 Well, o'clock has just struck 3.30. So I think we're going to get started. We've got a number of people who have signed in. A few names that I am unfamiliar with. So to those people, welcome to the webinar this afternoon that where Dr. Linda Maimer will be presenting on deaf blindness. I think many of you know Linda from all sorts of different venues, but certainly we've had her in Alberta in the past and she's always extremely engaging presenter. So without further ado, Dr. Linda Maimer. Well, thank you very much, Roy. I'm thrilled to be here. So I'd like to welcome you all to this. And I'm thrilled that you're wanting to learn more about deaf blindness. I'm going to talk a lot about what we do in the world of deaf blindness and also specifically here in British Columbia. And please feel free to send any questions our way. Many of the students that we see now who have the label of deafblind present with additional disabilities and needs. And this has really made us up our learning curve. So a lot of our students now have motor difficulties and they necessitate the use of wheelchairs, hand splints, foot splints, eating challenges. Many of them receive their nutrition through tube meals and have toileting needs. And in BC and our provincial outreach program for students who are deafblind, we see about 70 to 80 students who are deafblind throughout the province. And approximately 75% of them have additional needs. So we're covering a wide range of deafblindness now. And that is the new sort of future. And I know that the audience has teachers of students who are visually impaired and also I'm hoping teachers of kids who are deaf and hard of hearing. So some will be familiar to a lot of what I share today and some will be new to it. So please feel free to, as I said, send questions our way. And at the end of all this, there's some photos in the PowerPoint and videos that I'll take out because I don't think they would send well. And I'll share the entire PowerPoint with you. And I have links to almost everything I talk about for you to continue looking at where we are in deafblindness now. So we're going to look at what is deafblindness, what is intervention, and how do we define it here? In British Columbia, strategies and a total communication approach for deafblindness. We're going to look at a team approach. What do you do when there is a variety of people around a student who's deafblind and perhaps not many people on the team have experience with deafblindness? I'm also going to look at recent areas of interest and research. And if we don't get to those, I've added them on the PowerPoint with a little blurb about them and a link to more information about those areas and then a whole list of resources at the end. Linda, I'm just going to interject for one second here. When I get the PowerPoint, I'll share it with the PLC. But for those of you who are not actually part of our PLC, you're not on the list, just drop me an email to roi.mcconnell at gov.ab.ca. And I will send the PowerPoint on to you. That's great, Roy. Thank you. It was hard to compress all this into the time we have together, which is why I put a lot of links on. And for some reason, all my links turn out to be in yellow. I couldn't change the color without changing everything about it. So I apologize in advance if it's tricky to see. In British Columbia, we have a special education policy manual. It's currently undergoing a review. We were a little bit nervous because the review was looking at perhaps taking away labels in the area of special education. And we've had a lot of input about not that we're big on labels, but it is a way that we see as protection for students to get the type of help that they need. All students with disabilities are under this umbrella. And there's the link to the whole policy manual. So right now, there's supplementary funding provided to school boards in addressing the aspects of special education for all students who meet the criteria. Our students typically fall into level one, which is the highest need and the highest funded category. And level two is the students with moderate to profound intellectual disabilities, physical disabilities, chronic health impairments, visual impairments, autism, or students who are deaf and hard of hearing. And level three includes the students with intensive behavioral interventions or have serious mental illness. And this is the area that is under review. And fortunately, it was just postponed for several more months because we wanted a lot more input at the government level. So right now, NBC, our definition, excuse me, for someone who's deafblind, is someone who has a combined loss of both vision hearing such that neither of these two distance senses can be used as a primary source of learning. So both the vision and the hearing are hugely impacted. There are students out there who have a hearing loss and a vision loss, but they would only be considered deafblind if both senses were at a stage where the student could not gather information independently through one of these two distance senses. And so NBC, here's our bigger definition. They have to have a degree of vision and hearing loss, which when compounded results in significant difficulties in developing communicative, educational, vocational, and vocational and social skills. And our range is from partial sight to total blindness and for moderate to profound hearing loss, including now a unilateral hearing loss if that's impacting the student's ability to gather information independently. So that's a new area for us now is the unilateral hearing loss in students who are deafblind. Some of the causes here in BC, charge syndrome is our highest number. I think we have nine students in our school age population with charge. A lot of chromosomal disorders, usher syndrome, meningitis, trauma, brain injury. Right now, I think we have one student who is deafblind from Rubella who was not born here. He came from a developing country. We also have students with Ulstrom syndrome, Doné Barrow, Cretaceat, some of the Trisomy 21 situations, students with cortical visual impairment, and now a new area for us