Tag Archives: Audiologist

A Paradigm Shift in Practice

Becky Clem

Do you ever have someone inquire, “Why did you decide to become a Speech-Language Pathologist (SLP)/Audiologist (Aud.)/Teacher of Children with Hearing Loss/Deafness (TOD)?”  I love to share that my dad’s profession as a reconstructive and plastic surgeon led me to speech-language pathology.  His work with children with cleft lip and palate and his belief that SLPs played a critical role in his patients’ speech and language development influenced my career decision early in high school. I loved meeting his patients, learning about the surgeries, and seeing his beautiful reconstructive work on these small children. He frequently remarked that the SLP’s role was essential in helping these children have excellent speech and communication quality without social and emotional challenges.

Along my career journey, my passion for children with hearing loss and deafness developed.  My graduate school, Wichita State, required all SLP graduate students to take the maximum number of audiology courses possible. We did extensive hearing tests; used giant audiometers by today’s standards, made earmold impressions, debated the pros and cons of Aural-Oral and Total Communication at a monthly dinner, and fully integrated our thinking into the world of hearing.   One of my first clients was a homeless adult diagnosed with neurological deficits. As it turns out, he had an undiagnosed moderate to severe sensorineural hearing loss. Once fit with hearing aids, he began to explore the world of sound with joy and abundance.

Beginning the journey towards certification as a Listening and Spoken Language Specialist with Auditory-Verbal Therapy Certification was nothing less than an upheaval to everything I thought I knew about working with children with speech, language, and hearing disorders. From the beginning of my career, I wanted to work with children and only children in the field. In the field of LSL, the focus is guiding and coaching parents. LSL intervention was not taking the child to the therapy room for 30 minutes, 2 times a week, leaving the parent in the waiting room reading, watching TV or perusing the Internet! Parents would be in the sessions fully participating? How would I teach parents? Instead of using the SLP requisite mirror and photo cards for articulatory mouth positions, we would be teaching speech through listening only!  How was that possible?

There was a monumental paradigm shift in practice from my role as a speech-language pathologist to an LSL Cert. AVT speech-language pathologist. That shift changed my practice as an SLP for all my patients with communication disorders.

What did I learn along the way? I learned to:

  • Be open to learning something totally new and different. Learn with a clear mind and open heart.
  • Be willing to try new skills and methods even when they are not comfortable.
  • Be willing to have someone else evaluate your clinical skills. Be willing to have them evaluate and help immediately in the moment. As a clinical supervisor myself, it was rather humbling to have someone else evaluate my clinical skills in therapy sessions.
  • Be more concerned about learning and improving than what it might look like to the parent/family to have someone help you during the session.
  • Engage parents and family in therapy sessions, as full participants. The results in patient progress will be far beyond therapist-child only sessions.
  • Have the parent participate even in ‘the child does better without the parent’ situations.  How can we expect progress without the parents’ involvement in the session learning and practicing strategies?
  • Be willing to make mistakes. It’s okay!
  • Practice AVT strategies and techniques in as many situations as possible with children who have other types of communication issues.
  • Read current research about how we learn to talk by what we hear – not by what we see.
  • Ask questions of other disciplines who work with children with hearing loss.
  • Ask audiologists and TODs to teach you about what they do.
  • Be respectful of what others do in the profession of paediatric hearing loss.

A Paradigm Shift in Practice

What changed in my own practice as an SLP? I now try to practice by:

  • Involving all parents of my speech-language patients fully in therapy sessions had a dramatic impact on the child’s outcomes.
  • By teaching parents specific strategies for carry over and helping figure out ways to carry over in a functional way at home, results in faster discharge from therapy.
  • Growing my skill set to include how to teach to various adult learning styles.
  • Developing my skills in mentoring and coaching for parents and professionals could positively affect the outcomes for children with hearing loss.
  • Teaching children speech through listening instead of through vision and articulatory placement cues (exclusive of those children with motor speech disorders) leads to more natural sounds speech at discharge.
  • Evaluating suprasegmentals and vowels as part of articulation testing and conversation evaluation changed my starting point and goals for intervention.  Goals target errors in suprasegmentals and vowels before error consonants.
  • Being open to constant changes in the hearing technology field and learning how it could improve access to speech through listening for my patients.
  • Collaborating with other professionals within my own program and outside led to failures and successes. Learning from all encounters and using that information for future collaborations provided some key changes in my thinking and practices.
  • Partnering with families of children with speech, hearing, and language disorders is not exclusive to the field of LSL-AVT and paediatric hearing loss.  The principles especially related to “guide and coach parents” and “parents are the primary language model” became part of all my therapy sessions – became part of my professional personality and mission.
  • Parents want to be part of their child’s success. By guiding and coaching them to be their child’s primary language model and teacher at home and in the community, successful outcomes for children with communication disorders of any type are possible.

I am joyously passionate about pediatric speech-language pathology and pediatric hearing loss!  Speech-Language Pathology is a marvelous profession.  Megan Hodge, a speech-language pathologist at the University of Alberta has a perfect quote for my thoughts in closing:  “….a career in speech-language pathology challenges you to use your intellect (the talents of your mind) in combination with your humanity (the gifts in your heart) to do meaningful work that feeds your soul.”

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We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/a-paradigm-shift-in-practice), as being the originator of the content.

Do You T.H.I.N.K When Providing Intervention?

Karen MacIver-Lux

Auditory-verbal therapists spend a lot of time coaching, providing feedback and engaging in collaborative discussions with parents. Speech-language pathologists, audiologists, teachers and other early intervention professionals (professionals) are no exception. Effective communication is recognized as a priority across the health care continuum because it directly affects the quality of patient care, safety, medi-care outcomes and patient satisfaction (1995).

Occasionally, professionals may need to deliver news or feedback that can difficult for a parent/child (client) to hear. Some professionals dread having these conversations because, despite their best intentions, the information gets lost in translation and clients can end up feeling unnecessarily frustrated, discouraged or even angry. As a result, rather than putting into action a plan for care, valuable time can be spent recovering from the shock of the news.

In her book The Now Impact, Elisha Goldstein describes the T.H.I.N.K. strategy, which can be used when preparing to provide feedback or information so that the message is clear and concise. This strategy can also be used when communicating and engaging with young clients, particularly during behavior management.

