the child is hearing and what she is not hearing, speech and language development, and your concerns

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TEAM QUESTIONNAIREThis patient is being followed by the Pediatric Hearing Loss and Cochlear Implant Program at the

University of Chicago Medicine and you are a valued team member. Please fill out this brief questionnaire and feel free to share any additional information with us. Thank you for your time!

Hearing Performance

How often does this patient wear their hearing device?☐never ☐occasionally ☐almost always ☐all waking hoursPlease characterize current auditory abilities: ☐No visible detection☐Some environmental detection☐Some voice detection☐Ling sound detection ☐ah ☐oo ☐ee ☐m ☐s ☐sh☐Ling sound discrimination ☐ah ☐oo ☐ee ☐m ☐s ☐sh☐Pattern perception☐Word identificationDoes parent report a difference when child is wearing hearing device? ☐Yes ☐No

Team Questionnaire

Team Questionnaire

This patient is being followed by the Pediatric Hearing Loss and Cochlear Implant Program at the University of Chicago Medicine and you are a valued team member. Please fill out this brief questionnaire and feel free to share

any additional information with us. Thank you for your time!

Hearing Performance

How often does this patient wear their hearing device?☐never ☐occasionally ☐almost always ☐all waking hoursPlease characterize current auditory abilities: ☐No visible detection☐Some environmental detection☐Some voice detection☐Ling sound detection ☐ah ☐oo☐ee☐m ☐s ☐sh☐Ling sound discrim ☐ah☐oo☐ee☐m ☐s ☐sh☐Pattern perception☐Word identificationDoes parent report a difference when child is wearing hearing device?

☐Yes ☐No

TEAM QUESTIONNAIRE

Speech and LanguagePatient demonstrates spontaneously production with: ☐vocalizing babbling single words☐ ☐

☐consonant production phrases☐Patient communicates through: ☐crying and vocalizations gestures babbling ☐ ☐ total ☐

communication ☐listening and spoken language augmentative communication ☐

system What is the quality of production? Intelligible☐ Appropriate ☐

based on listening age ☐ Somewhat intelligible

Team Questionnaire

Please indicate any areas of concern:☐parental expectations emotional state ☐

of family oral motor cognitive skills ☐ ☐parental follow-up other disabilities ☐ ☐

Do you think this patient has hearing access to all the speech frequencies? Yes☐ No☐

Comments:

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IT’S A DREAM TEAM EFFORTTHE ROLE OF THE FAMILY

• Daily listening check of equipment– Really listening to hearing aids, verifying CI’s are functioning

properly– Monitoring perception for HA and CI’s (right, left, binaural)

• Ling sounds (ah, oo, ee, m, s, sh)• Identify problem areas

• Speech perception errors• Situations in which the child is not hearing• Learning concerns

• Have HIGH expectations– Set goals with your team and make sure they are being met

• Listen to your gut– You are your child’s voice and advocate

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IT’S A DREAM TEAM EFFORTTHE ROLE OF THE FAMILY

• The Power of Parent Talk - Provide lots of language stimulation

• Provide an auditory environment at home– Expect your child to be able to hear– If you expect your child to talk, they need to be amplified

• Be the “listening police”– Environment– Background noise– Proximity of your voice

• Work WITH your team– You are the expert in your child; your professionals are experts too– Work through disagreements and stay positive– Ask what has worked for others

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IT’S A DREAM TEAM EFFORTTHE ROLE OF THE FAMILY

• Parent support– Vital – no one can truly sympathize except for

another parent– Hands & Voices– Guide By Your Side– AG Bell Association– Ask for other family contact info from your

providers

Parent Advocacy Training

• Parent Advocacy Training online course– AG Bell; Listening and Spoken Language

Knowledge Center• Educational Advocacy and legal rights

– AG Bell; Listening and Spoken Language Knowledge Center

http://www.listeningandspokenlanguage.org/

QUESTIONS?COMMENTS?

THANK YOU