is Auditory Neuropathy Spectrum Disorder. And I'm going to get back to that down the way, because that, again, is impacting the students we see. We recently had Robbie Blayha from the Texas School for the Blind Up for our annual deafblind conference, and it was fantastic. And she gave us new information that the causes in the US, the number one cause for kids who are deafblind is charge syndrome. And the second one, which was a shock to us, is prematurity. And this is where the hearing loss is due to exposure to medications given in utero or at birth. And I went back to our data, because we have not had a student who is deafblind because of prematurity in years and years. And I checked with Children's Hospital, and they don't have any records of kids who are deafblind with prematurity back, I'd say, 10 years. So it's very interesting that we're following this now, and I'll talk a little bit more about this in the future, because the people in the states are realizing they have to now address these situations, because this is a new area for them. So in the world of deafblindness, we have two types, congenital and acquired. So congenital deafblindness refers to individuals who are born with both a vision hearing loss or experiences early in life. We typically say prior to about three or four or five years of age. Acquired deafblindness are the people who experience a combined vision hearing loss later in life, usually after the development of language. And the vision hearing loss is maybe simultaneous or occur at separate times. They could be acute or progressive. So we're seeing students now who are deafblind because of cancer treatments. So there are students who may go in for a cancer treatment. We have one just now, she's in grade two. She was typical, sighted in hearing, went in for cancer treatment up throughout the nasal area, and came out of the operation totally blind, and then had a reaction to the radiation and was registering as hard of hearing. And fortunately for her, it resolved, but she keeps getting her hearing tested every so often because of that. And the numbers of students, and you may see this in Alberta, who are becoming deaf or hard of hearing from the radiation of cancer is increasing at a huge amount here in BC. So another thing to keep on our radar. So deafblindness at its ultimate state is an information gathering disability. And that really is the phrase that helps people understand the situation. People who are deafblind just cannot gather information on their own independently because of a vision hearing loss. So deafblindness impacts a person's ability to communicate, interact, and learn in a variety of environments. It also affects relationships. And we're fortunate here in BC that it's recognized as a unique disability within our educational system. And we also get separate funding for deafblindness through our Ministry of Children and Family. That's very important. So here our vision impairments can range from partial sight low vision to total vision loss, as I mentioned before, and from heart of hearing to total hearing loss. So in Canada, we have interveners and intervention. And the term intervener, excuse me, intervention means to go between or to mediate between. With regards to persons who are deafblind, intervention is the process, which allows an individual who's deafblind to receive non-distorted information, such that they can interact with their environment. It uniquely applies to deafblindness. Intervention was created in Canada in the 1970s at the W. Ross McDonald School for kids who were visually impaired in deafblind in Brantford, Ontario, because they were dealing with the huge wave of students who were deafblind because of rubella from the middle 60s and late 60s. And Jackie and John McGinnis there looked at, how do we help students who are deafblind? This was brand new in the field. And they went and looked at successful adults who are deafblind, and what did they have? Well, they had someone who gave them the information that they weren't able to gather on their own. So Jackie and John looked at this and then created this philosophy of intervention and an intervener. So the intervener is the person who provides intervention to an individual who's deafblind. An intervener mediates between the person who's deafblind and their environment to enable them to communicate effectively with and receive non-distorted information from the world around them. And a simple way to look at the role of the intervener is that they act as the eyes and ears of the person with deafblindness. And often that's the first point of understanding for people who are coming into the world of deafblindness. And this was all really ultimately based on Helen Keller and Annie Sullivan. And Annie Sullivan realized that Helen had a brain. Excuse me, and if I'm just going to take a drink of water. And if Helen got the information in a way that helped her communicate, she was then becoming a person in the world who could reach out. So Annie Sullivan really was the first intervener because she provided that information that Helen was not able to gather on her own. And this is what drives us in Canada in deafblindness and eventually the world caught on to this. So why can it be difficult for an individual to communicate as deafblind? Well, there's ongoing sensory issues. And it creates limited access to information. Obviously, there's difficulty in establishing relationships with others. And adults tend to dominate the interactions. So when you have students who have a vision loss and a hearing loss, the combination really makes it difficult, obviously. And then they also have issues from other parts of their system from where their etiology came from. So with some of our students, we have students who really have no ability to take food in by mouth. So their sense of taste is so compromised. Many of them have really challenges using their hands and other parts of their body. So there's all these things we take into consideration when someone is deafblind. So we look at best practices. So we have to look at what is the visual ability of the child? What can they see? How