Transcript Slide 1

Intervention for Caregivers & Young
Children Who Have Multiple Disabilities
and Cochlear Implants: Training
Kathleen Stremel Thomas
The Teaching Research Institute
Western Oregon University
[email protected]
Model Components
• Parents/Caregivers are the primary change agents in their
child’s communicative competence
• There is a need to integrate communication, auditory
perception, language, speech and pragmatic elements into
a social context
• Intervention takes place in natural routines and activities
• Interventions for the child and parent are a systematic
process (small steps, discrimination/generalization)
• Intervention is individualized but follows normal
development for young children with adaptations
• Diagnostic strategies and data collection are used to
monitor progress
• Adult learning methods are used
Critical Components to Remember!
• Need to provide child’s brain with auditory information
• Need to create optimal set of interactive conditions for
facilitating the child’s communication & language
• Need for appropriate assessments to identify skills…not
a deficit model!
• Need for a quite environment (initially)
• Need for the parent to be close to the child
• Need to attempt to elicit a “response” from the child
• Need routine, normal, everyday caregiving and play
interactions to provide the context and content of
intervention.
Establishing a Listening Environment
• Minimize background noise
• Position oneself close to the child’s microphone
• Position oneself to best interact with the child in the
routine
• Speak at a regular volume
• Use speech that is repetitive
• Use speech that is rich in melody, intonation and rhythm
• Use acoustic “highlighting” techniques
Routines and Activities
• Pre-academic routines
• Play routines
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2.
3.
4.
Play with objects/constructive
Pretend Play
Physical play
Social games
• Caregiver routines
• 1. Comfort related
• 2. Dressing related
• 3. Hygiene related
• 4. Food related
Woods & Kashinath, 2007
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1.
2.
3.
4.
5.
Reading books-shared reading
Songs and rhymes
Computer, TV, video
Art play
Early numeracy
• Community/Family
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1.
2.
3.
4.
Community errands
Family chores
Socialization activities
Recreation
Adult Learning Methods (Trivette,
Dunst, Hamby & O’Herin, 2009)
• Introduce (Preview strategies, use visuals)
• Demonstrate/Illustrate the strategy for the parent
• Practice (Engage the parent in the use of the materials,
strategies with guided practice/coaching)
• Evaluate (Engage the parent in reviewing the outcome of
the application of the strategy with use of video files)
• Reflection (Self-Assessment)
• Mastery
Teaching in Social Interactions
• Critical behaviors are learned in familiar Routines and
Activities
• Build in beginnings, middles, and ends to each
routine/activity.
• Embbed multiple opportunities to learn in each routine.
• Focus on teaching Joint Activity and Joint Attention
• Don’t hurry through functional routines & activities.
• Provide maximum consequences for positive behavior.
• Build more action steps into routine gradually
• Wait for responses!
KidsDBCI
Routine/Activities Worksheet
Developing Routines: Intervention #1: Partial Participation/Responsiveness/Narrative Description
Name:
E.
Routine: Lunch Routine
Date: July 7, 2010
Major Purpose: Increase words that E. hears;
reinforce his verbalizations, responding to words.
Major Intervention Strategies: Joint activity, joint Attention, opportunities to hear
contexts/responsiveness; pairing verbal and sign, reinforcement, waiting time, Auditory-lead..
words
in
Vocabulary Used in Routine: Signs being used in conjunction with speech: kitchen, eat, bathroom, wash
hands ,get, towel, dry hands, step up, step down, turn on, water, soap, wash, turn off, lunch, plate, spoon,
peanut butter, chips, fruit, eggs, banana, yogurt, more, all done, my/your, cut, milk ,water, cup, clean, dirty,
wipe-em, open, close, put in, throw away, table, napkin, put away, down, wash dishes, help, yogurt, cheese,
veggie, clean, dirty( food items will change across meals and the names will be used), my, your, Mommy, no,
want.
New signs: want, apple, raisin, pop, work, help, bread, good, thank you, no, want, drink.
Context: Parents eat with E. If he throws food, discuss program with parents.
What is Important to the Parents?
What
you do!
E, let’s go eat!
Repeat “eat”
while signing.