Before engaging and communicating with clients, it is a good idea to T.H.I.N.K. by asking ourselves if what we’re about to do or say is:

True

When discussing treatment plans/options, try to ensure that the information shared is accurate and current. When sharing observations, try to accurately describe what was observed, remembering to include multiple examples/evidence. When the answer is unknown or unclear, say so. Then work together with the client to find the answers. If the client requests additional information about a topic or intervention approach we’re not familiar with, refer them to the appropriate source(s) or professional(s).

During my years working with children, I’ve learned to say what I mean and mean what I say. Body language and follow-through are as equally important as the message.  If I say I’m going to do something, I need to do it.  When working with clients, I need to walk the talk, truthfully.

Many years ago, I saw Jack (not his real name), an adorable three year-old boy who noticed every delicate décor accessory in the clinic. Jack would have these in his hands before his mother or I can move them out of reach.  One day, he looked at a flower vase, and reached out to touch it.  I smiled cheerily and said in the nicest voice I could muster, “No, no, Jack. Don’t touch the vase! If you touch it, it will break!” Well, guess what? Jack touched the vase and it didn’t break. My voice and body language did not match the message and the verbal consequences I presented didn’t make sense. Nor was it the truth.

The next time Jack walked by the vase, he reached out to touch it and looked back at me. This time, I didn’t smile and I used a quiet but firm voice and said, “No, Jack. Don’t touch the vase. If you touch the vase, I won’t be happy and there will be no bubbles.” He touched the vase, so we didn’t play with the bubbles during our session.

The next time Jack walked by the flower vase, he didn’t touch it and as a result the beloved bubbles stayed in our session plan. My body language matched the clear boundaries I set and the consequences were realistic and truthful.

Helpful

As professionals, we are accustomed to providing recommendations and suggestions and we expect the children and their parents to follow them. At times, however, due to a family’s circumstances, the recommendations may be easier said than done.

Consider the following case of a family whose baby, Molly, was fitted behind-the-ear hearing aids one month prior. During their follow-up visit with the audiologist, the parents reported that Molly had adjusted well to the hearing aids and is wearing then during all waking hours. Upon reviewing the data logging, however, the audiologist noticed a discrepancy that suggested that the hearing aids were only being used four hours a day.

Although tempted to question the parents about the discrepancy, the audiologist refrained. Instead he said, “I see that your baby is getting an average of four hours a day of hearing aid use.  This is a great start!  Our goal is to have the hearing aids on during all waking hours. How do you think we can achieve this goal with Molly? Is there anything I can do to help?” The parents showed surprise and responded that they are certain that the hearing aids are being used at all times except during rides in the car, bath time and sleep .

After the audiologist waited for a few minutes allowing time for self reflection, the parents suggested the possibility of the hearing aids not being used while Molly was at daycare. Later that evening, the parents discovered that the daycare staff were uncomfortable handling the hearing aids and were fearful of losing or breaking them. In addition, the other children were pulling Molly’s hearing aids off and placing them in their mouth. As a result, fearful for all the children’s safety, the staff weren’t always diligent in putting the hearing aids back on.

With this information at hand, the audiologist and the parents developed a plan of action to help ensure that the hearing aids would be worn during the baby’s entire time at daycare (e.g. a pilot cap and an in-service for the staff on the handling and care of the Molly’s hearing aids). Adopting a helpful attitude and supportive language is what often sets the stage for progress.

Inspiring

When I was 13 years of age, I decided that I wanted to become an audiologist.  It did cross my mind, however, that given the severity of my hearing loss the job may be difficult to do. How would I be able to do listening checks on a hearing aid? Was my speech good enough to do speech discriminations tests?

The list of questions grew longer and my dream drifted further and further away until I met Jeff Float.

As team captain in the men’s 4×200-meter freestyle relay, Jeff Float was the first legally deaf athlete from the United States to win an Olympic gold medal. Impressed by his story and example, I realized that if he could start a relay race, then so could I.

Meeting Jeff Float gave me the inspiration to pursue my dreams with dogged determination.

When parents are faced with their child’s diagnosis of a communication challenge, they are usually uncertain of what the future holds. In all honesty, so are the professionals.  Professionals however, have the advantage of having the skill set and knowledge to develop an intervention plan to help the child reach his/her highest communication potential. It’s important for  professionals to remember that parents not only need a plan of action, but that they need some inspiration as well. The same goes for young children, teenagers and adults with communication disorders.

  1. Arrange appointments so that clients have the opportunity to meet other others with similar communication challenges. Partner “new parents” with parents who have been through the process.
  2. Present opportunities for children with communication challenges (e.g. hearing loss, dysfluencies, cerebral palsy, auditory neuropathy spectrum disorder, etc.) to meet adults with similar communication challenges.
  3. Encourage children and young teenagers to join peer support groups of similar communication challenges (e.g. LOFTHitIt, etc.).
  4. Use language that is respectful of other professionals and communities who have embraced alternative communication approaches.

A good dose of inspiration goes a long way for those who have communication challenges and paves the way for the achievement of dreams and beyond. Encourage clients to aspire by introducing them to those who inspire.

THINK

Necessary

When my mother found out about my hearing loss when I was four years old, the doctor firmly told her that I would never hear or be able to speak.  He also added that I would never go beyond grade three, and that I would be severely limited in my vocational choices. He explained that it was necessary for my mother to adjust her expectations of me because of my mild to profound hearing loss. He then left the room to attend to another patient. Did my mother adjust her expectations? No, but she did feel devastated by his words and it took her some time to recover and move forward to find out what I really was capable of.  She later discovered that the doctor not only provided inaccurate information at the time (e.g. I could hear her voice even without hearing aids because I have a mild to profound hearing loss) but I also achieved outcomes beyond his expectations. To this day, my mother remembers his words and is still angered by them. Unfortunately, similar interactions still occur today unnecessarily causing parents grief and aggravation.

Each case is unique and professionals need to gauge the type and amount of information to provide. It is best to avoid making predictions about outcomes. Instead, listen to the parents’ dreams and desired outcomes for their children. Professionals should provide research data on outcomes and variables that can be controlled (e.g. hearing technology). Parents should be directed to resources so that they can do their own research. When parents’ dreams for their children have been heard and understood by professionals, parents will be more open to developing a plan of action in a collaborative fashion and following it.