do they see it? From where can they see it? How close? How big? For how long? What equipment do they need? If in fact they have some visual ability. The same with hearing. Can they hear? What can they hear? How close? What is the level of sound needed? What equipment is needed? So we have to look at the child with this whole view to all parts of their body. And now we also look at the physical ability of the child, as I said, and then we utilize all the senses. Vision, hearing, smell, touch, taste, kinesthetic, movement, and proprioception. But we have strategies or best practices that we have been very successful at using them through the years with our students who are deafblind. So and I'm going to go through, these will come up again and again. We utilize all the senses, of course, wherever possible. We involve the learner in the whole process. We build up anticipation. We learn by doing. Do with, not for. And I'll be sharing some of those areas with you in a minute. Hand under hand techniques. And I know that many of the people from visual impairment are very familiar with hand under hand techniques. But I'll go over it again in just a few minutes. Then we look at the use of functional scales, functional routines. What is meaningful to the child? What is their level of participation? And we have to consider, this is what Robbie Bleyha coined for us, deafblind time. Things take a lot of time in the deafblind world. How does a student who's deafblind get feedback? How do they know they've been successful? How do we give them confirmation for that? Another one of our strategies we have to consider. And then ultimately, total communication, receptive and expressive. So communication is in two parts. One, how someone receives information and understands it and how they convey that information to their communication partner. Right now in the States, Robbie Bleyha shared with us, because of these emerging new ideologies leading to deafblindness of charge and prematurity, they're now looking at different terminology around communication. And a working group in the States is starting this. And our program here, the provincial outreach program for students with deafblindness, has been invited to participate. And we're developing, excuse me, I'm so sorry. So we're looking at developing definitions. So the proficient group is typically like the acquired group with academic abilities and an intact neurology. So it's very interesting that no matter what they present with in terms of their physical aspects, they are quite able in terms of language. And then we have our emergent communicators, which are still at that beginning stage, needing a lot of the total communication. Oh, I'm sorry. OK. And they're looking at all the aspects of total communication, which I'll share with you in a minute. So we're going to look at hand under hand. Barbara Miles, a very famous person in the area of deafblindness, started looking at children who were deafblind and looking at how they learn, how we approach them, what is our style, what is our manner. And we made huge changes in our world because of what Barbara helped us see. In the beginning, everything we did was hand over hand. And we thought we were very successful with that. And she moved us completely to hand under hand. And this is extremely profound. This changed the course of children who are deafblind's life as far as we're concerned in the field. So we moved from moving their hands to helping their hands be more available to them because Barbara Miles realized that a child's hands were really their eyes. So with respect, how do we take that information and their hands and help them to learn? And the best part of hand under hand is that we're having more success and faster success with the learner becoming a much more active participant than before. It's been amazing to me. So I'm going to show you a few pictures in a minute with very slow gradual movement, shared experiences, exploring objects and joint attention, co-active movement, gestures, and directed pointing. And I put a link in the resources for this because this is extremely powerful because people who know me will know I say this all the time. I never, ever, ever, ever, ever, ever, ever take a child's hands anymore. Never for anything when they're learning how to be in their world. So I'm going to show you Paul. And some of you may have seen Paul. So Paul's one of my students. He's deafblind. I showed up in his kindergarten class. And he was fairly new to me. And his beloved intervener was not there that day. But the other kids in the class, of course, were learning letters. So she made up a tactile book for Paul. So he's in the class at the carpet time, and they're all learning their letters. So her sub that day was Vivian, who you can see in the picture, who's now a very highly trained intervener because she just totally absorbed this. I didn't know her. She didn't know me. She didn't know Paul. I barely knew Paul. And I said, you know, Vivian, we're going to try something. We're going to show the book to Paul. But we're going to do it in a hand under hand way. Paul at this point was our most complex, most complicated child in deafblindness in the province of BC. So he had, like, everything going on there. But he did have the ability to have Vivian's hand come under his, not take his hand. And her hand does the work. And his hand is resting on hers. And you can immediately picture in the old days we would have taken his hand, positioned his index finger on the little beans that are on the G there. So I want you to watch Paul's hand and how this exploration goes. So his hand is resting on Vivian's hand, finger, still resting. Then we move on to H. His hand is still comfortably resting on hers. But you can see that his index finger is now getting a little bit closer to the page. And there you see his finger independently moved to the H. This is very powerful. Paul is in control of his finger, of his exploration. So we continue on because this was going well. And I want you to look at where his eyes are. They're, like, looking up above the book. He's continuing on with his exploration. You