Monday, February 6, 2017

The Lunchbox

I went snowboarding over the weekend. When it was time for lunch, I went into the lodge and pulled out my bright green Phonak lunchbox from a past Clarke Mainstream Conference that proudly announces to the world that I work with, “…students with hearing loss in mainstream educational settings. 
A nearby teenager seemed to be watching me. After a few minutes, he came over and started chatting with people at our table and I noticed him eying my lunchbox. It wasn’t long before he started talking to me. I said something and he replied, “Oh, what was that? I’m deaf in this ear.” Now I understood the interest!
Students with hearing loss find us. They find us in schools, even if they’re not on our caseload, they find us in the community, and they find us out in public at ski resorts. Nobody wants to feel different and for students with hearing loss, it’s that connection to someone who understands them that they so desperately want.

When we work with the students on our caseloads, we’re supporting their academics, we’re fixing their equipment and we’re collaborating with their teachers… but there’s so much more. We’re helping students to connect to other people. We’re assuring them that they’re ok. We’re problem solving tricky social situations. We’re lending an ear when they need to vent or a shoulder when they need to cry. We understand their challenges and celebrate their achievements. I have a seventh grade student whom I consult with once a month and each time I arrive, she announces, “It’s my special person!” with a huge grin.
Schools often want to reduce TOD/HOH (teacher of the deaf and hard of hearing) services. It’s expensive. It may not look all that different from what an SLP or special education teacher can do. The difference is in the level of understanding that we have as TODs. Even though I only see my seventh grader once a month, this time is invaluable to her. We talk about her classes, her friends, her amplification and we problem solve situations that are not working for her. I know what questions to ask because I’ve had experience with so many students in so many schools. As a result, she’s confident and quirky and an active member of her school community.

As for my new friend at the ski lodge? We didn’t talk much about his hearing but the fact that he came over to me after reading my lunch box speaks volumes. He’d never heard of a TOD but thought it was a “pretty cool job.” I may never get the chance to work with him, but he inspired me nonetheless. It goes to show that as TODs, our work is never done!

Thursday, January 26, 2017

"I'm Not Using That."

I walked into a junior high classroom. I’d been called in to consult about a student who was suddenly refusing to use his HAT (Hearing Assistive Technology- formerly referred to as FM) and had even begun taking out his hearing aids when he felt teachers weren’t watching. The team was confused by this sudden behavior as the student had always been a reliable user of technology, so they decided to seek help from outside the school. I knew the student from local social programs for students with hearing loss but had never been to his school. We made eye contact before I walked to the back of the room. I noticed the student rummaging in his backpack. He turned to me, smiled and popped in his hearing aids.

            It’s time once again to revisit the issue of students refusing to use amplification since this is a problem that comes up routinely! Often, just engaging with the student leads to the real reason for the refusal. For this junior high student? When I met with him, he described his perspective… which was quite different from what the adults working with him had assumed.
His HAT transmitter and receivers were stored in a room nearby his homeroom but there was no clear procedure for how or when the set up should happen. Arriving even a few minutes late meant choosing between getting the HAT set up or being on time for class, and he did not want a penalty for being late. Additionally, there was no point person to troubleshoot problems with equipment so he’d often opt not to use it rather than trying to figure out who could help. Another issue arose when he’d raise his hand to alert teachers to mute (or unmute) the microphone only to be told, “I’m not taking any more questions” or similar. He was unsure how to proceed and would then remove his hearing aids instead so that he could focus on his work.
We were able to resolve these problems with minimal effort. The student and I wrote up the procedure for setting up his HAT in the morning and communicated with his homeroom teacher so that he would not be penalized for tardiness while setting up his amplification. The student identified an adult he feels comfortable with, and that person is now the point person when issues occur (after some additional troubleshooting training!) Rather than raising his hand to alert teachers about muting, he and his team came up with a separate signal. It’s been a few weeks and the new plan seems to have eliminated the amplification refusal!

            When students refuse to wear amplification, there are steps we can take to get to the root of the problem:
·      Get detailed information about procedures. How is the HAT set up and checked in the morning? What is the procedure for handing over the transmitter when the student arrives to class? What is the procedure for when the student leaves for the next class or for specials? If these procedures are not clear and consistent, it’s easy for students to get away without using equipment, or, to feel awkward during transitions trying to figure out what to do.
·      Observe the student in class as well as the teacher. Is the teacher wearing the transmitter correctly? Is the teacher muting the mic appropriately? Interference and incorrect use can lead to students’ giving up on their technology. Students get frustrated having to constantly remind teachers how to use the equipment. Additional training for staff may be necessary. I observed a high school English class recently because I’d been told that my student was refusing to use her HAT just in that class. It was chaos! Behavior management was a problem and there was no clear organization or structure. I would have wanted to tune out, too! When I checked in with my student, she went through the litany of reasons she didn't want her HAT in that room—and I could understand why. It was not possible to change classes so my contact at the school has taken on the task of addressing the classroom concerns.
·      How does the student talk about their amplification? My students have all—at one time or another—expressed some embarrassment or discomfort about having a difference. Helping them to better understand their hearing loss and amplification empowers them to talk about it with others when questions arise.
·      How do the adults talk about and react to the amplification? Students pick up on the non-verbal cues from adults. When teachers express frustration with the HAT system, annoyance at having to figure out the closed captions, or they are uncomfortable talking with the student about hearing loss, these can all lead to students rejecting equipment so as not to be an inconvenience.

