Houston avt telepractice_final


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Houston avt telepractice_final

  1. 1. Using Telepractice to Deliver Auditory-Verbal Therapy to Children with Hearing Loss & their Families K. Todd Houston, Ph.D., CCC-SLP, LSLS Cert. AVT Associate Professor School of Speech-Language Pathology & Audiology College of Health Professions The University of Akron
  2. 2. 2Learning Objectives Define the principles of Auditory-Verbal Therapy as practiced by Listening & Spoken Language Specialists – Certified Auditory-Verbal Therapists (Cert. AVTs) and Certified Auditory-Verbal Educators (Cert. AVEds) Define the use of telepractice as a service delivery model for young children with hearing loss & their families Describe the typical Auditory-Verbal session delivered through telepractice Discuss the skills of parents and professionals in the use of telepractice Describe the challenges & potential outcomes of telepractice
  3. 3. 3 Auditory-Verbal TherapyThe following Description of Auditory-Verbal Therapy andPrinciples of Auditory-Verbal Therapy were adopted by the AGBell Academy for Listening and Spoken Language on July26, 2007. www.agbellacademy.org
  4. 4. Early Diagnosis & Early 4Intervention  Benefits of early immersion in audition & spoken language:  Same results – regardless of:  Type of loss  Degree of loss  Socioeconomic level  Other variables  Permits natural development instead of remediation
  5. 5. 5Family Involvement:How Important is It? Factors Predicting Language Outcomes  Among factors such as degree of hearing loss, age of enrollment in early intervention, nonverbal intelligence, and family involvement. Two factors predicted language, vocabulary, and verbal reasoning skills at age 5. (Mary Pat Moeller Pediatrics 106, 3 2000)
  6. 6. 6 The Two Most Important Factors Age at enrollment in EI & Family involvement Family involvement explained most of the variance How do we facilitate Family Involvement?
  7. 7. 7The Promise of Early Intervention Remediation Developmental Approach Birth 6 yrs
  8. 8. Description of Auditory-Verbal 8Therapy Auditory-Verbal Therapy facilitates optimal acquisition of spoken language through listening by newborns, infants, toddlers, and young children who are deaf or hard of hearing. Auditory-Verbal therapy promotes early diagnosis, one-on-one therapy, and state-of-the-art audiologic management and technology. Parents and caregivers actively participate in therapy. Through guidance, coaching, and demonstration, parents become the primary facilitators of their child’s spoken language development. Ultimately, parents and caregivers gain confidence that their child can have access to a full range of academic, social, and occupational choices throughout life. Auditory-Verbal therapy must be conducted in adherence to all 10 Principles of Auditory-Verbal Therapy.
  9. 9. 9Parents and AVT“When parents learn how to integrateauditory-verbal techniques into everydaymeaningful activities and experiences, theirchildren have the best opportunity to achievegood listening and language outcomes.Parents can become the professional’sgreatest allies. To ignore their contribution isto compromise a child’s future”. --- Judith Simser
  10. 10. 10 Family Empowerment.. A primary goal of A-V practice  Competent and capable parents vs dependency on professionals Parent engagement in all aspects of the child’s habilitation Parent-professional partnership based on open communication, trust, respect, shared responsibility Begins with helping families identify what they want for their child
  11. 11. 11 Introducing the A-V Approach to Parents: Helpful Resources A-V Principles –AG Bell Academy for Listening & Spoken Language 101 FAQs (Fall 2012); 50 FAQs About AVT  Edited by W. Estabrooks - available through AGBell We CAN Hear and Speak  The Power of A-V Communication for Children Who Are Deaf or Hard of Hearing - available through AG Bell Children with Hearing Loss: Developing Listening & Talking, 2nd Edition by Cole & Flexer – Plural Publishing You Tube Videos – Many AVT videos now available
  12. 12. 12 Ensuring Successful Auditory-Verbal TherapyPrinciples of AVT What It Takes… To detect hearing loss as  Ensuring newborn has hearing early as possible through screening & follow-up visits; 1-3- screening in the newborn 6 Model nursery & throughout childhood.  Extra time for audiological management. The may mean To pursue prompt & vigorous more frequent trips to the medical & audiologic audiologist than parents who management, including choose a different approach. selection, modification, and  Could mean seeking a strong maintenance of appropriate pediatric audiologist who has the hearing aids, cochlear necessary experience, perhaps implants, FM, etc. not in their community.  Wearing technology 24/7
  13. 13. 13 Ensuring Successful Auditory-Verbal TherapyPrinciples of AVT What It Takes… Guide & coach parents to  Weekly AVT sessions help their child use hearing as the primary sensory  Regular attendance, come modality in developing prepared to learn spoken language w/o use of sign language.  Entire family must be supportive of the approach  Daily individual play time with child in a quiet environment (1 hour min)  High expectations for listening
  14. 14. 14 Ensuring Successful Auditory-Verbal TherapyPrinciples of AVT What It Takes… Guide & coach parents to  Active participation in AVT become the primary sessions facilitators of their child’s listening & spoken language  Parents must understand they development through active are the primary consumers of consistent participation in the approach, not the child. AVT.