can see his fingers are now up from Vivian's, more independent, more control, more under his own use of finger exploration. And look at his eyes there. He's looking right at the letters. Like, eye-hand coordination is so close to this. And this is blessed Vivian's heart, totally new to her. And what do the other kids see when this is all happening? They see Paul learning his letters. So we moved on to I. And again, his hand is engaged, comfortable. And then what we then learn is, eventually, we start pulling our finger away. And his finger is then on the desired object. So you can see why. This was hard for me to change from hand over hand to hand under hand. It took me about three weeks to completely change it in my mind. And now it would actually be hard for me to think about how I would sort of demonstrate the old way, the hand over hand. I'd have to really almost recondition myself to think about how my hand moves, because it feels so unnatural to me now. So I want you to really think about that, how we approach children, especially those who cannot see or hear clearly. And this went on for about 15 minutes. It was an absolutely amazing, wonderful attention span. So in deafblindness, we use a total communication approach. We use many modes of body gestures to help the child know what's going to happen. We shake an object to get visual attention. We nod our head. We shake our head. We open our hand to show something. We use sign language, name cues, finger spelling, pointing to the person or the object to get them to notice. All these different aspects in communication are used with our students. We use picture symbols, line drawings, boardmaker pics, and photos. We also use vocalizations, voice, speech, environmental sounds, tapping a bowl with a spoon to indicate giving a bite to them. We look at environmental sounds. We're aware of volume. We're aware of background noise, music in the room. We have to increase the efficiency of auditory cues. And we may use cute speech. We also would use print, braille, and tactile representations. We're moving into the area of 3D printing, which has been a little bit of a controversial area for people in the visual impairment field, because we know that 3D printing is really printing out a hunk of plastic. And so we have a project going on with our set BC organization around 3D printing. And a number of the projects involve students who are deafblind or those with visual and multiple disabilities, too, to see how can we help students relate to what we can 3D print if we can't find a tactile representation of it. We're also big users of technology, including iDevices. And we do a lot of experience books, memory books. They're often called story boxes, remnant books. And ultimately, all these areas of communication lead to a calendar system. And Dr. Van Dijk initially created calendar systems for individuals who are deafblind. I like to give him credit for that. Sadly, he just passed away in the spring. He was really the grandfather of deafblindness for those of you who don't know him. And he was a wonderful man who started working with students in the 60s and just gave so much to our field. But he's the one who realized that we have ways to have physical representations of our memories. But students who are deafblind don't have access to this and need that. And if you don't have that way to have memories or help you to anticipate something, you're always stuck in the present, as Robbie said, when she was here for our conference. So we all need to have ways to have the present, past, present, and the future represented. All individuals with deafblindness need a calendar. So we have calendar system using our total communication approach. And what is a calendar system? Well, obviously it's going to be clear to us. It's a concrete reference. It's a way to keep organized. It's a way to communicate, to anticipate, to motivate the student. And it gives you a structure for discussion and conversation. And why do we use them? Well, to develop communication skills, to provide security, support, opportunities for concept development, to manage time concepts, and to teach time vocabulary. Very, very important. And there's typically four parts to every calendar system. The symbols, the objects, tactile cues, line drawings, photos, printed word, Braille, how we display them. I'm going to show you photos of these soon. How we sequence things, and then a finish box. All the parts of a total communication approach are within this. And calendar systems are as varied as the learners who use them. And they should be built upon the learner's sensory needs, their experiences, and interests. And can be used at any level. We start every student with a calendar system with concrete objects and increase to whatever level of abstractness they can handle. So I'm sure many of you have seen calendar systems. We have lots of examples of them. Typically, we start with three things. It may be three things in the day. It may be three things in the morning, and then three things in the afternoon. This one has three components. And each of the components has a different tactile base because this is made for a student with no vision. So he would feel the one at the left, feel the ball. And then when the ball is then utilized as part of his communication calendar system, it would go in the finish bag when it's over. He would go back to this three system, feel the first one that now it's empty, then go to the second one. And he could feel the differences because of the tactile base. This one is an example of a finish bag. And the mom wanted the word done here for that. Here's an example of a different finish bag where we have the sign for finished and the printed word there. This was a calendar system for a student who was in a wheelchair. He had CVI and it was mounted on a bulletin board making it more accessible from his wheelchair. So we had to figure out which arm was more available to him, it was his left arm. And the large colored squares are separated with tactile strips. You can see the little white lines are actually pipe cleaners. So he could actually start feeling the difference