tele-intervention: a model program of service delivery usdb initial training diane d. behl marge...
TRANSCRIPT
Tele-Intervention: A Model Program of
Service DeliveryUSDB Initial Training
Diane D. BehlDiane D. Behl
Marge EdwardsMarge Edwards
Kristi BlaiserKristi Blaiser
Goals for today Start with what you already know: Review your
questionnaire responses Share benefits/challenges of T-I Provide overview of implementing a T-I session
What is a typical T-I routine? What do providers do differently? What do parents do differently? How do you ensure an effective session?
Discuss technology to be used Plan for follow-up activities
Diane: Overview & “Setting the Stage” for TI
Marge: Conducting TI sessions
Kristi: Evaluating how well TI works & Next Steps for T/TA
What is “Tele-Intervention”?(ASHA uses “telepractice”)
Providing services via telecommunications technology
Involves live audio
and video
NCHAM is working with numerous programs for D/HH using T-I Collaboration with
programs in CO, OK, WA, WI, UT (2)
Each serving 2-15 families
Mix of technologies: Tandberg, Sony, Polycom, Skype, SiteSpeed, Videophones
Develop resources to share with the field
Gain new knowledge, resources, colleagues
What are the Benefits of T-I over Traditional HV’s?
Bring specialized services to rural areas
T-I lends itself to coaching model
Fewer cancellations Facilitate “live” teaming Can use “ear bud” or texted
prompts Record sessions for sharing
with providers, other family members
Self-evaluate with recorded sessions
Preservice & inservice training
Limitations Access to a high-quality internet connection
is needed. Families need to feel open to working with
technology. A quiet space in the home is needed. Providers need technology skills, intervention
skills, and multi-task well!
A Skills Checklist for T-I Providers Basic knowledge of computers, equipment used Offers suggestions on trouble-shooting video/audio Organizes materials for activities ahead of time based on
naturally occurring routines Conducts activities that involve materials and actions
that are easily depicted over video/audio Has a variety of activities planned in case some are not
successful Can adjust activities based on immediate interests of
child/family Demonstrates good coaching of caregivers Can attend to the technology aspects while conducting
session
A Skills Checklist for T-I Families
Basic comfort level with computers and a willingness to learn new technologies.
Identifies activities, strategies, learning opportunities, and practices that will enhance their child’s learning and communication development
Demonstrates strategies modeled and/or discussed during the session
Makes decisions regarding which strategies and activities work best for their child/family
Reflects on the T-I sessions, repeating what works and revising what doesn’t work.
Technology Considerations Providers will be using existing computers
Families will be using PC laptops w/ built-in
cameras
DSL/Broadband connection with at least
2.0 Mbps
Work w/ IT support to identify: 1. What type of internet connection does the family currently use: __ Dial –up__ DSL __ Cable Modem__ Satellite__ 3G Cellular__ Fiber Optic__ Other
2. On a computer in the household, open a web browser and go to http://www.bandwidthplace.com and run a Bandwidth Speed Test.Maximum Download Rate ____Maximum Upload Rate ___
3. If needed, what other internet upgrades/services are available for their area?
Bandwidth is the KEY Technological Issue All technology systems,
regardless of cost, are effected by bandwidth
Bandwidth is an issue in all geographical locations (urban and rural)
Bandwidth is traffic dependent Traffic is dependent on time of
day, weather, location Bandwidth is increasing
dramatically nation-wide, but so is traffic (thanks, Netflix and youtube!)
Preparing for a Tele-Intervention Session
Checklist
….Refer to handout
Family EI Tele-Intervention Sessions:
Marge
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Parent Role
Active parent participation is key and required!and required!
Parents identify activities, strategies, learning opportunities, and practices that will enhance their child’s learning and communication development
Parents are able to demonstrate strategies modeled and/or discussed during the session
Parents can decide which strategies and activities work best for their child/family
Parent reflection on activities improves overall child participation
Practitioner Role (SLP/Teacher/EI)
Primary person/coach – using current evidence-based practices to facilitate listening and spoken language
Focus of Intervention
Identify activities, learning opportunities, and current practices with the parents
Demonstrate and model practices discussed
Discuss which strategies/activities work well and discuss what we might want to do differently
Sharing Knowledge and Skills with Families
Fluent implementation (based on knowledge and experience)
Teach parents to do the intervention
“By focusing on their children’s needs and creating support for the children’s development, we place parents’ learning of new skills in the context of their goals for their children and families.”
• Manage the parent teaching process(Adapted from Kaiser & Hancock, 2003)
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Family EI Sessions
Areas typically covered:
Audiological Management
Communication Auditory Learning Language Development Speech Development
Development of Inner Discipline/Behavior Management
Cognition/Pre-Academic skills/Pre-Literacy
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Would Families Choose T-I over Traditional HV’s?