Once we know for sure why the student is refusing to use the amplification, we can work with them to address the concerns. There is always a reason!

How do you help students who refuse to wear amplification?

Sunday, January 8, 2017

Hearing Loss Doesn't Discriminate

As an itinerant, I see the entire spectrum of education. I work with students in some of the poorest school districts in Massachusetts as well as some of the most elite private schools. As a parent mentioned to me the other day, “Hearing loss doesn't discriminate. Anyone can be affected.”  My role is not to judge but to work with what I’m given in terms of communities, resources, and professionals. No matter where I am, my goal is the same- to educate those around me about the impact of hearing loss on learning and to ensure that my students get their needs met, regardless of budget restraints. 
Several days each week I drive over an hour down winding roads without cell reception to an old mill town in Massachusetts nestled in a valley.  Poverty is widespread. Unemployment is an ongoing battle. The schools struggle to meet the ever-increasing needs of the students that they serve. Despite these financial struggles, accommodating my growing caseload of students with hearing loss has become a priority. Recently, the town approved the renovation of one of the crumbling elementary schools. The new building is beautiful with freshly painted walls, shiny floors, ceilings free of leaks, and expansive classrooms filled with new furniture. But the best part- the new speaker system installed throughout the entire school! 
When I first heard about the building renovations, I immediately got in touch with my contact in the special education department. She was well aware of my students and their needs. Inquiring about the technology for the new building, I learned that there were plans to install Soundfield systems in each classroom. Working closely with the technology department in the district as well as the educational audiologist, we were able to select a Soundfield system compatible with the students personal hearing assistive technology (HAT) systems. 

Additionally, once the administration had a better understanding of how this technology could benefit not only my students but all students in the school, the system was installed in the auditorium, “specials” rooms, and library as well. Now wherever my students go inside the building, they can directly connect to the Soundfield by plugging in their personal transmitters. Teachers only have to wear one microphone and the sound is projected through the speakers as well as being sent directly to my students through their receivers. This eliminates the need for teachers to worry about muting and un-muting since they can hear through the Soundfield rather than relying solely on students reporting. Similarly, when media is used, the sound goes right to my students without having to fuss with splitters and other connections. It’s taken some time and collaboration to set up, but the effort has been well worth it! 
In another town, an older student transitioned to a new private high school. The head of the technology department, my contact at the school, the student’s audiologist, and I communicated all summer.  When my student started school this past fall, the school had purchased equipment compatible with his HAT system directly from the same manufacturer so that he would have access in all school settings. He would be able to directly connect to the existing Soundfield system in the common areas. After some initial troubleshooting with the setup, my high school student now has access everywhere on campus. 
While money is a factor in many schools, educating teams about the benefits of technology and taking advantage of opportunities such as renovations can lead to optimal technology and access regardless of financial limitations. No matter where they live, all my students deserve the same audiological benefits and educational opportunities. These past few months have proven that it pays to get involved in the schools that we visit so that people know who we are, and that it never hurts to ask! 

Saturday, December 3, 2016

The Power of "Owning" Hearing Loss

     “Ugh! I HATE science! I give up!” my seventh grader grumbled, pulling her science book out of her backpack then laying her head in her hands, eyes closed. I opened the book to the unit her teacher had told me the class would be starting so that we could preview the material and concepts. He’d given me the page number, but not the topics. My student perked up as she watched me open to the designated page. “Hey! It’s about hearing!” She scanned the diagram of the ear, softly naming the parts, a smile beginning on her face, until she came to the bones. “Wait- hammer? Anvil? Stirrup? It’s the malleus, incus, and stapes! I should teach this lesson!” 
    When students have a concrete understanding of how hearing works, their own hearing loss and cause, and assistive technology, it’s empowering. There’s no longer a mystery as to why it’s sometimes hard to follow in class and they can advocate for their needs regarding access. The ability to independently answer questions posed by peers about the technology creates a sense of normality around the differences. Students who are able to have a sense of humor around their differences rather than constantly feeling uncomfortable are more accepted by peers. 
     Recently, a junior high student asked for help creating a presentation that she could share with her classmates. A strong advocate, she wanted to share information, particularly around the proper use of her pass-around mic to the whole group at once. It was her idea to personify the microphone as “Mikee” and do the presentation from his perspective. Her sense of humor around the equipment was well received by the group with peers laughing with her and asking relevant questions. The results have been fantastic- she reports fewer reminders to use the microphone during discussions and I’ve observed her classmates reminding each other! 

