Meeting Families in the Middle: Working with Deaf and Hard of Hearing Children
This is a transcript from our podcast episode published January 2nd, 2023. The podcast episode is offered for .1 ASHA CEU (introductory level, professional area). This transcript is made available as a course accommodation for and is supplementary to this episode / course. This transcript is not intended to be used in place of the podcast episode with the exception of course accommodation. Please note: This transcript was created by robots. We do our best to proof read but there is always a chance we miss something. Find a typo? Email us anytime.
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[00:00:00] Kate Grandbois: Welcome to SLP nerd cast, the number one professional resource for evidence based practice in speech, language pathology. I'm Kate Grandbois
[00:00:09] Amy Wonkka: and I'm Amy Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast.
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[00:01:43] Kate Grandbois: Welcome everyone to season four of SLP nerd cast. Today, we have the great pleasure of welcoming Sydney Bassard. Welcome Sydney.
[00:01:54] Sydney Bassard: Hi, thanks for having me.
[00:01:57] Amy Wonkka: Thanks for coming, joining us. Um, [00:02:00] you're here today to discuss how to meet families in the middle when working with deaf and hard of hearing children.
But before we get started, can you please tell us a little bit about yourself.
[00:02:09] Sydney Bassard: Yeah. So I have been practicing as a SLP for, um, around three years. And before I was an SLP I used to work for a reading intervention center, uh, really working with reading disorders and dyslexia. And so that is when I decided to switch my major from pharmacy and go on, um, into public health.
My college did not have a SLP undergrad program, or even like a, they used to have a minor, but got rid of it. So I had to like take one com B class. Uh, that was all that was offered at the undergrad level. And then I went straight into my master's because they had a bridge for people that were all non-majors that started in the summer.
Uh, so I did that and really loved, um, the experience that I had at the University of South Carolina. But what made [00:03:00] it special was they had a track for people that were interested in auditory, verbal therapy and the research lab that I was a research assistant in, uh, the professor focused on research for children who are deaf and hard of hearing, but use spoken language as their communication modality.
And so I was like, wow, like, this is really cool. Plus like I get to kind of specialize while still in grad school. Um, so I did the, ABT track. Learned a lot of those like techniques and principles really was involved with the research. Um, and then after graduation got a job at a cochlear at, not at a cochlear implant hospital at a hospital, um, and was on a cochlear implant team for around two years, worked really closely with E N T audiologist nurses, social work.
Uh, we had a fabulous team at the hospital I was at and I loved it. I, I loved seeing the connections of what I did in grad school, into clinical practice, um, and seeing how the [00:04:00] research that I had, like really been right there in the thick of it, seeing how that like directly applied too. Um, and so then probably a couple years after working on that team, I decided to change pace a little bit and move a little closer to home.
And so that's how I ended up, um, back here in Charlotte, cuz that's where my family is, but that's been kind of my, my journey with all of this.
[00:04:25] Kate Grandbois: That sounds amazing. And I, I know nothing about any of the things that you mentioned. So, as our listeners know, I work as a quote AAC specialist. So does Amy. So we love having, you know, people who work in other clinical disciplines on the show so that we can learn from you.
So I have lots of questions already, but before we get into any of them, we have to read our learning objectives and financial, and non-financial disclosures to get all of the housekeeping stuff behind us. So I'm gonna go ahead and quickly read those and get that off our plate. So learning objective number one, [00:05:00] list two ways in which the language development of children who are deaf or hard of hearing differs from that of children who are not deaf or hard of hearing.
Learning objective number two, list two roles of the SLP in supporting deaf and hard of hearing children and learning objective, number three, describe two current evidence based practices for, for supporting deaf and hard of hearing children. Disclosures Sydney Bassard’s financial disclosures. Sydney received an honorarium for participating in this course. Sydney's non-financial disclosures.
Sydney does not have any non-financial relationships to disclosure. Kate that's me, my financial disclosures. I am the owner and founder of Grandbois therapy and consulting LLC. And co-founder of SLP nerd cast. My non-financial disclosures. I'm a mass, I'm a member of ASHA, SIG 12. I serve on the AAC advisory group for Massachusetts advocates for children.
I'm also a member of the Berkshire association for behavior analysis and therapy and the association for behavior analysis, internationals corresponding, speech pathology, applied behavior [00:06:00] analysis, special interest group.
[00:06:02] Amy Wonkka: Amy that's me. Uh, my financial disclosures are that I am an employee of a public school system and co-founder of SLP nerd cast.
And my non-financial disclosures are that I'm a member of Asha, SIG 12, and I serve in the AAC advisory group for Massachusetts advocates for children. All right. Onto the good stuff. Uh, Sydney, why don't you start us off by telling us just a little bit about the language development of children who are deaf and hard of hearing?
[00:06:29] Sydney Bassard: Yeah, so I think that sometimes one of the biggest misconceptions is that if a child is deaf, um, that their trajectory is going to look a lot different than a typical hearing child. And the reality is that we can introduce language for a deaf or hard of hearing child. Early on, like you would do for a typical hearing child.
Um, and so one way that you could do that is by the introduction of sign language. And so really starting like you would with a typical [00:07:00] hearing kid, you know, we wouldn't go from, um, expecting a kid using like full signs to communicate very early on. It would start with one sign, two signs, and then, you know, progress to more complex and using, um, the sentence structure that's used in sign language, which is different.
Um, I think that's important to be clear. ASL or American sign language has its own grammar and syntax. It's not like a signed version of English. Um, so depending on where you are in the world, actually the sign language of that country might be slightly different. So it's important if you are going to, um, use any type of signed language that you do understand the grammar, um, and the syntactical structure when working with a child with that.
I think the really cool thing as well is that when we have children who are, um, within that deaf and hard of hearing category, but their parents might put, you know, [00:08:00] hearing aids on them, um, or pursue cochlear implantation. Our focus is really going to be, um, that auditory system a little bit earlier on, and it's not to say that you have to do sign or spoken.
Oftentimes I think professionals get into a kind of heated discussion about which one people are going to choose instead of really encouraging families. Like you can do both a child that wears hearing aids can sign and, um, and use sign language and spoken. Um, so just knowing what the points of emphasis are.
