Tag Archives: Paediatric hearing loss

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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