ROUGH EDITED COPY
2017 EHDI Annual Meeting
Topical Session 6
Hanover F
DEVELOPING LANGUAGE AND LISTENING SKILLS
THROUGH THE USE OF DAILY ROUTINES
2:15 p.m.
February 28, 2017
CART SERVICES PROVIDED BY:
ALTERNATIVE COMMUNICATION SERVICES, LLC
PO BOX 278
LOMBARD, IL 60148
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This is being provided in a rough-draft format. Communication Access Realtime Translation (CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings.
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> Hello, we're going to start our next session. Hello? Can everyone hear me? So we have Cindy Boyd and Lucia Quiñonez.
> CINDY BOYD: Thank you. All right, guys, it's so nice to be here and today we're going to talk about developing language and listening skills through the use of daily routines. I'm Cindy Boyd. I'm a teacher with the Early Learning Sensory Support Program in North Carolina, and I work with kids that are birth to 3 and that have hearing loss. And this is my colleague. She's not are you mic'd up?
> LUCIA QUIÑONEZ SUMNER: I think so, yes. My name is Lucia Quiñonez Sumner.
> CINDY BOYD: So here's a quote that kind of speaks to why we're here today and when you read it, just kind of instead of "people," insert the word "parents," and read that with the word "parents."
And that's why we're talking about routine based intervention. So what is routine based intervention? It's a way of providing information where the therapy is embedded throughout their whole life instead of in isolated therapy sessions. Where does the therapy take place? It takes place where the kids are naturally in their natural environments.
So we can go into their homes. We can go outside into play grounds, parks, we can go to the museum, we can go to the grocery store, wherever the child is normally, that's where we can have a therapy session. How is it different from traditional therapy? Well, I've been teaching this particular area for 15 years and I've always gone into the home with a toy bag and a lesson plan where I've already planned my activities, I've got my toys, I know exactly what's going to happen and then at the very end of the session, you spend time with the parent brainstorming: Okay, now how are you going to do this in your home? And they jot down ideas so it's very different from that. So I don't know why it's taken us so long to move to this method because doesn't it make so much more sense to actually do the therapy with what the parent already has in their normal routine?
So now, yes, we don't bring in toys, we use whatever resources the parent has in their natural environment. So that could be toys, or it might just be nature if you're outside.
Also, instead of me planning everything, the parents and I, we plan together. It's based around their family routines and we use coaching techniques. Now, this is referencing a website called vroom.com. If you get a chance, check it out. It's a wonderful resource but they have a video that was so powerful, I love showing it to my family's. It's a video about a family that wants to help their child. They want to do everything they can, and so vroom is sending them a box that has everything they need to help their child, so they're excited, they're waiting for the box to arrive in the mail and when it comes you see them opening up the box. The only thing in the box is a mirror. And they see themselves. So that just blew me away, because that's what we are trying to do. We're trying to build the capacity of the parent to become their child's main teacher. They're going to be with their child throughout their life. They're going to be throughout all day long and if it is embedded into their everyday life the child will advance more quickly.
This is talking about the hours. If I see a child for one hour a week, the most I could ever see them is 52 hours. And if you look at this slide, that is less hours than a typical 2yearold is awake in a week. So who is going to be with the child more, who is going to have more hours? The parent, so that's why we're trying to build the parents' capacity and since we're building the parents' capacity, we have to switch from our wonderful time playing with children to learning about teaching adults. So what we do know about adult learners is they are selfdirected. They want to say, they don't want to be told what to learn. I don't know if you've ever had the experience of someone telling you: Okay, you need to do this, and you think: I don't care about that. I'm not doing that. So we want the parents to be involved so they have a say in their, what is happening. They want it to be applicable and use the information right now in their real life.
One of the unique aspects of this method
> LUCIA QUIÑONEZ SUMNER: I just wanted to add, when we work with, when we work with adult learners, we need to take into consideration the learning styles.
> CINDY BOYD: Yeah, just like kids. We have to know what our parents' learning styles are. One of the unique aspects is coaching. You want to use reflective questions, is how we're going to coach our parents. And the purpose of reflective questions is to build the parents' capacity. It's to not, it's not an inquisition, getting them to say what you want to say, but it's asking questions to get the parent to think about what is happening, what they learned, what they need to do differently and come up with ideas for themselves.
Now we're going to watch a quick video of one of my students. This is Lincoln. I've only been seeing him for a short time, and the parent had chosen the routine of getting dressed, and she wanted to work on the Ling 6 sounds and on modeling the language of selftalk. This takes place right after that. We did that routine and right after, I am asking questions to help the parent think through what happened. So I wanted you to see this.
[ Video ]
Slightly painful to watch yourself on video, but anyway, what was neat about that, there were several things. She had said, when I got there, she didn't have time to work on homework because they'd actually been at Disneyworld for a conference, work/fun for a week, so then we're saying: Even if you don't have time to work on it, you're going to be getting him dressed every day, so you can just work on it even when you're not planning on it. What was neat is when she started getting him dressed, she said to herself: Oh, I need to put his hearing aids on. She realized that herself that she wasn't doing that.
And then through the use of questions, she was doing some problem solving herself about: Oh, I need to move where I keep the hearing aids to where I'm getting him dressed. So that's what reflective. The parent is coming to an understanding themselves, and you're just kind of assisting in that, you're assisting.
Okay, so let's see.
> LUCIA QUIÑONEZ SUMNER: Technical difficulties?