  15. 15. 15Ensuring Successful Auditory-VerbalTherapyPrinciples of AVT What It Takes… Guide & coach parents to  Control background noise create environments that within the home. support listening for the acquisition of spoken  Designated time each day language throughout the spent talking, reading, & child’s daily activities. facilitating listening & spoken language.  Goals integrated during daily routines: bath time, dinner time, going on walk, etc.  Auditory Learning vs. Auditory Training
  16. 16. 16 Ensuring Successful Auditory-Verbal TherapyPrinciples of AVT What It Takes… Guide & coach parents to  Focus on auditory learning help their child integrate during regular care giving & listening & spoken language play activities (3-4 hours per into all aspects of the child’s day minimum) life.  Control background noise; children must be able to hear spoken language w/o the t.v., radio, etc.  Listening become a part of child’s personality; s/he wants to wear technology
  17. 17. 17 Ensuring Successful Auditory-Verbal TherapyPrinciples of AVT What It Takes… Guide & coach parents to  Typical language development is use natural developmental followed patterns of speech, language, cognition, &  Child’s progress is measured communication. against hearing peers  An average or better than average rate of progress should be expected  Speech therapy – may be needed; should follow AV principles
  18. 18. 18 Ensuring Successful Auditory-Verbal TherapyPrinciples of AVT What It Takes… Guide & coach parents to  Child progresses through normal help their child self-monitor stages of learning speech: spoken language through vocalizes, plays with voice, listening. produces vowels BEFORE s/he says words.  Develop the auditory-feedback loop  Child begins to monitor the speech of others & self- monitors their own speech
  19. 19. 19 Ensuring Successful Auditory-Verbal TherapyPrinciples of AVT What It Takes… Administer ongoing formal &  Parents must support ongoing informal diagnostic monitoring of progress assessments to develop individualized Auditory-Verbal  Could mean extra visits for treatment plans, to monitor formal diagnostics; depending on progress, & to evaluate the insurance, could mean higher effectiveness of the plans for expense the child & family.  Understand sessions are diagnostic in nature – but not “testing” the child every time
  20. 20. 20 Ensuring Successful Auditory-Verbal TherapyPrinciples of AVT What It Takes… Promote education in  Parents actively involved in regular schools with peers transition process fro EI to who have typical hearing & public schools (or private with appropriate services school) from early childhood onward.  Mainstreamed education is the goal, with proper supports in place  Child should have language ability to be successful
  21. 21. 21 A-V IS WORKING for a variety of families because… A-V facilitates a mutually satisfying parent-professional relationship From the Professional Perspective:  Professionals desire to help but do not want the total responsibility for the child’s outcome  Given A-V training, professionals can provide parents with cutting- edge information, high-level intervention skills, fact-based information & documented outcomes consistent with parent goals
  22. 22. 22 A-V IS WORKING for a variety of families because… A-V facilitates a mutually satisfying parent- professional relationship From the Parent Perspective:  A-V employs a problem-solving approach that empowers the parent to take responsibility in decision- making  Parent input/questions are welcomed  Parents are included in every activity
  23. 23. 23 Parent Support, Education and Guidance in the A-V Approach “Parents are included in every activity.” What is involved in “including the parent?” In A-V, the parent IS the student BUT… Teachers/SLPs are trained to work with children, not adults…
  24. 24. 24“The ultimate potential for the childto become a successful language-useris directly related to parentinvolvement. Parents are the magicand parental buy-in (what it takes) iswhat makes the magic work!” (K. Anderson, 2005)
  25. 25. 25What is Telepractice? The application of telecommunications technology to deliver professional services at a distance by linking clinician to client, or clinician to clinician for assessment, intervention, and/or consultation. (ASHA, 2004a)  Services provided solely by correspondence should not be considered acceptable application of telepractice. (American Speech-Language-Hearing Assn.2005)
  26. 26. 26Terminology
