Nicole Brown: Hi, everyone, I'm Nicole Brown, and I'm from the Minnesota Department of Health, and I help to coordinate our Early Hearing Detection and Intervention program. And I'm also the interim manager for our children and youth with special health needs section at the Department of Health.
So, I'm thrilled to introduce Kristina Blaiser to give the next talk. She is an associate professor at Idaho State University, and also coordinates ASHA's SIG 9, which is the special interest group for children who are deaf and hard of hearing.
She has been a speaker that has been invited to present both nationally and internationally and has over 30 publications.
Kristi has worked with children who are deaf and hard of hearing and their families for over 20 years, and I can tell you personally that those families that have had the opportunity to work with her have a very special place for her.
You may recognize Kristi because she served many of those 20 years here in Minnesota, with families and their children who are deaf and hard of hearing. In fact, in 2007, Kristi was at the legislature helping to advocate for our very important early hearing detection intervention system bills, including newborn hearing screening, the Deaf Mentor Program, parent guides, and our hearing aid loaner bank. So, please help me welcome Kristi Blaiser. [Applause]
[A PowerPoint slide appears that says, “Assessment Results as a Tool for Effective Family-Based Communication Development, Kristina Blaiser, PhD, CCC-SLP, Associate Professor, Idaho State University”.]
Kristina Blaiser: Thank you so much for coming to this presentation. I can tell you that it's an honor to be here in Minnesota with all of you. This is where I did a lot of my work. I did my master’s and my PhD here, and then I did a lot of the work here.
It's also very humbling to be in front of you with people that I've seen your kids, I've worked alongside of you and you've taught me. So, I'm really happy to be here and I hope you can get something out of this presentation.
So, we're going to talk today about an assessment, -you can see the title is “Assessment Results As a Tool for Effective Family-Based Communication Development”, and so what does that mean?
We do assessments, right? We all do assessments with kids, and we're going talk about, how do we make these easy to interpret for families and for each other?
[PowerPoint slide appears “What we’ll be thinking through today, 1) Assessment of the whole child, 2) How can assessments/results support family-based activities, and 3) How can data visualization support families’ (and other professionals) understanding of assessment results”.]
I love that every presentation I've been to so far today talks about the whole child, and I think that's one of the things that I hope you get from this is that alone we can't really assess the whole child.
We all come with different professional backgrounds. Parents come with their own perspective. And, so, alone we really can't do that. We have to be able to work together.
And we're going to talk a little bit about how assessments can actually support family-based education and family-based activities.
We're also going to talk about something called data visualization and we're going to talk about, how does this help support these processes and these activities when we're working with families?
[PowerPoint slide with text, “So why do we do assessments?”.]
So why do we do assessments? We do assessments for a lot of different reasons. We do them for eligibility. We do them to progress monitor. We do them for baselines. We do them for a lot of different reasons.
And, so, when we go into this assessment, sometimes what dictates how we're doing that, is the protocol that's been laid out before us, right?
The school district or the part C program or depending on where you work it may be very scripted in what types of assessments we do. But it's also important to think about what are families looking for from assessments?
They're looking for really different types of information than we are. They're wanting to know, will their child be able to go to school? Who will they go to school with? What will it look like for their child?
And, so, as we think about this, we have to think about how are we pulling this all together?
[A PowerPoint slide with the text, “Balancing Act” and has different terms on a balancing board.]
And a lot of us, as early interventionists or educators, we have this balancing act, right? We have this information that we want to, especially in early intervention, we want to go in and we want to be encouraging.
We're going into their home. We want to have this positive relationship with them, and we want to be supportive of the family and the family's choices. And, yet, sometimes we get information back from assessments that's hard. That's really hard. And, so, how do we balance this? How do we take this information and balance this?
And, so, one of the things that I've seen is that through some of the results of the data that I've collected, is that families love their early intervention providers. They think they're fantastic. And they're also shocked when they enter into a school system and they find out that their child is not where they expected them to be.
And, so, here we've had this amazing supportive relationship, but the hard information hasn't necessarily been shared because it's hard to talk about when a child's not meeting developmental milestones.
[A PowerPoint slide appears that has text that says, “Support vs. missed opportunities, How do we support families but make sure that we are encouraging growth”.]
So how do we consider support versus missed opportunities? And how do we support families when we want to be following their leads, and we want to make sure that they understand that no matter what they choose, that it's the right choice for them and their family. So how do we do this, and still make sure we're encouraging growth?
[A PowerPoint slide appears, that has text that says, “Who participates in our assessments?, What do they offer to the bigger picture of child performance?”.
Good question, right?
So, one of the things we have to think about is who's participating in the assessments. And what results do they get.
[A PowerPoint slide appears that has text that says, “Who are collaborative team members for children who are D/HH in early intervention?” and several hexagons with different pictures and terms for groups who may have an interest in deaf and hard of hearing children.]
As we think about these different collaborative team members, particularly in early intervention, we think that there's all these different people who provide some piece of the pie, right?
The really interesting thing of early intervention is that we all come as providers and parents and families, and we come with very different backgrounds.
As speech-language pathologist now, which is my background, we don't have audiology-based course work anymore. Audiologists don't often have speech-language pathology course work.
Teachers of the deaf and hard of hearing may not have each one of those. Early interventionists may not have anything specialized with children with hearing loss at all.
In Idaho, we have what we call developmental specialists. And this means that they may be very good at child development, but the idea of a child having a hearing loss is very foreign to them.
[A PowerPoint slide appears that has text that says, “Overcoming a Singular Point of View” with a photo of a pool with a lone, multicolored beach ball.]
So, what I want to think about is that when you work with someone who is a child and you come in with your lens, it's almost like the child is the beach ball. And as a speech-language pathologist, I may be sitting on that red part of the beach ball saying, this ball is red. That's all I see.
But the audiologist may say, this ball is blue. And it's really hard to get an idea of how we are communicating because a lot of times the reports that we're sending, -I don't know how recently you've received an educational report or you've received a medical report, but they're black and white. And as much as we try to make this information family-friendly, a lot of times it's a lot of words that people do not understand.
