Tele-Intervention: A Model Program of Service Delivery USDB Initial Training

1. Tele-Intervention: A Model Program of Service DeliveryUSDB Initial Training Diane D. Behl Marge Edwards Kristi Blaiser

2. Goals for today • Start with what you already know: Review your questionnaire responses • Share benefits/challenges of T-I • Provide overview of implementing a T-I session • What is a typical T-I routine? • What do providers do differently? • What do parents do differently? • How do you ensure an effective session? • Discuss technology to be used • Plan for follow-up activities

3. Diane: Overview & “Setting the Stage” for TI • Marge: Conducting TI sessions • Kristi: Evaluating how well TI works & Next Steps for T/TA

4. What is “Tele-Intervention”?(ASHA uses “telepractice”) • Providing services via telecommunications technology • Involves live audio and video

5. NCHAM is working with numerous programs for D/HH using T-I • Collaboration with programs in CO, OK, WA, WI, UT (2) • Each serving 2-15 families • Mix of technologies: Tandberg, Sony, Polycom, Skype, SiteSpeed, Videophones • Develop resources to share with the field • Gain new knowledge, resources, colleagues

6. What are the Benefits of T-I over Traditional HV’s? • Bring specialized services to rural areas • T-I lends itself to coaching model • Fewer cancellations • Facilitate “live” teaming • Can use “ear bud” or texted prompts • Record sessions for sharing with providers, other family members • Self-evaluate with recorded sessions • Preservice & inservice training

7. Limitations • Access to a high-quality internet connection is needed. • Families need to feel open to working with technology. • A quiet space in the home is needed. • Providers need technology skills, intervention skills, and multi-task well!

8. A Skills Checklist for T-I Providers • Basic knowledge of computers, equipment used • Offers suggestions on trouble-shooting video/audio • Organizes materials for activities ahead of time based on naturally occurring routines • Conducts activities that involve materials and actions that are easily depicted over video/audio • Has a variety of activities planned in case some are not successful • Can adjust activities based on immediate interests of child/family • Demonstrates good coaching of caregivers • Can attend to the technology aspects while conducting session

9. A Skills Checklist for T-I Families • Basic comfort level with computers and a willingness to learn new technologies. • Identifies activities, strategies, learning opportunities, and practices that will enhance their child’s learning and communication development • Demonstrates strategies modeled and/or discussed during the session • Makes decisions regarding which strategies and activities work best for their child/family • Reflects on the T-I sessions, repeating what works and revising what doesn’t work.

10. Technology Considerations • Providers will be using existing computers • Families will be using PC laptops w/ built-in cameras • DSL/Broadband connection with at least 2.0 Mbps

11. Work w/ IT support to identify: 1. What type of internet connection does the family currently use:  • __ Dial –up • __ DSL  • __ Cable Modem • __ Satellite • __ 3G Cellular • __ Fiber Optic • __ Other 2. On a computer in the household, open a web browser and go to http://www.bandwidthplace.com and run a Bandwidth Speed Test. • Maximum Download Rate ____ • Maximum Upload Rate ___ 3. If needed, what other internet upgrades/services are available for their area? 

12. Bandwidth is the KEY Technological Issue • All technology systems, regardless of cost, are effected by bandwidth • Bandwidth is an issue in all geographical locations (urban and rural) • Bandwidth is traffic dependent • Traffic is dependent on time of day, weather, location • Bandwidth is increasing dramatically nation-wide, but so is traffic (thanks, Netflix and youtube!)

13. Preparing for a Tele-Intervention Session Checklist ….Refer to handout

14. Family EI Tele-Intervention Sessions: Marge

15. Parent Role Active parent participation is key and required! • Parents identify activities, strategies, learning opportunities, and practices that will enhance their child’s learning and communication development • Parents are able to demonstrate strategies modeled and/or discussed during the session • Parents can decide which strategies and activities work best for their child/family • Parent reflection on activities improves overall child participation

16. Practitioner Role (SLP/Teacher/EI) • Primary person/coach – using current evidence-based practices to facilitate listening and spoken language • Focus of Intervention • Identify activities, learning opportunities, and current practices with the parents • Demonstrate and model practices discussed • Discuss which strategies/activities work well and discuss what we might want to do differently

17. Sharing Knowledge and Skills with Families • Fluent implementation (based on knowledge and experience) • Teach parents to do the intervention “By focusing on their children’s needs and creating support for the children’s development, we place parents’ learning of new skills in the context of their goals for their children and families.” • Manage the parent teaching process (Adapted from Kaiser & Hancock, 2003)

18. Family EI Sessions • Areas typically covered: • Audiological Management • Communication • Auditory Learning • Language Development • Speech Development • Development of Inner Discipline/Behavior Management • Cognition/Pre-Academic skills/Pre-Literacy

