Parent and Early Intervention Provider Perceptions of Tele-Intervention: Qualitative Class Project Alison R. King.

Parent and Early Intervention Provider Perceptions of Tele-Intervention: Qualitative Class Project

Alison R. King

Early Hearing Detection & Intervention

• Early Hearing Detection and Intervention (EHDI) laws or voluntary hearing screening programs are in place in all 50 states and the District of Columbia (ASHA, n.d.) and by 2009, 97.4% of the nearly 4 million babies born in the US had their hearing screened prior to leaving the hospital (CDC, 2012).

• Goals for EHDI: 1-3-6• 1 month= All infants are screened for hearing loss prior to discharge

from birthing/neonatal facilities, or within one month of birth.

• 3 months= All infants referred from the screening process complete diagnostic audiological evaluation.

• 6 months= All infants with diagnosed hearing loss receive appropriate interventions including amplification and Early Intervention. (Virginia Department of Health, 2003)

Early Intervention• Since the IDEA 1990 (P.L. 101-476), early childhood providers

are challenged to provide services to children with disabilities ages 0-2 in the natural environment with the goal of transfer of skills into family and community contexts.

• According to the IDEA Infant and Toddlers Coordinators Association (2000), services are provided within natural contexts defined as where a child “lives, learns, and plays”. Settings which are excluded within this definition are clinics, hospitals, therapy rooms, or rehabilitation centers.

Spoken Language Options

• Yoshinago-Itano (2003) found that early identification of hearing loss and early amplification by either the use of hearing aids or cochlear implants have positive effects on the language, speech, and social-emotional development of children.

• The first seven years of life are critical for learning verbal language. Past those 7 years, it becomes much more difficult to acquire verbal language and the window of opportunity slowly closes neurologically (Lillard & Erisir, 2011).

• Oral methodologies such as Auditory-Verbal, Auditory-Oral, and Cued Speech have grown in popularity and are now considered a viable option for the education of children who are deaf (Dornan et al., 2010; Estabrooks, 2012).

Spoken Language Options

• Listening and Spoken Language Specialists (LSLS) are Teachers for the Deaf/Hard-of-Hearing, Audiologists, or Speech-Language Pathologists who are certified by the AG Bell Association for the Deaf and Hard-of-Hearing. These professionals specialize in developing spoken language outcomes in children by demonstrating a high level of competency and adhering to the Principles and Practices of Auditory-Verbal Therapy (AG Bell Academy for Listening and Spoken Language, 2007).

Parent Coaching• Hanft, Rush, and Shelden (2003) described coaching as the

backbone of services for early intervention providers as required by the intention of IDEA 2004 for such services to be provided within the natural environment.

• Hanft, et al. (2003) defined coaching as a process to support the learner in developing their skills to, “facilitate the child’s active involvement in his community and family” pointing out that the strategy of coaching can be used within any service delivery model (p.35).

• The parent coaching model is the core of Auditory-Verbal Therapy (AG Bell Academy of Listening and Spoken Language, 2007).

Parent Coaching & Spoken Language Options• Research in early language learning has documented the

crucial role of parents in the development of fundamental language skills necessary for spoken language in children who are deaf (Estabrooks, 2012).

• Barker et al. (2013) examined the effects of maternal sensitivity during parent-child interactions using play tasks within clinical and hospital settings. They found a significant increase in a child’s oral language growth in the context of high maternal sensitivity indicating that parent behavior training is an integral part of the child’s habilitation process. Maternal sensitivity is presumed to lead to greater spoken language outcomes.

Professional Training• Critical shortage of trained professionals to provide EI services

as children are being identified with a hearing loss earlier as a result of EHDI programs (White, 2006).

• The number of professionals specifically trained to address spoken language outcomes in children does not meet the demand for these services (Dornan, Hickson, Murdoch, Houston, & Constantinescu, 2010).

Tele-intervention• Tele-rehabilitation is the delivery of (re)habilitation services

via information and communication technologies (American Telehealth Association, 2012; Brennan, 2010).

