0:06

You're tuned in to the Hearing Matters podcast

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, the show that discusses hearing technology,

0:11

best practices, and

0:13

a growing national epidemic: Hearing

0:16

Loss . Before we kick this episode

0:18

off , a special thank you to our partners

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. Sycle - built for

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the entire hearing care practice . Redux

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- Faster . Drier . Smarter

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. Verified . Fader Plugs

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- the world's first custom adjustable

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ear plug . Welcome back to

0:35

another episode of the Hearing Matters

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podcast , and joining us again this

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week we have Nell Rosenberg

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, who is the National Director of Teleservices

0:44

at Clarke Schools for Hearing and

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Speech . Nell , welcome back to

0:48

the Hearing Matters podcast !

0:50

I'm so happy to be back . I feel like we could

0:52

have talked for hours last time , so a

0:54

second episode is very welcome .

0:56

The week has gone by incredibly fast

0:59

and we were really excited

1:01

to have you back on the show because we

1:03

really wanted to introduce our listeners

1:06

to who Clarke is , how

1:08

long you've been serving your community

1:11

and now we're going to really dive

1:13

in deep to telehealth

1:15

, because this is really a huge

1:17

passion of yours and

1:19

your teams . Last week , we talked a little

1:22

bit about the benefits of telehealth and

1:24

the incredible statistics that you

1:26

shared . When we talk about

1:28

the positive impact , personally

1:30

and professionally , how have you seen

1:33

telehealth positively impact

1:35

the accessibility of hearing

1:38

and speech services for

1:40

families in remote or

1:42

even underserved areas ? Because it

1:44

has to have a major impact .

1:46

This is one of the biggest things

1:49

about teleservice is that it can overcome

1:51

these barriers . So I

1:53

mentioned in last week's episode the zip code

1:55

lottery . We used to say it all the time that

1:58

kids won or lost the zip code lottery based

2:00

on where they happen to be born . Maybe

2:03

they're by a major pediatric

2:05

audiology center , maybe there happens to be one

2:08

AVT in their county

2:10

, maybe there is no one . There

2:12

are states with no practicing

2:14

teachers of the deaf child's born

2:16

in that state , out of luck for

2:19

services , right ? Well

2:21

, not anymore , but that was the reality

2:23

for the vast majority

2:25

of our field

2:28

existence . It's only in

2:30

recent decades that we've had the opportunity

2:32

to utilize telehealth to reach families

2:35

who are not specifically

2:37

located very closely to

2:39

a Clarke campus or another

2:41

similar programs campus . Right

2:44

, because we have many amazing colleagues in the field

2:46

, but they're not everywhere . So we

2:48

have served students in geographic

2:50

areas with no specialists , all

2:52

over the country and children and

2:55

families outside of the USA . For

2:57

example , right now we have three

3:00

little girls under the age of three

3:02

, all residing in Bermuda , not

3:04

related to each other , but they

3:06

happen to all have hearing loss , which

3:09

is very rare for the population

3:11

of that nation . They travel to the

3:13

US for their audiological care , but

3:15

there are no teachers of the deaf in Bermuda

3:17

, nor are there SLPs

3:20

with listening and spoken language background in their

3:22

entire nation . And now these

3:24

three children all have access

3:26

to T visits and , in fact , are

3:28

achieving beautifully meeting

3:30

their language milestones . I

3:33

recently tested one of them , who I see personally

3:35

, and she exceeded

3:37

the expectations compared to her

3:39

same age hearing peers . So

3:43

the benefits are endless . And when you mentioned

3:45

those underserved areas like rural and

3:48

urban both areas

3:50

we see huge , huge benefits

3:52

because in those rural areas there's

3:54

now high speed internet whereas there did not

3:56

used to be .

3:57

Right .

3:58

Over COVID . We saw a huge improvement there

4:00

and those families were driving hours

4:03

and hours for services and can now get access

4:05

. And then the barriers in

4:07

intercity areas

4:09

or just urban areas in general are

4:12

the same but different . Right , we have other

4:14

transportation challenges . Now we're relying

4:16

on public transit with small children . Now

4:19

, perhaps you know , there's other

4:21

barriers involved and we may

4:23

have families with alternative work

4:25

schedules doing shift work who

4:27

cannot maintain a regular schedule

4:29

for center-based care . So

4:32

the impact on accessibility

4:34

is one of the biggest benefits

4:36

to telehealth and I see no

4:39

limits on it .

4:40

That is super exciting . I mean Bermuda

4:42

. These three kiddos now

4:44

again have access to

4:47

a language-rich environment

4:50

, not only at home , but now they're

4:52

teamed up with professionals like you and your

4:54

team that will give

4:56

them the tools to communicate

4:58

effectively . That is super exciting

5:00

. Now that's got to make you just smile

5:02

ear to ear .

