 Hello everyone my name is Sarah Burns. I'm an educational audiologist and I work with Elbert education low incidence team in the school community support branch Just a reminder and I'm sure Elena's already mentioned this to have your camera and microphone off at this time And if you have any questions for dr. Johnson, can you place them in the Q&A at the bottom of your screen section? And we will if time permits we'll ask dr. Johnson these this These questions Today, we have the privilege to have dr. Cheryl Daconde Johnson with us She is presently residing in sunny Tucson, Arizona, and we're not going to talk about the weather here Cheryl's not only well known in the field of the deaf and hard of hearing But her influence in our practice has and will continue to affect our work for years to come Her contributions span a number of disciplines including educational ideology teachers of the deaf and hard of hearing speech language pathology Her work in the area of self-esteem self-advocacy educational audiology and management issues in the school environment as it relates to children who are deaf and hard of hearing has Guided guided many of us over the years Today Cheryl will be speaking about single-sided deafness and the implications for self-esteem and self-advocacy With this very short introduction. I'm handing this over to Cheryl. Welcome, dr. Johnson Thank you. That was way too kind and I Just appreciate the opportunity to chat with all of you today and hopefully we'll have some good discussions This is a topic that became More apparent to me in terms of our need to build much better awareness about the impact of single-sided deafness and really unilateral hearing loss With the children that we see and it's as i'm sure you all know any of our kids who seem to have great speech and talk well and Respond when people talk to them. They may not totally understand but they respond um, they present a different picture to um, our educators who aren't familiar with deaf and hard of hearing children and so They are often um under unreasonable expectations for their participation and their behavior is often attributed to Other things than their hearing loss. And so that's really kind of the focus of this presentation today I'm going to move through it at a reasonable speed and again, please do keep your questions I'm anxious to have some discussion When we wrap up So let's go to the first slide Second slide actually and I wanted to just start to sort of set the stage about how important this whole idea of um self-identity self-esteem leading into self-determination self-advocacy and I think for me what was really important is that I've seen we've done so much work to have students become better self-advocates for their needs And oftentimes I felt like we were expecting children to advocate for themselves when they really didn't Um understand their own hearing loss or how to advocate or the importance of it because I felt like we had jumped over some steps that perhaps Needed to occur first before we could expect kids to um successfully advocate for themselves So this little roadmap is sort of some steps I see that are really important and obviously the the path could be a bit different for different children but um Promoting the development of identity and self-esteem is absolutely critical from the very beginning This is something that begins at birth through early childhood with parents and their children And then um continues as those children develop Helping them understand their hearing loss As educators deaf educators and audiologists. I think we understand or recognize how important that is But I have to say I teach the audiology course for our master's degree program at the university of arizona and I always have Oh about a third of my class are deaf or hard of hearing themselves And I can't tell you I would say maybe 10% really understand their hearing loss So as they take my course oftentimes, that's the first time they really understand an audiogram Its implications on speech understanding listening and noise all things that they've experienced But really haven't had the background understanding to sort of connect the dots and so Again, I we can't start too early and emphasize how important this is For our students and children as they grow up Promoting choice-making um I remember back when um, I was working in the schools and Colored hearing aids first came out and I was a huge proponent of that As well as the colored ear molds and I remember laying out the Old phonic ear keychain with the different colors and offering a student to pick their color and the parent sitting next to me is hyper-vetilating because oh my gosh, why would you ever have a bright color of a hearing aid? But it goes back to having a voice and a choice for children and the decisions that we make about them And it's more than just picking hearing aids, but all kinds of communication accommodations Encouraging children to problem solve so that they learn The implications of the decisions that they make Developing understanding the process of goal setting and planning so that They have goals particularly in the area of Communication and interacting with their peers How they may go about that planning trying Evaluating how it goes making changes based on what their results were Continuing to explore all of these different possibilities for Opportunities that they can participate in in school Knowing that perhaps they won't get the lead role in a play But by exploring the possibilities they understand what it takes to be in that particular position Again looking at the outcomes of the choices that they have problem-solving What they might have done differently Promoting