between each of the symbols. And the cues are attached of course with Velcro. Here we have a system where all the cues for one child were all stored in this one area because this child could actually handle that without going over to it and perhaps stimming on it. This student could go over and you could see her start to almost think about as I'm gonna say in air quotes, what that cue was about. And it seemed to us that it was the beginning of remembering for that student. This is a calendar system of one of my students where she started out with three things and we just kept increasing and increasing and each of the sections represents one thing in the calendar and it's a combination of tactile letters, object cues and we're moving to photos for some of her cues. With this student, she had a tactile tee for bathroom so she carried the tactile tee to the bathroom and matched it there. This one was a way we had clear labeling so the adults would know what the cues were and kept it very organized. This is a sequence board where the student is starting to pair the object with photos and line drawings. So we make that move, it's a slow move but you can't jump to line drawings or photos without having the objects there because the student has to be able to make the connection that that object is represented in a 2D format and that takes a long time but that's okay, that's sort of part of the process. Eventually the student would move to line drawings or pic sims or board maker. So this student is pairing concrete objects with a line drawing and some due tracing of the actual objects, some students don't need to do that. So again, it's all individually based. This was a hugely extended calendar system which was amazing to be part of. He started out again with three objects and moved up to where he used. We went into a weekly calendar here then we kept developing it to add more. So the day, the period of activity and then each activity represented on the board that you see there, because now we're moving through the week, each board maker symbol there had a little book, a little sequence calendar of its own of three, four or five things that Keegan would carry to his class and it would have on the room number, a photo of the teacher, what they were gonna do there and we just kept adding and adding to this amazing calendar. Then he was moving to a paper-based calendar and eventually it went on to his iPad and then we moved to a monthly calendar. So most of our students would have two, three, four calendars for different concepts. And there we could add the time. Again, I said time concepts before, the place and then whatever the picture was for that. Nicole has no vision. Her early calendar consisted of concrete cues that gradually became smaller and more abstract and the wicker box that you're gonna see is her finished box, okay? So then we created a tactile communication board for her. So she knew what these abstract tactile symbols were and each of them was a topic that she might wanna discuss. Once she picked a topic, she was then given another set of symbols that were specific to that topic. So it could be play, drink, washroom, music, that sort of thing. These cues are created for students totally blind. He recognized all of his cues by touch and he started with concrete objects. You see a theme here and gradually faded to the object cues. All of our people have personal identification cues, different in texture color. It's something you're always gonna have with you. So the intervener wears the ID bracelet and working with the student and when they leave for a short amount of time, the bracelet is given to the student to keep until the intervener comes back. It's a concrete way of letting the student know that you're only going for a short time and we'll be back. At the end of the day, the learner helps that have them put your bracelet in the finished box or back on the board with your picture and to let them know that your time together is finished. This is a sample of mine. So one of my schools, they took my photo and they made a little tactile cue of little pink glasses that they would bring out on the day of my visit. The student would have it with him when I arrived and then when I left, he and I would put it in his finished bag. Here's another example of choices where we're pairing the actual object with the board maker and the label of the board maker too. We always put print and our braille on them so that A, the adults know what that's called and two, I believe that the children see the print enough, there's a good chance they're gonna connect to it. Here's Theo and this is Theo at choice making time. So look at all the different ways we're helping him to learn to communicate. Okay, so now Theo is making choices for us. More actual, so we have the photos with the names on it. You get a couple of pieces, he's got his little thin toy. So you saw a lot of different aspects there. There's no sense of overloading with the students, with the number of modes of communication we use in a total communication approach because we're exposing the child to these modes and we're gonna see for which activity does the child relate to. There's no fairy godmother syndrome from the visual impairment world and our favorite phrase of all time is do with not for. So here, Victor, we're gonna see Victor who has charge he's one of my students and he receives his nutrition entirely by tube. He will never be able to take anything by mouth unless there's a miracle operation. So his intervener realized three times a day he's getting his meals and he wanted to figure out a way to help Victor be part of his tube meals. So he put a little sequence board together with the object cues, a photo of the object cue and the name of the object cue. So here he's gathering his supplies. So Victor picks up the syringe, puts the syringe in the water. He takes the syringe out of the water bottle. What a wonderful routine this was, pushes the water in, puts the syringe in his tube, returns the syringe to the sequence tray. Then of course, because there is no fairy godmother syndrome and do with not for, Victor helps