15th ANNUAL EARLY HEARING DETECTION & INTERVENTION MEETING
March 13-15, 2016 • San Diego, CA
Sunday, March 13, 2016
FULL DAY SESSIONS:
Simulated Deaf Mentor Program Session
9:00 AM - 4:00 PM
Jodee Crace, Paula Pittman, Stacy Abrams, Danelle Gournaris
In this day-long instructional session, three goals are: 1. What is the Deaf Mentor Program (research citations, history, curriculum, training components and home visit framework) 2. Simulated Deaf Mentor Home Visit (mock home visit sessions will be performed with participants as either family members or observers). 3. How can you set up a DMP in your state (or region). This instructional session supports the JCIH 2013 Supplement that states that new identified families are provided full range of services, including the Deaf Adult support and community. Researches also state that new families who have met Deaf adults increase their coping strategies due to the additional new skills from the Deaf adults and the community.
Introduction to Multilevel/HLM Modeling
9:00 AM - 4:00 PM
Craig Mason, Shihfen Tu
With the growth of longitudinal, population-based EHDI data systems, state and territorial EHDI programs have an increasing wealth of data that can be used to inform their practice and policy efforts. The purpose of this instructional session is to provide a hands-on introduction to multi-level or hierarchical linear (HLM) modeling – one particularly powerful tool that can be used to understand EHDI program effects on child health and development. We will focus on two applications of HLM that are particularly relevant to the EDHI community. The first is where data for individual children are nested within larger entities, such as birthing hospitals. In this case, HLM might help EHDI programs accurately assess whether there are characteristics of hospitals (e.g., size, access to services, percentage of births to low-income parents, etc.) that are related to child outcomes, such as infants who fail their hearing screening becoming lost to follow-up. The second application is where one has longitudinal data on child measures, such as language development over time. In this case, HLM might help EHDI researchers assess whether early identification and intervention lead to more rapid growth in language skills for children with hearing loss. This work session will be hands-on, with participants analyzing and interpreting data using a free version of a widely used software program (HLM, by Scientific Software International – note the presenters have no affiliation or financial relationship with the software company). Participants will be asked to download the software prior to attending the training. The session will involve lecture and discussion regarding the principles of HLM analyses, paired with collaborative analysis and interpretation of simulated EHDI data provided by the presenters. Participants will also be provided with detailed handouts used in the training session that illustrate the basics of HLM modeling and the interpretation of HLM statistical output.
Serve and Return: AV Strategies to Maximize Child Engagement
9:00 AM - 12:00 PM
Teresa Caraway, Wendelyn DeMoss
One of the most essential experiences in shaping the architecture of the developing brain is 'serve and return' interaction between children and significant adults in their lives (The Center for the Developing Child, Harvard University). Young children with typical hearing naturally reach out for interaction through babbling, facial expressions, and gestures, and adults respond with the same kind of vocalizing and gesturing back at them. This back-and-forth process is fundamental to the wiring of the brain, especially in the earliest years. Early Interventionists recognize the importance of “serve and return” interactions for young children who are Deaf or Hard of Hearing. As professionals we are trained to always expect a response from the child through implementing specific strategies and techniques. This presentation will discuss and demonstrate how to utilize auditory-verbal strategies in a hierarchical sequence, how to modify quickly to engage a child in the “serve and return” process, and how to guide and coach families to provide this essential experience for young children with hearing loss. Participants will analyze and apply auditory-verbal strategies relative to the child’s developmental level in order to continually engage a child in the critical process of “serve and return” to shape the architecture of the developing brain for listening and spoken language as the building blocks towards literacy.