19. Would Families Choose T-I over Traditional HV’s? • Yes, definitely! • Predictable format, schedule, materials • More control of family routine: Gives us our lives back… • Child “stranger anxiety” not a problem • Can hold sessions when child/family member has minor illness • Recordings allow other family members to be involved • Can involve other providers (i.e., audiologists)

20. Family Recommendations for Organizing Sessions • Dedicated equipment and room w/door • Tech support person for training in home • Send materials, lesson plans ahead of time • Involve children in preparing for session • Let child interest direct activities • Reinforce parents frequently, specifically • Have recordings uploaded quickly for others to view

21. Getting Started • Know the child’s current audiological status • Know the child’s current level of communication performance • Know the child’s goals • Determine the parent’s goals/intended outcome • Assess parents’ comfort level with audiological and language facilitation strategies (Comfort Levels Checklist) • Run a test session

22. Lesson Plans and Materials • Prepare a lesson plan that clearly outlines child’s goals and session targets • Listening • Receptive Language • Expressive Language • Cognition and conceptual development • Plan and prepare materials “packet” to mail to family prior to the session • When appropriate and possible, have duplicate materials • Have the family compile materials at home • Materials may be used for multiple sessions • ALLOW FOR ADDITIONAL PREP TIME!

23. Preparing for the Session • Email/call the family the day before to assure materials are ready • Assure that the parent has the room ready • Clarify if the child should be in high chair. • 15 minutes before the session review “Preparing for TI Session Checklist” • Prepare your environment • Prepare your equipment and Connection

24. T-I Session Routine • Discussion of goals from the previous week • Update on new communication milestones, new behaviors, sounds, words that have emerged • Review of goals for current session • Demonstration of new or ongoing strategies, techniques with appropriate activities • Coaching the parent as he/she performs the activity

25. T-I Session Routine • Discussion of continuation of goals or selection of new goals based on present performance • Discussion of integration of goals into the daily routines of the home • Summarizing of the session and goals for the coming week • Allowing questions from the parents about next steps, goals, short- and long-term outcomes

26. Conducting the Session • Record the session • Allow 1-2 sec. time lag in audio • Pre-brief with the parent • Audio and visual connection is OK? • Discuss aid hearing device issues • Review previous week’s goals & child’s progress over the week • Discuss goals for current session

27. Conducting the session (con’t) • Explain how you will model the activity and then expect parent to take over • Clearly communicate to the parent the goal of each activity • “Hand” the activity over to the parent • Provide feedback at strategic times or when the activity has been completed • Always provide positive feedback

28. Conducting the session (con’t) • Session review: • Review the session goals • Make recommendations for parent follow-up • Schedule next session • Discuss problems with connection/audio/visual transmission • Assure that you are no longer logged on to connection!!!

29. Conducting the session (con’t) • Session Follow-up • Email/mail the following: • Summary of session recommendations • Parent support/coaching information • Any new materials • Date of next session

30. Nancy & Alex

31. Nancy & Alex

32. Alex & Nancy

33. Provider Perspective: Logistics • High-quality microphone – at both sites • Use of a document camera – to show smaller toys, books • Planning therapy sessions – requires more time, logistics due to a pure coaching model • Gathering of toys/activities and communicating in advance with the family • Bigger toys! • Sending activities to the family to have

34. Outcomes/Progress Monitoring: Kristi

35. Provider Perspectives: Outcomes • Children are acquiring communication milestones that approximate or are equal to their hearing peers • Families/parents are more confident in their own ability to facilitate listening and spoken language goals • Fewer cancelled sessions and more overall intervention being provided over time

36. Family Perspective: What are the Benefits of T-I? • Stronger parent knowledge of language development process • Increased skills and confidence in promoting child’s language, listening • Increased child responsiveness to parent • Enhanced child language development, listening skills • Increased skills of family members as coaches themselves

37. …But can we prove that TI is effective? • Is TI cost –effective in terms of child progress, family knowledge/skill development? • How much acoustic and visual clarity needed? • Can you emotionally connect & provide support to families? • Does TI work for various interventions? • Are some parents/children a better fit? • Are some “interveners” a better fit?

38. How can we measure effectiveness? • Service delivery outcomes • Family outcomes • Child outcomes

39. New technology/New process • Want to ensure that we are tracking progress • Variety of surveys, videos, assessments • Review with providers questions, thoughts, comments, concerns • Consent form: Discussion

40. Tracking success/challenges • Contact logs: Does TI result in more completed visits? • Technology surveys: What type of technology background is needed from providers/families?

41. Child outcomes • MacArthur Bates Communication Development Inventory (CDI): 6 months • Preschool Language Scale: 6 months • Auditory Skills Checklist: 6 months

42. Family outcomes • Auditory Verbal Comfort Checklist: Every month: • SPISE (Scale of Parental Involvement and Self-Efficacy): 6 months

43. Provider feedback • Meeting/Check-in: 1/month to review • As needed if questions/concerns

44. Questions? Comments? Ideas?