that reasonable risk-taking so trying things that might not seem In their sphere of what they think they can do, but maybe they can and they won't know that without taking the risk So these and I'm sure there's many other steps that we would think about that Really would be better off Discussed and developed before we expect students to start out on that path of really being able to advocate for themselves So in the end the self-determination skills are important because it helps them really be more confident about managing the decisions that they make and the consequences of their actions Light I'll start with some takeaways For this presentation just in case you get bored and want to get to the end first. We'll start right there first of all just a quick Distinguishing between unilateral and single-sided deafness unilateral hearing loss being Any hearing level that affects one ear And single-sided deafness being a subset of that where there's deafness in one ear So I think that Generally hearing loss is invisible. We know that but that's behaviorally insidious That identity as a person is paramount to their well-being But identify identity as a person with hearing loss particularly with unilateral or single-sided deafness Is often unclear because of um, they have the ability in many situations to Listen and respond effectively But other times they don't and so it really requires support and counseling to help sort out when it works and when it doesn't work Every child is different, but all kids are at risk for the same problem as a child with bilateral hearing loss when I say every child is every child with Unilateral or single-sided deafness We can't assume that these children are fully accessing their environment communication or learning even with the best hearing technology Or that when they do access They are able to understand and process everything that they hear And there are often a variety of interacting variables Meaning that there could be other Deficiencies going on with a child in addition to the hearing loss But it's critical because the sensory impairment is The first thing that occurs and and so we have to give precedence in that area To thoroughly evaluate and investigate the role the sensory impairment plays And how that relates to the child's behavior and learning abilities And it has to be done by qualified qualified personnel who can recognize How these are tied together and how they may not be Part of each other's So and again audiologists are at the beginning of this journey and can have a significant impact on the outcomes so I'm going to start about talking about this case study I was involved as an expert witness um with this case and um That really was was my involvement As you'll find out we ended up settling out of court So I never had to make a test provide testimony for a judge But in the process provided a lot of guidance To the attorney that was representing this particular student and parents So here's kevin and this is not his real name Uh, but he was the other guy in that first picture. I forgot we skipped right by the first slide But kevin is the young man in the picture and the other little girl is ali and ali's mother Heads up the microchatrisia support group that some of your families might be part of So back to kevin um early history. So he um is now 13 He's lived with his grandparents since he was four. He was adopted by them at six along with his younger sister He refers to them now. It's his mother and father The prenatal birth and developmental history is mostly unknown except that we know that his mother Was reported to have bipolar disorder and a history of drug use He was removed from the home Um by grandparents because she was not able to care Um for for her her daughter. This was her daughter. So she was removed to the care of Her parents the children's grandparents Uh when he arrived at four he attended a community preschool and then at school entry for kindergarten There was no reported significance in learning or any medical issues We can go to the next slide So in um kindergarten he passed his hearing screening Um the teacher however noted in her notes about the progress he was making that he had difficulties with listening comprehension and talked these over with The grandmother the mother now and during the summer she did consult a pediatrician Um, they diagnosed um ADHD attention deficit hyperactivity disorder And the doctor referred to an ENT And then the ENT had the audiologist assess him and that was the point where the diagnosis of single-sided deafness in his right ear occurred In first grade um then His mother referred him for special education and I um I'm going to do my best to explain Our terms in the u.s Many of you may be familiar with him and in many times familiar with them and many times there's Very much parallel language In uh Canada so I i'm not specifically sure about Alberta but assume that um as I explained these there will be a corollary type of of regulation or um team that's available there for you so they um Where this student resided they called it a multidisciplinary educational team that comes together to do the assessment once the referral is made Um, they did assessments in the areas of speech language um occupational therapy in part because of the ADHD And then they use the audiologist From the ENT that evaluation to cover um the audiology part of it So their findings again heard the audiology report that he had single-sided deafness and 100 speech discrimination in um his other ear The receptive language was low average His expressive language showed a moderate delay. Um, they found that intellectually he was functioning fine and that his pre-academic skills