The Impact of Family Involvement in ‘Moving the Needle’ in EHDI Systems: Hands & Voices 20 Years Later
9:00 AM - 12:00 PM
Janet DesGeorges, Lisa Kovacs, Sara Kennedy, Stephanie Olson, Vicki Hunting, Terri Patterson
Twenty years ago, the role for family involvement in the establishment of EHDI systems was often defined for parents in sharing their stories about the impact of late identification and the need for newborn hearing screening. In today’s world, participation in improvement of statewide EHDI systems incorporates high level parent involvement in areas such as loss to follow up, Quality Improvement initiatives, cultural reciprocity, data collection and analysis, research participation, prevention of child abuse and neglect, and formalized parent to parent support, as well as established educational advocacy programs – while still maintaining that essential ‘parent perspective’ of real life experience. Hands & Voices has led the way in moving beyond the ‘token parent’ concept to trained parents in positions of leadership with the ability to bring solutions to the table in the gaps that EHDI systems face. For parents who are moving through the EHDI system in today’s world, the timeliness of services and the delivery of information and opportunities may be more available than it was 15-20 years ago, but some things remain true to this day... the need for an unbiased supported journey, the fidelity of early intervention systems that meet their child’s unique needs,, and ultimately systems that work for them, as they would define it.
It Can Be Done: Creating Dynamic Parent/Professional Collaboration
9:00 AM - 12:00 PM
EHDI stakeholders, from medical staff, to early interventionists are often frustrated when families appear unresponsive to the professional’s recommendations. This can result in conflict or dissonance between the parties involved in the child’s life. In reality, there usually exists various cultural differences resulting in poor communication and collaboration. This interactive workshop will explore the dynamics that can affect the relationship between a family and the professionals who serve them. We will discuss how education, culture, family interactions have an impact on both parents and professionals as they strive to provide the best care for the child who is deaf or hard of hearing, especially in the early years within the EHDI system. Participants will be able to: define collaboration as it relates to parent and professionals; Identify social, cultural, familial factors that affect collaboration; develop practical strategies for positive collaboration. This session will involve the facilitator 1) presenting definitions and examples of factors impacting collaboration using powerpoint, 2) monitoring small group discussions involving case studies relevant to EHDI; and 3) guiding the development of plans for applying the information to the audience’s work. Resources for learning more about this topic will be offered. This session will be of interest both family members and professionals from all points in the EHDI system.
Speech to My Ears. Coaching Parents on Using Wireless Technology with their Very Young Child
9:00 AM - 12:00 PM
Valerie V. Le Beau, Meghan Crimmins
Early Intervention Providers who work directly with children and their families in their homes and daycare centers provide ongoing support, education and therapy during visits in uncontrolled noisy environments. Everyday activities can provide challenging listening environments for a parent to communicate with their child (Mulla, 2013). Toddlers in daycare centers can spend 80-90% of their day trying to hear speech in noise levels averaging 75dB (Crukley, et al., 2011). For young listeners, who are developing speech and language skills, it is important to clearly hear and understand the voice of the speaker. A typical hearing child accumulates 45 million words by age 4 (Hart, B. and Risely, T.R., 2003). In contrast, children with hearing loss are at risk for developing language on par with their typical hearing peers because their access to words in these challenging listening environments is sub-par. Therefore, optimizing listening environments is necessary to facilitate speech and language development. Although advancements in hearing technology has allowed children access to spoken language, listening challenges exist in real life: noise, distance and reverberation. Hearing speech directly from the parent to the young child’s hearing aids or cochlear implants through the use of wireless technology such as Roger can minimize these challenges and optimize the listening environment. Research has proven that by providing wireless technology to children during noisy, challenging listening environments or from a distance can encourage children to imitate speech (Benoit, 1989) and increase language acquisition rates (Moeller et al, 2009). Early intervention best practices encourage coaching parents to foster communication in natural environments like the home (kitchen, bathroom, etc.), playground, the car, play groups, and grocery stores. But there has been little guidance on how early intervention providers can coach families on the benefits of wireless technology for their very young child and practical ideas to help families consistently use wireless technology appropriately across everyday environments. This interactive session will review relevant research related to the benefits of using wireless technology with very young children, provide hands on experiences with wireless technology, and provide practical ideas to educate, coach families, and use wireless technology in everyday environments.
