Newborn Hearing Screening - a Continuing Procedure: Peter Zoth
Integrating Listening and Spoken Language into Daily Routine - Christine Evans: ENG+RU
1. Integrating Listening and Spoken
Language into Daily Routines
Включение слушания и говорения в повседневную рутину
Christine Schmidt Evans, M.S., CCC-SLP
Кристина Шмидт Эванс, сертифицированный логопед
March 3, 2013 – 3 марта 2013 г.
2. About the Speaker – О докладчике
• Christine Evans, M.S.,CCC-SLP
Кристина Эванс, сертифицированный логопед
– Speech-Language Pathologist
Работает логопедом-дефектологом
– Adjunct Faculty and Clinical Supervisor
Адъюнкт-лектор и клинический супервайзер
• Texas Christian University (TCU), Fort Worth, Texas
В Техасском христианском университете в Форт Ворт, Техас
– Formerly in private practice
Ранее занималась приватной практикой
3. Today’s Goals – Цели этой презентации
• Explain why home practice is important
Объяснить важность практики в домашних условиях
• Identify tools and techniques to measure
parent skills and promote parent participation
Определить инструменты и приемы, с помощью которых измеряются
навыки родителей и поощряется их активное участие в реабилитации
• Identify steps for integrating listening and
spoken language into daily routines
Определить шаги, необходимые для интеграции слушания и устной речи в
повседневную рутину
4. Why is Home Practice
Important?
В чем важность практики в домашних условиях?
5. Parents are a child’s first and best teacher –
Родители – первые и лучшие учителя ребенка
Theory suggests unique bond between parent
and child allows for more meaningful
experience with target skill ; has potential to
make them a better facilitator of a new skill
(Russo & Owens, 1982).
Теории указывают на уникальность связи между родителем и
ребенком, что позволяет получать более насыщенный опыт
освоения целевого навыка; создает для родителей возможность
более эффективно помогать ребенку в освоении нового умения
(Руссо и Оуэнс, 1982)
6. Parents are Experts – Родители = эксперты
• The parent spends the most time with the
child and has the opportunity to elicit a
behavior in a natural context (Sweet &
Applebaum, 2004).
• Родитель проводит больше всего времени с ребенком и имеет
возможность стимулировать определенное поведение в
естественных условиях (Свит и Эппльбаум, 2004).
7. Parents can make a difference –
Неоценимое влияние родителей
• Mahoney & Bella indicated changing parental
behavior can produce better outcomes in
children across a variety of disabilities (1998).
У Мэхоуни и Беллы указано, что модуляция поведения родителей
может улучшить результаты терапии для детей с различными
нарушениями (1998).
• Nearly all early intervention programs
acknowledge the parent as a key player in the
therapy process. (Matthews & Hudson, 2001).
Почти все программы раннего вмешательства признают за
родителем ключевую роль в лечебном процессе (Мэттьюс и
Хадсон, 2001).
8. Parents are Essential – Родители необходимы
In the practice of Auditory-Verbal therapy 6 of the
guiding principles start with “guide and coach the
parent”
Шесть из десяти основополагающих принципов
аудиовербальной терапии начинаются со слов «наставлять
и обучать родителя».
9. Why Daily Routines? – Почему
ежедневная рутина?
• There are more opportunities in the home
Дома существует больше возможностей и контекстов
• Hours in therapy vs. hours at home
Часы, проведенные в лечебном кабинете, по сравнению со
временем дома
10. Why Daily Routines? – Почему
ежедневная рутина?
• Overhearing language from daily routines is
the way hearing children learn language
Пассивное слушание во время осуществления обычных
действий – именно так слышащие дети учатся языку
12. Where to start?
С чего начать?
• Always start with the child
Всегда начинайте с ребенка
• Regular visits to the audiologist for hearing tests, and
device programming
Регулярные посещения аудиолога с целью проверки слуха
и программирования устройства
• Child must wear cochlear implant all waking hours
Ребенок должен носить КИ все время, пока он бодрствует
• Therapist should conduct thorough evaluation of
speech, language, listening, and cognition
Терапевт (врач) должен тщательно оценивать речевые
навыки, словарный запас, навыки слушания и
понимания.
13. Where to Start? – С чего начать?
Don’t forget the Parent
Не забывайте о родителе
•Parents need to learn skills for integrating listening
and spoken language into daily routines
Родителям тоже нужно понять, как интегрировать слушание и
устную речь в ежедневную рутину
•A baseline of parent skills will help direct the therapist
to skills that the parent may need to learn
Базовые критерии оценки навыков родителей помогут терапевту
определить те навыки, которые следует освоить родителям
14. Parent Skills Assessments – Оценка умений родителей
• Consider using – Можно использовать:
– Parent Skills Check Lists
Списки родительских умений и навыков по
• Karen Rossi “ Learn to Talk around the Clock”
Карен Росси «Учимся говорить в любое время»
– Parent-Child Interaction samples
Типовые образцы общения родителей с ребенком
– Parent Knowledge Assessments
Материалы для оценки знания родителей
• Sunshine Cottage “Comfort Levels for Auditory Verbal
Families”
«Уровни комфортности для семей с устным модусом общения»
– Adult Learning Style Inventories
Инвентари стиля обучения взрослых
15. Active Participation – Активное участие
– Parents must be active participants in therapy
Родители должны принимать самое живое участие в терапии
• Therapist plays the role of a coach
Терапевт исполняет роль коуча
• Therapist gives parents feedback on skills to use at home
Терапевт советует родителям, какие навыки использовать дома
• Parent actively engages in all parts of the therapy session
Родитель активно участвует во всех частях встречи
• Parent can model the skill to the child
Родитель может смоделировать навык для ребенка
• Parent and therapist work together to plan activities and
skills to be addressed in home practice
Родитель и терапевт вместе разрабатывают план действий и навыки,
которые будут освоены на практике дома
16. “Tell me and I will forget.