So if we're working and they're really little, how I've traditionally done therapy is we're gonna start without auditory system, because most of my kids have always used some type of amplification. So that would be, you know, detecting of environmental sounds. That would be, um, you know, really just starting to kind of focus on that vocal player that babbling and for most people you would think like, well, why would you do that?
[00:09:00] That that's pretty mundane or that's pretty like, that's something that we pick up, but depending on the degree and the severity of the hearing loss, the child may not have ever been exposed to the doorbell, ringing the dog barking. Um, and what we know about auditory development of, for the brain, especially is the starts in utero.
There's a reason that mothers have been told traditionally to sing and read to their babies. It's not just because, you know, you, you do establish that connection, but also your child can hear you. Um, so you start hearing within utero. So even by the time a baby is born, even if they get hearing aids like day one, which they don't, it's still nine months that we've missed out on auditory development and listening skills.
Um, so that's kind of where I traditionally start and how that might look.
[00:09:53] Amy Wonkka: Okay. I already have a question.
[00:09:53] Kate Grandbois: I have, I have so many questions. Go ahead.
Just go.
[00:09:56] Amy Wonkka: Um, I guess I'm, I'm the [00:10:00] person who's always asking, like, but what does that look like? Can you just give us like an example of, of how just working on some of the auditory stimulation might look a little differently from what we might traditionally be used to doing a speech language pathologist in terms of, I feel like a lot of us start right with receptive following directions, receptive vocabulary.
And it sounds like you're talking about something that's a little bit different from that.
[00:10:24] Sydney Bassard: Yeah, absolutely. So it just depends on the level of where the child is. So most people that work within the realm of like that listening and spoken language development are going to start with these kids when they are like babies.
Um, Really small. So not our traditional, like we're thinking entering school age. Like, no, these are like your three, six month olds. And so what that might look like is, you know, we might just be making that sound or having the parents kind of make that sound and then starting to attach it with the object.
So if we have a dog, I might [00:11:00] make the sound for a dog barking. Did you hear that? Really cue them to their listening? Well, let's listen to that again. And then point to the object. Oh yeah. That was a dog. One thing that I do caution therapists with is, um, and this happens, I think across the realm of peds, we see people attach very strongly to animals or, um, farm animals specifically.
And while those are great sounds to learn, that may not be the most appropriate sounds to work on for that child. Um, if they don't live by a farm, I'm so sorry, but the child that lives in New York city doesn't necessarily need to know what the cow sounds like, but you know, what might be more functional for them knowing what the taxi sounds like.
and what horns beeping are, because those are the things that they would be exposed to, um, quicker than let's say the farm animals.
[00:11:57] Kate Grandbois: I, I have so many questions. I wanna back up for a second [00:12:00] and go back to one of the first things that you said about how these two groups of children. I'm just thinking about our first learning objective and any developmental linguistically developmental differences there may be between these two groups, um, thinking about an SLP who might be listening and be interested in, in going into this area of practice. So does the research, I had read something that you had posted a while ago. Um, some, some research that you had posted, does the research say that there is a difference between these two groups generally?
Or does it depend on a variety of factors, like degree of hearing loss or whether or not they've had amplification at an early age?
[00:12:38] Sydney Bassard: So which two groups, typical hearing and, yes. Okay. So traditionally what's been kind of noticed is grammatical markers. So what we tend to see is that as our kids with hearing loss get older.
We tend to see that some of that complex syntax is a little bit more difficult for them to put [00:13:00] together whether that's directly related to hearing, or if they have true like underlying language disorder that they might have had, regardless of their hearing status that sells something that I think the research is trying to tease apart.
But from what we know so far is that they might have difficulty with plural marking or, um, irregular past tense or third person singular. And so those are things that you really kind of wanna pick up for, or even sometimes like past tense ed. I mean, you'd be amazed. They might start picking up these structures.
Um, but then certain ones we wanna emphasize. And I think that this is kind of a side, but that's why it's really important. Especially with this population to go beyond the standardized testing. Um, I actually had a study that got published in 2020, where it looked at that. And when we saw these kids that had high IQs on a standardized language measure, they were [00:14:00] doing pretty well.
And these are kids with hearing loss. They were doing well compared to their typical hearing peers. But when you throw them in with a language sample, are they matching up the same? No. And so it, like, it's going to show that we have to go beyond just the standardized test, because if we look just at the standardized test, most of them have patterns that you can follow.
The example sets the pattern for you and a kid that has decent test taking skills is able to figure this out. But in a language sample analysis and conversation, there is no pattern. It's it like you're having to discuss, you know, whether it's narrative, uh, telling a story, whether it's expository. You know, talking about, um, like facts and being able to retell and provide steps and sequence of things.
That's sometimes where we see the holes for these kids really kind of glare. And that's because a lot of times those grammatical [00:15:00] syntax markers are where they're having the difficulty.
[00:15:03] Kate Grandbois: And I can't not say this. This is only a little bit of a side bar. But anybody who is listening, who has just heard this very important cautionary tale of standardized assessments, we should always be cautious of standardized assessments in our evaluations.
We're we're teaching a class on this right now. There's a lot of research about this out there. So if you're listening and you are, you know, looking at this topic through the assessment lens, please just always be very cautious about over-relying on standardized assessments, because that is not a comprehensive way to assess, uh, pediatrics.
So soapbox over had to say it gonna move on to my next, to move on to my next question. So I'm wondering about, you know, anybody, any SLP who's listening, our scope of practice is so wide. And so often we are expected to provide intervention and treatment for such a wide variety of clinical presentations.
And for any SLPs who are listening, who maybe have a student [00:16:00] or a client or a child on their caseload, who is deaf of in heart of hearing. And maybe this is their first. Time treating someone of this profile. Are there other skills that are, or other differences that are really important to be aware of besides linguistic presentation?
I'm thinking in particular about any, any kinds of counseling skills or important awareness around cultural or community, um, components? Um, I remember in graduate school, when I took audiology, there was a really big emphasis on the deaf community. Um, very, you know, as a community that we need to be respectful and aware of.
So can you tell us a little, I know that was a very big question with a lot of components um, but is there anything you can tell us about that aspect of things?