Be mindful of when and how we share information.  Is it necessary to call a parent on a Friday afternoon to recommend a cochlear implant candidacy investigation when your next appointment with them is on Monday? Is it necessary to tell a parent of a one year old child to work on producing “s’ in words?  Is it necessary to provide parents of a newly diagnosed infant with a thick binder of information on hearing loss?  Is it necessary to tell a child that he’s a good boy when he hears a clock ticking?

When we take the time to consider the necessity of the information we provide to parents and children, chances are they will be more open to listening and moving forward with a plan of action.

Kind

Kindness is not just about being polite or generous; it’s also about having and demonstrating empathy.

Unfortunately in today’s world, kindness and empathy are sometimes regarded as signs of weakness. Often, the perception is that kind and empathetic professionals are either too timid to be effective or that they rely on their “niceness” in place of knowledge and the ability to effectively treat or impact clinical outcomes. Additionally, there seems to be a fear among some in the “helping” profession that empathy will lead to “burn out” early in their careers, and they develop a persona of polite indifference to protect their mental health and livelihood.

Clients who engage with professionals who behave with indifference, understandably, lose trust in the professional and their treatment plan, and progress for positive change is disrupted or grinds to a halt (2014).

Kindness and empathy is demonstrated by adopting body language that clearly shows that the professional is truly listening and by providing feedback the professional confirms that the client/patient was heard and understood.

It’s important for the professional to remember, that they need to move quickly from empathy toward developing a plan of action in collaboration with the client/patient.  Such collaboration will lead to the client/patient acquiring greater knowledge, trust, and motivation during the intervention process.

Remember Molly’s audiologist?  Her parents were given the opportunity to take the time to think about why her hearing aids were not being used as often as they thought. How?  Making sure to keep his arms uncrossed and open, leaning forward and providing good eye contact, making sure that his legs are uncrossed as the audiologist waits and allows the parents to self-reflect. Adopting such body language conveys that he is open to hearing whatever they have to say and that he’s open to being helpful.

When planning your next session, celebrate your professional strengths and challenges and T.H.I.N.K. before doing and saying. When we T.H.I.N.K., communication and collaboration will lead to better understanding, collaboration, client satisfaction and outcomes.

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We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/do-you-THINK-when-providing-intervention), as being the originator of the content.

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References

Stewart, M. (1995) Effective physician patient communication and health outcomes: a review. Canadian Medical Association Journal. 1995;152(9):1423n1433. 261
Back, A.L. & Arnold, R.M. (2014). “Yes It’s Sad, But What Should I Do?”: Moving from Empathy to Action in Discussing Goals of Care. Journal of Palliative Medicine 17(2):141-4.

Why audiologists should care about the ten principles of LSLS Auditory-Verbal Therapy

Stacey Lim bio

As an individual who has been a recipient of auditory-verbal therapy, I consider myself fortunate to have had an excellent paediatric audiologist who provided my parents – and me – with knowledge about hearing loss, hearing technology, and how to develop spoken language skills. As I’ve joined the audiology profession, I have reflected on the guiding principles of auditory-verbal practice and what role audiologists can play as they serve auditory-verbal families. It is not only the auditory-verbal therapist who can follow these guidelines, but also other professionals, such as audiologists. I firmly believe that by supporting an auditory-verbal family, we have a large role to play in the child’s development and growth, and by incorporating the auditory-verbal principles into our practice, we can ensure that we are providing the services the child needs.

The ten principles of auditory verbal practice are highlighted below, and how I have incorporated them into my practice and philosophy as an audiologist.

1. Promote early diagnosis of hearing loss in newborns, infants, toddlers, and young children, followed by immediate audiologic management and Auditory-Verbal therapy.

A goal in audiology is to ensure that hearing loss is identified early.  Today’s universal newborn hearing screening programs allow audiologists to determine which infants need to have follow-up audiological assessments.  According to the Joint Committee on Infant Hearing (in the United States), hearing loss would be identified within three months of the newborn hearing screening.  Early identification in infancy allows the child to have the opportunity to develop age-appropriate language skills, when hearing loss is managed through amplification and a spoken language program such as auditory-verbal therapy.  With early diagnosis, amplification, and intervention, it is possible for children with significant hearing loss to develop age-appropriate language skills. As audiologists, we can provide our families with information about early intervention services, and why it is important to have early intervention services—that we need to get information and language to the child’s brain as early as possible.

Not only can hearing loss be present at birth, but hearing loss can occur later in childhood. Some children may have progressive hearing loss, or hearing loss that worsens over time. Hearing loss is not always present at birth, and as audiologists, we can work with physicians or other health care and educational professionals to educate them about the importance of early identification of hearing loss.   By identifying later onset hearing loss in toddlers and children, we can then move toward appropriate intervention of hearing loss. In doing so, we can ensure that they do not lose any language learning opportunities.

2. Recommend immediate assessment and use of appropriate, state-of-the-art hearing technology to obtain maximum benefits of auditory stimulation.

A key point in auditory-verbal practice is the use of appropriate hearing technology that provides the child with the fullest possible range of speech sounds. In addition to fitting the child with hearing aids best suited to their hearing loss, it is also critical to ensure that benefit is being provided through hearing aids, via real-ear measures and behavioural testing in the sound booth. If it is determined that a child is not obtaining benefit from hearing aids, the audiologist should discuss other options, such as cochlear implants, with the child’s caregivers.

In addition to hearing aids and cochlear implants, the audiologist should also recommend the use of FM technology. FM technology allows the child to hear the speaker’s voice as if he or she was next to the child. In this way, the acoustic signal is not lost over distance and can be heard over background noise.  This option can be considered not only for educational environments, but also for use at home or in other surroundings, such as the car or environments where background noise can compete with the parent’s voice.

Appropriate hearing technology is important, not only for making sounds audible, but fitting hearing aids and mapping cochlear implant devices appropriately allows the child to have full access to the spectrum of speech sounds.  This is important for language development, and later literacy development.

3. Guide and coach parents to help their child use hearing as the primary sensory modality in developing listening and spoken language.