Even just receptive and expressive language can be very unfamiliar to a family or to an audiologist, hopefully not, but to maybe a developmental specialist.
And, so, how do we go across this when that professional has no idea what type of assessments we're doing or why those assessments are important?
So, how do we overcome this singular point of view?
[A PowerPoint slide appears that has text that says, “The relationship between professionals is particularly important when we are talking about children who are DHH”.]
And this relationship is particularly important when we're talking about children who are deaf or hard of hearing.
As I look around this room and I see all of the people that are involved in supporting, even if you just look at the presentation team. It's very important that we make sure that we all understand the same language.
For kids with hearing loss, it's particularly important for two reasons, and this goes beyond communication modality.
[A PowerPoint slide appears that has text that says, “Access-Quality and Quantity” and bubbles that connect access to quantity and quality.]
t's very important that children have access, and they have both quantity and quality of access. This is true in listening and spoken language when a child or a family has chosen a spoken communication modality.
This might mean that they have full-time use of their hearing technology. And it might mean that their child's hearing technology is not on and not working, but that it's fit appropriately for that child's hearing loss.
In a signed communication, it's the same thing. Look at the people standing up here with me who are ensuring that we have access.
And, again, it's about quality, right? It's about making sure people are certified and getting the right information, and it's about quantity. If someone was only signing every other word, you would not get the full message.
So, when we talk about access, it's not necessarily about a spoken communication modality or it's not about a signed communication modality. It's about ensuring that that child has access to language around them.
When we think about input, the language that comes into a child, again, we have to think about quantity and quality.
When we think about quantity, are we talking just as much? Are they getting access to everything around them?
In listening and spoken language, this could be through an F.M. system. This could be making sure that they know who's talking and that people are talking a lot, providing narratives.
And in terms of quality, are we making sure that they're using specific vocabulary? Are they using the words that we expect them to be able to know?
In a signed language approach, we have these same pieces. They need to be able to get access to everything around them and it has to be of this high quality.
So, when we think about a child with hearing loss, access and input, the quantity and quality of both these things are so important for us.
But if we are working on this beach ball, and we don't necessarily know how to communicate about this, we've missed this great opportunity for us to serve the child.
[A PowerPoint slide appears titled, “Challenges with assessments”, with several bullets under it.]
So, the challenge with the assessments is that we don't all speak the same language. We don't always understand everything that comes in a speech-language pathology report. We don't always understand everything that comes from an audiology report. We don't understand everything that comes from a teacher from the deaf/hard of hearing report.
We just don't understand that because it's not our background, and that's okay. And I think that's one of the things of this vulnerability, of being able to recognize, that I didn't have that class in graduate school.
I don't know why it's so important that the child wears their hearing technology all waking hours.
I don't know what it means that the child is developing one part of spoken language and one part of sign language, and how to set my goals from that.
So, this is all so important for us to be able to have something to have a shared framework. And if you think about that, if we don't understand that, what are the odds that the parents or the families that we're working with understand it?
Many times, we're working with young families who, maybe it's their first child, maybe it's their second child. Sometimes they've never met anyone with hearing loss before.
Sometimes they're not sleeping. Sometimes the child's not eating.
They're meeting this new being for the first time and they're getting black-and-white reports, and they don't understand it.
And, so, how do we make sure that all of us speak the same language?
The other piece is that these assessments that we're using often, are not normed on children who are deaf or hard of hearing.
And, so, while that is a really important thing for us to be able to talk about, it's actually really important for us to be able to interpret. Because a child gets a certain score on a certain test shouldn't necessarily preclude them for eligibility.
Because a lot of times the assessments are not normed on kids with hearing loss, and they're not specific to the errors that those kids might make.
So, it's really important for us to be able to have a tool to talk about these assessments, not just what the scores are but what they mean.
So, in Idaho, we developed a project called the Idaho Collaborative Assessment Project.
[A PowerPoint slide appears that is titled, “Goal of Project”. Under the title is several bullets.]
And the goal of this project is to have a common language for providers and parents to look at a child's development.
Another part that we want to do is we want to, in addition to looking at that individual child's strengths and opportunities, we wanted to be able to look at the strengths and opportunities throughout the system.
Because sometimes when we were looking at a certain score on a certain test, we would find out that everyone was having difficulty with that, and that gives us opportunity for professional development.
The last part is that when we notice these challenges or opportunities within our state, we can start looking at different ways to support families using providers, in terms of using technology.
I went to a great presentation right before this where they were talking about all these different ways to share information through technology, but sometimes just knowing what information do we share?
[A PowerPoint slide appears that says, “Starting Point: What outcomes do you care about? For a family/child? For a provider? For a region? For a system?”.]
So, I do want to take a moment and for you all to come together at your tables and just talk a little bit about what are the outcomes that you care about for the children that you see?
What are the outcomes? It could be the kids in your school. It could be the kids on your caseload, but what are the things that you're wanting to know?
So just talk a little bit about what are some of the things that you would actually want to measure in terms of the kids that you're seeing?
And we'll have interpreters around if you need them.
[A brief cut in video.]
Kristina: What are some of the outcomes that you're thinking of when you're working with a child or a family?
Audience member 1: We talked about social/emotional development and if they're learning an academic subject, such as math and also if they're mainstreamed or not. Those are some of the factors we talked about, like what kind of accommodations would they be needing and how do we fill in any missing gaps.
And also communicating with parents, what they're doing at home as well and being sure that we have all of that information.
Kristina: Great.
What else do we have? What other types of outcomes?
That's great. That's perfect. What else are we thinking about?
Anyone?
Yeah.
Audience Member 2: I want the child, the parents, and the family to have good communication.
Kristina: So, the family to have good communication, yeah.
Anyone else have thoughts?
Audience member 3: Everything!
Kristina: Yeah. Yeah. They want everything. Okay. Yes! We want everything.