5:03

It does . It really does , you know , and

5:06

it always takes work to figure out , you know . Can we practice

5:08

in this nation ? What are the regulations

5:10

? Can SLPs do it ? Can teachers of the deaf

5:12

do it ? But then

5:15

you see the outcomes and it's all worth it

5:17

.

5:17

Access to hearing health care . That is really what we

5:19

believe in Breaking down those

5:21

barriers . Who would have thought

5:24

, you know , even when you were talking

5:26

about how 2011

5:29

, I believe you had said , was the first T-visit

5:31

that Clarke did to now , 2011

5:34

does not seem that far away , but

5:36

the advancements that have been implemented

5:38

in this field and industry have been incredible

5:40

. When we talk about , there

5:43

has to be some challenges or considerations

5:46

, right . So , like no service delivery

5:48

model is perfect , we try to refine

5:50

and get better every single day . But , you

5:52

know , are there any specific challenges

5:55

or even considerations when

5:57

providing hearing services

5:59

through telehealth compared to , like , in-person

6:02

sessions ?

6:03

Yes , absolutely . Now

6:05

I truly believe that we can

6:07

provide appropriate services

6:10

to any child via tele-service . I

6:12

do not believe that there are children who

6:14

quote unquote can't do T-visits . I

6:16

don't believe that . I believe that it is on

6:18

us as a professional to make it work , and

6:21

that is why sessions are

6:23

so highly individualized for the child's

6:26

needs . Now , there

6:28

may be some children who also need in-person

6:30

services for other challenges . You

6:32

know if they perhaps they also need physical

6:34

therapy and some of that needs to be in-person

6:37

. Or perhaps we have an oral motor component

6:39

and we're going to need to do an in-person evaluation

6:41

for that type of thing . But when we're really

6:43

talking about oral

6:46

, aural habilitation

6:48

and rehabilitation , I believe that

6:50

tele-services can work for any child if

6:52

you put the right strategies in place . The

6:54

challenges , which I

6:56

don't want to consider them challenges , but what you need to

6:58

be prepared for is that there's more planning

7:01

involved .

7:02

Okay , tell us more .

7:03

So , yeah , for there to be an effective

7:05

telehealth session , you need to

7:07

do more planning up front and the

7:09

provider needs to have really , really

7:12

strong coaching skills , and that is

7:14

not something we're always taught . So

7:16

you need to go into a session

7:19

ready to coach whoever

7:21

is there . So if that's the caregiver

7:24

, which I'll use parents and caregivers interchangeably

7:26

, anyone who's important in the child's life caregiver

7:29

, school personnel , the child

7:31

themselves if it's an older child , you

7:34

need to know how to coach appropriately

7:36

to that person . And we don't all know that right

7:39

, because maybe we didn't learn

7:41

much about adult learning theory . So

7:44

our providers , before they start providing

7:46

tele-services , go through quite

7:49

a complex training process

7:51

to increase their coaching skills

7:53

and their knowledge of adult learning theory , and

7:56

you really need to have multiple backup plans

7:58

. You do for a center-based session too

8:00

, right , like you don't know what a three-year-old's going to

8:02

do . But you can't just think

8:05

it now , because now you need to have communicated that

8:07

to whoever's in charge of the session there , because they

8:09

have to have everything ready . So you do

8:11

need to communicate very effectively

8:14

between sessions before and after . You

8:16

know , let's have this ready . This is the goal we're

8:18

working on . These are the strategies we're

8:20

going to focus on . Please have XYZ

8:23

ready . Are there any toys

8:25

that she's been really into lately ? Let me know

8:27

and we'll incorporate those . So

8:29

everybody in the session has to be ready

8:32

to go on both ends , and

8:34

you need to send updates , you need to send

8:36

videos , you need to send whatever resources

8:39

are needed for the parents or the school

8:41

teams so that they can succeed , because

8:44

now my role is not just to make

8:46

sure the child succeeds , but to make sure every

8:48

participant in the session succeeds .

8:51

And there's carryover there too . I

8:53

love the implementation

8:56

of adult learning theory and

8:59

not many may think

9:01

of that and understand how

9:03

important that is . But for carryover

9:06

, specifically , it's just ensuring

9:08

that what you're teaching

9:10

the child will be carried over in

9:12

the home . That's interesting .

9:14

And I think it's a huge gap in training

9:16

preservice audiologists and speech

9:18

pathologists , even though audiologists

9:21

and many speech pathologists do work with adults in

9:23

their day-to-day , not just as caregivers .

9:25

I would have loved to been trained on that and

9:27

have a class on that for sure

9:29

.

9:29

There should be .

9:30

And .