and academic skills were estimated to be in the average range In the social emotional area, there were concerns related to his hyperactivity. There felt there was some conduct problems They call it atypicality It was a bit withdrawn had some attention issues They did a functional behavioral analysis and indicated that his behavior was attention seeking So at his um eligibility meeting and again in the u.s We have a a meeting that first sees if the students meet eligibility for special education followed by a meeting that actually designs the individual educational program that the child will receive So they um identified his primary disability as other health impaired based on the ADHD And his secondary disability is speech and language impaired Neither the district audiologist or the teacher of the deaf or heart of hearing was invited to be present or part of the assessment or the eligibility or IEP meetings Mom told the IEP team That he's easily frustrated at home. He can be bossy. He lacks social skills That he's having problems interacting with other children He tends to give up easily when learning something new and has temper tantrums And um in the notes the slp responded to her saying that well lots of kids that age are like kevin So I hope little red flags are growing up in your minds So again at the IEP there was no recognition of his hearing loss and there was Or the implications of his hearing loss and no accommodations were made to address his hearing loss Now we're on into second grade Just before starting second grade. He did have surgery for a bone anchored hearing instrument specifically pontos aponto At the fall IEP review Excuse me the um At the fall IEP review they um determined that um He would continue they indicated that he had a hearing aid But there was again no audiologist or teacher of the deaf involved and no adjustments were made based on the fact that he had um had this device implanted Although recognized that the processor was not activated until march. So there was quite um a distance between It surgery and then actually um activation But again, they mentioned that it occurred but made no um changes to his IEP as a result Next year. He's in third grade again. No changes. They felt like he met standards on state tests. It was um making good progress At the beginning of um fourth grade We have a three-year eligibility reevaluation So they make determined they look and really see if the student is still eligible for special education They did not complete any additional testing But went ahead and staffed him out of special education because the goals on the IEP had been met and they declared that he was now a model student The multidisciplinary education team noted that Um The ADHD disability was still present but did not feel it was significant enough to require especially designed instruction Which is the critical component that a student needs to be eligible for special education by his grades at that time were mostly B's and C's But he did have a D in math and actually an F in his fourth quarter And on the state test he was minimally proficient minimally proficient in math And partially proficient in English language arts So even though he was staffed out there's still some questions about um his school performance Fifth grade again now he's not receiving any special services Um his grades in math were C Quarter three. He had a D His reading was C minus And he again had a D in quarter two So grades are done um as a semester reporting, but they also have interim reports for quarters. So that's why you see that Um, and he was partially proficient on all of his state tests Now we're coming to sixth grade And in the fall we began to see reports of discipline issues There were three in one month centered around inappropriate language He threw an object at a student and ended up with in school suspension At this time his mom requested that there be another special education evaluation Again noting the decline in grades behavior issues and concerns with his hearing So the multi disciplinary educational team again did not include the educational audiologist or teacher of the deaf But noted in the reports, he fails his hearing screening annually That's interesting since he has a device Anyway, um, they stated on the ip that he um his current difficulties are not primarily the result of the adverse impact of deafness in the right year And they determined that additional assessments were needed to look at eligibility again So they wanted to look at his general intelligence academics communication social emotional functioning Motor sensory and they did another functional behavioral analysis because of his um behavior At the eligibility meeting they again determined that his eligibility would be other health impaired Saying that most of his behaviors were a result of his ADHD Um, again, they made the statement that his difficulties were not primarily the result of the adverse impact of deafness in the right year At this point mom asked for evaluations related to audiology and hearing impairment And that the eligibility include hearing impairment And the school district denied that request And she asked for an independent educational evaluation at school expense And the district denied that because they didn't had not conducted their own evaluations in those areas And the way it works in the u.s. Is you can't get an independent evaluation unless The district has already done their evaluation so that there's something to compare to So they did grant that um independent educational evaluation for um psychos educational assessment Which they had done in the ot occupational therapy evaluation in which they had done At that point