Show me and I may remember.
Involve me and I will understand.”
Author Unknown
«Расскажи мне, и я забуду. Покажи мне и, возможно, я запомню. Вовлеки
меня, и я пойму» (Автор неизвестен)
Active Participation means
the parent is DOING.
Активное участие
значит: родитель
ДЕЙСТВУЕТ
18. Implementation - Исполнение
• Start with the daily routine
Начните с повседневных рутинных действий
– Parents won’t have to add to what they are
already doing
Родителям не придется брать на себя дополнительные виды
деятельности
– Parents will already be familiar with the activity
allowing for them to focus on the strategies and
techniques
Действие уже будет знакомо родителям, что позволит им
сосредоточиться на стратегиях и тактиках
19. Parts of a Daily Routine – Части
повседневной рутины
• Mealtime – Приемы пищи
• Getting Dressed – Одевание
• Playtime – Время для игр
• Bath time – Купание
• Getting in car – Поездка в машине
• Gardening/outside – В саду (на улице)
• Anything unique to the family’s daily life – Что-
то особенное из ежедневной жизни вашей семьи
20. Putting it all together – Составляем все
вместе
• Parent and therapist identify skills/vocabulary to be targeted
Родители и терапевт определяют целевой навык или
словарный запас для освоения
• Parent & Therapist pick a part of the daily routine to focus on
Родители и терапевт выбирают, на какой части ежедневной
рутины сосредоточиться сейчас
• Parent learns strategies/techniques for incorporating the vocabulary
during the routine
Родитель осваивает стратегии и тактики для включения новых
слов в рутину
• Parent and therapist practice strategies during therapy time
Родитель и терапевт оттачивают стратегию во время занятий
• Parent comes back to the next session with comments and feedback
about how things worked
На следующую встречу родитель приходит с впечатлениями о
том, как все получилось
21. Moving through the Routine –
Прохождение рутинных действий
• How long you focus on a particular routine will depend on the family and
child
Время сосредоточенности на конкретном действии зависит от
особенностей семьи и ребенка
• Some parent skills and child skills can be addressed in multiple routines
Некоторые навыки родителя и ребенка могут отрабатываться
при разных рутинных действиях
• You can teach the same skill across multiple settings
Одно и то же умение можно тренировать в разных условиях
• You can teach different skills in the same routine
Можно обучать разным навыкам в той же самой рутине
22. Example Routine: Mealtime – Пример
рутинного действия: прием пищи
• Targets: Vocalization with intent/meaning
Цель: обучение вокализациям с выражением намерения
• Parent Skill: Pause time
Родительское умение: выдерживание паузы
• Activity: Parent sits with child at highchair. Before the parent feeds the
child their next bite they pause and wait for some kind of vocalization
with intent
Действие: Родитель сидит напротив ребенка, который усажен
на детский стул. Перед тем, как поднести ребенку следующий
кусочек, родитель делает паузу и ждет какой-нибудь
вокализации для выражения намерения
• When the child vocalizes the parent rewards the child and they take the
bite of food
Когда ребенок вокализирует, родитель хвалит его и дает
требуемый кусочек
23. Questions – Есть ли у вас вопросы?
• ???