Children who have normal hearing have 24/7 access to their hearing. This means that even when they are not actively listening, such as when they are asleep, they are exposed to auditory information. Children with hearing loss have access to sound when they wear their hearing technology. Thus, they do not have 24/7 access to auditory information. Thus, when children are awake, they should be wearing their hearing technology, and parents are the ones who can ensure that their children’s hearing aids or cochlear implants are being worn. If the parent’s desired outcome is for their child to learn spoken language auditorily, they must encourage the use of hearing technology. And not only wear the technology, but highlight the auditory information that is being accessed. As audiologists, we can stress the importance of exposing the child to auditory information, because it is how children will acquire their knowledge of language and the world.

4. Guide and coach parents to become the primary facilitators of their child’s listening and spoken language development through active consistent participation in individualized Auditory-Verbal therapy.

The child spends up to a few hours a week with the auditory-verbal therapist, perhaps 30-40 hours a week with teachers, and the majority of his or her week with parents or primary guardians.  Thus, parents are truly the language models for children.  Parents, then, are the ones who may have the greatest amount of responsibility, not only for ensuring that hearing aids and cochlear implants are working correctly, but also for facilitating auditory learning.  In conjunction with the auditory-verbal therapist, the audiologist can work with the parent to develop individualized tools and strategies to emphasize auditory learning and development.

5. Guide and coach parents to create environments that support listening for the acquisition of spoken language throughout the child’s daily activities.

Children’s brains are developing skills, such as top-down processing or filling in the gaps in information that is missed during conversation.  These are skills that adults have, as a result of years of practice listening and communicating.  Because children are developing these skills as they acquire language, they require environments to be optimal for language learning. There are several things parents can do. One is for parents to speak at a clear, slower pace with a melodic voice. Children will “hear” that information better. Other adaptations parents can make is to the physical environment, by making it acoustically optimal for language learning. Parents can make sure that there is less background noise present during conversation. For example, the television should be off or at a quiet level (if someone else is watching it) when the parent and child are interacting with one another.

Warren Estabrooks reviewing the auditory-verbal principles with some students

Warren Estabrooks reviews the ten principles of LSLS Auditory-Verbal Therapy

6. Guide and coach parents to help their child integrate listening and spoken language into all aspects of the child’s life.

Again, children with normal hearing have access to auditory information 24/7, and children who use hearing technology have access to auditory information only when they are wearing and using hearing technology.  Thus, audiologists have to educate the parents about the importance of providing information and knowledge about the world to the child’s brain through their ears.  During all waking hours, the child should be wearing hearing aids, cochlear implants, and FM system so they have access to sound and spoken language.  Not only should the child be wearing hearing aids, but the parents should also provide auditory input in the form of complete, complex sentences. Other auditory activities can also include reading out loud with the child and singing with the child. These activities of conversing, narrating, reading, and singing will help the child’s brain develop listening skills and knowledge about the world.

7. Guide and coach parents to use natural developmental patterns of audition, speech, language, cognition, and communication.

Our role as audiologists run deeper than simply telling the parents about the thresholds that were obtained on the audiogram.  While it is important for parents to understand the X’s and O’s on the audiogram, what is even more important is for the parent to understand the critical importance of accessing the child’s brain and providing knowledge to the child’s brain. It is not just sound, but all the meaningful aspects of sound that we want to provide through hearing aids, cochlear implants, and FM systems. In order for that knowledge to become a part of that child’s personality, the parents need to provide the child with a rich, complex language base. This means reading every single word in books. Not only reading, but also having conversations about the book, the characters, motivation to build cognitive and linguistic skills. Another way to build language and vocabulary knowledge is to have conversations about the daily activities. It is also important for the parent to communicate with the child in complete sentences, not short, monosyllabic words or short phrases.

8. Guide and coach parents to help their child self-monitor spoken language through listening.

While parents can – and do – play a role in monitoring their child’s spoken language output and auditory skills, it is also important for the child to develop skills to independently monitor their own understanding of spoken language and their own language productions. The child, who has a strong focus in listening, can learn to assess their own understanding of what is being said around them. Parents can help by modeling or demonstrating good listening behaviors and clarification strategies. Children should also be involved in their audiology appointments, even listening to the audiologist explain hearing technologies, how they work, listening to descriptions of their audiograms and the test results. Making sure children have a complete understanding of their hearing loss gives them ownership of their hearing loss. By having a greater ownership of their hearing loss, they can develop advocacy skills, which are necessary when they are in situations (such as noisy environments) when it is more difficult to understand spoken language. This, of course, is a skill that is built over time, but it is a good skill to develop early, so it becomes natural for the child to independently self-monitor their own access to auditory information at an early age.

9. Administer ongoing formal and informal diagnostic assessments to develop individualized Auditory-Verbal treatment plans, to monitor progress and to evaluate the effectiveness of the plans for the child and family.

As audiologists, our scope of practice includes diagnostic audiological assessments to evaluate our client’s hearing status. What we can do for the auditory-verbal child is to assess not only the unaided thresholds, but also aided/cochlear implant thresholds at varying intensity levels (soft, average, and loud conversational levels). We can also assess the child’s speech understanding ability not only in quiet, but also in noise. These are important for several reasons: administering audiological assessments on an ongoing, regular basis allows us to determine whether there has been any change in hearing status. If there is a change in hearing ability, we can use this information to make the appropriate adjustments to the child’s hearing technology or recommend more appropriate hearing technology.

10. Promote education in regular schools with peers who have typical hearing and with appropriate services from early childhood onwards.

A major goal of auditory-verbal practice is for the child to be in the mainstream educational environment. This means that children will be in classrooms with normally hearing children who are their peers. However, classrooms are noisy environments, and in order to keep up with material presented in class, the child with hearing loss will need accommodations to ensure that they have full access to information.  An audiologist’s role in this case may include being involved on the child’s IEP team and working with the school to determine the types of accommodations that may be necessary for the child’s success in the educational environment. Some accommodations may include an FM system, acoustically treating the classroom, a buddy system, textbooks for the parents to use at home to reinforce the concepts in class or to pre-teach unfamiliar vocabulary, among many other possible accommodations.  It is incredibly important to have a working relationship with the other professionals who work with the child. By having this open communication about the child’s progress in school or in auditory-verbal therapy, we can ensure that the child continues to progress at an age-appropriate level.

In understanding all ten principles, and incorporating them into professional practice, we can be certain that we are providing the best services possible to an auditory-verbal family.  We have a role in developing the child’s brain and access to the world.  This concept of helping the child’s brain grow is a motivation for what I do and how I approach my practice as an audiologist.