[00:16:46] Sydney Bassard: Yeah. I think that over the past couple years we have seen a big push in the world, but especially in our field about being mindful of inclusion.
And so oftentimes, um, I think [00:17:00] therapists get these kids and they're like, okay, well I'm gonna work on the artic because that might be something that they hear. Um, but they might negate or like, forget about some of the, you know, feelings and social aspects behind things. So I always encourage people, uh, find out as much as you can before you see that kid, you know, have books that feature, um, deaf and hard of hearing characters.
And I don't think that all of them should necessarily be kids that use amplification. A lot of the books that come out now, which is, which are great, um, feature kids that use hearing aids or cochlear implants. Okay. But let's make sure that we have some representation of kids that sign as well, because a lot of the kids that we see, um, truly to some degree are bimodal, meaning that they use more than one communication modality, which is why their research within this space is a little bit muddy because most of the kids are not [00:18:00] true, like monolingual or one modality. They don't just use one. They might use a combination of both. Um, so, so making sure that we are having those things represented within our materials, but also then like knowing about what your deaf community resources are, you know, if you're able to have the parents connect with the deaf mentor.
Um, the one thing about the internet is that you have more access to Deaf people than I feel like ever before. Uh, there are so many people who are very loving and willing to share their stories or share, um, stories that they experience as a parent or stories about their kids on platforms, on the internet, in which they have made it really accessible, uh, to reach out to them, to, you know, ask questions for your kids to kind of connect, uh, even for you, you know, as a professional.
And then [00:19:00] really just being mindful that if you've met one Deaf child, you've met one deaf child and one deaf family, the experience is so different for people across the board. Um, some people have gone through very rigorous auditory verbal therapy, and they've loved it. There have been some people that have gone through auditory verbal therapy, and it was a very like difficult experience for their family and their child.
So I think always being kind of respectful that there's never one approach or one size that fits all is really helpful. Um, when interacting with the kids too, because they're gonna come with their own experiences and then making sure that, you know, the technology. I know that that sounds kind of. Okay.
Yeah, sure. Um, but each implant company, there's three there's cochlear, there's advanced bios, and then there's Medow um, they each have slight modifications. The overall system is the same, but how the pieces are connected [00:20:00] and work might be slightly different. Most schools are going to have a, uh, teacher of the deaf who is either within the school or itinerant.
So you can always rely on them, but sometimes you may not have access to them for when a battery is not working or if a magnet falls out or if we're not sure if the processor is working. So being able to just understand the very basics so that you can troubleshoot, um, if needed, I think is always kind of helpful.
That was a lot
[00:20:30] Amy Wonkka: no, I that's a big question. I think those are such good points too. And I think connected with the tech. I don't know if you wanna talk a little bit about FM systems, but that's another piece that sometimes comes into play if you're school based, um, and can be another like kind of scary thing.
If you're not like, you know, it's expensive and you don't wanna break it, but you're not sure how to use it. And I, I wonder if there are kind of like basics that would be helpful for everybody to know. [00:21:00] Like you mentioned batter. I think batteries are really big one. Um, I didn't know if there's anything else.
[00:21:04] Sydney Bassard: Yeah. The thing about FMS are, they're so different based on like what the system is. Um, I mean, this is definitely my soapbox, but FMS are beneficial for all children and I really get on it. Get on the soapbox.
[00:21:22] Kate Grandbois: Yes. Yeah.
[00:21:23] Sydney Bassard: That's what we're here for. I really wish that people would like stop this notion of they're only good for the deaf and hard of hearing kids in the classroom.
Um, like, no, they're good for all kids. We know that schools are noisy. Um, all kids benefit from the boosted sound. I, I mean, they just do. Um, so if you're a school based therapist. seeing if you can make that argument for having a sound field within your speech room, I think is always a good push. Um, but, even like, beyond that, like just figuring out how to work that FM, because they are all so different. So, um, reaching out [00:22:00] sometimes to the companies, some school districts are wonderful and have educational audiologists, some do not. And so that's okay. Um, what I have found as a therapist is it never hurts to ask.
So even though I had access to audiologists and ENTs right there by working in the hospital, um, there were plenty of times that I like needed things from the implant companies or I had questions and I would just send an email , um, and just like contact the, the manufacturer myself and say, Hey, like, this is my role in position.
And I work with these kids. Can you like, send me a video or explain X, Y, Z, and nine times outta 10, they have already had somebody, um, Create a video because other people have asked this question or they have a rep for your area. And that person is always willing to kind of chat with you quickly or do some troubleshooting with you.
[00:23:00] Amy Wonkka: I think those [00:23:00] are such helpful tips. Um, and the idea that you can reach out to the company is, is a really empowering thing. Just send the email. Worst thing they'll say is no.
[00:23:10] Kate Grandbois: And most of the time, at least through our experience with AAC is that vendors can be tremendously helpful. I mean, super helpful.
It's also a company that's making a sale so most of the time they're pretty motivated to provide good training and customer service. Um, and so I think that's a, that's a really wonderful suggestion. I wonder if you could sort of, I had just Al as you were talking, I was remembering something that I learned in graduate school.
That was a really long time ago. So it's probably outdated information, but it made me curious. You were talking about how, when you're working with babies three to six months old, and you, your focus might be tuning them into auditory stimuli in their environment that are maybe non-linguistic are there other early developmental differences that you might see?
[00:24:00] So the research that I'm recalling from my audiology class was the, um, if you have a working with a child who is, um, being raised, let's say by Deaf parents and their first language is American sign language, you know, looking at potentially babbling in sign or other, other markers, that language just like, just like you said, language can be introduced at the same ages as our typical hearing children.
Is there, are there any other, first of all, I guess my question is, is the babbling with hands true? Am I remembering that correctly? And then are there any other early developmental differences that, that you can tell us about.
[00:24:39] Sydney Bassard: Yeah. So I wish I could comment about the babbling with hands, but I didn't.
[00:24:44] Kate Grandbois: Somebody listening knows you have to write in and tell me I'm gonna have to Google it. Maybe we'll put a reference in the show notes.
[00:24:49] Sydney Bassard:Um, I don't know enough about like early development of sign to know. Like specifically. Um, but I have seen people kind of show that, or like kids will [00:25:00] use like word approximations.