mom filed a due process complaint meaning that she Did not support the recommendations the school were making and she Refused to sign the paperwork and so um once the IEP meeting was scheduled So remember that first meeting there was eligibility the next meeting is to develop the IEP She's told the school that she's bringing her attorney And at that point the district decided to invite the educational audiologist to attend So at the IEP meeting which continued um even though mom had not given permit permission for um Or she filed the complaint But I guess with the complaint because things were in process They were able to continue um with their meetings And so you know again, this is a lot of what has been stated already the psychologist talked about his difficulties because of the ADHD It's interesting that the symptoms included difficulties with focus and attention For listening skills being in trouble for not paying attention And that he's extremely self-conscious about his hearing aid implant. Um, which seemed to also impact his mood ADOS, um, is an autism diagnostic Observation schedule evaluation and they looked at that. Um, but there was no evidence of him being on the autism spectrum disorder um Speech language pathologists thought that he needed um that he had the ability to understand and use language In a social language appropriately but not need some some guidance um at times And there was um, no real concerns on the occupational therapy summary The audiologist um at the IEP meeting did not do any additional assessment And so simply just noted that um based on his last evaluation with the ENT's audiologist documented that he had right single-sided deafness that he wore a pontobone anchor hearing aid on the right side And that his last evaluation demonstrated Excellent aided benefit in quiet situations Another thing to note um So what they agreed on in terms of needs is that they could increase his communication ability by recommending Some kind of hearing assistive technology Either a classroom or personal FM amplification device So this is the first time that that's been suggested for him They did not pursue special considerations and this is a unique part of our IEPs in the U.S for children who have deafness deaf or hard of hearing behavior Issues or are blind visually impaired And there's something called special considerations for each one of these populations And for the child who's deaf or hard of hearing It allows us to more deeply investigate opportunities for direct communication with peers in the language mode and communication mode and and some other areas But because he was not identified as deaf or hard of hearing on the IEP He did not have access to special considerations Because you have to have that disability label in order to get special special considerations in the area So i'm not going to read these goals, but the goals that they offered in the social emotional area really Put in my mind a lot of onus back on kevin to fix himself Rather than the school to try to accommodate In support through development some of the concerns and social skill areas that he was having the behavior outbreaks so You know, this is our typical IEP lingo where we're very critical about writing smart goals And you know they did you know the last one about if he becomes upset frustrated or angry He would choose to use some kind of coping strategy deep breathing Um a fidget whatever but again what I see here is not The ability to look at kevin and really talk through why he's frustrated But sort of to put a band-aid on the frustrations and problems that he's having with these kinds of recommendations In terms of the uh accommodations for him, they did recommend finally preferential seating Making certain that he understands directions and if necessary provide close captioning For any kind of movie medias Media that would be part of his classroom instructions. So Just a few accommodations for him and the services um Were much more extensive than in the past that they offered But again, if you look at audiology all their offering is an annual audiogram that could be provided by the district audiologist or by the parents audiologist Paid for by his insurance The FM system would be something that could be supported by the audiologist but only at an hour per semester Which when you're orienting to new equipment That's not a whole lot of time if we want to support the school personnel also in in its use But again to me most of these services Are not really dealing with the self-esteem and the other underlying issues that this young man has been experiencing for a number of years so um Why did it go to due process and this is I I came in In the at the IEP meeting involvement stage and at that point I was primarily guiding the attorney In what to look for what to ask those kinds of things But to me these are kind of the steps about what went wrong one They did not re-screen his hearing in kindergarten when the teacher expressed a concern And I know that oftentimes if you have volunteers conducting your hearing screening program or even a trained technician Kids get used to that routine of raising their hands and we could overlook a single-sided deafness situation although I think it's relatively uncommon But nonetheless if the kindergarten teacher expressed concerns even in light of him passing his screening the district I think should have Gone back and did a re-screen we have a law that in the u.s. That Schools are required to ensure all children with disabilities are identified located and evaluated So it would be there that that would be one law that What that was not observed um This assessment they did not conduct the assessment according