• Tele-intervention is used to describe EI services for children birth- 3 years of age who have been identified as having a developmental disability (NCHAM, 2012).

• Distance technologies, such as Skype or Gotomeeting.com, are being used to provide services to families by therapists in working with children who are deaf (Hamren & Quigley, 2012).

Tele-intervention • The Volta Review 112(3); Winter 2012• Dedicated issue completely to Tele-practice for audiology,

cochlear implant mapping, (re)habilitation, early intervention, professional trainings, learning communities.

• Highlighted 10 programs worldwide currently using tele-practice.• Houston & Stredler-Brown (2012) presented a conceptual

framework for early intervention provided through tele-intervention.

Behl, Blaiser, Callow-Heusser, & White (2013) examined the cost-effectiveness and outcomes of tele-intervention using a mixed methods approach. Results indicated significantly higher scores in expressive language for TI group than the control group. However, parent perceptions of TI varied greatly.

What does TI look like?

Research Questions

• What are Early Intervention Providers perceptions of tele-intervention as an Early Intervention service delivery model for children who are Deaf/Hard-of-Hearing that they currently serve?

• What are parent perceptions of tele-intervention as an Early Intervention service-delivery model for their children who are Deaf/Hard-of-Hearing?

Methods• Semi-structured interview process (due to limited qualitative

information available in literature review regarding TI, EI and Oral methodologies).

• 3 interviews with EI professionals who currently work with children who are deaf/hard-of-hearing using oral methodologies (known to interviewer).

• 3 interviews with parents of children who are deaf/hard-of-hearing using purposeful chain referral sampling.

• Interviews by phone or in a mutually agreed to site.

• Interview transcription, Member checking, Interview questions for parents based on interview answers from professionals, Professionals asked more questions after parent interviews

Participants - Professionals • One Speech-Language Pathologist, Two Teachers for the

Deaf/Hard-of-Hearing• Years experience: 14-26 total; EI experience 6-19• All have extensive training in oral methodologies (All have

additional graduate coursework ; 2 attended the Carolina Institute- 2 week-intensive and prestigious training program)

• One works full-time with EI and exclusively with DHH• One works part-time EI and part-time school-age (all DHH)• One works part-time EI and part-time school-age (not all DHH)

Initial Findings - Professionals• Theme One –Tele-intervention is not appropriate for all

• Child – complicated medically• Family – require extensive modeling• Therapist – not skilled at parent coaching

• “I think for some families who know what they are doing it would be easier just to tell them what to do and you can model it for them through the tele-therapy but some families you actually need to have them sitting next to you in order to facilitate what they are supposed to be doing because they need more guidance and they need someone to show them what to do rather than just trying to explain it. Some families are more complicated and require you to actually go through the home with them and teach them about language opportunities.”

Initial Findings - Professionals• Theme Two: Addresses critical shortage

• TI gives children and families who live in remote areas an opportunity to work with professionals trained in oral methodologies.

• “I think face-to-face is obviously the preferred method however in situations especially in the remote areas in Virginia where they don’t have service providers who are knowledgeable in deaf education or they don’t have a teacher of the deaf etc. that would probably be the next best thing to do. But umm bottom line I don’t know how comfortable I would be doing it just because you don’t have that interaction with the kid.”

Initial Findings - Professionals• Theme Three: Collaboration

• “I see the potential of using tele-therapy as a way to work with other professionals…….like you and I work with some of the same kids. This would be a way for us to work with the child with me in the home and you in the office and we can both use the session to co-treat and that way you have an idea of what I am doing and to be part of the session. I always welcome a different perspective and sometimes you need another perspective especially when you are stuck or worried about a particular issue.”

Next Steps• Develop questions for parents based on the responses from

the professionals and issues brought forth in the literature (re: access, parent coaching, comfort level)

• Coding and analysis

• Write-up

My Thoughts….• Tele-intervention is interesting although not widely used in

Virginia.

• TI is not a topic I can be “married to” for a dissertation.