Data Mining Using Excel - How to Tell Your Story. Tips and Tricks for EHDI Program Personnel
1:00 PM - 5:00 PM
Mary Catherine Hess
EHDI Coordinators are constantly being asked to tell the story of their programs. They are asked to respond to a variety of questions ranging from how many babies have been diagnosed as deaf or hard of hearing, what parts of the state have the highest loss to follow-up rate, how many children return for a screen after being discharged from the hospital, what is the state’s loss to follow-up rate, to who is reporting diagnostic care. Local hospital administrators, audiology and early intervention providers, parents, state and federal agencies and other stakeholders invested in the work of EHDI programs want to know how a program is performing in order to continue to rally for additional support and resources. To that end, EHDI coordinators have to always be on the ready to tell their story and include those critical details that demonstrate their successes and challenges. In this session, the presenter will review a variety of tools for analysis and the reporting of performance measures critical to EHDI programs. The session will includes details about the data elements needed and the Microsoft Excel tools used to expedite the analysis and reporting. At the end of the session, attendees will have a framework for developing their own reporting tool, be able to describe how to use Excel’s pivot table feature, and identify the various data elements needed for reporting on specific performance measures.
Supporting Texas Families in Signing and Literacy Skills through Tele-Intervention
1:00 PM - 5:00 PM
Lynn Reichert, Avonne Brooker-Rutowski
The Educational Resource Center on Deafness (ERCOD) in Texas currently offers two programs that serve families through tele-intervention. These programs, Family Signs (FS) and Shared Reading Project (SRP), offer sign and literacy support for families of deaf/hard of hearing children in the state of Texas. Professionals who are interested in setting up similar programs will benefit from this hands-on session.
First half of the session: Participants will be learn the background of Family Signs, learn how to set up the program, and experience the program from a student's perspective. Participants are asked to bring a laptop. While a laptop is not required, it is highly encouraged for hands-on participation.
Second half of the session: Participants will learn the background of the Shared Reading Project, understand and apply the 15 principles of reading to Deaf/Hard of Hearing children, and view a video of a parent/tutor/child class.
As a conclusion, the challenges and solutions of both programs using tele-intervention will be discussed, with sufficient time for questions and answers.
More than Checking the Box: Mining Assessments to Drive Early Intervention
1:00 PM - 5:00 PM
Allison Sedey, Dinah Beams, Denise Davis-Pedrie
Appropriate assessments are a vital component of early intervention and are used by programs to monitor a child’s progress, meet requirements for outcome data, and evaluate the effectiveness of a program. Often, however, professionals are not trained in utilizing these assessments to their full capacity to drive early intervention services and set appropriate goals and strategies on the IFSP. The information gathered through formally assessing the skills of a child with several different assessment instruments can be applied to guide parents in making informed decisions regarding the amount of intervention, the effectiveness of the current intervention, the communication method being used, and the need for additional services. The information gained from assessments is much richer than merely establishing a baseline for the child, determining a percentile score for a particular skill, or determining a child’s developmental age. This session will explore three widely used assessment instruments, The MacArthur Communicative Development Inventory (Fenson, Dale, Reznick, Thal, Bates, Hartung, Pethick,& Reilly, 1993), the Minnesota Child Development Inventory (Ireton & Thwing, 1972), and the Play Assessment Questionnaire (Calhoun, 1987) and analyze the information gathered from these assessments in detail. Particular attention will be given to the interpretation of the assessment data as it applies to intervention for an individual child. Case studies will be shared and participants will have opportunities to apply information covered in this session to the development of appropriate goals and next steps for a child’s intervention plan.