wash, to wash up. Helps to zipper the bag, washes the table, pushes in the chair. Every opportunity in the child's day is an opportunity to communicate. We have a land here, one of my students, she loves making coffee and I now have a focus that every one of my students is gonna graduate with a job. It can be a paying job, it can be a volunteer job, doesn't matter, but they're gonna have something that gives meaning to their life when they leave into their adult world. So we thought about, well, is there something about coffee that might lead to a job? So she had her early sequence board here, we had the objects, connected them to the photos and the words, she has her finished bag there, we kept growing the sequence board, then she started delivering coffee. We picked two very choice people in the school, the vice principal and the librarian. And then we bought a special cup for the librarian and then we thought, well, is this another opportunity to help Ellen communicate? We decided that she would make some choices as to which napkin she would give to the librarian that day. So you can see her here with all her cues, fully participating, and her mom put together a lens coffee corner. And so it was amazing. And she left the school with a job and she now has another job where she makes dog biscuits for dogs of different types and varieties and flavors. Because we all had a focus that she was gonna have something to do when she left school and we built her whole total communication program into it. It's another one of my students, Monique. Monique is deafblind and sadly is losing some of her abilities. And so she has the ability to speak and we wanted to teach her how to put her hearing aids, her hearing aid batteries in. So we made a video of her doing that so that eventually she could watch the video as her equivalent of a sequence board. I'm just gonna use this shirt, please. So we wanted to build up Monique's ability to use her technology to be her sequence board. We have Liam's calendar here and Roz is utilizing many different modes. We're doing the calendar with Liam and Roz is using photos, board maker and the iPad. We're working with all the areas together as well as sign language. He's using the handmade wand that our vision teacher can need a quang name. We're doing a lot of comparing of the photo to the iPad, just to obviously make the transition. I just wanna also thank all the people who willingly volunteered to be videotaped. We're gonna skip over some of these because I wanna get to a team approach. So becoming a communication partner, a great conversation has a way to communicate what is the form, a reason, what is the function, something to communicate about, shared interests, somewhere for this to happen and someone to communicate with. So to be a communication partner, you have to be interested to be interesting from Gundur Veg in Scandinavia. So key aspects here, we're all sensory detectives, have expectations for your student, expect them to learn, do with, not for, strive for independence with some skills. The process is always more important than the product and never interact in a child without telling the child what you will do, very important. So now we're gonna look at a team approach and these will all be in my notes. So don't worry about that. Typically, a student has a needs, a large team and it can include a teacher consultant, those students with deaf blindness, a teacher, students with visual impairment, teacher, students deaf and hard of hearing, an O&M instructor, classroom teacher, case manager, learning resource teacher, intervener and a backup intervener, family members and educational audiologist and OT, PT, SLP and SLP, AAC, other school-based professionals, community members and representatives from the Community Deaf Blind Associations. So how do you go forward when you have a student who's deaf blind on your caseload? Well, the most important thing is having regular meetings of all the team members because you all have to learn and hear things at the same time and together. You have to hear about the student and hear perspectives from the team members and developing communications paramount for our students and as I've said, a total communication approach is the key. So most students who are deaf blind, as I said, use many modes of communication and the teacher or students who are visually impaired and the teacher or students who are deaf and hard of hearing can be very helpful in designing the communication system. So what people bring to the team because you typically don't come with a lot of experience with students who are deaf blind and that's completely realistic and legitimate, but all the areas, in particular, the two teachers of the sensory losses need to learn about the other main sense to understand the combined impact of the vision and hearing loss. And a team approach, the most important thing that everyone needs to absorb is that it's not deaf times blind, sorry, excuse me, not deaf plus blind. Deaf blindness is deaf times blind. And I have to tell you, when I've discussed this with principals, this is the one thing that they remember. It's not deaf plus blind, it's deaf times blind. This is an enormous aspect to this unique disability. So how do you learn this? Well, I find visiting together, having the teachers of the students who are visually impaired and teachers of deaf and hard of hearing go together to the classroom with consideration for how busy a classroom can be and you don't wanna be in the way, but this is the best way for each professional to learn what's important. So initially, these two areas of sensory loss, professionals, are not gonna really understand the loss of the other sensory aspect. So it's by working with the team, the in-class personnel and possibly the student and learning to read the eye reports and the audiograms that a growing comfort level can be achieved. So I have lists here of what the teachers of students who are visually impaired can do and can offer. Well, first of all, of course, reading and interpreting the vision reports, including what does CVI mean in a student who's deafblind? Looking