They use sign approximations too. So if the sign for more is more, you know, maybe they'll start by like putting their whole hands together and the same motion. So it's the same, um, type of concept. It's just not as refined. And we have to think that a lot of science might require a little bit more fine motor skill, um, than we're expecting kids to have.
So if they're able to get an approximation, then I would say like, Hey, like we have it. And, and they're using it consistently, you know, all the things that you would expect, um, and make true for anything else they're using it consistently. They're using it across context. Then we would kind of count. So I think that those are like kind of the, the big things, but I think the sooner that we can make whatever we're doing meaningful to the kid is really where we want to move to.
Um, that's why I said like, don't pick environmental sounds that don't work for that [00:26:00] family, but you're also gonna want the family, not just to be walking around making sounds. like we wanna give language input too. So even if they're short phrases or they're narrating as they are, um, engaging in activity, they're reading books, the same is true for sign. Parents of children that sign, you know, they are going to be, um, narrating.
They're gonna be providing that input throughout their day. They might be signing the book as they're reading along with it. Uh, so really making sure that the experience is, you know, true of both. I, I really. I know that I used to struggle with, like it had to be auditory verbal, because that was what I learned in grad school.
Um, instead of giving honor to like, this is really a continuum and we can be respectful and make sure that people are getting everything that they need in order to set these kids up for lifelong success. [00:27:00]
[00:27:01] Kate Grandbois: I, I wanted to sort of reflect that back to you, as I heard you say it, because what it sounds to me, it sounds like your, the emphasis is really providing a linguistically rich environment in the continuum of modalities that are right for that child and family.
Is that, is that a, a good synopsis?
[00:27:23] Sydney Bassard: Yeah. Oh, absolutely. Um, so I share, and that sounds
[00:27:26] Kate Grandbois: like good clinical practice, no matter, no matter what you're doing
[00:27:30] Sydney Bassard: it is, but it's so interesting. So. I've shared recently, um, how I have stopped pursuing my auditory verbal therapy certification. So if you didn't catch it on my stories, you're now catching it here on the podcast.
um, and it was a really tough decision. I mean, it's a lot of training and I pretty much had done all the continuing ed for it, um, was really close with all the clinical hours I needed in order to be able to [00:28:00] sit for the exam. And in like reflecting on my clinical practice, there were just things that just did not sit well with me.
And that was part of it. It was how, even though a lot of AVTs that I know that practice say the same things that I do, you know, we give honor to the experience, but when you look at the board who is certifying people to be auditory, verbal therapists, um, That's not necessarily always the message that's reflected and in knowing that so many people have had bad experiences
we know that there have been children that, um, they've had signs withheld. They've had gestures withheld in order for them to like speak it. It's a little frustrating, um, because nobody else communicates like that. I communicate a lot with my hands. My facial expressions will tell a whole story before I open my mouth.
So why would we deny that same type of privilege to kids who are deaf and [00:29:00] hard of hearing? Um, so that's why I just was like, you know what, I'd rather spend my energy and time on making sure that we're meeting the needs of everybody on an individual basis, having the training of AVT and knowing a lot about the auditory system is wonderful.
And I still think that therapists that are working within the space and working with children, especially those that use any type of amplification need to understand that because there are certain, um, points of emphasis that you're gonna have to make based on their degree, um, and configuration of their hearing loss.
But also we need to understand that you don't walk around not using your hands, not using your gestures, not using your facial expressions. Um, we wanna make sure that like we are training these kids to really be able to communicate in the ways that are intuitive for them and authentic for them.
[00:29:54] Kate Grandbois: And so that, so they can choose in a moment.
And I know this, [00:30:00] this episode is not at all about AAC, but I hear so much of what you're saying. Reflected in the work that we do in terms of choosing a modality and honoring all modalities that are empowering and, you know, are authentic to the communicator and really continually shifting the focus to person-centered care and making sure that the, the client or the child or the family, um, and their perspectives and values are held at the center of the clinical choices that we make.
So I'm, I'm experiencing some joy in these, in these parallels. I don't know if you are too Amy.
[00:30:35] Amy Wonkka: Yeah. I mean, in, in obviously not having the training sitting that you have and not fully understanding what it even means to be an AVT therapist. Um, you know, I, I, I at least think about the ASHA evidence based triangle, you know, and just thinking about how we, as a field in more recent years have done a better job, giving the weight [00:31:00] and value to our clients and their other and other stakeholders in helping to craft what types of interventions we are supporting them with.
Um, and so, yeah, it makes a lot of sense. I also like heard you talking and heard it through my like AAC filter. Um, but I think that it does, it does make a lot of sense, but I'm sure, you know, there's a lot. To be gained through going through that training. I'm sure that there are a lot of pieces of value as well.
[00:31:27] Sydney Bassard: Oh, absolutely. And I think that the big thing is understanding that you don't have to agree. I think that sometimes people and therapists, especially, um, I mean, I'm a young therapist have not been practicing terribly long. Uh, but I had that issue, you know? Well, I'm the professional. You come out of grad school, they instill in you like you're the professional, you have the keys, you know, the things which is true, you know, the knowledge, but you don't know what people are bringing to the table and you don't have to agree.
I think that, especially [00:32:00] working in pediatrics, people really get offended almost when parents and caregivers do not follow their recommendations instead of realizing that, they don’t have to
[00:32:10] Amy Wonkka: I agree
[00:32:11] Kate Grandbois: no, for all you listening and you can't see us. Amy and I are just emphatically nodding our heads at like here, here. Yes. Get on another soapbox.
It's so true. That was me as a, as a new grad. I think there is so much, you know, wrapped up in us as clinicians being the quote expert or, you know, having this ego just out of wanting, you know, maybe having good intentions, just, just because we wanna help. And we wanna provide that, that high quality evidence, but to, you know, looping this back to Amy's point about continually refocusing the, the caregiver and client perspectives and understanding that that's not you giving in or, or giving ground because it's not a fight, it is evidence based practice.
It is part of your evidence based model to hold those [00:33:00] values at the center of what we're doing. Um, and this is, you also mentioned something that I learned from Amy a long time ago, which. You do it, doesn't have to be a fight. You can disagree and be at peace. That is a, that is an option. That is an option.