Neurodevelopment of Language and Listening: Using What We Know about the Brain to Inform Clinical Practice
1:00 PM - 5:00 PM
Amy Szarkowski, Denise Eng, Jill Grenon, Nicole Salamy, Robin Hough
This session will foster an understanding of how to improve intervention for d/hh infants and toddlers using brain-based science. We will draw upon empirical findings, explain how they were used to arrive at suggested techniques for supporting the development of children with reduced hearing, and share specific recommendations that will be of use to professionals from a variety of backgrounds. We anticipate that this session will be of most use to experienced service providers who are willing to allow themselves to “think outside the box.” The information presented in this session is the result of months of collaboration and thought-provoking discussion by a working group of 12 professionals with considerable expertise in working with d/hh children. Through this process, we have explored and incorporated the cognitive science that explains how the brain learns to make sense of language. Employing a brain-based approach to understanding these phenomena has allowed for professionals from different disciplines (including audiology, speech-language pathology, early childhood education, early intervention and psychology) to step outside of their traditional disciplinary boundaries. We have challenged each other to think more empirically and holistically about the roles that each service provider plays in helping children to develop. Through this process, we have examined and critiqued existing ideas within specific disciplines about how to help children with reduced hearing learn to listen and build their language and cognitive skills. Rather than accept widely held views within our fields, such as the “listening hierarchy” and “building blocks of language,” we have used our emerging understanding of the neuropsychological processes involved in making sense of language and comprehending information to anchor our discussions. This has allowed us to set aside disciplinary presumptions, and to consider how to adjust our models of intervention to align with how the brain actually learns.
Build Your Skills and Capacity to Develop Community-based Screening Programs
1:00 PM - 4:00 PM
William Eiserman, Jeff Hoffman, Terry Foust
Early Head Start, Head Start, Part C Early Intervention and other early care and education have a growing commitment to developing community-based hearing screening and follow-up practices. The success of such practices is highly dependent on quality planning, training and follow-up technical support from pediatric audiologists or others skilled in evidenced-based hearing screening practices for infants and young children. While many audiologists and experienced screeners may have advanced skills for conducting otoacoustic emissions screening, a broader set of skills, resources and tools are necessary to help programs design, implement and evaluate their own OAE screening practices. Building on more than 14 years of experience developing OAE screening practices in Early Head Start and other early care and education program settings, the ECHO Initiative is making a concerted effort to build the capacity of audiologists and other experienced OAE screeners who are interested and able to serve as consultants, trainers and technical assistance providers to programs in their state and local communities. This hands-on instructional session will provide participants with information about how to identify programs who may need their help (either as volunteers or as contracted consultants), the specific ways to help programs in developing their OAE screening practices, and the many tools and resources that are available that will make the process of developing community-based hearing screening practices relatively easy and successful. Whether you are looking for additional income and using your skills in a new way, have a current job that encourages community outreach, or have an interest and ability to offer your services as a volunteer, this session will provide you with information and a set of easy-to-use tools enabling you to hit the ground running with programs seeking help in designing and implementing evidence-based hearing screening and follow-up practices with infants and young children.
Awakening the Possibilities through Strengths-Based Coaching
1:00 PM - 4:00 PM
Hannah Eskridge, Kathryn Wilson, Lillian Henderson
A primary purpose of family-centered early intervention is to establish and maintain a strong parent-professional partnership. To this end, effective and positive communication and collaboration between partners is essential. The ultimate goal is for parents to become empowered as primary teachers, decision-makers, and advocates for their child. How do professionals best serve families in order for them to achieve their desired outcomes? Experts in early intervention support a coaching style of interaction (Rush & Shelden, 2011); one in which the professional nurtures the natural interaction between the parent and the child. Parental style, needs, and level of development -- not the professional's -- determine how to proceed with the objectives established for the child. Coaching and guiding parents requires skills that are different from those required to teach children. Professional development includes acquisition of knowledge and expertise in adult learning styles and preferences as well as a variety of coaching strategies and techniques designed to empower parents as the primary teachers of their child. This presentation will up-level and advance the knowledge and abilities of participants coaching families of children who are deaf/hard of hearing in early intervention. Specifically, participants will engage in learning about Evocative Coaching (Tschannen-Moran, 2010), an approach that builds on existing strengths and incorporates the principles and practices of Appreciative Inquiry (Copperider, 2001; Orem & Binkert, 2007; White, 1996). This interactive session will offer participants abundant opportunities to apply new knowledge and information to transform practice in early intervention and improve outcomes for children and their families.