Christine.evans@tcu.edu
Editor's Notes
Hello everyone and welcome to Integrating Listening and Spoken Language into Daily Routines. My name is Christine Evans, and I am a Speech-Language Pathologist from Dallas, Texas. Today we are going to talk about using the daily routine as a way to teach listening and spoken language
I thought I would start by sharing experiences and background in working with children with hearing loss. I went earned an undergraduate degree at TCU in speech pathology, and then went on for some post graduate training and audiology. Following that, I went back to TCU where I earned a masters degree in speech pathology. I placed an emphasis in my studies on teaching children with hearing loss to listen and talk. My master’s thesis aimed to develop a system for measuring parent behaviors in auditory-verbal therapy. After finishing graduate school I worked at a school for children with hearing loss, and the worked in private practice for 5 years serving families of children with hearing loss. Last year I returned to TCU where I am now teaching coursework regarding listening and spoken language, and also supervising our clinic of children with cochlear implants. I am working towards my PhD and my certification as an Auditory Verbal Therapist
So let’s now talk about our goals for today First we will explain why home practice is important Next we will identify tools and techniques to measure parent skills and promote parent participation Finally we will identify steps for integrating listening and spoken language in home routines
When we talk about working in the home setting, it is important to recognize that we are moving from a more professionally mediated form of therapy to a more family centered. The family, and their daily routines become the focus of the therapy
On that note, home practice becomes important because we know that parents are a child’s first and best teacher. Theory suggests unique bond between parent and child allows for more meaningful experience with target skill ; has potential to make them a better facilitator of a new skill . In short, if we can get a parent working in the home on a strategy, the child will find the target more meaningful
Another reason why home practice is important is because the parent is an expert in their child. They have the opportunity and the knowledge base to really interact with their child naturally
Additionally, parents make a difference. Mahoney & Bella indicated changing parental behavior can produce better outcomes in children across a variety of disabilities . Nearly all early intervention programs acknowledge the parent as a key player in the therapy process. Training parents will lead to better outcomes
By now you can probably see that parents are an essential component to the therapy program. For children in an Auditory-Verbal program, 6 of the 10 guiding principles start with “guide and coach the parent”
We have established that parent training is valuable, and that the home environment presents a favorable setting to teaching language. The next question is, Why Daily Routines? The reality is that there are simply more hours available for learning in the home environment, than there are in the weekly therapy setting. Additionally there are more opportunities to use language in a meaningful way in the home.
We also know that children who have normal hearing learn language by overhearing it in their daily routines. Working in a daily routine allows the practitioner to have the child with hearing loss learn language the way their hearing peers would. Studies estimate that 80% of the vocabulary we know, we learned not from didactic teaching but from overhearing
Now we will talk about how to get started, and assess the skills needed for implementation of strategies into home routines
Of course as with any skill taught, you will want to start with the child. Make sure the child has appropriately fit amplification, and has visited the audiologist regularly. Additionally ensure that the child is wearing the cochlear implant all waking hours. If they are not wearing the cochlear implant all waking hours, then the child wont be able to access the parent’s teaching and modeling in the daily routine Next the therapist should conduct a thorough evaluation of speech, language listening and cognition
Since the goals of home therapy include teaching the parent, we will need to baseline parent skills to help direct the therapist as to where to start teaching, and which techniques the parent may need to learn
These are some of the ways that I assess parent skills. At least as for as published tools here in the states, I don’t have a lot of options, and all are non standardized measures, or criterion referenced One type of assessment I use a parent skills checklist available from AG Bell through a program called “Learn to talk around the Clock” In this tool there is a parent skills assessment therapy ideas for the entire daily routine Sometimes I will simply collect a parent-child interaction sample. When I do this, I simply allow the parent and child to play together, and take an inventory of the skills the parent uses in the sample There are some parent knowledge assessments available. In these assessments the parent fills out a questionnaire and lists their comfort level with certain skills. The one I use most often is from the Sunshine Cottage in San Antonio Texas. It is called “Comfort Levels for Auditory –Verbal Families I will also do some assessment regarding the parent’s learning style. There are a variety of tools available for this and if anyone is interested, they are welcome to email me for references
Once you assess the parent and the child, you need to establish active parent participation in the session so that the parent is ready to learn skills for the daily routine. This means Therapist plays the role of a coach Therapist gives parents feedback on skills to use at home Parent actively engages in all parts of the therapy session Parent can model the skill to the child Parent and therapist work together to plan activities and skills to be addressed in home practice
A famous proverb reads Tell me and I will forget. Show me and I may remember. Involve me and I will understand In shot active participation means the parent is doing
Now that we know where to start, and how to structure parent participation, let’s focus more about the act of using daily routines, and how to implement the techniques
When I go to see a family for the first time, I like to get a sense for what their typical day looks like. I ask the parents who the child spends the most time with, I ask them about activities the family likes to do together, and then I start with those routines. Starting with the daily routine allows the family to not have to add to what they are already doing, and then can focus just on the strategies, and not on the activity.
Here are some common parts of the day that I have found useful in teaching listening and spoken language. Any of these would be fine areas of the day to target first.
When I get started in therapy this is how I usually get working on the daily routine. Parent and therapist identify skills/vocabulary to be targeted Parent & Therapist pick a part of the daily routine to focus on Parent learns strategies/techniques for incorporating the vocabulary during the routine Parent and therapist practice strategies during therapy time Parent comes back to the next session with comments and feedback about how things worked
As you move through a routine, How long you focus on a particular routine will depend on the family and child Some parent skills and child skills can be addressed in multiple routines You can teach the same skill across multiple settings You can teach different skills in the same routine
Here is an example of a skill that could be taught at mealtime Targets: Vocalization with intent/meaning Parent Skill: Pause time Activity: Parent sits with child at highchair. Before the parent feeds the child their next bite they pause and wait for some kind of vocalization with intent When the child vocalizes the parent rewards the child and they take the bite of food I might have the parent work on this skill for a week or so, and then depending on how they are doing with pause time, and how the child is progressing with vocalizations, I might move to a different part of the daily routine, perhaps during playtime, and have the parent use pause time for the same goal.
We have gone through a lot of information here. I will pause now for some questions.