1. The Dream Team - The Playbook for Partnering Parents and Professionals in Early Intervention Monique Baker Monique@Kyhandsandvoices.org Jane Madell Jane@janemadell.com Sally Tannenbaum-Katsaggelos Sallyt@uchicago.edu

2. 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

3. The Dream Team: Shared & Collaborative Partnership

4. IT’S A DREAM TEAM EFFORT THE 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 www.JaneMadell.com

5. 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

6. www.JaneMadell.com + = Appropriate Technology Enriched Auditory Exposure AUDITORY BRAIN DEVELOPMENT + =

7. The Audiology Fruit www.JaneMadell.com 7

8. Can We Call It The Speech Bean? www.JaneMadell.com 8

9. 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 www.JaneMadell.com 9

10. 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.

11. 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

12. 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

13. 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? www.janemadell.com 13

14. IT’S A DREAM TEAM EFFORT ROLE 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 www.JaneMadell.com

15. IT’S A DREAM TEAM EFFORT ROLE 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 www.JaneMadell.com

16. 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 hours Please 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 identification Does parent report a difference when child is wearing hearing device? ☐ Yes ☐ No Team Questionnaire

17. 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 hours Please 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 identification Does parent report a difference when child is wearing hearing device? ☐ Yes ☐ No

18. TEAM QUESTIONNAIRE Speech and Language Patient 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

19. 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:

20. IT’S A DREAM TEAM EFFORT THE 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 www.JaneMadell.com

21. IT’S A DREAM TEAM EFFORT THE 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 www.JaneMadell.com

22. IT’S A DREAM TEAM EFFORT THE ROLE OF THE FAMILY www.JaneMadell.com 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

23. 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/

24. QUESTIONS? COMMENTS?

25. THANK YOU