Nice is Not Enough: How Does a System Support a Family?
1:00 PM - 4:00 PM
Johnnie Sexton, Patti Martin
“Nice is not enough…” may be an apt tongue-in-cheek expression when it comes to identifying the elusive “something” that is the authentic change agent for supporting families of children who are D/HH. It is what not only drives, but also perplexes, many EHDI professionals as they struggle with ways in which a system can provide care to families that is “up close and personal”. This instructional course builds upon a conceptual framework to identify key resources necessary to provide high quality support programs to families and offers a mixed-presentation format designed to be both interactive and engaging. Participants will be nudged out of their comfort zone and challenged to coalesce across disciplines, agencies and service delivery models to delve in to opportunities that assist families in successful integration of hearing differences into their lives. Finding the balance between family support as a systems issue that is operationalized and measured and giving an individual family the formal and informal tools they need for their journey offers the promise of improved outcomes and is both the challenge and the call to action.
Family-Based Interventions for Children with Hearing Loss
1:00 PM - 3:00 PM
Elizabeth Adams Costa, Lori Day, Colleen Caverly
Primary caregivers are critical in facilitating appropriate early interaction patterns, developing language, and promoting overall social-emotional development of their children. Parent-Child Interaction Therapy (PCIT) can support such growth. PCIT is an empirically supported treatment that works with parents and children together to promote child development and positive parent-child relationships. Summary The importance of early intervention for children with a hearing difference, especially for fostering language, has been well documented (Moeller, 2000; Mayberry 2007). While professionals play a critical role in early intervention services, there is increasing evidence that interventions that facilitate parent engagement often result in improved child development (DesJardin & Eisenberg, 2007; Moeller, 2000; Zaidman-Sait & Young, 2007). Houston and Bradham (2011) note that while early identification of a hearing difference and hearing technology are important for spoken language development, appropriate intervention, with the active participation of parents, is critical. Parents serve as primary language models for their children, and supporting parents in providing enriching language environments will support overall development. Fleming, Sawyer, and Campbell (2007) advocate for a model that includes parent participation in audiologic habilitation. While related service interventions should continue to strive for parent participation, several studies show that most early intervention settings actually use traditional child-centered services (Peterson et al., 2007; Campbell & Sawyer, 2007). Encouraging parents’ engagement and participation in intervention can take many forms. Through parent-infant programs, parent workshops, presentations, panels, or parent groups, providers can provide direct teaching and education about how to best include learning strategies in activities and routines that parents experience with their children on a daily basis. In addition to didactic training and interventions that utilize modeling, educational systems may consider using structured therapeutic techniques to educate and coach parents on effective child-parent interaction. While including parents in audiologic habilitation intervention has been examined and supported (Fleming, Sawyer & Campbell, 2007), the impact of parents’ everyday interactions with their children also serves an important role in development. Quittner et al. (2013) found that maternal sensitivity predicted significant increases in language growth for children with cochlear implants, and that linguistic stimulation for the child was only related to language growth in the context of high maternal sensitivity. Notably, the effects of both maternal sensitivity and cognitive stimulation were similar to the effects found for age of implantation, which has long been considered one of the most powerful predicators of CI outcomes (Quittner et al., 2013). This study has important implications for the impact of parent behavior on overall development for children with hearing loss. Other studies have also supported the importance of emotional availability and maternal responsiveness on language learning and developmental play for children with a hearing difference (Pressman et al., 1999; Spencer & Meadow-Orlans, 1996). Quittner et al. (2013) suggest that cochlear implant programs can likely improve outcomes if maternal sensitivity training were incorporated into the intervention. There are several parent interaction training programs that incorporate didactic and/or hands-on experiential coaching to guide parents in effective interaction with their children. One such program is Parent-Child Interaction Therapy (PCIT; Zisser & Eyberg, 2010), an