     And as for my seventh grader? Not only did she talk to her science teacher about a more in-depth lesson on hearing, after creating an in-service for her teachers, she supported two of my younger students in the school when presenting to their class, emphasizing for me to, “Teach them the real names for the parts!”  Alongside the two second graders, she served as a role model, expanding on what they shared with the class, comparing cochlear implants and hearing aids, and helping them to answer questions posed by the other children. This group has now reached celebrity status in the elementary school, featured as “Scientists of the Week,” further empowering all three! 

One of the second graders shyly slipped me this note as I was leaving. I agree! I think hearing aids are so awesome, too!

Tuesday, November 8, 2016

How Much Time?

We’ve all had the experience of having to fight for services for our students. Sometimes districts refute the recommendation for our direct services, sometimes they try to cut consult, and far too often, they try to cut TOD/HOH hours altogether stating that the SLP or sp-ed teacher can handle it. Lately, I’m finding the opposite. Districts are wanting more than my recommended time. I’ve established myself in several communities over the past few years and special education teams are starting to see the impact of my services as the students make documented gains in all areas. Families are asking for increased hours. Preschool teachers are recommending TOD support as soon as children enter school. Educational teams want even more consult. New families hear through the grapevine that these supports exist and are wanting the same for their children with hearing loss. It’s overwhelming.

So how do we make recommendations for services? We need to be looking at each students’ educational program, skill level, and individual needs. We need to balance our services so that students are getting the specialized instruction and support they need while still allowing for growth in independence without missing too much classroom time.

For example, I recommended reducing the direct service hours for an older student who was becoming dependent on me. I cited examples where she was almost regressing in coming to me with issues that she previously would have gone directly to her teacher with. She’s making steady progress and after several years, now needs more consult and in-class support to carry over the skills she’s learned, and fewer hours 1:1 with me.

Similarly, last spring, an elementary team requested an additional day of individual time for one of my students based on his performance with me versus his performance in the classroom.  Rather than add another full hour of pull-out, we spread the existing hours over more days and refined the skills that will be addressed during that time so that he would have the consistency with me but also have the important classroom time each day for subject areas where he is confident.

With a new first grader on my caseload with needs in addition to hearing loss, looking at the number of pull-out supports he was already receiving influenced my recommendation. Rather than excessive pull-out with me, meaning even more time out of the classroom, I recommended more consult so that his needs could be met across all service providers with some pull-out to address specific auditory and language skills.

I’ve used the Hearing Itinerant Service Rubric to support my recommendations. Additionally, Karen Anderson has several models for determining service delivery for students with hearing loss. These tools can help justify our recommendations when teams want more or fewer hours than we recommend.
The ultimate goal is for our students to make steady progress and eventually succeed independently in the classroom and outside of school as well. When they no longer need my intensive support- I know I have done my job! 

Friday, September 30, 2016

Cue the Awkward Silence...

It’s the start of the year so I’m spending as much time as possible in classrooms, observing, consulting with teachers, and figuring out what my students need in terms of supports. Recently in a seventh grade Social Studies class, the teacher was leading a whole group discussion about the events of 9/11. Students were raising their hands to ask questions or share stories they had heard from their parents. I watched in anticipation as my student raised her hand and was then called on. “I had a soccer game over the weekend and I got hit in the face with the ball,” she stated confidently. I cringed. There was that awkward pause as the teacher was unsure how to respond until finally he called on another student and the class moved on.  Later in the week I was observing an 8th grade Science class. The topic was how topographical maps can help us to identify landforms as well as elevation changes. A question was asked and my student shot his hand up! When called on, he said, “These chairs remind me of my camp because we had the same desks there.” Again, cue the awkward silence.

            It’s not uncommon for students with hearing loss to comment off topic. Sometimes it’s developmental. Anyone who has spent time in a preschool or kindergarten classroom knows that MOST young children speak whatever is on their mind- related or not! Sometimes our students have missed the transition and are still focused on the original topic. Sometimes they miss or mishear what has been said due to distance or noise and the response is incongruous.
            In social situations, I often observe my students attempting to change the topic of conversation when they are having difficulty following or have limited knowledge of the topic. While not always socially appropriate, these circumstances are understandable. But my junior high students commenting this way during a whole group discussion?
            I checked in with both students after my observations. My soccer pal stated that she had just been thinking about soccer. Similarly, my camper told me he was thinking about camp and making a connection. My upcoming plans for these two will have to include strategies for participating in a group discussion. For my soccer player, I plan to help her find strategies to identify the topic of the group discussion and think of a relevant comment or question. Additionally, if she was tuning out and thinking about soccer, this may be due to fatigue that she is unaware of. Structured listening breaks may help. I will also include her teachers, working with them to be more visual than they already are. Writing the topic of discussion on the board and asking more direct questions so that my student can respond appropriately are two strategies.

For my camper, I want to help him identify what a connection truly is. I have desks at camp and desks at school is an observation, not a connection. Comparing and contrasting these two will hopefully help him to make meaningful contributions in class.
On the plus side- my students are contributing! Many students with hearing loss are resistant to speaking up in class at all. Now, my job is to help refine those contributions.

How do you help students contribute to class discussions?