And, so, one of the things, -yes, we all want everything, right? So that may be a longer presentation. [Laughter]
[A PowerPoint slide appears that says, “Idaho Collaborative Assessment Project (ICAP)”.]
[Another slide appears that says, “Stakeholders”, and under the title is a list of different organizations.]
But one of the things that we did is that when we charted the Idaho Collaborative Assessment Project, we brought together these stakeholders from across the community who decided what outcomes we cared about for our families.
Because we wanted to do the same assessment, which, you know, I've lived in Minnesota, I know everybody doesn't like to do the same assessments. But we decided that we wanted everyone to have the same assessment across the state, so we could look and see what our strengths and weaknesses were across the state.
In Idaho, -I know every state has a rural contingency, and I know Minnesota's not all, -we drove here, so it's got some rural. But Idaho wins because it's got what they call a frontier population, so that means that rural looks really urban.
But what we did in Idaho, what we're finding is that we have whole regions without a pediatric audiologist. We have whole regions without access to a provider. It takes four hours to get there.
So, we were concerned about when families lived in these regions, what kind of access to services they were getting, and how did that impact their outcomes?
So, we pulled together. We did get a grant for $300,000 to look at this assessment project and, so, we pulled together these community stakeholders to look at how kids were doing.
And, so, when we looked at the outcomes, we brought together the Idaho educational services for the deaf and blind. We brought together the infant, toddler program, and Hands & Voices, and then we also brought together the Elks or St. Luke's Hearing and Balance Center.
So, all of us together, we talked about what we were looking for in terms of outcomes, so that we could look at how do we improve those outcomes.
And, so, this was for early intervention. The earliest that we assess kids is 9 months, and then we go up to 5 years of age because a lot of the kids are still receiving some types of early intervention or even preschool services.
So, we wanted to see what we were looking at.
[A PowerPoint slide appears titled, “Identifying outcomes for Early Intervention”. Under the title, there is a table with a column titled, “Outcome” with 5 rows with different outcomes. There is another column that is titled, “Measure” and has five rows with no text.]
So, these are the outcomes that we decided for early intervention.
One of the things we wanted to look at was child language, in terms of the content of the language of what they were talking about.
Another thing we wanted to see is that we wanted to see language use and, so, social/emotional skills are tied somewhat in terms of language use, but we were looking at more complex language as they go beyond just vocabulary development.
We did want to look at child hearing skill development. Particularly, because we did have certain regions where there were very limited access to resources, and, so, we wanted to see how were auditory skills and listening skills going in those regions.
And I would have to say, in Idaho, we do have a strong, -I think it's about 75 to 80% of families are using some sort of total communication approach. So even while they are using some sign language approach, they are using sign language, the kids are also using hearing technology as well, especially in that birth to 3 area.
And then we also wanted to really look at family support to see if there were differences in terms of family support in these different regions and what we could do to support families, and make sure they had access to the resources.
So, one of the things that you're thinking about or talking about at your tables, you have these ideas of what these outcomes might be that you want to be able to look at. Well, then you have to come up with how would we actually measure that, right?
So, you're saying, social/emotional development or communication with the families, how do you measure communication development with families? How do you make sure, if that's one of your goals or your outcomes, and, so, we went through this process of how do we know if we're doing it?
And, so, that's why it does take a lot of discussion, and it is worthwhile talking about with your group of people that serve the children that you see. What do we care about?
Because while we do want everything, it's hard to do that at once.
But this was the battery of assessments that we thought we could do and get the best picture at this moment for birth to 5.
So, then we came up with these metrics.
[A PowerPoint slide appears titled, “Identifying measures to address outcomes”. It has the same table from the previous slide with the columns for “outcome” and “measure”, except now the column for measures has text.]
And, so, as we look at content, we're using the MacArthur-Bates Communication Development Inventory, or the CDI.
For language use, we're using the Language Use Inventory. Have you heard of that, Language Use Inventory?
For hearing skill development, we're looking at the Little EARS, and we also get audiology reports from every single one of the audiologists on the kids that participate. And then we look at the Family Outcome Survey.
[A PowerPoint slide appears that says, “How are we collecting outcomes?”. Under that question is a list.]
So, what we did is that we got permission from the publishers to be able to create an online or survey-based version of all the assessments. I'm sure all of you are somewhat familiar with the CDI and how long it can take.
It's where you fill in bubbles of what words the child is saying or signing. And, so, we got permission from the publisher to put it into an online survey. And, so, the families can actually just click which ones they're doing.
And we do have it where they say spoken, signed, spoken and signed, and then how they understand that. So, we did change it a little bit from, -we did want to make sure we were encompassing both signed and spoken communication.
Then with collaboration with the Idaho Educational Services for the Deaf and Blind, all of the providers have iPads and all of the surveys are downloaded on the iPads. The provider goes in, -we also have the link document with all of the links on there.
So, we can just send it to the families via email or the providers can give them the iPad to complete the surveys. So, they can either do this together or independently.
[A PowerPoint slide appears that says, “Going beyond the black and white…”.]
And, so, the goal of this was to create something that went beyond the black and white, right?
So, you can all get a report that says that the child has 250 words or 12 words, right?
But what does that mean? What does that mean to that family? What does that mean to that provider about, “Wait, what was that milestone about when they get 12 words. When do they get 250 words?”.
And if we have a hard time remembering that, there's a good chance that the families never have heard that before.
[A PowerPoint slide appears with a photo of a page from the Idaho Collaborative Assessment Project. Next to the photo is text that says, “ICAP report. Describe outcomes to families and provide developmental norms”.]
So, what we did is we created this ICAP report, and so on the front page we have the milestones that we would expect. So, you can see in the middle of the page there's vocabulary language and hearing aid use, as well as family support.
And, so, what this does is it gives you some sort of idea of what we would expect, developmentally, at different time points.
So, again, it helps to provide providers and families with a shared framework of, what do we expect for a 2-year-old to be able to do?
And that is one of the things when I showed you that balance, that see-saw at the beginning, that sometimes parents are thinking their child's doing great by having 150 words when they're going into transition into part B services. But, actually, that's not enough words to be able to communicate with their peers. And this goes beyond communication modality, right?