Yes, definitely!
Predictable format, schedule, materials
More control of family routine: Gives us our lives back…
Child “stranger anxiety” not a problem
Can hold sessions when child/family member has minor illness
Recordings allow other family members to be involved
Can involve other providers (i.e., audiologists)
Family Recommendations for Organizing Sessions
Dedicated equipment and room w/door
Tech support person for training in home
Send materials, lesson plans ahead of time
Involve children in preparing for session
Let child interest direct activities
Reinforce parents frequently, specifically
Have recordings uploaded quickly for others to view
Getting Started
Know the child’s current audiological status Know the child’s current level of
communication performance Know the child’s goals Determine the parent’s goals/intended
outcome Assess parents’ comfort level with
audiological and language facilitation strategies (Comfort Levels Checklist)
Run a test session
Lesson Plans and Materials Prepare a lesson plan that clearly outlines child’s goals
and session targets Listening Receptive Language Expressive Language Cognition and conceptual development
Plan and prepare materials “packet” to mail to family prior to the session
When appropriate and possible, have duplicate materials Have the family compile materials at home Materials may be used for multiple sessions ALLOW FOR ADDITIONAL PREP TIME!
Preparing for the Session
Email/call the family the day before to assure materials are ready Assure that the parent has the room ready Clarify if the child should be in high chair.
15 minutes before the session review “Preparing for TI Session Checklist” Prepare your environment Prepare your equipment and Connection
T-I Session Routine
Discussion of goals from the previous week
Update on new communication milestones, new behaviors, sounds, words that have emerged
Review of goals for current session
Demonstration of new or ongoing strategies, techniques with appropriate activities
Coaching the parent as he/she performs the activity
T-I Session Routine
Discussion of continuation of goals or selection of new goals based on present performance
Discussion of integration of goals into the daily routines of the home
Summarizing of the session and goals for the coming week
Allowing questions from the parents about next steps, goals, short- and long-term outcomes
Conducting the Session Record the session Allow 1-2 sec. time lag in audio Pre-brief with the parent
Audio and visual connection is OK? Discuss aid hearing device issues Review previous week’s goals & child’s
progress over the week Discuss goals for current session
Conducting the session (con’t) Explain how you will model the activity and
then expect parent to take over Clearly communicate to the parent the
goal of each activity “Hand” the activity over to the parent Provide feedback at strategic times or
when the activity has been completed Always provide positive feedback
Conducting the session (con’t)
Session review: Review the session goals Make recommendations for parent follow-up Schedule next session Discuss problems with connection/audio/visual
transmission Assure that you are no longer logged on to
connection!!!
Conducting the session (con’t)
Session Follow-up Email/mail the following:
Summary of session recommendations Parent support/coaching information Any new materials Date of next session
Nancy & Alex
Nancy & Alex
Alex & Nancy
Provider Perspective: Logistics
High-quality microphone – at both sites
Use of a document camera – to show smaller toys, books
Planning therapy sessions – requires more time, logistics due to a pure coaching model
Gathering of toys/activities and communicating in advance with the family
Bigger toys!
Sending activities to the family to have
Outcomes/Progress Monitoring: Kristi
Provider Perspectives: Outcomes
Children are acquiring communication milestones that approximate or are equal to their hearing peers
Families/parents are more confident in their own ability to facilitate listening and spoken language goals
Fewer cancelled sessions and more overall intervention being provided over time
Family Perspective: What are the Benefits of T-I?
Stronger parent knowledge of language development process
Increased skills and confidence in promoting child’s language, listening
Increased child responsiveness to parent
Enhanced child language development, listening skills
Increased skills of family members as coaches themselves
…But can we prove that TI is effective?
Is TI cost –effective in terms of child progress, family knowledge/skill development?
How much acoustic and visual clarity needed? Can you emotionally connect & provide support
to families? Does TI work for various interventions? Are some parents/children a better fit? Are some “interveners” a better fit?
How can we measure effectiveness?
Service delivery outcomes Family outcomes Child outcomes
New technology/New process
Want to ensure that we are tracking progress Variety of surveys, videos, assessments Review with providers questions, thoughts,
comments, concerns Consent form: Discussion
Tracking success/challenges
Contact logs: Does TI result in more completed visits?
Technology surveys: What type of technology background is needed from providers/families?
Child outcomes
MacArthur Bates Communication Development Inventory (CDI): 6 months
Preschool Language Scale: 6 months Auditory Skills Checklist: 6 months
Family outcomes
Auditory Verbal Comfort Checklist: Every month:
SPISE (Scale of Parental Involvement and Self-Efficacy): 6 months
Provider feedback
Meeting/Check-in: 1/month to review As needed if questions/concerns
Questions? Comments?
Ideas?