• However, I was particularly interested in one comment from one of the interviews……

My thoughts….

• “I think it would fit in very nicely if you have families that can do coaching but the problem becomes the families for example in Richmond City who don’t even stay in the same room with you when you do therapy….that’s a problem……They just want you to come in and work with their kid and leave. Like you are the professional, you do the job, that is what you are supposed to do……. Part of it is that I don't think they care whether their kid gets therapy or not. Part of it is because I think they were told by a doctor that they needed to do it. It’s sad but that is what I get”

References• AG Bell Academy for Listening and Spoken Language. (2007). Principles of LSLS auditory- verbal

therapy. Retrieved from: http://www.listeningandspokenlanguage.org.• AG Bell Academy for Listening and Spoken Language. (n.d.). What LSLS do. Retrieved from:

http://listeningandspokenlanguage.org/AcademyDocument.aspx?id=433. • American Speech-Language Hearing Assocaition. (n.d.). Early Hearing Detection and Interventon

(EHDI). Retrieved from: http://www.asha.org/advocacy/federal/ehdi/.• American Speech-Language Hearing Association. (2010). Professional issues in telepractice for

speech-language pathologists. [Professional Issues Statement].Retrieved from www.asha.org/policy.

• Barker, D., Cruz, I., Eisenberg, L., Niparko, J., Tobey, E., & Quittner, A. (2013). Effects of maternal sensitivity and cognitive and linguistic stimulation on cochlear implant users’ language development over four years. The Journal of Pediatrics, 162, 343-348.

• Behl, D., Blaiser, K., Callow-Heusser, C. & White, K. (2013). Measureing costs and outcomes of tele-intervention when serving families who are deaf/hard-of-hearing. International Journal of Rehabilitation ,5 (2), 3-10.

• Centers for Disease Control (2012). Summary of 2009 national CDC EHDI data. Retrieved from: http://www.cdc.gov/ncbddd/hearingloss/2009-data/2009_ehdi_hsfs_summary_508_ok.pdf

• Dornan, D., Hickson, L., Murdoch, B., Houston, K., & Constantinescu, G. (2010). Is auditory-verbal therapy effective for children with hearing loss. The Volta Review. 110 (3), 361-387.

• Estabrooks, W. (2012). 101 Frequently Asked Questions About Auditory-Verbal Practice. Washington, D.C.: Alexander Graham Bell Association for the Deaf and Hard of Hearing.

References• Harmen, K., & Quigley, S. (2012). Implementing coaching in a natural environment through

distance technologies. Volta Review 11(3), 403-407.• Hanft , B., Shelden, M., & Rush, D. (2003). Coaching families and colleagues: a process for

collaboration in natural settings. Infants and Young Children, 16(1), 33-47.• Houston, K. & Stredler-Brown, A. (2012). A model of early intervention for children with hearing

loss provided through telepractice. Volta Review 112 (3). 283-296.• Houston, K. & Perigoe, C. (2010). Speech-Language Pathologists: Vital Listening and Spoken

Language Professionals. The Volta Review, 110(2), 219-230.• Individuals with Disabilities Education Improvement Act, Pub. L. No. 108-446, § 104, Stat. 1142

(2004).• Lillard, A. & Erisir, A. (2011). Old dogs learning new tricks: Neuroplasticity beyond the juvenile

period. Developmental Review, 31 (4), 207-239.• Virginia Department of Health. (2003). Virginia early hearing detection and intervention Program

2003 annual report. Retrieved from: http://www.vdh.virginia.gov/ofhs/childandfamily/childhealth/hearing/documents/2012/publications/pdf/2003.pdf

• White, K. R. (2007). Early intervention for children with permanent hearing loss: finishing the EDHI revolution. The Volta Review, 106, 237-258.

• Yoshinaga-Itano, C. (2003). From screening to early identification and intervention: discovering predictors to successful outcomes for children with significant hearing loss. Journal

of Deaf Studies and Deaf Education, 8(1), 11-30.