I don't care if it's signs or words. We need to have more.
So, as we look at this, this gives us both the providers and the parents more comfortable way to enter into this conversation because the parents have an idea of what the expectations are early on.
[Another PowerPoint titled, “ICAP report” appears. On the slide, there is also a photo of a page. There is text next to the photos that describes the page.]
Then on the second page, what we did at the beginning is that, we broke down each one of these different sections so that we could give the parents information about how their child was doing in the different communication modalities in the different domains.
So, on the top you can see that this is a child who is using both spoken and signed communication. It gives some information about what percentage of different types of words are used in spoken communication, as well as in signed communication.
So, what we can look at with this family is this is not an opportunity for judgment. This is an opportunity for communication. And this is an opportunity to have a shared framework with the family and with other providers about this is what's happening here.
Is this on track with what your expectations are for when the child turns 3? Great.
Is it not on track? And, so, if it's not, what do we do? What are we going to do differently to help this child to be able to enter school with age-appropriate skills?
The next box down, the middle box, is looking at language use. What this does is breaks down language use into gestures, words, and sentences.
And, so, again, this is not communication modality specific. We do have someone, -if someone's using sign, their ability to combine words and use more complex language is very similar than if someone's using spoken communication, right?
We still want kids, in both modalities, to be able to express themselves completely. And, so, we give some information here. And this makes it very clear for providers and parents to have an idea without much discussion about where some opportunities for growth are, right?
So, when you see this, you can say, “I think we might need to work on more complex language”, right?
Then we also have hearing skills and then we have family support. This was our very first attempt at these reports and, so, we were trying to figure out how do we put information in for the hearing skills to make it really easy for families and, so, you can see, we've come away from just using this little box.
But the other part on here is looking at family support. And it's been so amazing for us to get these reports back from families. And when you see what they look like visually, it's pretty amazing, because every provider that goes into a home wants to be supportive to that family, right?
That's not a question. No one's doing it to get rich. But sometimes it's hard to know what to do because families are having that same see-saw of this positive relationship, but how do they say that they don't know about where to go when they need more information?
What if they don't know about the options that are available when they are finished with birth to 3? And sometimes it's just as hard for that family to break that bad news of I need more help, as it is for us as providers to break that bad news of, like, we need to work on changing something because your child's not developmentally ready.
Kristina to person-off-screen: Yeah
Audience member: Could you explain what that family support says?
Kristina Blaiser: Oh, right. So right here for family support, it's broken down into, -I might have to squint for a second.
So, for this family that we have as a sample, it's knowing your rights, I think it's accessing your community, helping my child grow and learn, and having a support system. So those are just sort of the main chunks. And, again, this was our first stab at this before we got the grant. So, I'll show you what it looks like now too.
So, this was graduate students. We would get the reports. They would put the information in. They worked on developing these reports. And then we even had some ideas of these are some things you can do at home.
And, so, it worked really well for the first year, but then we needed more information. We needed more specific information.
[A PowerPoint slide appears, with text that says, “Example of a report for an individual child”. Next to the text is a photo of a page titled, “LUI, Language Use Inventory”. The rest of the page is blurry.]
Just wanted to give you an example of what the Language Use Inventory looks like.
So, what you can see, not very well here, but it gives you gestures at the top, and then part 2 is looking at how well the child's using words, and then the last part is how they use complex language.
And then what it does is breaks down into how well that child's doing in very specific areas.
And I think this is a nice model because when you see this, which you probably cannot see this very well on here, but it is on the PowerPoints, and on your handout. It gives you so much more information to talk about strengths and opportunities.
So, this is just what the Language Use Inventory looks like.
[A slide that says, “Consider this child…”.]
So, what we did, we created, -because we had everything in Qualtrics, we created data visualizations, using Tableau, which is a data visualization software, so that we could create better pictures.
[A PowerPoint slide appears, titled, “Auditory Skills”. Under the titled is a table.]
So, the next four slides are going to be all the same child.
So, as you're looking at it, you can be problem solvers of thinking about what's going well for this child, what's not going well for this child, and maybe you can think about, where would you go from here?
Now, again, the idea is thinking about, this is not about my specific background. It's about that this is a child that you may be seeing.
Okay, so this first one is looking at auditory skill development, and what you can see is on the top here that he's a male. He uses hearing aids. He's 36 months of age.
When we look at the questions that he was asked about, auditory skill development, we see that 29 of those skills were at a no, that he was not able to demonstrate those skills, and then six of those were a yes.
Then what we have below here is, -we can highlight what are blue are the questions that the child, -the parents responded that they were not able to do, and the yeses were the ones that the child was able to do.
So, as we look at this child, we can say that the child is using hearing aids. Hearing aids have been purchased for this child, and the child has them in the house. But we're not seeing a lot of clear auditory skills development at this point.
[A PowerPoint slide appears, titled, “Vocabulary” with a photo of a table.]
So, then we look at how the child is performing in vocabulary. And what you can see here is that the child understands, -so, again, this is 36 months, a child who's 36 months of age, and that the child understands 110 words, understands and signs 126 words, and then they have an "other" category, which might be gestures, for about 117 words.
So that gives us some more information. So, when you're thinking about this child who's maybe not using their hearing aids a ton right, or not getting a ton of benefit from their hearing aids, and it does seem like they're using some signed communication.
So, as you're putting this picture together of this child, -you don't have to answer this out loud, what would you be thinking about your goals for the child?
The other thing to be thinking about is, how many words or signs are they actually able to understand and use?
And, so, we're looking at about 124 here, okay?
So, does that help you at all, to have this idea that you may not know this child, but you're starting to get an idea of a profile a little bit.
The other thing that I think is really interesting about this, is that when you see down below, -and, again, sorry if it's small font for you to be able to read but you have access to this, -it breaks down all of the vocabulary that the child has strengths and weaknesses in.
So, you can look and see that this child has 32 animal names, and then the next one that follows is food and drink.