  27. 27. 27Benefits to Telepractice Services  Provides access to qualified providers  Decreases travel constraints  Reduces health-related cancellations  Facilitates access to interpreters  Increases use of family-centered coaching strategies  Intensifies family member involvement  Provides opportunities to work as a team
  28. 28. 28Providing Access to Qualified Providers Many children are not receiving appropriate services Severe shortage of early childhood professionals with adequate knowledge & training to effectively educate Lack of a “critical mass” of children who are D/HH in a specific geographic area  Resulting in difficulty finding qualified providers in that area Listening and Spoken Language Specialists (LSLS) are often in demand in rural areas and can be accessed through telepractice
  29. 29. 29Decreasing Travel Constraints Travel-related expenses can consume a large part of a program’s budget; TI can reduce direct expenses such as mileage reimbursement and professional time Travel time for professionals can be significantly decreased, allowing more children to be served in the same amount of time Eliminates the family’s need to travel to a clinic Avoids the effect of inclement weather resulting in cancelled sessions
  30. 30. 30Reducing Health-Related Cancellations Health-related cancellations can be reduced when the child only has a minor illness and can still participate Doesn’t expose the early interventionist to illnesses Can decrease exposure of chronic health conditions to others, reducing the risk of health problems Decreased cancellations for families participating in TI
  31. 31. Increasing Use of Family- 31Centered Coaching Strategies Families can learn new skills to interact with their child through “coaching” by increasing parent knowledge and improving parent-child interactions The coach (early interventionist/professional) supports and encourages parents as they learn and practice new strategies by providing ongoing feedback Coaching is an important part of fostering listening and spoken language in children who are D/HH.
  32. 32. 32 Intensifies Family Member Involvement Opportunity for all family members to benefit and be involved in the early intervention Ability to record and store sessions  Can be shared with family members and professionals on intervention team  Family members absent from session can learn strategies used  All family members can observe week to week progress  Videos can be posted on secure website for ongoing access  Can be shared with friends and other caregivers
  33. 33. 33Challenges of Tele-Intervention Accessing a high-quality internet connection Feeling confident with technology Having a quiet space in the home Assuring providers have skills with technology and intervention Recognizing telepractice isn’t for everyone Obtaining reimbursement Accessing materials
  34. 34. 34Feeling Confident with Technology Some families are not confident in using technology, regardless of training  Can influence decision to participate in TI services There are ways to simplify technology, such as using a laptop with built-in camera, microphone, and speakers Availability of a technical support staff may ensure continued services when trouble-shooting problems occur
  35. 35. 35Skills Checklist for Providers of Telepractice Has basic knowledge of computers and other equipment being used Can trouble-shoot video and audio equipment Attends to technology while conducting the session Organizes materials for activities ahead of time based on naturally- occurring routines Conducts activities that involve materials and actions that are easily depicted over video/audio Has a variety of activities planned in case some are not successful Can adjust activities based on immediate interests of child Demonstrates use of coaching techniques when working w/ family
  36. 36. 36Accessing Materials Preparing materials for a telepractice session may be more time-consuming Using a coaching model requires the interventionist to have two sets of materials: one for the interventionist to use during demonstration and one for the caregiver to use at home Additional time is often needed to make sure that the family and the interventionist have all materials ready prior to starting the session
  37. 37. Implementation of Telepractice 37Services Services must adhere to ASHA Telepractice Service Delivery Guidelines Important that services are keeping with recommended family-centered intervention practices A good telepractice session should look the same as a high-quality traditional home visit Recommended practices include:  The use of coaching strategies  Routines-based interventions  Naturalistic teaching opportunities