Um, and I learned that from her because I was the one who was like, ah, no, this is, you know, so I think, I don't know if that's something that comes with experience. Um, Or just something that comes from a friend or a colleague who just continually reminds you of that. Um, but for anybody who is listening, who is hearing that for the first time, you're not, you're not alone.
Take it, take it to heart. It's, it's very good advice.
[00:33:36] Amy Wonkka: Um, well inward, like we're all human people and we all have our moments, right? So you catch me on the day that I didn't sleep well. And I, I spilled my tea on the way to work. Like, you know, I mean, I think we're human people interacting with other human people.
I think it's making me think though about our, our second learning objective, cuz we've sort of been talking around it. Right. So what are we supposed to do as the speech language pathologist? We, we have [00:34:00] learned, we are not the ultimate prescriber of exactly what should happen rigidly and you know, without care for our clients or their families, but like what should we do?
What, what is our role, um, in supporting our clients and their families?
[00:34:16] Sydney Bassard: Yeah. I think the biggest one is to. The start is you have to be a good listener. Um, oftentimes by the time a family is coming to see you, they've encountered a ton of other professionals unless you work, you know, very closely within this realm.
Um, but traditionally, especially if this child. Was identified at birth through newborn hearing screenings. Okay. So they've encountered a newborn hearing screener at the hospital who, um, referred them out. So then they probably encountered a pediatric audiologist depending on the choice that the family makes with the pediatric audiologist.
They might have also encountered an ENT at that [00:35:00] at this point and discussed options. So right there alone, you've gone through 1, 2, 3 professionals. And now here comes the SLP that enters the stage. And depending on these interactions that have happened before, it could have been a very beautiful interaction.
There could have also been really painful. Um, so your first job is really to listen because there's also a lot of shock. What we know is that most kids that are born with hearing loss are born to hearing parents. So this isn't necessarily something that was even on the cards for a lot of people. When they went to have their child, this wasn't something that they were thinking about.
So knowing that going into the situation and really doing check-ins with families up front, how are you feeling about this process? Um, how can I support you? Being able to provide, I think those resources early is helpful. Some people are ready to accept them and some people aren't. And I think if you're encountering, um, kids within the school age realm, [00:36:00] Your role is to really support what the family has chosen.
So if the family has chosen that their modality is spoken language only, um, then you wanna make sure that you're supporting that if it is, you know, that they are going to be bimodal, then your job is to support them in that and really make sure that they are having to access to everything within the educational environment being oftentimes we push, well, they need to be doing this.
They need to be doing that, but really meeting the kids where they are. Um, I used to work with a lot of kids who they were not your traditional, um, auditory spoken language kids. And when I say traditional, these are the kids that are early identified early amplified, um, using, you know, Pretty strong language skills by the time they're entering into kindergarten, first grade, and they're rolling off the caseload.
We're not really seeing them anymore. A lot of my kids [00:37:00] were the ones that got implanted later, due to various different circumstances, or they had comorbidities in other things going on. Could I have pushed them in like you're in first grade and you're supposed to be right here? Or did I meet them where they were? So understanding that like each kid is going to be different and figuring out where that kid is, and what's gonna be most functional.
Okay. This kid can't make their th sound, but they also don't know the name of any of their family members. Well guess what, we're gonna be working on making sure that we know the names of our family members long before we're working on a speech sound. We can incorporate that maybe into learning about our family members names, but our focus is gonna be making sure that we have some functional language skills so that we can communicate with the people within our environment.
[00:37:47] Amy Wonkka: Listening to you speak right then was, was making me think back to your comment about, you know, standardized and I think specifically norm reference assessments, aren't enough to kind of give you that information because part of how you're going to find that out [00:38:00] and maybe part of why some of us do tend to focus on the th sound is because we can do a norm reference assessment and it, and it flags that skill right there for us.
So I don't know. I don't know if you have any like thoughts or tips for maybe specifically the school based person who has a student who's deaf or hard of hearing on their caseload, like how they can, we know language samples can be really helpful. Are there other pieces of information that you might use to help identify those priority areas as the SLP?
How do you, how do you pick out that information? How do you know that they don't know the names of their family members?
[00:38:39] Sydney Bassard: Yeah, that one's hard. Um, that's I mean, like that's when interactions with the kids come into a big play. Um, but they do have this thing online called the TEGI and do not quote me because I cannot think of the full name.
[00:38:56] Amy Wonkka: Can you spell that for us? Just so we can
[00:38:56] Sydney Bassard: T E [00:39:00] G I, uh, but it's free. Thank you, FYI. And it was, it comes out of, um, like maple rices lab in her area. It's the test of early grammatical impairment. Um, it's free and it's online and you can download it and it has probes for wanna say it has probes for like phonology past tense marking, um, And with the past tense, there's like irregulars in there as well.
And then third person singular probes. And so you can, like, when I say you can really download the whole thing, you can download the whole thing it has, um, where kids should be like by criterion. I wanna say don't quote me, but either way it is, um, it's a really great tool that is available to SLPs. It's pretty quick to give, you give the kid a word.
Um, you give it in like a [00:40:00] sentence. And their job for some of them is to like conjugate it to third person or conjugate it to past tense based on the context that's given for them to fill it in. Um, so that's like a really good one because then right there, you can see like, Hey, our third person, singular killers are really difficult or we did pretty good with some past tense marking overall, but I'm really seeing that we're having a huge difficulty with irregulars.
[00:40:28] Amy Wonkka: That's awesome. Thank you for that.
[00:40:29] Kate Grandbois: One of the things that you said earlier, I, I absolutely loved, and that was about taking the time to thoughtfully and carefully choose targets and objectives that are not only functional, but meaningful. You've mentioned it a couple of times through, you know, identifying sounds in an environment or choosing targets, you know, family names over random speech, not random speech sounds, but you, you get what I'm saying.
Um, and I find that that's a thread that's common [00:41:00] across all of speech pathology as, as a fundamental, you know, something that is important that we do as clinicians. I'm wondering if you have any strategies for how clinicians can go about, um, developing, how clinicians can go about choosing those targets, um, for this population.