So, action words, they have about 40 action words. But you start putting this into the idea of, what would you expect right now, right?
And, so, it helps the early interventionist to be able to think about, what would I focus on here, right? Maybe I would start doing some two-word combinations.
What are the parents' signing skills? Is the child's focus working on, -like is the family's focus working on signing skills? Is that what they want to do?
Well, if it is, then we need to bump it up a little bit because they don't have the vocabulary at 36 to be able to very successful in a fully signed classroom.
They have hearing aids, but they don't seem to be using them or they don't seem to be developing auditory skills. What do the parents think about that?
Are they using them? Do they work? Do they have access to a pediatric audiologist who's making sure they're fit appropriately?
So, the nice thing is that, -I mean, the bad thing, I don't think this gives you a lot of answers, right?
It's not giving you answers, but the best part about this is that I'm getting great questions from the providers now who say, “this is the profile of the kid that I'm seeing, what do we do next?” And I've never seen that before.
I've seen that I would send the reports back, and they would be black and white, or I would send this little tiny grid and they would just put them in to the progress report. But we never got these questions back that said, “what does this mean? What do we need to do and how do we check back in with the parents about how the child's performing?”
Okay.
[A PowerPoint slide appear that says, “Language complexity” and has a table.]
So still the same child. This is how we're looking at language complexity. So, what you'll see here is the blue, -this is a little bit hard to orient yourself to.
But across the very bottom you'll see blues and you'll see yellows.
So blue items are the items that the child is getting correct. Yellow items are the items that the child is getting incorrect. And as we go from left to right, what we can see, it moves from less complex to gestures to words to sentences.
So, what you're seeing here again is that at 36 months, this child is strongest in gestures. They're okay in combining words. They're, I think, at the sixth percentile, but as we're using more complex language, they're at less than the first percentile.
So, what we have here is this opportunity to be able to say, again, what are our goals? What are the outcomes that we need to be able to work on, and how are we as the early intervention team or the transition team going to support this child in terms of communication development?
[A PowerPoint slide appears, titled, “Family Support”. Under the title is a table.]
Then the last part of this is looking at this Family Outcome Survey, and so, what we can do is take a snapshot of this and give this to the provider to talk to the parents about. And what you can see is that there's a lot of things that this parent is really happy with, but one of the questions that they have is that knowing their rights or advocating for their child.
That's this one where it says "somewhat" at the bottom. So, this is an opportunity for the provider to give very specific feedback to the family about, I noticed that this was something that you mentioned was something you would like more information on. How can we talk about this?
And, so, again, it's about taking this information and making it usable, right? And sometimes if we just get a report back, it's really hard to take that information and make it really salient.
Any thoughts about that?
Okay.
[A PowerPoint slide appears, that says, “Child #2”.]
[A PowerPoint slide replaces the previous slide, titled, “LittleEARS”. Under the title is a table.]
As we think about the second child, we do see a little bit different profile, about the same age, using hearing aids, but we see that auditory skills are a little bit more of a strength for this child. When we look down through the yeses and nos, we still see that there's some opportunities for the child to develop auditory skills a little bit more.
One of the things that we're seeing as we look across the state, is that sometimes things like turning to sound and recognizing sound or detecting sound seems to be sort of low-hanging fruit that a lot of providers are working on, but as we move into connecting sound to meaning or making sound into language, that becomes more challenging.
So, this is giving us opportunities to think about professional development opportunities as well.
[A PowerPoint slide appears, titled, “CDI”. Under the title is a table.]
For this child, one of the things that we're seeing, -so we can look at the child understands about 213 words, and we do have an "other" category here that we're still trying to figure out what this means, but the child's spoken communication is not great. The signed communication is not great, right?
They're understanding a lot, but there's not very much expressive communication here.
The other thing that we're seeing is that, -again, I always wonder when we see food and drink to the top if we're just requesting a lot, so, we're doing a lot of "more" or "please."
So, it gives us a lot of opportunities to think about, okay, we have some work to do, the child's having a certain amount of auditory skills success. We still have some opportunities here. We're seeing some vocabulary opportunities as well.
So, what are we going to do next? What's our next step in terms of how to support this child?
[A PowerPoint slide appears that says, “Language use Inventory” and has a table on it.]
As we look at language complexity, we're looking at even more challenges in terms of how well they're using even combining words, which makes sense if you think about that they have very limited expressive language.
And, again, what the thought is for this is that this gives a platform that parents can easily understand, if they've had some sort of orientation to this, of being able to say, okay, so this is what my child's profile looks like and this is how I set my goals.
[A PowerPoint slide appears, titled, “Family Support” and has a table on it.]
As we look at family support for this one, one of the things that this family was saying that they really needed some help on, is helping their child to be able to develop and learn.
So, what a great idea to be able to say, this is one of the things that you said that you needed some help with, here's some ways that we can work together, right? Here's some resources that we have.
Again, it's just about taking this information and making it easily translatable, both to the provider and to the parent, to have a common language.
And if you think about, if all of the providers on the team give the same report and you're all oriented to it enough, what an opportunity we have for discussion.
And this is really why we have early intervention teams, right? This is why we have these meetings that we have, is so that we can say, what's going on here?
And providers have this opportunity to say, yeah, what is going on? Why is this child developing with better auditory skills, but then they're not using any of the language? What's happening here?
Why do they have great auditory skills and great complex language, but the family needs the support? Like, how do we meet these individual children's needs?
And this is why I think, for me, data visualization, even though it sounds like some really, -well, maybe it is sort of a geeky concept, but it is super exciting for me because I feel like if everyone even understands that we're on the same beach ball together, what an opportunity!
What an opportunity for us to collaborate and have the shared framework when maybe I don't even remember what the Self is, or the PLS, or the EOWPVT, or the PBK, right? What if I don't know what the things are, or the Hawaii, or the HELP?
I don't know. That's not what my background is, but if we can talk about this, then we have an opportunity to help that family.
And the other thing that's so cool about this is that when we have this in this sort of visual way or this way that makes it more salient, we can talk to families with lower SES, lower educational backgrounds. We can talk to families with different language backgrounds, because we have something together that we can show.