First, “wash
hands”
Say, let’s go
wash hands
and sign wash
Describe what
you are
doing…turn
water on, get
soap, wash
hands, water
off, dry
hands…say
first, wait and
then say and
sign.
R E M D Co Supp
L g ort &
Co
AT
mm
uni
( might
X
add spoon
as object
cue)
X
Targeted
Outcomes for the
Child
Consequences
&
Expansions/Rec
asts
E. Gets up and takes Mom’s hand
Yes, we’re going to eat lunch!
PParticipation; assists washing
hands
Reinforce behavior
Sign
support
X
X
X
Sign
support
X
X
Use “Say it Participates and access to spoken
first; then language
Say it –
Sign it”
total
communica
tion
strategy
Reinforce behavior
Parent/Caregiver Skills- Level I
• Opportunities for Partial Participation
(examples for different children C and E)
• Responsiveness:
- Infant-directed talk (specific to development)
- Follow lead of the child
- Use simple phrases
- Imitate the child’s vocalizations/motor movements
- Talk about what the child is interested in
- Later, acknowledgements, expansions, topic extensions
• Narrative Description
- Describe both your motor actions & the child’s
- Use verbal comments
- Name objects & actions in context of activity
- Verbalizing the child’s nonverbal communication
Auditory Lead-Wait-Support-Auditory
Follow-up
• 1. Lead with speech! Say it 1-2 Times!
• 2. WAIT (1 second for narrative description)
• 3. Support with Visual/Tactile prompt while repeating
the word (1 time)
• 4. Say it again – end with speech only
• Example: (a) Say, “We have milk!”; Sign and say,
“milk”, with emphasis on last word,
repeat, “milk.”
Parent responds contingently to any response the child
makes
Parent/Caregiver Skills-Level II
• Opportunities & Teaching to Listen: Environmental
Sounds
• Opportunities to teach discrimination, identification and
comprehension
- Directives
- Joint Activity/games/rituals
- Turn-taking
- Identification of objects (dissimilar to more similar)
Parent/Caregiver Skills: Level III
• Opportunities for Child’s Communication
- Protest
- Turn-taking
- Recurrence
- Response to Questions
- Change directives to opportunities
- Shaping gestures
- Up the ante
- Playing naïve
- Focus on the most informative of the context
(interesting, novel, dynamic)
Strategies
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Provide a small portion
Provide opportunities for “recurrence”
Offer a non-preferred item
Provide opportunities for rejection
Provide choices (preferred-in context/non-preferred-out of context)
Change directives to a question, “What do you
need?”
• Take a turn/Use a sibling to encourage “offering”
• Nothing is Free! Play dumb! Break the chain!
• Use less to more support strategies
Auditory Lead-Wait-Support-Auditory
Follow-up
• 1. Lead with speech – “What do you want? Say it 1
Time! Later, Delay any verbalization
• 2. WAIT (4-5 seconds for motor or communication
response)
• 3. Support with Visual/Tactile prompt while saying the
word (1 time) – “Cookie!”
• 4. When child uses any communication act, Repeat the
verbal word again –
• 5. If parents are using total communication, the signed
word is used for support if the child knows it; if not, use
the verbal word and sign at the end of the
interaction..”You have Cookie!”
Zone of Proximal Development
Use of Scaffolding (Vygotsky, 1978)
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Use less intense prompts whenever possible
Know exactly the response you expect from the child
Set the child up to succeed, not to fail
Reinforce successive approximations
Use partial participation strategies
Up the “ante” gradually
Pair the learned behavior with the new behavior
Gradually withdraw your support
References
• Barnes, J. M., Franz, D., & Bruce, W. (1994). Pediatric
cochlear implants: An overview of alternatives in education
and rehabilitation. Washington, D.C.: Alexander Graham
Bell.
• Cole, E. B. & Flexer, C. (2007). Children with hearing loss:
Developing listening and talking. San Diego, CA: Plural
Publishing.
• Estabrooks, W. (2001). 50 frequently asked questions about
auditory-verbal therapy. Toronto, Canada: Learning to
Listen Foundation.
• Ertmer, D. J. (2005). The source for children with cochlear
implants. LinguiSystems.
• Wilkes, E.M. (2001). Cottage Acquisition Scales for
Listening, Language & Speech. San Antonio, TX: Sunshine
Cottage