to the requirements of our federal law the individuals with disabilities Act because they did not do a full evaluation in all areas of suspected disability Including some functional performance Assessments, but again, they didn't recognize that the hearing loss was part of the disability But in the end that failure to conduct those assessments is a denial of that child's free and appropriate public education So as part of all of that they didn't recognize the possible implications of single-sided deafness they didn't identify The hearing impairment as a disability category didn't address the special factors And they also didn't offer a 504 plan once he was staffed out of special education In the u.s. A 504 plan simply provides people with disabilities access accommodations. It does not provide specialized instruction It's critical that even if you don't have instructional needs you need to have access And access to your learning environment Or what's going to happen is you're going to develop more problems That will require special education so through the due process the attorney went ahead and brought in myself and again a speech language pathologist Outside of the school to do these independent evaluations And I was so lucky to get hooked up with this marvelous speech language pathologist. I can't say enough about how thorough she was and how much she understood the implications of hearing impairment on this young man and but in general on the ability to function in school and the impact of language So first test that she gave was a clinical evaluation of language function the self And what she found as there was a significant difference in understanding language and then how he was able to express himself And also The difference between semantic knowledge and the ability to apply memory to language tasks And you can see here the percentile ranks if you just look at those in language memory is very low expressive language Is quite low So again in summary, um It was hard for him to deal with some of these more higher level meta linguistic skills that are needed to Really interpret and understand complex language And so she said we would expect him to have processing problems and some other language issues that would impact his academic performance In the test environment she noticed some struggles That he would get frustrated and would bang the chin his chin on the table and actually start crying When he was really really struggling Um His productions were characterized by fault starts stopping restarting and very long pauses So he needed extra time to formulate answers and um would make many self corrections even after an item had passed So he was still mowing over um what he had said and wanting to make corrections So this is that processing time that we talk about is so important And her comment was in a classroom if kevin is rethinking things The rest of the class is moving in moving ahead and he is likely to be frequently lost Throughout his school day Overall kevin's scores may appear to be better than his actual functioning As a great deal of effort and self correction was noted And in a rapidly paced classroom. He does not have the luxury of time that the testing environment affords Next assessment was a functional listening evaluation And she was able to um perform this and um what's interesting to note here is the difference in his scores when we use common phrases Which are simple phrases like the buses here. It's time to go Things that would be very simple for um a person it with single-sided deafness to Repeat because there's so much context in those phrases And if you look at the scores you can see that all of them Are in the 90% range So then she switched to nonsense phrases and this really looks at how he understands a word without any context And so here you can see how his scores really changed and this challenged him and if you look at the most difficult of the conditions which is the distance noise And either auditory and visual or no auditory input. So no speech reading You can see how his scores of 50 correct and 30 correct Really show how he struggles when those situations occur in his communication and again They're very frequent. There's noise in classrooms. The teachers talk to you at a distance and oftentimes they're not facing you when they speak I interviewed him and Did the classroom participation questionnaire? This is looking at his ability to Understand the teacher other students in the classroom and then how he feels about that both from a positive and negative perspective So you can see in the slide The yellow boxes are his scores. It's rating The box off to the side at the top 3.25 would be the lower range of The norm for this child So his scores 2.75 so below average 2.5 for understanding students again well below The cutoff score How he feels about it 1.25 again well below He does not feel good at all about communication with other children And then the negative effect His levels of frustration and being upset and unhappy in discussions also were significant in a much greater incident of incidents of those so clearly When we talk to him about how he functions in his classroom environment There's lots of issues that are impacting How those um how he participates and how that communication goes So some of the implications of um This particular case study that I think were really important and included in my report were Just first of all his identity as a person This child had a rough beginning um with his mother And maybe there's some feelings of rejection Although I think the adoption process with his Grandparents was very smooth and everything I observed with his relationship with his grandmother I didn't