[A PowerPoint slide appears that says, “What does this mean for the families I serve? What are their goals? How am I supporting them?”.]
So, when we think about this and what it means for the families that we serve, the other thing we can do now is we have this opportunity to look at, what are provider trends?
So, we can look at, again, how are the parents doing on our caseload, but as a provider, you can also pull your reports of all the kids on your caseload. So, you can look and see, woah, none of the kids on my caseload have very complex language or no one's working on verbs, right?
So, we have these opportunities to be able to say, I need to work on verbs. Or maybe we have one of the skills that we're thinking of that, none of the kids are using any sound to object associations. I don't really even know what that means. Maybe this gives me an opportunity to talk to someone who does, right?
Because it's okay to not know it all. I don't think anyone in this room really knows it all because we come to this with different backgrounds, and that's part of the beauty. But if we can't be vulnerable and say, I just don't know, then we haven't really stepped up our game.
[A PowerPoint slide appears, that says, “What does this mean for us as school district/region/state?”]
The other thing that we're looking at is, how does this impact our state? How does it impact my region? How does it impact my school district? And being able to think about that and then allocate resources to the needs of your program.
Having professional development opportunities based on outcomes is potentially the coolest thing ever, right?
Because then you have the ability to look and directly apply what you're learning.
[A PowerPoint slide appears, that says, “Looking at statewide trends”.]
One of the things that we did when we did this, and this was from last year, but I can tell you it's almost exactly the same this year, is that when we looked at the Language Use Inventory we started really looking at how well kids were doing at these different parts.
[A PowerPoint slide appears, titled, “Language Use Inventory: What’s happening?”. Under the title are three different bar graphs.]
And if you look, what we can see is for that top left box is, that that's how well kids are using gestures. So, you can see that as we go across, that 99% of the kids are using gestures pretty well. Then as we go down to the bottom, we can see that we see this bimodal distribution of how well kids are using words.
So, we see some kids that are not really putting those words together, and then we see other kids who are doing okay with using words.
The challenging part is that as we get to more complex language, that is we're really seeing that kids are really at that first percentile.
And this part is what's happening that we're finding shocks to parents as they enter into the part B system, and they're realizing that their child doesn't have the ability to communicate as well as they thought, because they just have words or gestures. And, so, again, this goes across communication modalities.
Christie Yoshinaga has done some work in looking at pragmatics in kids that are older, and what we're seeing is that, if we can find this out at 3 years old, 4 years old, right? We can start working on it early. We can start talking to parents about using theory of mind. I don't care if it's spoken or signed.
I hope, I wish, I'm worried about, I'm thinking about this. I think you're teasing me. Right?
And if we can start modeling this earlier, maybe we have the opportunity to change it for later.
But these visualizations for me have helped me get so clear about how well kids are doing.
[A PowerPoint slide appears that says, “Language Use Inventory: Heat map”. The slide also has table.]
So, this is that same information in a heat map. And, so, what you'll see here is that we have age from the left to the right, so all the different columns are ages. And then as we get more complex, we go from gestures on the top to complex language on the bottom.
The other thing that we have here is that red or reddish colors, the darker the better, that means that that many kids have mastered that skill.
As we go to blue, we have that many kids have not mastered that skill. So blue, dark blue would be zero. The darkest red would be 100. And, so, as we see this heat map, what we can see is that it's not getting better with age. It's not getting better.
The complex language is not getting better. And this is an opportunity for all of us.
So, one of the things that we have this great thing right now is technology. So, we are creating webinars and Facebook pages and PowToon posts, different things, I think I might do a Smore, so we can create these resources for families and send them out, and say, “hey, did you think about saying, I wish?"
I'll give you a 30-second idea about how to use "I wish" in the home.
But we have this opportunity now that we've identified what's not going right. We have an opportunity to make it better. But isn't data visualization cool?
Now we have this opportunity to talk about it and think about, wow, this is for all of us, all of us need this.
[A PowerPoint slide appears, that says, “How do we apply this with older children?”.]
Okay.
So, the last part that I just want to talk about a little bit is how do we think about this with older children? So, some of you are not seeing birth to 3.
But one of the things I want to just think about are the trend, again, that we're seeing. And this is going to be a spoken language trend that we're going to talk about now.
But I wanted to not just be about, she's talking about spoken language so this doesn't apply to me, but what other assessments are we using that we might need to go beyond what just the score is?
So that's what I want to talk about right now.
[A PowerPoint slide appears, that says, “What are our metrics/outcomes?”]
So, as we think about our metrics and outcomes, a lot of times as they get older, we just start using more and more standardized assessments. And, unfortunately, a lot of these standardized assessments are not normed on kids who are deaf or hard of hearing.
In fact, it used to be that it was taboo to use a standardized assessment on a child who was deaf or hard of hearing, but then the Joint Committee of Infant Hearing came along, and we started talking about this idea that we should have really high expectations for kids who are deaf or hard of hearing, but we just don't have the tools always.
[A PowerPoint slide appears, titled, “Access” and below the title, there are several bullet points.]
So, again, as we think about kids who are older, we still have to think about access. We have to think about how are they getting this information, right?
Are they getting it through visually? Are they getting it through hearing? Are they hearing their peers?
I remember when a child transitioned to kindergarten, and I was so worried about her hearing the teacher, and we talked about F.M. systems and all these different pieces. She entered the classroom and she did great.
We checked in her with a week later, we said, “how's it going?” She said, “I can't hear my friends. I don't know what my friends are saying.”
So, we missed the boat, right? That was an important piece. She missed what her friends were saying.
And then the other part is thinking about how are they accessing this information in different environments, right?
We don't always have this much support, so what happens when they go to the lunchroom? What happens when they go to different places? And how are they making sure that that access is still so important?
[PowerPoint slide appears, titled, “Input”. Under the title are bullet points.]
As we think about older kids, we have to think about input.
How are they getting this input? Are we using common core? How are they getting the vocabulary?
