Using telepractice, auditory-verbal therapy can be delivered to children who are deaf or hard of hearing and their families. Telepractice allows children to receive services from certified auditory-verbal therapists even when qualified providers are not available locally. During telepractice sessions, therapists use coaching strategies to teach parents how to facilitate their child's listening and spoken language development through everyday activities. Both parents and therapists must have skills in using technology effectively for telepractice. Challenges include ensuring a strong internet connection and helping families feel comfortable with the technology.

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
Learning 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
Auditory-Verbal Therapy
The following Description of Auditory-Verbal Therapy and
Principles of Auditory-Verbal Therapy were adopted by the AG
Bell Academy for Listening and Spoken Language on July
26, 2007.
www.agbellacademy.org

4. Early Diagnosis & Early 4
Intervention
 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
Family 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
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
The Promise of Early Intervention
Remediation
Developmental Approach
Birth 6 yrs

8. Description of Auditory-Verbal 8
Therapy
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
Parents and AVT
“When parents learn how to integrate
auditory-verbal techniques into everyday
meaningful activities and experiences, their
children have the best opportunity to achieve
good listening and language outcomes.
Parents can become the professional’s
greatest allies. To ignore their contribution is
to compromise a child’s future”.
--- Judith Simser

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
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
Ensuring Successful Auditory-Verbal
Therapy
Principles 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
Ensuring Successful Auditory-Verbal
Therapy
Principles 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
Ensuring Successful Auditory-Verbal
Therapy
Principles 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
Ensuring Successful Auditory-Verbal
Therapy
Principles 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
Ensuring Successful Auditory-Verbal
Therapy
Principles 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
Ensuring Successful Auditory-Verbal
Therapy
Principles 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
Ensuring Successful Auditory-Verbal
Therapy
Principles 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
Ensuring Successful Auditory-Verbal
Therapy
Principles 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
Ensuring Successful Auditory-Verbal
Therapy
Principles 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
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
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
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
“The ultimate potential for the child
to become a successful language-user
is directly related to parent
involvement. Parents are the magic
and parental buy-in (what it takes) is
what makes the magic work!”
(K. Anderson, 2005)

25. 25
What 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
Terminology

27. 27
Benefits 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
Providing 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
Decreasing 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
Reducing 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. Increasing Use of Family- 31
Centered 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
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
Challenges 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
Feeling 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
Skills 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
Accessing 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. Implementation of Telepractice 37
Services
 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. 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
Technology and Home Environment
Telepractice 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. Conducting the Telepractice 40
Session
1. Reviewing goals and activities
 Reviewing goals from previous week, new updates,
review goals for current session, check hearing devices
2. Conducting the lesson/activity
 Demonstration of new strategies/techniques, coaching
the parent, discuss integration of goals into daily home
routines
3. Debriefing
 Allow questions from parents, discuss continuation or
selection of new goals, summarize session and goals
for the coming week

41. 41
Monitoring 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
Technologies 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
Types 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
Technology 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
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. Beneficial Outcomes Reported by 46
Families
 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
Nancy & Alex

48. 48
Nancy & Alex

49. 49
Nancy & Alex

50. 50
Summary
 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
Thank you for listening!
K. Todd Houston, PhD, CCC-SLP, LSLS Cert. AVT
Associate Professor of Speech-Language Pathology
School 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