observe him with his grandfather Um were very positive um and very warm and loving so um, I think he's in a good environment But you know, you just wonder about his general identity Then you add on to that a person with hearing loss and my my sense with this is if we Deny that all of the issues that he's experiencing are not associated with the hearing loss Then how does he think that hearing loss plays out in who he is as a person? And if the school continues to Not acknowledge How that might impact him? Um, I think that's very hard on a student Or a person and so I think in this case and you know, we found later on too through counseling that You know, he thought that that was just something that he had that couldn't be dealt with And that there was all these other problems yet the other problems in many ways were associated with The hearing loss and the lack of ability to really Work on that early on in his life And then when all of the accommodations and support were taken away when he was removed from special education And the fact that he was moving on into Adolescence his behavior in school performance really spiraled So the school never recognizing his hearing loss was a factor and the fact that they really put The focus on his behavior. I think was really misplaced In the support for his challenges And then overall obviously his rights were denied So Again, the slp made a great summary statement in her report An unawareness of the effects that single-sided deafness can have on a child's academic performance can lead to a reactive or failure-based approach towards intervention By recognizing the significant Effect of kevin's hearing loss supported intervention efforts can be proactive and can lead to successful academic and social functioning So to tell you what happened as a result of the due process hearing We never made it to court in a fairly arduous mediation settlement the Attorney prevailed on behalf of kevin They had already placed him in a private school that following fall as a seventh grader because the mother couldn't She just couldn't face having him go back to his other classroom Even though the school offered him to go to a different school The school that he went to was a um Charter school for children with learning disabilities And so it was quite interesting because there were three other students there That had hearing loss in this category of what we kind of call minimal mild unilateral single-sided deafness Um, so he found some other students that had similar listing and communication means that he had Um, the district had to pay big time for services So they're paying for his private school placement until he exits the education system. So from seventh grade on they're paying for An fm system for him to use at that school They're paying for um counseling services. It turns out the counselor at this School for kids with learning disabilities has a husband who has single-sided deafness What more could we ask for other than maybe the counselor themselves? So in the end the placement has served him well and he's Struggles still but through counseling is making some really good progress Again just reflecting on this case I I keep going back to identity and social emotional development and how those considerations are just paramount to how any child functions And that um, you know, we've got to have a handle on identity and support Um for developing that identity that then Crosses over into how kids relate with other kids and how they develop social communication skills And again the fact that his hearing status was not never recognized or factored into how he functioned. I think was a major issue Um Again the counseling that he's receiving now and ongoing support is serving him well And he has some peer opportunities to share experiences with um at his particular Charter school that he's at looking at um single-sided deafness I think um one of the things that we could look at and this is unilateral hearing loss as well is maybe kind of a risk factor approach um There's those external factors the amplification that's chosen and the quality qualifications of the personnel that um serve these students But I think some of those other factors the internal ones looking at age of identification When there was diagnosis Was it a progressive hearing loss? How appropriate was the assessment and the intervention? What's the family situation? What was the early development? challenges or birth history that were there The more of these issues that enter in I think the more risk factors we have And the more these children are at risk for having significant school problems and so That may be one approach as we're looking at this population of children Is to make sure that we have looked at all of these internal factors and then looked at whatever external support They're being provided And getting back to the social emotional component It's important that somehow in our practices we incorporate identity Self-determination and self-advocacy And ask students, you know, what do you think your strengths are? What are your challenges and maybe you site start outside of the realm of communication and anything associated with hearing loss But you know get to know what's underneath the children that we're serving dig a little deeper You know ask them about their barriers and and if they need help or what they're doing to overcome any kinds of communication challenges Um and ask them how they interact with others as well So just some some conversation that we can have to understand Some of the underlying Precepts of how these children function that I think are easy to overlook in our routine audiology assessments using a tool like the classroom