at the environment, the lighting, glare, equipment to support the low vision needs and positioning in the classroom. How to help the team look at the array of possible communication modes from a visual or tactile point of view. This is huge. So looking at the size of object cues, the size of photos, size of font, color preferences, contrast, large print examples, high tech strategies, teaching of visual strategies. How do we help this child to focus, track, scan, and including strategies specific to cortical visual impairment? A teacher of students who are visually impaired can help the team understand what does visual fatigue mean? They also can bring the concept development, excuse me, to the team to help. The team choose concepts wisely because you can't cover everything in the curriculum because of the level of need of input. Teaching the students how to care for the equipment like we did with Monique and her hearing aids. Teaching the student about vision, their eye, the anatomy, their condition, where they're able to handle that level of communication and how to advocate for themselves. A teacher of students who are visually impaired can help the class learn about the visual impairment part with the student if the student can be part of the workshop through simulation, activities and discussions and the reality of the student's vision needs and what helps and why. What is the role of the teacher of students who are deaf and hard of hearing? Again, complimentary to the teacher of students who are visually impaired. Read, interpret the hearing reports, the audiological assessments, helping them understand the impacts of, if it's unilateral loss, bilateral loss, when and why hearing aids might work, might not work. How do we work with the equipment in the room? Assessing the functional auditory ability of the child in a variety of settings. Looking at the environmental considerations. This is what the teacher of students who are deaf and hard of hearing can bring to the team. Positioning, lighting, glare, reduction of noise, the impact of noise level in the school on the student's learning and how to take in information. Helping the team learn about the hearing technology, the hearing aids, the FM systems, the classroom sound fields, the cochlear implants. Again, awareness of auditory fatigue. Helping the team look at the array of communication modes from an auditory point of view. Teaching the child how to care for their hearing aids, hearing equipment, the microphone, sound field. Teaching the student about hearing, their ear, their condition and how to advocate. Help with vocabulary development. Again, teach the class or simulations and with the student where possible. And together, the teachers can work to give a combined view to the specifics of the visual condition and hearing condition and help the class develop strategies to help their classmate. O&M is very important. Orientation mobility is a huge part of students who are deafblind. And you can address concept development, spatial development, environmental development and body concepts, mapping. How do you figure out where you are? What are some good landmarks that are gonna work? Travel techniques, guiding. Should the child be using an adaptive mobility device? Cain skills. The advanced travelers who are deafblind can work towards using apps, such as Google Maps, Transit Maps and working towards greater independence, including their neighborhood community and introduction to public transportation and safe travel at night. In the deafblind world, we typically talk about interdependence. We don't envision a student who is truly deafblind to be out on their own without a lot of input and travel experience. But in interdependence, how can they be more a member of a partnership when they're out walking? Do they know how to get somewhere? Can they plan a route? That sort of thing. NBC, we have the framework for independent travel, FIT, a resource for orientation mobility and I've included a link here for you. It's a free download from our Ministry of Education website. Now, many of our students, of course, have OTs, PT's and SLPs. So again, the most critical thing is learning the visual and hearing status of the child. You need to spend time with the child. I've seen people, therapists especially, SLPs come in, leave a handout and then go and it's just not enough to help a team when the child is very complicated. You need to learn about the child. But an OT can help with physical aspects of access to cues, where are we gonna position them? Where will the switch go? Where will the wheelchair go? Some of the roles of the SLP, SLPAC, again, you need to learn the visual and hearing status of the child. You need to recognize that the aspects of hearing loss means that the majority of students do not use speech as their main mode. And this is a big switch for a number of people who have been trained as SLPs. The total communication approach is best. And people may think it's overwhelming to look at the total communication approach with all those things I listed. But in the beginning, we're just exposing. We're not assessing. We're offering these things to students to see. Can they relate to them? Will they help? What do they gravitate to? Typically we start with concrete words. We look at the size of cues, the background color, typically one photo or boardmaker pick at a time. And the initial solution is often not a high tech device. So many people think of Proloquo2Go or GoTalk or TouchChat. And often that's because that's the comfort level of the therapist. But most of those programs are based on having lots of photos on the screen or the sheet at one time. And we have to scale way back, go to the concrete objects before we move to photos or boardmakers to make sure the child understands that the 2D representation is based on the 3D object queue. So we try to steer away from a high tech device in the beginning. Many students go on to use their iPads and certain programs as communication devices. And that's fine, but it's because the team has looked at it and felt it was the best match. The physiotherapist again, needs to learn the