Is it an interview style that you find to be the most helpful? I'm just thinking about the SLPs listening who have caseloads of 140 and are eating lunch and crying in their car. Like what can we actually do to get more information, to help us choose these functional, meaningful targets?
[00:41:34] Sydney Bassard: Yeah. So let's break this down into like, setting and think of it that way.
So if you're working in the early intervention setting, you have access to parents. So asking interviews, um, but also really being observant. So people tell you a lot without telling you a lot, by looking at their environment. And even sometimes when they have like offhanded conversations that you're like, okay, this has nothing to do with your child.
[00:42:00] They are telling you so much about their life, their emphasis, their stressors, um, what's important to them, even in those conversations that aren't directly related to the child. So kind of making notes of those things, um, especially in that early intervention or even outpatient, pediatric private practice setting are really, really huge.
And then being mindful of the cultural differences that might be, um, influencing some of their decisions and their thought processes. For my school based people. Um, it's a lot harder because you don't have access to families as much. If you have a kid that is even like remotely , um, able to communicate, I would kind of follow their lead.
And I feel like that term gets overused truly. Um, but really trying to see where they're going, see what their interests are. And that's when you use the people in your school as your team. So find out from their teacher, like, [00:43:00] how are they doing? You know, what are they seeing as interest? Um, I feel like at the beginning of the school year is a wonderful time to kind of get to know the kids.
And I know that SLPs loved us in those, like meet the SLP and like have people know about you stuff, which is great. Right? Like parents should definitely know about you as a professional, but have you ever flipped that around. And maybe like, you know, especially if there's kids on your caseload that are new or you know, that they're coming from somewhere else, um, I've done this in therapy or I've sent parents like kind of a, I wanna know about your child.
And I think when we frame it in the framework of like, no, this is not just another sheet of paper you need to fill out in order to get the school year started. Like this is going to help me to be able to make sure that therapy is meeting the goals that you want to accomplish. Making sure that your child is engaged and interactive in this [00:44:00] learning process and making sure that we are all on the same page for our common objective of making sure that little Johnny X, Y, Z.
I don't think I've ever had a parent that's been like, I'm not gonna fill that out because they, they want to make sure that they are feeling a part of the school team. It establishes the relationship with the caregivers up front, and then it's giving you a better insight as to what is going to be like really important for them.
We obviously know sometimes that parents' goals are all the way up here and we might be right here. So, you know, maybe you're gonna have to explain that of like, okay, mom really wants them to be, you know, halfway up this ladder. And we're really kind of starting at the bottom of this ladder. Um, but at least, you know, where the parent's coming from and what you can kind of work towards to get kind of in that space in realm.
[00:44:54] Kate Grandbois: I, I think there are, so everything that you're saying, I'm coming back to something that you said [00:45:00] earlier about being an active listener, um, and you know, re centering this as, as person-centered care. And I know for anybody who's listened to this podcast, I think we talk about counseling during every single episode, no matter what we talk about, because it is such an undervalued underutilized, um, but critical piece of being an SLP.
And it's obvious from what you're saying, there's no difference here. And I'm wondering if you have any thoughts about how counseling, how counseling skills can be applied, um, by SLPs to this, to this particular clinical presentation.
[00:45:39] Sydney Bassard: Mm-hmm so there is a book, I think it's called counseling and speech language pathology, and I love that book.
Kate Grandbois: Is it David Luterman,
Sydney Bassard: uh, no, I don't think so. I don't think so. I don't remember. It's been a while. Um, we used it in my counseling class in grad school and [00:46:00] it was, or maybe it's like counseling and communication, sciences and disorders. I don't know something along those lines.
Kate Grandbois: We'll put the, we'll put [00:46:07] the link in the show notes.
[00:46:08] Sydney Bassard: Um, but it's a really good framework and kind of talks about. How we should interact with our clients. Um, I think the biggest thing is that active listening piece. So oftentimes, and I do this, I'm a terrible person at this with my family. Um, but I am like 10 steps ahead in the conversation. So I already have planned out in my mind what you are going to say before you even like, say it.
And I
[00:46:39] Kate Grandbois: you're, my husband have my response. That's my husband. You're my husband. It drive me crazy
[00:46:40] Sydney Bassard:. And it's a terrible habit. It is so awful. It's so awful because you're not really listening to what the person is saying.
[00:46:49] Kate Grandbois: That's what I always say
[00:46:52] Sydney Bassard: what you've done is I really kind don't care what you're gonna say. I already know what I wanna tell you,[00:47:00]
As a therapist, not, not want to do that. And oftentimes we do, we do it, um, subconsciously, especially if we're nervous and we're not sure how we are going to be perceived. We are already like planning because we don't wanna be caught off guard. So really allowing families to, um, say what they need to say. And one thing that I learned, uh, from someone.
Really on like early on in my career during my CF is that she told me to ask the parents how things were going. And I thought, why would I want to do that? Who wants to sit there and ask people for their honest opinion? Because that's, nerve-wracking like, you're already feeling like, oh, maybe I'm not doing the best job.
And then you ask somebody and they confirm it. And it's like, oh, this is not great. Um, but what it allows is for check-ins, it allows for people to really take ownership of the whole process and [00:48:00] open the doors for communication, and then counseling's gonna look different. Um, a lot of parents are going through the grieving process when their child is diagnosed with a hearing loss, whether they're early on in the stage, Whether they have gone through all the way to acceptance.
Um, it's important to realize these stages are fluid. And so even though somebody may look like they've gotten into acceptance, they might go back like to step one in the grieving process where it's really difficult for them, especially as different social situations might arise. You know, so being mindful of those things and sometimes being prepared ahead.
So let's say this kid's been doing well and they're entering preschool moms and dads might start feeling a little bit, you know, tight with their emotions again, as they go into kindergarten opening those doors for conversation. How do you feel about so and so going to kindergarten, [00:49:00] let's have a conversation about it.
Can I connect you with this group or this parent who their child is a little bit older, but they've been exactly where you are. Um, and then recognizing your boundaries. We are not mental health professionals. So when you see something and you're like, you know what, this is outside of the realm. Um, it's time to refer out and there's no shame in that.