participation questionnaire some of the tools that We have the other tools that we have available to us. I think Are good door openers to use so that the children respond or the students respond to questions And we can say let's talk about this a little bit more. You you noted that You struggle when other children are talking in the classroom Let's talk about what you might do to help improve that particular situation I do want to recommend a guidance document that's on the educational audiology association website Because these Advocacy statements and guidance documents are written for school administrators parents teachers not specifically for audiologists We did pull all of these categories together because we felt that from their perspective They kind of have similar behaviors And implications even though we need that we know that the accommodations and interventions may be very different. So We've just called this group mused minimal mild unilateral hearing loss and single-sided deafness To have some kind of an acronym And so the document provides a bit of an introduction and overview What we would recommend in terms of educational audiology oriented evaluations so things that look much Greater at functional assessments on how children function in their school environments I think back to the audiologist Of kevin who diagnosed the hearing loss and only did speech discrimination and quiet And how we could expand on our evaluations to really look at listening in noise in the sound booth we can simulate by lowering the level distance listening perhaps But looking at more functional characteristics of hearing loss so that we don't misrepresent how that child actually functions Um it includes some technology considerations Obviously the accommodations that we would recommend an intervention and some of those are um laid out for each of the unilateral hearing loss or single-sided deafness And all of the statements are supported with research. So I think it's a nice document if You're struggling at your school district level about supporting these students have These more what we used to call minimal hearing losses all right So in closing, um, I think as audiologists because we're that very first oftentimes Point of contact that we've got to get it right and so I um I just think that so much of this is about awareness for um educators outside of deafness And again our kids act like they can hear and talk So that's the perception and we don't always recognize the extra energy fatigue other things that go into Having to perform up to that standard As well as getting back into some of those identity self-esteem issues Oh, I'm going to end there. I hope that we have at least 10 minutes for some questions and um Sarah I'm I'm not sure if this goes back to you to field questions, but I'm gonna Just wait and see what happens next Okay, thanks Cheryl. Um, this was great. It really Reminds we have so many children I Met over the years and I'm so pleased that we're beginning to have recognition of their needs um I'm just uh, we're going to wait a couple of moments just in case there are some questions Remember to put them in the q&a at the bottom of the screen um, and we'll If you don't mind Cheryl for a moment We'll see what comes up Well, you're doing that. I think I have one more slide if anybody is interested The carl of the audio or the speech language pathologist that I worked with We published an article Um In the educational audiology journal it's not called that anymore, but I can never remember the new name There it is journal of educational pediatric and rehabilitative audiology. So if anybody um, What is interested you can download the article? I do have to Sorry about that I feel like I'm back in disco days We do have a couple of questions Cheryl and um, I'll send this out with my um Sharing email That I send out it once a month the um, I'm having to move a little bit so I could see the writing on the Actually, I can I can see it starting the technology issues. Do you have any advice regarding roger focus? Versus a cross situation Uh, there actually will be I can't probably say too much because I just reviewed the article and it's You're not supposed to share everything coming out of a review but um There was a paper written as a result of phonics Excuse me, you you know lateral hearing loss conference um last year And there are some specific recommendations for when you would use cross and focus From that conference that the kind of consensus panel that was brought together included so Watch for an article. Um I would hope in the next couple of months it'll be in the international journal of audiology and um It has a whole crew but um Um, oh and blanking on her name at Vanderbilt is the lead um lead author But anyway, um my perception is that it's pretty individualized Um, the obviously the advantages of the roger focus is that you're getting that dm signal So it's coming right into the ear whereas with the cross device. It's not um So I think I'm always been a proponent of some trial periods because sometimes we don't know How students respond? um And if there's a way to sort of do a baseline assessment let the student try a device for You know, maybe three weeks or so and then go to a another device after that I know that's hard with a cross device because you probably don't have loners that could be um used but um I think you know, it depends on what their Processing is when there's a lot of background noise and how great the need is for that A direct input that focus provides I don't know if I answered your question. Thank you Um another question and this is from a teacher of the deaf and hard of hearing What would I request for an audiologist