visual and hearing status of the child. How do we position the child? How do you help the team learn that? We have to allow deafblind time to help the child prepare for movement changes with language and cues. And you prepare the child in advance with these cues and help the staff see that it's gonna take a fair bit of time for the child if we're wanting them to maybe change position or move from a chair to a wheelchair. They need the cues, it just can't happen by us moving them. They need the communication strategies. So that's the main part of what I was gonna talk about. I've just put in the areas of interest and they all have links. So I'm just gonna go through Dr. Van Dyke who we're sadly missing has really put together some wonderful areas, child guided assessment, the biobehavioral states. If you can recognize these in a student, you become much more competent at matching their needs with what you're trying to do with them at the time. Deep sleep, quiet sleep, active, drowsy, quiet awake, active awake and fussy state. And as they say, ah-ha, the uncontrollable agitation. You need to see where the child is coming from. So his information is on aph.org and there's a wonderful video of him. And also at Perkins, they're doing quite a bit more now with literacy for students who are deafblind, the paths to literacy. Another area is all children can read. And this is a very comprehensive website for children of complex learning challenges, including those who have a combined vision hearing loss and the link is there from the National Deaf Blindness Organization. And when Robbie Bleyha came and spoke with us, she brought up the whole area of sound travels and how audiologists can help students with deafblindness who are learning orientation and mobility travel and traffic skills and was very interesting. That, and I've listed many links there. Essentially, it's on the path to literacy. It's really working as a team with the orientation mobility instructor, the teacher of students who are deaf and hard of hearing, the teacher of students who are visually impaired and the audiologist to have everyone understand that if a child's ready to be out learning or orientation mobility skills in traffic, how does that impact how a hearing aid is programmed? And I'm simplifying it here, but it was like a whole new area. We thought, well, we never thought of that before. And if the audiologist understands what we're expecting of the child and the child's able to demonstrate some of those ability areas, then the team can work together to make sure the child has a hearing aid that's truly matched to his or her needs for those skills to develop. Another area of interest is Auditory Neuropathy Spectrum Disorder. We're starting to see a number of children here in BC. It's a very low number of students in the province, but a lot of them have additional needs. So we're seeing them in our deafblind world. And right on your own website, Beatrice Ho has a wonderful website on this. And we also have a handout from BC and there's a link that's written for families to understand what ANSD is. Now, a huge area of interest now, and I'll finish up with just a few more, is the whole area of toxic stress. Trauma is now becoming one of the highest discussed and researched areas. And when you look at our students who may not have had healthy relationships in the beginning because of sensory needs, the areas of how children learn to connect is so important. And we're now learning that if a child even sees violence in the home when they're young, it starts to actually change their brain. This is huge new information that is very, very, very scary. But the more we know about it, the more we can be aware and the more we can help address these things. And I put links into all these areas from Harvard there. And I just put in some aspects of training that's happening in the states, the open hands. We're doing a lot of trends, disciplinary play-based assessment here in BC for students with deafblindness. And I wanted to bring up a couple of things and I wanted to bring up someone who you may or may not have seen, I don't know if she's been to Alberta, but we had Dr. Lauren Lieberman here for two days and it was amazing that if you were looking at having a guest speaker, we're thinking of bringing her here in one of our upcoming deafblind conferences we hold every December and we'll be sure to include you because she has done so much work with students with visual and multiple disabilities, including deafblindness and looking at universal design. And I put a link to all of her handouts that she shared with us here. We also have a new transition handout for students moving on to adulthood. And I just put a lot of other things here, a lot about the provision communicators at the Texas School for the Blind and the websites to follow that. And my final thoughts are being organized is crucial for the whole team, a daily schedule, a lifesaver for our students, regular team meetings are of the utmost importance. We want to expand participation. The process is always more important than the product and incorporating the goals throughout the day avoids rushing in order to work for the student. That's sort of like a overview of how we run our philosophy. And I then put in a list of conferences and links to either their upcoming or they've passed and then there's links to the information that was there. And finally, I put in some training opportunities and resources and there's the article of Barbara Miles and your own website has a lot of stuff on it on deafblindness and I invite you to look at that. There's the fit. And finally, don't assume a door is closed, push on it. Don't assume if it was closed yesterday that it is closed today. And I wish you all the best in working with the students who are deafblind. It truly is a remarkable field and thank you for your time. Well, thank you very much, Linda. That was action packed, a ton of information and so many additional resources that folks will be able to access once we send the PowerPoint out. So thank you very much. We have run over time a bit here. So thanks and take care. Thank you.