Are we making sure that it's just that we have those high expectations? Are we using those complex language to understand, and to use it so that they can talk about their hopes and dreams, and science projects.
[A PowerPoint slide appears, that says “Standardized Language Assessments-a new challenge”.]
So, these standardized assessments are this brand-new challenge for us, right?
It used to be that we couldn't, we just simply couldn't give anyone who had a hearing loss a standardized assessment. We just couldn't do it.
But now we can. In fact, we can give a whole bunch of them. And I did.
[A PowerPoint slide appears with a bar graph, titled, “Commonly given assessments arranged by average Standard Scores”.]
So, what we did is, we gave these assessments to a whole group of kids who are deaf or hard of hearing.
And one of the things I want you to just think about is that, as we looked at this whole line of assessments, -and talk about being on my beach ball, these are a whole bunch of acronyms that if you don't work in speech-language pathology look like alphabet soup.
But what we wanted to do is see if we gave a whole bunch of kids assessments, what were they the best at and what were they most challenged by?
And, so, what you can see is that on the far right here, we have four vocabulary tests. So those vocabulary tests tend to be the strongest for these kids who are preschool. These are preschool-age kids. So, what we saw was that the receptive vocabulary test was the highest test.
So, if we lined them all up, on average, they were all within normal limits on the vocabulary test.
But what's interesting is that we saw this real dip in terms of how they were doing in terms of expressive language. And this is going to be their composite score.
So, I drilled down deeper. So, this is the poorest one they did, right? So, this is the poorest assessment. They were not able to do this.
[A PowerPoint slide appears, titled, “Within the composite scores (Expressive)”. Under the title is a small bar graph. One of the bars, labeled “word structure” has an arrow pointing at it.]
But when we go in deeper, what we can see is actually that poor score was inflated by expressive vocabulary, which is that middle bar.
So that poor score that we saw was actually inflated because we incorporated a vocabulary score in there. So that's not great, right? That's not good for us saying, how well is the child doing by using a standardized assessment.
And then the other part I just want to show you, the fourth bar from the left is the core score. And that's actually what most people use, -I would say is often used in considering eligibility. So that's something to think about.
One thing I would say that we could think about is maybe using the self-expressive to think about eligibility. But, again, it's inflated.
[A PowerPoint slide appears with an image of from test.]
So, I wanted to go deeper into this word structure question. And, so, this is what the word structure item looks like.
How many of you are speech-language pathologists out there?
It's a lonely crowd today. So, speech-language pathologists give this, -I'm with you. But this is a test that we look at to see how well kids can do morphemes, right?
So how well they are able to use morphemes. This is, again, spoken language, but there's important messages for everyone in here. So, we give this test, right? And we looked at it to see what were the errors that kids were making?
[A PowerPoint table with a graph appears. The slide is titled, “Item Analysis: Word Structure”]
So, we did, on all these different groups of kids. We took this test and we had 47 kids in this, and we said, if they got it right, we're going to call it a blue. If they got it wrong, we're going to be red.
And, so, what you can see here, there were some items that hardly any of the kids got right. They didn't get it right.
[A PowerPoint slide appears with an image of from test.]
So, then what we do? We look at this, and we look at. What are those items on this assessment?
And what they are is that they are plurals, they are possessives, they are third-person singular. And what those things are all high-frequency sounds.
[A PowerPoint slide appears, with a table describing what sounds are at different hertz.]
And if you look on this, they're all happening around 4,000 hertz, so on the far right.
So, why this is so important is that we give these assessments, we could just give a score. We could just take the core language score. We could just take the expressive language score, and maybe the chances are that they would qualify, maybe.
But if we don't understand the assessments that we're giving, and we don't understand what those scores mean, we might not have the opportunity to look at the other color of the beach ball and say, “hey, audiologist, it doesn't seem like they're hearing that sound”.
Are we wearing the F.M. system? What are we doing to get access to the sound?
So, again, this is a spoken language example, but I think it's very true also about access in sign language. Are we doing language samples? How do we know what these outcomes are and when they have gaps?
Are we able to go back through and say, what does that mean about the services and the environment that they're in? What does it mean about their access and about their input?
Sometimes when I go to teams, and we talk about this, I will have teams say, “it's not developmentally appropriate for the child to be able to produce those sounds”. But, again, I want to remind us that it is.
[A PowerPoint slide appears with a table, titled, “Grammatical Morphemes Acquired in Early Childhood” There are several rows of text in the table.]
That it is.
So, when you look on this, plural S is between 27 and 30 months, you can't even give the Self ,unless they're 36 months of age.
So, again, it's about thinking about the outcomes that we care about, and hopefully at your tables you had a little bit of time to talk about this.
What are these outcomes that we actually care about? How do we measure? How do we measure if the child's successful?
Are we looking at their auditory skills? Maybe. Maybe not.
Are we looking at their vocabulary? Maybe.
Are we looking at how we're combining words? Are we looking at their success with peers?
There's metrics for all of these, but you have to, as your teams, figure out what those metrics are.
Then what we have to do is go back through and figure out, how are we going to measure that, how are we measuring this, and then, what are we doing with this information and am I vulnerable enough to be able to say, I don't know what that one means? And talk about it with the team.
If we think about the team as our learning community, if we think about that team and the parent included in this as a problem-solving bunch of detectives with the same vision and mission of helping that child reach their full potential, then we have an opportunity here.
But I can tell you what I think, in my world, black and white reports don't get us to that same place. They don't get us to the same place about sharing information because we don't always understand them.
Okay.
[A Slide appears, that says, “Reflection”.]
Do you have any thoughts on this? How about, -you don't have to raise your hand, but talk in your small groups for a second if there's any applications that you would have for this presentation. So, take about five minutes.
[Video cuts for a second.]
So, if you're talking about anything loosely related to what I've talked about for the last 50 minutes, then that's good, right?
Because, again, I have no answers for you today. But I do have good questions, right? I think that's pretty good.