*An Auditory-Verbal Practice requires all 10 principles.

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We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/why-audiologists-should-care-about-the-ten-principles-of-lsls-auditory-verbal-thearpy), as being the originator of the content.

My clinic piano as a teaching moment… for me.

Dr. Marshall Chasin

I have long known about the research of Dr. Brian Moore, specifically about his work with dead regions in the cochlea.  I have even purchased and used the TENS test to determine whether or not a region was healthy  enough to receive amplified sound.  “Cochlear dead regions” is a phrase that refers to a very significant amount of damage to the inner hair cells in the cochlea such that amplification with hearing aids may not be a good thing.  This is a case where less may be more.

Academically I know about “cochlear dead regions” and have even spoken about them; the literature has been discussing this issue for more than a decade.  But only recently have I begun to really use that knowledge.  In the past it was almost as if I was being macho and felt that the more gain I could give my clients at 4000 Hz (the top note on the piano keyboard), the better job I was doing.  And, of course, I “knew” my clients would hear better- never mind that that was not always the case. After all, as a macho audiologist, I knew better.

Back then, I felt, “cochlear dead regions” was a subject better left to the ivory towers of universities, and if my clients couldn’t use the amplification I gave them, that was their problem!

Of course, I am being tongue in cheek.  In the vast majority of hearing aid fittings, because of the limitations of modern hearing aid technology and the severity of a person’s high-frequency hearing loss, insertion gain measures would generally fall short of the “target” gain at 4000 Hz.  It is a rare situation where I can actually achieve the desired gain at 4000 Hz in any event, so  why worry about specifying less gain?

Clinically I would do everything to enhance the amount of amplification in the higher frequency region- I would program the hearing aid to generate that gain.  I would use acoustic plumbing to ensure that the earmold coupling was as optimal- I even referred to myself as a “dB squeezer”- someone who got those last few dBs out of a hearing aid fitting, like squeezing the last bit of toothpaste from the tube.

But back to “cochlear dead regions”.  Once a cochlear dead region is suspected, the clinical approach is to stay away from that frequency region.  One would typically reduce the amount of amplification in that frequency region(s) or perhaps use frequency transposition to shift the effective amplification to a lower (and hopefully) healthier cochlear region.  But even though I knew that intellectually, it wasn’t until recently, when I started to use my clinic piano, that it was driven home.  The piano is now part of my clinical armament- almost as useful as my audiometer.

Here’s how it works.  I have my hard of hearing clients (with or without their hearing aids) sit down and start playing the notes sequentially from about 1000 Hz and up … white key, black key, white key. One thousand Hz is about two octaves above the middle of the piano keyboard and about half way between the middle (near 250 Hz) and the top note (4000 Hz).  I ask clients to tell me when they can no longer distinguish between two adjacent notes.  For example, they may find that starting around G, that G and G# sound about the same pitch.  This corresponds to 1500 Hz (or perhaps 3000 Hz if it’s in the top octave of the piano).  This is an area that I want to stay away from.

The following table gives some “approximate” frequencies and their corresponding musical notes starting at middle C (the middle of the piano keyboard):

piano-notes

Of course, middle C is not 250 Hz; it is 262 Hz, and the top note on the piano keyboard C is not 4000 Hz; it is 4186 Hz, but the numbers in the table are close enough.  This takes about 15-20 seconds and gives clients a sense of being involved in their hearing rehabilitation.  Interestingly enough, this corresponds well with the results of Dr. Moore’s TENS test- actually not so surprising since this is really just another way of assessing the same phenomenon.  A comparison of Dr. Moore’s TENS test and this adjacent piano note test would make an interesting Capstone project for some AuD student.

I saw two hard of hearing musicians earlier in the week whom I have been seeing for at least 1000 years.  They had complained about “fuzziness” despite my best macho audiology tactics.  After this brief piano test, I reduced the gain above 2000 Hz in one ear (and bilaterally for the other musician) and the fuzziness went away.  I had to explain that I knew about this for the past decade but was too clinically pig-headed to do anything about it!

Although I have not done a statistically valid survey of audiology clinics, I suspect that most clinics do not have a piano in their office.  However, this is not an issue of pitch perception or even one of “just noticeable difference”.  It is a simple issue of “same” or “different”.

A $25 Cassio 1970s kid’s piano keyboard would do the trick, and you can still  find them for sale at low-end electronics stores or at many garage sales.  Pull out the portable keyboard, ignore its tuning, and just go to work.  Are two adjacent notes the “same” or “different” is all we need to know.  If two adjacent notes are the same, then minimize the amount of hearing aid amplification in that region.

*

Republished with permission: http://hearinghealthmatters.org/hearthemusic/2014/clinic-piano-teaching-moment/

Common Myths about AVT (part 1 of series)

Karen MacIver-Lux

 

I once attended a conference of audiologists and while waiting for the shuttle bus to take me back to the hotel, an audiologist approached me to ask how I was enjoying the conference. After we had exchanged introductions and information about our practices, she asked a number of questions that we have decided to share in a series of blogs in the hope that we can dispel some of the misunderstandings about Auditory-Verbal Therapy. 

Question One:
“Why do you auditory-verbal therapists insist on covering your lips while speaking?  It’s so unnatural looking, don’t you think?”

Ah.  The hand cue.  Yes, it is unnatural looking.

Advances in hearing science and hearing technology over the past few decades have caused auditory-verbal therapists around the world to reconsider their use of the hand cue. Historically the hand cue has been used to prevent speechreading but in actual fact it makes it more difficult for children with hearing loss to hear the speech clearly.  In my opinion, it also sends a subliminal message to the child that we don’t trust that they are listening unless we cover our lips. If we don’t trust their listening, how can they learn to trust their own hearing and listening skills?  Auditory-verbal therapists are now using alternative techniques and strategies to encourage children to listen.  In the 101 FAQs about AVT (page 113), there is an excellent response regarding the use of the hand cue in Auditory-Verbal practice and alternative techniques that can be used to foster confidence in listening.

Question Two:
“I thought that if you cover your lips when you speak, then it’s called Auditory-Verbal Therapy!  I’m confused!”