And even with that, making it a conversation with, um, the families, I don't, I don't necessarily see myself referring out with pediatrics. I just haven't had to. Um, but sometimes when it's the adults that I work with with hearing loss, that's when you tend to see a little bit more referring out for mental health, only because the majority of them are, um, what we would call post lingually deaf.
So meaning after they had language and speech, they are now losing their hearing loss. And so their journey tends to be a little bit, [00:50:00] uh, rougher for them as the person, as far as emotions, just because they are losing a sense and a skill that they once had and having to make adjustments, which is difficult and can be tough.
[00:50:13] Kate Grandbois: I would imagine that's a very different journey and a very different approach as a clinician. That makes a lot of sense. I'm wondering if, and I'm sure this would change through, you know, depending on your work setting, but I'm wondering if there are collaborative relationships. You've already, men mentioned referring out to other mental health providers, but are there other collaborative relationships that are really important for the SLP, such as an audiologist or another medical professional, like an ENT, um, who do you find to be one of the most important, um, team members or collaborative relationships to, to better support persons with hearing loss.
[00:50:56] Sydney Bassard: Yeah. So, um, love the ENT that [00:51:00] I work with. So I, uh, contract and work with an E uh, not an ENT with an audiologist two days a week, um, out of their office. And it is wonderful. We are able to really provide our clients with like interprofessional holistic care right there from the office.
So if you have a kid, um, or even an adult, that is deaf and hard of hearing, really collaborating with that audiologist early on is gonna be key. Now that can be a little bit tricky. So if you're in like the private sector and you're connected with them, then you'll be able to do that a lot easier. Versus if you're kind of in separate entities, that might be a little bit more difficult.
Uh, but in the school settings I'm telling y'all school, school based, people fight for these educational audiologists. They will make life a lot easier on you and make the like treatment that's available for these kids a lot better because they sometimes are able to [00:52:00] provide, um, mappings at the school or they're able to, you know, Fine tune hearing aids or change tubing or, um, all of the things that like are gonna be really important for the kid to be successful within the academic space, oh words are hard.
Um so that would be, um, my biggest thing. And so I love working with the audiologist. I think also too, like getting to know the teachers of the deaf teachers of the deaf are our best friends. And sometimes they are very underutilized tools, um, within the school districts and systems, getting to know them, making sure that you become their friend.
They oftentimes have a lot more training with the equipment aspect of things that SLPs just don't, especially with our field being so broad, but their field is pretty narrowed in. They like that is who they work with. So they have a lot more training if you're having questions about goals and where to go and you know, you're [00:53:00] not really sure.
What you should be doing with this kid, ask them. They probably know they have resources, they will collaborate and help you and be of assistance. Um, and then if you're working with the older population, um, especially if you're in like a sniff setting and you're like, you know, this person has hearing aids.
I'm not sure, work with nurses. Um, I cannot tell you the amount of times that people experience, um, what looks like mental health kind of disabilities or challenges or cognitive impairment. And sometimes it really is their hearing. What they're needing is they need someone to put their hearing aid back in, or they might need adjustments.
Um, and so making sure that, you know, the nursing staff is trained on how to put them in that we're keeping them in, uh, cuz it's gonna take some adjustment for the brain. And so those things are all helpful to making sure that we are, [00:54:00] um, giving people holistic care, but also it prevents us from misdiagnosing people.
Can you imagine if grandpa gets diagnosed with like cognitive impairment and then what we go on later to find out is like grandpa had a severe hearing loss and wasn't able to hear half the stuff. Um, and all he needed was someone to put his hearing aids in. Yikes. Like that's crazy, poor, poor, poor grandpa.
Um, so that's not to mitigate and say that like, you cannot have both, you can definitely have both, but sometimes it definitely helps if we are, um, making sure that we're having access to all of our equipment and things that we need early on.
[00:54:39] Amy Wonkka: And making sure our clients have access to all of their sensory aids that they may need.
Um, I think you make such great points about collaborating with other professionals and learning from other professionals. And I feel like it sort of brings us into the last learning objective and just thinking [00:55:00] about what are evidence based interventions for supporting children, um, who are deaf and hard of hearing and supporting their families.
So I was hoping you could tell us a little bit more, um, about what some of those best practices might be.
[00:55:13] Sydney Bassard: Yeah. So the work of Dr. Emily Lund, out of TCU is really phenomenal. Her work centers, a lot on, uh, vocabulary intervention research. And so she talks a lot about how we should best be introducing vocabulary with our kids who are, um, deaf and hard of hearing.
One of her studies that she published with, um, Michael Douglas basically talks about how explicitly teaching vocabulary and then pairing it with, um, experience is going to be best for our kids that are Deaf and hard of hearing. So you can't just introduce a word and give vocabulary , but [00:56:00] we need to make sure that we're explicitly teaching it and across the board, that's, what's found to be the best with this population.
Um, some people talk about embedding instruction. That can be nice. But what tends to happen is if a child is already having difficulty with understanding and processing language, you've just made what you're trying to teach way more complex. So if you can be very direct with what you're doing, you know, we are explicitly teaching, um, this concept.
We are explicitly teaching this vocabulary skill. We are explicitly teaching these words. It's going to go a lot further. Um, so I love her work. Um, another researcher is, I love Dr. Crystal Warhol. Um, she's at a Boystown national research hospital. Her work in this space is also really great. Um, Mary pat Mueller has published a lot within the realms of deaf and heart of hearing.
And basically all of the [00:57:00] research that's boiling down to is that we need to be direct. We need to be explicit in our instruction. Um, so those are researchers. And then if you're looking for strategies and like, what techniques can I use? Um, so one of the ones that's really good is, um, it's like Milu teaching and essentially what that is, is it's parent coaching.
So you would model what your expectation is. Um, Then you would explain it, you'd have the parent do it, and then you would review how they did together. So you would follow that kind of step in sequence, especially when you're working with like the little ones. I also tend to adapt that when I'm working with older kids and do the same type of thing, I might model what my expected behavior is.