But I think that we have some opportunities to bring things together, and to think about them a little bit differently. And maybe you don't have to use data visualization, but maybe it just gives you this idea of, like, we have to open this door somehow.
And I do, again, want us, as professionals, to be open to the fact that we don't know everything, and that we do have to use each other to get to the next place, and parents really need us to be able to do that.
And, so, I think this is a real opportunity. And, again, the best part that I've seen about this so far is that I've had providers call me and say, I've been thinking a lot about this test result, and I'm really curious about, like, what you think. Or what should we do next?
And, so, we're starting learning communities over Zoom, right? We're going to be having, like, discussions about how do we interpret this? What does it mean?
What do we do in our region, we don't have a pediatric audiologist, how are we going to incorporate tele-practice? What are we going to do here?
So, we have this opportunity, because we're thinking about it and we're open to the possibility that we don't know everything, but we feel like we want to work on it together.
[A PowerPoint slide appears, that says, “What does this mean for the families I serve? What are their goals? How am I supporting them?”.]
So, what does it mean for the families we're serving?
I think that it means that we have an opportunity to talk about goals, and we have an opportunity to talk about where they're at in a supportive, loving way and say, I think that -- I think we want our kid to meet their full potential, right? They can do it.
We just got to figure out how to do it and I want to be supportive of you, but my support of you is going to be that we need to do something different because we're not on the trajectory that we want to be.
[A PowerPoint slide appears, that says, “What does this mean for myself as a practitioner? What am I doing really well? What skills do I need to learn?”.]
As a provider, it means that sometimes I need to be able to say, I I need to talk to somebody else about, what are we going to do?
Someone just called me the other day, and they said they're doing pretty well in their auditory skills, but what we're seeing is that they're not wearing their hearing technology a ton and they're transitioning to preschool. How can I use this information during that transition?
So, we talked about the different auditory environments that would be in a preschool setting. We talked about the different communication partners that they would have in preschool. We talked about the noise, right?
So, it gave her a lot of opportunities to say the foundation is there, but as we transition, there's going to be some new questions.
[A PowerPoint slide appears that is titled, “SLPs can offer”. Under the title, there are bullets that list what SLPs offer.]
As we think about different professionals on our teams, there's a lot of different things that all of us can offer each other.
Speech-language pathologists often work in a quiet office.They know how a child can perform with some more structure, more practice. They might have more individual time with parents or family members. And, again, they can practice things, right?
They may be able to do something five different times, that in the classroom you can't really stop and have someone do five different times. And we can look at differential diagnosis about speech-language errors.
[A PowerPoint slide appears, titled, “AUDs can offer”. Under the title, there is a list of what AUDs can offer.]
Audiologists offer things about programming changes. If I say that the child's just not able to hear this, or not able to hear in this environment, or can't hear his peers, they can talk to us about that and say, well, let's look at what the different options are.
We can look at different retention options. Look at different technology options, provide us with information about wear time and data logging. Not as a, what did you say, but more as a, let's talk about what we can do to make this better.
They can give us speech perception results. And I also think audiologists can give us some periodic check-ins to see how well they understand the child.
[A PowerPoint slide listing what educators of the DHH can offer.]
Teachers can give us information about classroom behavior, how well does the child do in different settings, how well do they do with rules and reinforcement strategies.
When I directed a school, one of the things we did is we brought those reinforcement strategies from the classroom into the audiology booths, so we could get a good test.
If I only saw the red color of the ball or the blue color of the ball, we could never do that.
But the child got to add a little rock to the jar of the classroom jar because they did a great job on their hearing test, right? Easy! But it takes communication.
Looking at how well things are generalizing, looking at how well a child's doing in different situations and with different noise and looking how well they do in less-structured environments.
So, all of us offer these different pieces but we have to be able to look at them, and be able to say, how does it fit for this whole beach ball of a child.
Ooh, that's horrible. But that's what I mean. [Laughter]
[A PowerPoint slide appears, listing take-away points from this presentation.]
So, one of the things that we're thinking about is knowing your metrics, like knowing the outcomes that you care about and going that next step of saying, how are we actually going to measure this?
It may be different for different kids. It may be different for different families. But having something that you can check in and say, like, is it actually working, maybe even beyond IEP goals, right? That's what we, like, well, yeah, we do this.
But are we doing it systematically enough that we can figure out, are there had trends, right? Are there opportunities for us to be able to do?
We need to be able to look across professions and across these different domains and then we can see if they apply to us or not, right?
They may not. All the things that I've talked about may not apply to every kid that you're seeing, and even someone came up, she's, like, well, I'm talking about a whole different group. That's great.
I'm not having the answers for everyone. I don't have the answers for myself. But I think the things that we have, we have some good questions of things that we can start asking so we can do a better job.
And, so, data visualization is not really just about pretty pictures, although I do think they are pretty.
[A PowerPoint slide appears, titled,” It’s not about pretty pictures…”. There is a list under the title.]
It's about this idea of creating the shared framework.
It's about this idea of us working together and understanding what we're talking about, and having a common language when we talk about strengths and talk about opportunities.
It's giving us better ways to support families and having them understand truly where their child is at.
It's helping us to connect with others and it's about reflecting on our own skills and our own opportunities for professional development.
Like the primary goal that we have that you're all here at this Collaborative Experience is to maximize outcomes for the whole child. To think about that little person in front of you and their family and to think about, you know, what can we do here, and that's why we're here.
[A PowerPoint slide appears, with a Charles Darwin quote on it.]
So, I found this quote, and I think it's really just important to think of that when we can collaborate, that we have this opportunity, right?
We have this opportunity to improvise and work together and create a learning community to really help our kids reach their full potential.
End scene. So that's all I have. Are there any questions?
There is a fireside chat, which I'm informed there's no fire. [Laughter] Which was a little disappointing, but I will be there.
So, if you do want to talk about it or think about it a little bit more, I'm happy to talk to you there. [Applause]
Thanks. [Applause]
[The video ends with a PowerPoint that says, “Thank you! Kristina Blaiser, PhD, CCC-SLP, [email protected]”.]