There is a lot more to Auditory-Verbal Therapy than just encouraging children to listen.  In fact, in the auditory-verbal approach, the parent(s)/caregiver(s) are the primary clients, not the children.  In every session, the auditory-verbal therapist invites the parent(s)/ caregiver(s) to actively observe and participate during the process of:

  1. selecting and using techniques and strategies that are used to gain diagnostic information about the child’s current skills in areas of audition, speech, language, cognition and communication during the session and at home;
  2. selecting session targets and long term goals that are appropriate according to the child’s chronological age, hearing age, developmental age, culture and interests.  Parents learn to navigate and document their child’s acquisition of developmental milestones with their hearing technology;
  3. choosing which techniques and strategies work best in helping make spoken language and the sounds of the environment easier for the child to hear and process;
  4. reporting on the child’s current skills, strengths and challenges and advocating for additional supportive services when necessary; managing the child’s hearing health, use of and benefit from hearing technology, and accessibility to learning opportunities (within and outside an educational setting) that’s easy to hear;
  5. transferring the above learned skills to their children so they can take responsibility for their own hearing, listening and spoken communication skills, and their self advocacy during all life situations.

Question Three:
“Aren’t those who follow the auditory-verbal approach against American Sign Language (ASL), Cued Speech, and other intervention approaches that include the use of visual cues?”

Every child with hearing loss is unique so it is important that parents of children who have hearing loss have an abundance of options when it comes to choosing an intervention approach that best meets the needs of their child and the family.  It is absolutely crucial, that no matter the decision, the family’s choice is respected and supported by all professionals with whom the family comes in contact with.

Karen in therapy session

There are some auditory-verbal professionals who are proficient in sign language but the majority are not.  There are some children and parents who come to auditory-verbal therapy with some sign language skills, but most do not.

When families choose the auditory-verbal approach, they make a commitment to help their children learn spoken language through listening with appropriately fitted hearing technology by following the Ten Guiding Principles of Auditory-Verbal Practice, and engaging the guidance of an auditory-verbal professional.  Although the auditory-verbal professional would not provide sign language instruction, it does not mean that an auditory-verbal therapist would discourage a child from using sign language if that is indeed what the child currently uses to communicate.

Here’s an example of an Auditory-Verbal Therapy session I conducted with a child who was using sign language when I began seeing her.

Sally is a child with a bilateral profound hearing loss who at 18 months of age had developed age appropriate skills in sign language.  Sally’s parents made the decision to proceed with cochlear implantation, and just prior to activation of her cochlear implant, enrolled her into the auditory-verbal therapy program. At the time of Sally’s first auditory-verbal session, she had been listening with her cochlear implant for one week and her chronological age was 20 months.   After providing Sally’s mom with the session targets (a few of which are listed below), I proceeded to begin the Learning to Listen (LTL) Sounds lesson.

Audition: Show detection responses to all LTL sounds by stopping activity, turning head in the direction of the sound, and pointing to their ear (“I hear that!”)

Speech: Make approximations of the LTL sounds using vowel sounds and match suprasegmental features of speech.

Language: Follow simple directions such as “Wave bye bye!”

Cognition: Demonstrate evidence of associating the LTL sound with the object (sound-object association) and associate the LTL sound with the known sign.

Communication: Demonstrate appropriate eye contact with the speaker; make attempts to put verbal approximations or LTL sounds with natural or signed gestures.

While Sally was engaged in a quick cuddle with mom, I quickly placed a dog wind-up toy in a little box and shook it and waited.  Sally became quiet and looked at her mom.

After waiting a few seconds more, I shook the box again and waited.  Sally looked over in my direction where she saw the box.  I pointed to my ear and said, “Did you hear that Sally?”

Sally leaned over to take a closer look at the box and looked back at her mother and made the sign for box.  Mom nodded her head and said, “Yes! Karen has a box!”

I laughed and Sally looked over at me.  “Did you hear me laugh? Let’s listen to the box again.” And I shook the box.

Mom said, “I hear something in the box.  Karen, what is it?”

I replied, “It’s a dog! Do you know what the dog says?”

Mom replied by saying “Woof, woof” and then she waited.   Sally looked over at mom, smiled and mom exclaimed, “You heard the doggie!”

After waiting a few more seconds, I said, “woof, woof!”  Sally turned in my direction, and I smiled “I think you heard the dog again! Let’s open the box and see what’s inside!”

When we opened the box, Sally smiled and made the sign for the dog.  Mom replied, “Yes, it’s a dog!  You’re right!”

I then proceeded to guide the mom to make the sound for the dog, and look expectantly at Sally.

Sally repeated the sign for the dog and looked at me.  I smiled and said, “You have the dog!  Lucky girl!  Let’s play with the dog.”

Over the next few minutes we proceeded to take turns making the dog walk, bark, jump, run around and around.  After Mom and I barked a few times, Sally said “mm mm!”  Mom said, “Yeah, I heard your doggie go woof, woof!”

Once it appeared that Sally was becoming disinterested in the dog, I said, “Let’s put the doggie away in the bucket and bring out a new toy.  Wave bye-bye!”  We all took turns waving to the doggie and put the dog in the bucket.

The lesson continued with the rest of the LTL toys.  Throughout the session, we monitored Sally’s auditory responses to our voices, to the LTL sounds, and the spoken language we provided.  After following the same routine with five more toys, Sally began to show understand of the direction by waving every time someone said, “Wave bye-bye!” Mom and I discussed and recorded Sally’s auditory responses, signs, and spoken language attempts.  We then discussed ways that Mom could incorporate LTL sounds into the family’s daily routines.

Signs made by the children during auditory-verbal sessions are acknowledged and responded to by using spoken language, facial expressions and gestures.  At no point do I discourage a child from using sign language.  I demonstrate to the parent(s) and caregiver(s) the use of techniques and strategies that will support the development of spoken language primarily through hearing and listening with the children’s hearing technology and I quickly hand over the activities to the parents so they can practice while I coach on the sidelines.  After all, it is the parents who are their children’s primary spoken language models.

Auditory-verbal therapists are privileged to be members of a team of professionals supporting families who are helping their children with hearing loss reach their highest listening and spoken communication potential.  It is a truly privilege to be a part of this wonderful profession, and I endeavour serve all families and professionals with respect, integrity and kindness as their auditory-verbal therapist.