regarding further testing? What tests I assume you're asking what tests would you want them to perform? Um, oh here. I see the rest of it now I think any audiology assessment has to include Measures that would reflect how children hear in their customary environment of the classroom Whether you do a functional listening evaluation Whether you do in the sound booth testing in noise You know to try and simulate what's going on in the classroom. You can do testing speech discrimination testing in noise. You can do testing at a softer listening level Again for these children until the listening environment because becomes complex. We often don't see them breakdown and kevin was a good example And um, that's because they have good hearing in one ear but I think And the problem is if you isolate and test the good ear you're going to get pretty decent results So you have to test them, you know kind of in sound field to get the impact of How they would listen in a regular classroom There are other tools. Karen Anderson has a lot of great tools on her website That can help get at sort of how kids function I love the classroom listening classroom Communication the cpq classroom participation questionnaire Because it gets input directly from the student about how they feel they're able to participate in the classroom Um, you can download that from my website. You can download functional listening evaluation from my website I don't know if it's I don't know if I put that on one of the slides, but I'll can certainly add it up real quick. Um So I would request Assessments that get at how children perform in the classroom. So more functionally based assessments I'll send out your um website information as well Okay, um one more question um Actually a couple more questions uh this from uh An audiologist an educational audiologist who works with dispensing audiologists. I'm finding one of my challenges with m m u s sd I'm not sure I'm going to pronounce that is the lack of recommendation of assistive technology equipment outside of a hearing aid Uh dm equipment for example from the initial diagnosing audiologist It would it then becomes more of an uphill battle as a new team member to get Buy in for the kids to get the this equipment for school use I guess that we're looking at how can we Um bridge diagnosing audiologists to make those recommendations for um technology That's I think part of the awareness that we have to build is to help the diagnosing audiologists In cases like this and the many other ones that we're all aware of that um It has a significant impact and because the diagnosing audiologist Is that first point of contact? We want to get it right so Conversations that you can have with them um This document that um is a very simple document to to review that the educational audiology association has on muzzed um minimal mild unilateral single-sided deafness The article that's going to come out from the phonac conference and the international journal of audiology Provide some recommendations It has a huge research agenda The phonac conference proceedings are also available online at on the phonac website and all of those Um articles would be good support For making sure that we're looking at all kids regardless of level of hearing loss thoroughly and really recognize that um, you know our assessment protocols it minimally have to include listening in noise and and really um I think soft and with and without visual cues all of those things and we have to look at context too We have to make the The um diagnostic procedure difficult enough that we force the child to break down if they're going to break down if they do well Then you know, that's another issue I think the idea of processing time is really important and that's not something that comes really through in an audiological assessment um, so maybe figuring out a way that um, you know, we can kind of get at get at that in our testing also But I think just conversations, you know A way to share information About what the research is showing and and somehow capitalize on something that happens as an opportunity to go back and say Is the protocol we're using for children sufficient? And is there other things that we can do to improve on it because I understand in your system that diagnosing audiologists does include um FMDM In the u.s. That would be a school decision. So um The dispensing audiologist or diagnosing audiologist doesn't have as big a role in the assistive listening devices that are used A different landscape here And the final question was maybe related to what your website would be so that we um, it was related to The classroom participation questionnaire your cpq Um, what is your website? Maybe you can just give it to us verbally so people can look that up Yeah, just um www.advantage.com And it's ade vantage like here audiology deaf education vantage Great, and you can navigate to a section. I think that's it Wonderfully on time. That's amazing Um, I want to thank you. Cheryl for bringing this. I think the conversation will continue um in in our little cohorts all over the province We had a great number of people joining us today and um I want to thank jeff for doing the captioning and tracy for Doing the sign language interpretation And this is just a reminder that the next plc is december 13th from noon to one And this is with a q&a with a cid regarding spice and the spice for life kit so um I appreciate everybody's participation and this has been fabulous. Thank you And thank you to the interpreter. I um Talked a little too fast at the beginning and I realized that I needed to slow down So I apologize for getting off to probably a little rough start for you, but you were great