  38. 38. Preparing for a Telepractice 38 Session Create a listening environment  Limited distractions & background noise, check listening device Management of others in the environment  Ensure others know when sessions are & not to interrupt Selecting instructional materials  Use culturally and developmentally appropriate
  39. 39. 39Technology and Home EnvironmentTelepractice Checklist Prepare your environment  Choose optimal room, have materials ready, remove distractions, prepare child for session Prepare your equipment and connection  Make sure equipment is on and working, reduce interfering internet connections Ending the session  Discuss problems, plan date and time of next session, notify others that session has ended
  40. 40. Conducting the Telepractice 40Session1. Reviewing goals and activities  Reviewing goals from previous week, new updates, review goals for current session, check hearing devices2. Conducting the lesson/activity  Demonstration of new strategies/techniques, coaching the parent, discuss integration of goals into daily home routines3. Debriefing  Allow questions from parents, discuss continuation or selection of new goals, summarize session and goals for the coming week
  41. 41. 41Monitoring Child Development &Audiological Functioning Via Telepractice Monitoring child developmental progress in an important part of early intervention Observation scales and language samples are a good way to evaluate via telepractice Session recordings can be used to evaluate child performance with observation scales or to code language samples  Inter-rater reliability checks Opportunities to consult with the audiologist, other professionals
  42. 42. 42Technologies Overview The “videoconferencing system” uses digital compression of audio and video streams in real time  Codec: coder/decoder Other requirements:  Video input- video camera/webcam  Video output- computer monitor, TV, projector  Audio input- microphones  Audio output- usually loudspeakers  Data transfer- analog/digital phone network, LAN, internet  Computer
  43. 43. 43Types of Videoconferencing Systems Dedicated Systems  Have all required components packaged into single piece of equipment  Types: large group, small group, and individual videoconferencing Desktop Systems  Add-ons (usually hardware boards) to normal PCs, changing them into videoconferencing devices  Use a range of different cameras and microphones
  44. 44. 44Technology Considerations Up-front Costs  Quality of Equipment (video, image size, camera Ongoing Service Fees pan, and zoom) Bandwidth  Recording telepractice session Bandwidth Reliability  Security Technology Maintenance & Support  How to Create Optimal Security Ease of Use
  45. 45. 45 Proposed Outcomes of Telepractice Increased parent knowledge, skills in cultivating development, satisfaction with services and providers Increased child developmental and communication outcomes Improved parent-child interactions Important to measure impact of telepractice on:  Increased frequency & intensity of intervention; provider skills and competence; use of time; decreased costs in regards to travel time
  46. 46. Beneficial Outcomes Reported by 46Families Better knowledge of language development process Increased skills and confidence in encouraging child’s language and listening Child responsiveness to parent improved Augmented child language development & listening skills Increased skills of family members as coaches
  47. 47. 47Nancy & Alex
  48. 48. 48Nancy & Alex
  49. 49. 49Nancy & Alex
  50. 50. 50Summary Newborn hearing screening, early diagnosis of hearing loss, early intervention, early fitting of hearing technology – all lead to better communication outcomes for children with hearing loss & their families Parents want access to well-trained professionals who have the knowledge & skills to facilitate listening & spoken language, such as Auditory-Verbal practitioners Because of cheaper technology & access to broadband Internet connections, telepractice is a viable model of service delivery that is increasing in the United States & around the world!
  51. 51. 51 Thank you for listening! K. Todd Houston, PhD, CCC-SLP, LSLS Cert. AVTAssociate Professor of Speech-Language PathologySchool of Speech-Language Pathology & Audiology The University of Akron (330) 972-6141 Houston@uakron.edu Facebook: Todd Houston LinkedIn: Todd Houston LinkedIn Group: 6 Sound Off