*

Resources: 101 FAQs About Auditory-Verbal Practice (Estabrooks, 2012): renowned experts in the field provide up-to-date information — current theory, practice, and evidence based outcomes. 101 FAQs offers knowledge, guidance and encouragement for speech-language pathologists, audiologists, teachers, doctors, schools, and parents.

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/common-myths-about-avt-part-1), as being the originator of the content.

Importance of Relationship between Audiologists and AVTs

Stacey Lim bio

 

No man is an island,
Entire of itself,
Every man is a piece of the continent,
A part of the main.

-John Donne

Although it goes without saying that an auditory-verbal therapist (AVT) and the family are integral components of a child’s spoken language development, the Audiologist also plays an important role.  Audiologists fulfill the auditory needs of the child by providing ongoing audiological assessments, ensuring the use of appropriate hearing aids and/or cochlear implants and FM systems.  These fall within the scope of audiology practice, as well as the guiding principles of auditory-verbal therapy.

Working with an auditory-verbal family and AVT requires the
development of a symbiotic relationship that promotes
the child’s spoken language development.

As an auditory-verbal graduate, I have been fortunate to benefit from the relationship between my Audiologist and my AVTs, who worked closely with each other and with my parents to create the best kind of opportunities for me to learn spoken language.   As an Audiologist, I have been fortunate to have been in environments where the development of a relationship with Speech-language pathologists and AVTs not only is possible, but also encouraged. As a graduate audiology student, I had the opportunity to work closely with the AV clinic at my graduate institution.

First, in the therapy sessions with my fellow speech-language pathology classmates, I was also providing auditory-verbal/auditory-based habilitation, with a stronger focus on auditory skills development.

Second, during my audiology practicum clinic assignments, we shared information from the sessions with the child’s AV clinicians.  If the child’s graduate SLP clinician was available to come to the audiological evaluation, it was not just welcome, but also encouraged.  Through this relationship and inclusion in each other’s professional domains, we could see the relationship between access to sound and language/speech development.

It is these personal and professional experiences that lead me to the conclusion that having an Audiologist on the AV team is highly beneficial.

stacey-blog1

One of the key relationships in auditory-verbal practice is the one developed between the Audiologist and the AVT. The AVT will see the child on a very regular, frequent basis, such as weekly or even more, while the Audiologist may only see the child once a year or several times a year. The AVT can closely monitor the child’s auditory development and any changes in the child’s listening abilities during the AV sessions. If the AVT notices a change in the child’s perception of sound or speech production, one of the potential causes of this change in speech production or perception could be a change in auditory access.  Ideally, the AVT would recommend that the family make an appointment with the child’s Audiologist.

Prior to the child’s audiological appointment, the AVT can provide the Audiologist with a list of phonemes or sounds that are being misinterpreted or are no longer being produced clearly.  Armed with this information, the Audiologist can check the child’s hearing aids, reprogram them, or if the child is a cochlear implant user, re-map the child. All these would go toward the goal of ensuring that the child has full access to those phonemes.

Further, to ensure that the AVT and child’s caregivers know what access the child has to sound, the Audiologist can provide these partners in the child’s auditory development with the results of the audiological evaluation, hearing aid programming sessions, or cochlear implant mapping session.

By sharing this information with each other, the AVT and the Audiologist ensure that the child’s auditory skills and language development will continue to grow.

Not only do the Audiologist’s roles include the optimization of auditory devices and ongoing assessments, but also includes working with the family and the AVT to promote emerging auditory skills that carry-over into daily life. For example, telephone usage is one of the most challenging activities for individuals with hearing loss. In addition, ensuring that the child’s hearing aids or cochlear implant devices are compatible with the chosen telephone option, the Audiologist can work with the family and AVT to select appropriate telephone accessories, such as amplifiers or cords that connect the phone to the hearing aid/cochlear implant, etc. The Audiologist and AVT can also work together to ensure that these telephone accessories are appropriate and that the child’s hearing devices are effective for telephone use. The AVT could, for example, incorporate telephone practice into the auditory-verbal session, and provide the Audiologist with information about how the child was able to communicate on the telephone.

Working together, the Audiologist and AVT become partners and
combine technology and practice to maximize the child’s

listening abilities in different situations.

This is by no means the only way that Audiologists and AVTs can have a relationship that fosters the child’s development.

One of the other principles of auditory-verbal practice is also mainstreaming in a regular education classroom.  Again, providing appropriate auditory access to educational material is important for language learning, as well as expanding world knowledge. The Audiologist can work with the auditory-verbal family to ensure that appropriate assistive technology (e.g., FM systems) are being used in the classroom.

Moreover, the Audiologist can work with the child’s school to make sure that the FM system is being used correctly by their teachers. The Audiologist can also provide in-service training to educate the child’s teachers about hearing aids, cochlear implants, FM systems, and the importance of auditory access in the educational environment, as well as be a part of the child’s IEP team.

As a guide through the child’s landscape of listening, the Audiologist can work with both the family and the AVT to navigate the intricacies of auditory skills, auditory perception, and hearing technologies.

Working closely with the AVT and the child’s caregivers allows the
Audiologists to see the child’s developmental milestones,

as well as the needs of both the child and the family.

Because hearing and auditory access are such critical components of auditory-verbal practice, the Audiologist is a part of the “continent” of auditory-verbal life.

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/relationship-between-audiologist-and-avt), as being the originator of the content.

 

Hearing Heroes

Carrie Spangler

I am honored to be asked to write the first blog post for the Audio-Logic blog.  As I was thinking of an appropriate topic, my mind went directly to Karen, the owner and founder of SoundIntuition and how I met this wonderful person.

I met Karen for the first time she was a graduate student in audiology, and it was life changing for me!  This life changing event is supported by the Supplement to the Joint Committee on Infant Hearing 2007 Position Statement:  Principles and Guidelines for Early Intervention Goal 11 which supports that all children who are deaf/hard of hearing and their families have access to support, mentorship, and guidance from individuals who are deaf/hard of hearing.

Growing up as the only person in my family and my mainstream school with hearing loss posed a challenge at times.  I know that my parents felt alone in the journey, not having any support or what to expect.  I know that I felt that life was not fair that I had to wear hearing aids when seemingly everyone else in the world had nothing in their ears!