> CINDY BOYD: Technical difficulties, yes. So this is based on the work of Dathan Rush and M'Lisa Shelden. This is reflective coaching questions from their Early Childhood Coaching Handbook, and it's a variety of questions that are wonderful so if you don't have this resource, I would encourage you to get this, because it breaks down questions into separate categories and you can choose some of these. There's analysis questions, like, how well did that work? Awareness: What do you know? Alternatives: What ideas do you have? Action: What is your plan, or decision?
So what are some of the routines we do? This is some examples of routines. But ideally what you will do is you will ask your parent: What are some of the things you do during the day? You'll make a list and ask the parent which one they want to work on the next week. And here is a video of one of my parents. She wanted to do a laundry time routine and we're working on having the little girl imitate and then spontaneously say some oneword utterances.
[Video]
[ Laughter]
> CINDY BOYD: I have no idea what that is.
It is not any routines I do.
[ Laughter]
I'm having trouble flipping from the video back.
> LUCIA QUIÑONEZ SUMNER: Can anybody help us?
> CINDY BOYD: Let me hit escape. I think that's what I did. Ah, that's it, okay. So you continue to work on the goals that are based on the parents' desired outcome so this can work for any mode of communication and then you're continuing to work on the goals and use the tools that help you reach that goal.
So you're going to continue using your CASLLS or auditory learning guide, whatever tools you'll use to reach the desired outcome but you leave space open for what the parent wants to work on if there's anything additional. I had a parent that wanted to work on shapes so we just added that in.
Every session will have these components, you're going to review what the parent did during the week, the past week, and then you're going to review the plan for this week. So last time, you talked about it. Don't ever go in and just say: Hey, we're doing bathtime. Let's go. Because nobody wants to be surprised.
First you want to decide together and you want to have decided last week. So you go in and say we wanted to work on laundry time and we were going to work on these goals. Is that still okay? And you wait and see. If it is, you go forward. If it's not, you make a new plan. Then you're going to spend a few minutes deciding how to put that in action. So if the parent wants to work on twoword combinations while they're playing outside you're going to brainstorm some twoword combinations and go outside and start inputting them.
After the session, you're going to skip to reflection where you ask reflective questions to see what the parent thinks about what happened, what they think went well, what they think they need to change, anything they need to learn. And then you'll give them feedback. At the end of the visit, you will ask them: What do you want to work on this week? And they'll jot down what they want to work on and then that's where you'll discuss what they want to do next time. What routine do you want to do next time? What goals do you want to focus on?
And then I had skipped observation, that doesn't occur in every session but in some sessions, there will be time where the parent will observe the teacher modeling a new strategy or you might observe the parent to see, what do they have? What do they not have? What do we need to work on?
> LUCIA QUIÑONEZ SUMNER: I just wanted to say we still can provide instructions and introduce strategies, that is all part of within the feedback part.
> CINDY BOYD: And this is a tool that was developed by some of my colleagues, Preston Collins and Kristin Skill, and I love using this sheet. I've used it in different ways. At first I would use it at the end of the session and say, what do you want to work on during the week? And then the parent would jot down their ideas on this sheet.
I've also used it to plan the action for the day where the parent could say: Okay, we want to work on the vowel of the week, OW and we're working in the bathroom so we might label one of the rooms the bathroom. We might brainstorm: What in the bathroom can we talk about with the OW sound. We might talk about, we're going to get your towel. We'll touch the word and go ow, it's hot or we'll put bubbles in there and go wow. So you can use this form in many ways and I'm going to turn this over to Lucia so she can share how she uses this form.
> LUCIA QUIÑONEZ SUMNER: I use it the same way. I'm just going to go with my next part. I don't need two microphones, I'll take this one off. So now we're going to talk about on how to capitalize on the cultural strengths. I know it says differences but I call them strengths of diverse families, specifically I'm going to talk about Latino families and I'll tell you why later. When we are using daily routines. So why do we need to know about Latino families in our field? The fact is Hispanic Latino children are the fastest growing youth population so we're seeing, well maybe we won't see them anymore, but anyways, we're going to be seeing some of these children.
We're asked to work with children with hearing loss. Hispanic children in America, demonstrate a higher prevalence of hearing loss, especially conductive hearing loss with microtia and atresia than the higher population. Why we don't know yet. There are studies coming on why so that's why we need to be familiar with this population.
So why do we need to know about a family's culture in order to improve our practice? There is a long list but I may not have time to go through all of them but when we know about family culture, whatever the culture is, we will be able to recognize the strengths, their needs. We will form a bond, because we if we want to know about culture, they will feel valued. Hopefully we'll do away with stereotypes if we learn more about the families individually and we could avoid definitely cultural misunderstandings and I will share a cultural misunderstanding that I had, because I forgot to use my cultural assessment.
And most important part is that it will help us understand that differences are not deficits. In fact it can be assets for us in order to provide appropriate routines and activities that make sense culturally, and honors those families. And if a family feels valued, they will be more likely to follow through.
So why should we bother? Are cultural differences real? They're so real that within a group of families from the same ethnic background, you're going to find that each family has their own cultures and values. Yes, it's true the different countries have different belief systems, values, rituals, celebrations, but we have to remember we cannot make a blanket statement. Not all American families are the same, not all Latino families are the same. Not all Asian families are the same. So that is why it is important to know as much as possible all the particular culture of the family that you go and see and in that way we can provide better services that are targeted to them.