empirically supported treatment that works with parents and children together, along with a therapist, to promote child development and foster parent-child relationships (Eyberg, 1988). In PCIT, parents are taught skills they can apply in the home to promote child development (Bell & Eyeberg, 2002; Allen & Marshall, 2011), establish a nurturing and secure relationship with their child, increase their child’s prosocial behavior, and decrease negative behavior. The treatment is structured in two parts: Child Directed Interaction (CDI), which is similar to play therapy and engages parents and children in play situations; and Parent Directed Interaction (PDI), which teaches parents consistent and effective behavior management techniques as they play with their child (Schuhmann et al., 1998). The therapist serves as a “coach” for the parent, providing live, real-time feedback. PCIT has been utilized with a range of populations. The approach was initially developed to support children with behavioral difficulties, but has since been used children with various presenting concerns (Storch & Floyd, 2005). Children with behavioral concerns, anxiety, oppositional behavior and difficulty following parent’s instructions can benefit from PCIT. PCIT has also been shown to improve language and prosocial behavior, as well as help increase positive interactions between the parent and child as oppositional behavior decreases (Allen & Marshall, 2011). Given the specific behavioral and social development difficulties of many children with a hearing difference, this intervention can be an excellent fit for this population. PCIT has demonstrated statistically and clinically significant improvements in the oppositional behavior of participating children (Rich, Querido & Eyberg, 2002). In addition to significant changes on child behavior, studies have demonstrated important changes in the interactional style of the fathers and mothers in play situations with the child. Parents show increases in key interaction patterns such as reflective listening, physical proximity, and prosocial verbalization, and decreases in criticism of the child after completion of PCIT. These outcomes relate to improvements in child’s behavior and also help to support healthy child development through effective play (Rayfield, Monaco & Eyberg, 1999). Outcome studies have demonstrated significant changes on parents’ self-reported measures of personal distress and parenting locus of control (Ross et al., 1998). Previous research suggests that PCIT can be a successful and important intervention for parent-child dyads in which the child has a hearing difference. Children with hearing loss may benefit from additional time in play that helps promote development (Spencer & Meadow-Orlans, 1996). Research has also shown that positive interaction and play between parents, and specifically participation in PCIT, may help to improve language growth, particularly in the area of pragmatic language (Allen & Marshall, 2011). Further, our ongoing program of research implementing PCIT with a diverse group of families of children with a hearing difference, including those who communicate via spoken language and those who communicate via sign language, shows pre- to post-treatment changes in parent communication, child behavior, and child language growth. PCIT teaches parents strategies to apply at home in a way that is enjoyable and educational, and is likely to improve maternal sensitivity, parental responsiveness and emotional availability.
Who Cares about Attitudes, Anyway? Dispositions as the Gatekeeper to Exemplary Practice
1:00 PM - 3:00 PM
Kathleen Sussman, Mary Ellen Nevins, Joy Kearns
Dispositions, defined as ongoing tendencies that guide behavior, are seldom explored with the same rigor as the development of knowledge and the acquisition of skills for early providers. Despite this trend, attention to dispositions should be a critical element of workforce development and supervision. Research suggests that attitudes likely control “dosage” of implementation (how much or how often knowledge is applied and skills are demonstrated) and “fidelity” of implementation (the use of a strategy in the manner in which it was designed to be used). Additionally, dispositions affect any individual’s choices or enthusiasm for accessing professional learning to expand knowledge and/or skill. Professionals who seek continuing education opportunities that only reinforce their fixed, firm beliefs will never experience the dissonance from which new learning often arises. That said, well-designed professional education on any topic must provide a safe place for professionals to explore previously held beliefs in light of new research. It is of utmost importance that they guide the workforce to stay current and explore new skills that result in evidence-based, exemplary practice. This session will facilitate conversations regarding how EHDI leaders and administrators can influence professional dispositions most effectively to create a workforce that is motivated and enthused to continuously shape dispositions and drive new learning.