I'm gonna have them do it and then we're gonna review it together. Is that right? Is that what you heard? Is that what we're supposed to be, you know, doing? Um, so really [00:58:00] kind of tuning them into, having a little bit more ownership in the process of learning instead of it just being, um, you directed. And then, um, there is a handout it's actually free online and it's called toy talk, um, by Pam Hadley and colleagues, and that one is great for if you're working on, um, kind of those grammatical structures. So we can always do, um, re casting, which most SLPs have heard of, but why I like this one is because you can really like make the toys or the games or whatever you're using really involved. And so, um, the research is on one side of the handout.
And then on the back, it gives examples of like how you would use this.
[00:58:47] Kate Grandbois: This sounds like an amazing handout. We will put a link to it in the show notes for anybody who's driving or running or folding laundry. And you would like to look at it further. We'll, we'll pop a link in there
[00:58:57] Sydney Bassard:and these skills are not like, I think [00:59:00] sometimes people go, oh, well, what do I do for deaf and hard of hearing kids?
Like these, these are not just for DHH kids. These are good resources and strategies for all children. Um, and like the differences may not be in like how you introduce the intervention. The differences might be is we know that these kids will need more repetition with a particular skill. Um, we know that they might need different acoustic emphasis in order for them to hear and fully detect all of the sounds that you're saying.
We know that, you know, they might need the supports of visuals and not just visuals with pictures, but maybe visual signs in order for them to fully understand a message. Um, so those are where I really see those differences come in.
[00:59:53] Kate Grandbois: That that all sounds very applicable. Like you said, to across a variety of, of [01:00:00] children on your caseload.
And again, you know, thinking about SLPs who are listening, who maybe this isn't their area of specialty, but they're curious to move into this area of specialty or they have a case. They, you know, this is represents one child on a caseload of X number of children. a lot of the strategies you're talking about could be very easily applied across the board as just good as good quality, good quality intervention.
[01:00:25] Amy Wonkka: I wonder if in our last few minutes there was anything else that we didn't have a chance to ask you or anything else that you wanna get back up on a soapbox about like sound field amplification in more broad environments in the school system or what have you. Um, but we have a few minutes left where we can review any key pieces.
You've already shared a number of awesome references. And I know Kate and I have been taking notes and they'll all be available, um, to listeners on the, on the website. But is there
[01:00:56] Sydney Bassard: anything else. Um, [01:01:00] I think that we just have to realize that, um, people are going to bring their experiences, um, and that's with anything, but especially with this population.
Um, so I caution therapists that are listening to this, like, don't get into these nasty debates that you see on the internet. Um, because parents are watching, parents are watching to see how the professionals are doing and treating each other. And so even though you might think like, well, I'm just really passionate and I need to share, um, we can always share with kindness because you never know the parent that's really just trying to search for answers so that they can do what's best for their kid or the adult who, you know, is now finding themselves is maybe con considering themselves as hard of hearing.
Um, And they were never seen as that before, because they had typical hearing, you know, whatever the case may be. They're also watching you [01:02:00] too. And there are people that are just genuinely looking for help without feeling as though they are going to get beat over the head. Um, so that's my kind of like big one is let's all kind of be mindful about these conversations you don't have to, and that doesn't mean that you have to agree with everybody, but I think that there's a way to have, um, respectful discourse.
That's not always in agreeance and then no, there's a lot of discussion sometimes around, um, should we be using the terms Deaf, hard of hearing. Um, and there are other terms that I personally don't like, um, that people choose to go by. The reality is that that is a choice um, if somebody chooses to identify as Deaf or hard of hearing, or however else they choose to identify, um, that's their right.
And you don't have to like what other people's rights are and what they choose, but you [01:03:00] can just respect it and you can agree to disagree. It does not have to be a fight and a battle
[01:03:09] Kate Grandbois: here, here. I feel like I feel like saying that again, but that would just be redundant. It's just so important across everything.
[01:03:17] Amy Wonkka: I think there there's such good points. And as someone who, who is like medium old and has been doing this for a while, you know, I, I reflect back and I'm, I'm always learning. I'm always, you know, sort of to your point about. Being a person and carrying yourself with respect and professional humility, um, and engaging in discourse with other people who may have different ideas from you.
You know, I mean, I think most of us, if you do something long enough and you are thoughtful about your practice, you can look back on it and think, Ooh, I did that. And, and that's how we learn and that's how we grow. And if we don't, if we don't have the ability to do that, we sort of get stuck where we are.[01:04:00]
Um, so I think there's always this balance of, I don't know, this is, this is like a bigger now you've like thrown me on like a bigger, a bigger social media piece. But you know, we also are sort of controlled by robots who tell us more of what we, what they think we want to hear and what they think we wanna know.
So it's also helpful sometimes to listen to things that you don't necessarily agree with. And then just think about that and take some other perspective. And like you said, Sydney, you may still decide that you don't agree with that. Um, but it doesn't hurt to sort of, feed your brain, some different perspective type too.
[01:04:33] Kate Grandbois: And I think learning to be, and this is true for this is a piece of professional maturity that I think isn't really discussed enough, but being comfortable in your discomfort. So learning requires vulnerability. Vulnerability can be very uncomfortable. It can mean that you're wrong. It can mean that you've made mistakes and learning to be more resilient and comfortable in that discomfort [01:05:00] can give you access to so many new learning opportunities and ultimately make you a much better clinician. I mean, it can make you a much better person, but this is about clinical work and really trying to continually shift to person-centered care and evidence-based practices. Um, and that is a really big piece of it.
That again, you've sort of kicked us up on the soapbox by accident, but it is relevant. It is clinically relevant. It's a huge cornerstone of professional maturity and good clinical practice. Um, and I really appreciate you bringing that all to light through this lens.
[01:05:38] Sydney Bassard: Anytime ,
[01:05:41] Kate Grandbois: We've so appreciated having you here today.
Um, all of the references and everything that you shared is all going to be listed in the show notes, along with, um, some research that I'm sure you can provide for us, for anybody who wants to do a little bit more nerdy reading, um, or nerding out on any of the information that you've [01:06:00] given. We're so grateful.
Thank you so much for teaching us so much today. You're welcome back anytime.
[01:06:06] Sydney Bassard: Oh, thank you guys for having me. This was fun.
[01:06:10] Kate Grandbois: Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.
Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com
Thank you so much for joining us and we hope to welcome you back here again soon.
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