Then I met Karen.  I will never forget that day when I was in high school attending an appointment for an annual audiological assessment and she introduced herself as a graduate student in audiology.  She went on to explain that she had a hearing loss like me and wore hearing aids (now she wears cochlear implants) and uses a personal FM system.  I remember thinking….”Incredible!  This beautiful young adult studying to be an audiologist, AND wears hearing aids just like me!”.  This day was a pivot point for me.  I realized that I could be at peace with my hearing loss and make a choice to change my attitude about hearing loss.  I realized that hearing loss was a positive asset and would be one of the greatest gifts that I could have.

The American Speech-Language Hearing Association’s Joint Committee on Infant Hearing (JCIH) Goal 11 states that “families who have many contacts with adults who are D/HH exhibit a strong sense of competence with regard to raising their child who is D/HH”.  Audio-Logic “ally” speaking, I would expand to say that children and teens that have contacts with mentors who have hearing loss exhibit a strong sense of competence with regard to themselves.

I am thankful that Karen and I share audiology as a career path, which has allowed us to reconnect both personally and professionally.  However, there was a long period between the first time I met Karen and the next.  With that being said; this ONE meeting can leave a positive imprint on individual with hearing loss, especially a tween or teen-ager that may be dealing with self image and fitting in.

Carrie's Group

As a professional working with individuals with hearing loss or a parent who has a child with hearing loss….what can you do?  You could make the “pivot point” happen for that important tween or teen.   When I began my first year working as an educational audiologist for Stark County Educational Service Center (Canton, Ohio USA) I made the decision that I wanted to be able to offer this “pivot point” for students with hearing loss in the mainstream.  I had vision that every student that I worked with should have the opportunity to meet another student with hearing loss before graduating.  I began to share my vision with colleagues and the idea of a support group called Hit It! (Hearing Impaired Teens Interacting Together) was born.  When I had this vision in my head, it was no longer the question of “should I do this?” it became “how can I do this?.  When you ask “how?” ideas start developing and action begin to take place.  Our first Hit It! meeting took place in 1999 and has been going strong since.  We have been connecting students with hearing loss, hoping to move their “pivot point” positively.

Starting a support group seem overwhelming?  I know how you feel!  I am now in a new position at The University of Akron and starting over.  To get started, I reflect back on the “pivot point” of meeting Karen for the first time in my own life and realize that I want to positively influence the lives of teens with hearing loss wherever I am.  I am now asking “how?” and talking to colleagues.  As professionals working with children with hearing loss, we have tremendous influence and connections.  Still overwhelmed?   Think about starting small and connecting families and children with hearing loss for a 2 hour event.  Or strategically schedule patients and families back to back that you think would benefit from meeting. Creatively act and you will be rewarded knowing that you have made a difference!

As I wrap up this blog entry, I encourage every professional and parent to CONNECT children with hearing loss with others who can be a positive “Hearing Loss Hero” in their life.

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://www.soundintuition.com/blog/hearing-heroes-2), as being the originator of the content.

It all comes down to: S.H.A.R.E.

Erin Smith short bio

Support – Help – Acknowledge – Respect – Encourage

Writing an inaugural blog for Speaking of Which is an unnerving yet thrilling honour.  Karen approached me to write for her because she believes in me… as a clinician, professional and as a team member. This caused me to pause and reflect on the importance of being surrounded by people who support, help, acknowledge, respect and encourage.  People who S.H.A.R.E  move us forward in our lives – personally and professionally.

Imagine that you have just finished an incredibly challenging assessment or treatment session. What is the first thing you do?  The first thing I do is find a willing colleague and debrief about the experience I had. I have the pleasure of working in an environment with other Speech-Language Pathologists, Audiologists, Early Interventionists, Physiotherapists (PT) and Occupational therapists (OT).   Chances are good, that they have had similar experiences and will not only listen, but may add examples from their own practice to support our decisions or ask questions that may inspire us to take a different perspective.  It doesn’t seem to matter what profession the colleague belongs to, we all share similar celebrations and challenges. Having the support of colleagues is one of the greatest contributors to my job satisfaction and career growth.

Now, imagine that you are about to see a client for therapy and you are at a loss for an exciting therapy idea to target ‘food’ vocabulary (for the 28th time).  Who do you turn to for help? Where do you go?  My next favourite team is my ‘virtual’ team.  I have made connections with professionals (such as yourself) who have a wealth of creativity and have willingly shared those ideas through discussion groups, forums and websites.  I have never physically met many of you, but the desire for accessible information and materials drives you to share and help professionals such as myself.

Zackie interacts with Erin

I believe what makes a person an integral part of a team is self-reflection and the ability to acknowledge one’s own strengths and ‘needs improvement’ areas. Although I have been working for over a decade and I am familiar with many of the resources in my geographic area, there are times when I consult with my team members to ensure that I can provide all of the information and resources to a family. We can’t know everything about everything.  But if we know our own resources, we know where to find that information. Sometimes, I have an “off” day and I know it, I try to brush myself off and address any lingering concerns with my team (colleague or family).

Respect is crucial as we strive to work together to improve the lives of individuals, families and communities. We have to respect ourselves – knowing our value and worth in our profession is important and we should not undervalue our skills and knowledge. Respect for each other is essential to maintain the integrity of our professions. Speech-Language Pathologists acquire training that is diverse and is dependent on where they trained and what continuing education they have chosen to attend.  Because of this, we all bring to the table a somewhat different approach. I have to respect the fact that although I may not practice the same techniques and strategies, it doesn’t mean that I am right and they are wrong… it is different… I respect that, and I learn.

At the end of the day, something makes us want to wake up and go to work again.  We are encouraged by our team members who confirm our decisions or invite us to try something new. We are encouraged by our clients and families who make progress or give us positive feedback. I am encouraged when I see parents ‘buy in’ to the approach I present and are motivated to participate in the process of changing communication behaviours.

Speaking of which, sharing seems to be the common thread in my success with teams. We each have something to contribute.  Some days it is more than others. One day I might be a listener, one day I might contribute by sharing information.  Today, I shared my time and materials by opening my ‘food folder’ and cutting out a pizza craft for a colleague who was rushing off to a therapy session.  I did this because I had materials that my colleague could use to have a successful session.  Sharing our time, knowledge, ideas, experiences and respect is key to creating successful outcomes for all..

As I wrap up my first blog entry, I encourage you to SHARE what moves you forward in your professional career!

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://www.soundintuition.com/blog/blog-speaking-of-which-share), as being the originator of the content.