9:31

I've learned a lot now , but

9:33

it's really important

9:35

because we send parents

9:37

or adult patients off thinking like , oh , we

9:40

taught them all these things .

9:40

They've got it .

9:42

They don't have it . Could you remember

9:44

all of that ? There's no way . So

9:47

we have to reiterate , we have

9:49

to send follow-up , we have to know what

9:51

works for this adult a video

9:53

clip , like a

9:55

visual , a bulleted email

9:58

? How are they learning best so that they can

10:00

carry over ? Because nothing

10:02

that I do in the 30-minute session is changing

10:04

the child's life . It's what everyone

10:06

else is doing all the other

10:09

hours of the week that matter .

10:57

But that 30 minute session really

11:00

does matter and , to your point , making sure

11:02

that you are prepared pre and

11:04

post . Curious to know , with

11:07

today's advancements in technologies

11:09

and innovations , as we discussed last

11:12

week , do your

11:14

communications with the caregivers

11:16

are a lot of those , because I know

11:18

in speech language therapy like we

11:20

would have maybe pre-written

11:23

lesson plans for if you're working on

11:25

the S sound or the Z

11:27

sound . Do you have like automation

11:30

tools that you're able to use and tap

11:32

into and you can make selections

11:34

to then create like an automated

11:37

workflow ?

11:38

We do have some , but they're so highly

11:40

customized to the children's needs that

11:43

that's not primarily what we rely on . But

11:45

we do use some of

11:47

the same progress monitoring tools for

11:50

all our kids and

11:52

we can screen , share those and send PDFs

11:54

of those to the parents so that they

11:56

really develop a deep understanding

11:59

of the developmental trajectory

12:01

and exactly the gaps that we're trying

12:04

to fill in our sessions .

12:05

That's excellent when we

12:07

talk about carry over

12:09

communication . Communication

12:12

in the simplest form is the

12:14

exchange of ideas . How do you

12:16

, as a speech language pathologist

12:19

, and how do you and your colleagues ensure

12:22

effective communication and engagement

12:24

with the child

12:26

during telehealth sessions

12:29

? Cause I'm sure not every single one

12:31

is sunshine and rainbows ?

12:34

Oh , it sure isn't , and I have endured

12:36

plenty of sessions with a 360

12:40

minutes of a three-nature

12:43

, having a complete meltdown and

12:45

hanging off .

12:46

You say three-nature .

12:47

I sure did , but

12:50

you know they're my favorite secretly . So

12:54

yeah , there are

12:56

challenges , but it is possible to

12:58

do this at any age . And now , as

13:00

I said , each team is highly customized

13:02

because every individual student is different and has different

13:05

needs and every family is different in

13:07

terms of their learning needs , their culture

13:09

, their home environments . We take all of that into

13:12

account , right , but in general

13:14

the model shifts in

13:16

a pretty predictable way throughout

13:19

the years to match the child's

13:21

developmental needs . So I'll give kind of a high

13:23

level overview of that . So

13:25

for our birth to three , our early intervention

13:28

population , we're following very

13:30

strictly apparent or caregiver coaching model

13:32

, those birth to three kids . I have

13:34

seen kids as young as two weeks . That is not too

13:36

young to be in speech therapy because , as

13:39

you've mentioned , we are not learning

13:41

to talk really , we

13:43

are training the brain

13:45

to hear and listen . All of that

13:47

happens in the brain and it's never too early for

13:49

that .

13:50

And it's never turned off .

13:51

It's never turned off and it's never too early

13:53

for parents to learn and to become advocates either

13:55

. So , birth to three , we're using

13:58

a parent coaching model in which

14:00

I don't actually even want the child to

14:02

pay attention to me on the screen . I

14:04

am the coach or the provider is the

14:06

coach . I'm the expert in the listening

14:09

and spoken language content and

14:11

the parent or caregiver is an expert in their child and

14:13

they are the interventionist . They are

14:15

the interventionist . They are there with the child

14:17

, doing in-person developmentally appropriate

14:20

activities with the child and I'm giving

14:22

feedback and suggestions and coaching

14:25

along the way to enable

14:27

them to have those activities

14:29

and interactions hit all of our goals . So

14:32

the child , hopefully

14:34

, is not engaged with their provider because

14:36

it's not developmentally appropriate for a nine-month-old

14:39

to chat with someone on Zoom .

14:41

Right , they're very advanced .

14:45

And at times , even if it's distracting , I

14:47

can turn my camera off and just talk to the parent

14:50

, and if that becomes distracting

14:52

, the parent may wear one like

14:54

AirPod or something so that I'm

14:56

coaching them in real time if the

14:59

audio and visual is just too distracting

15:01

for the child , and we can turn it on and off

15:03

as we switch throughout the session

15:06

. But for those early years

15:08

, people worry about screen time

15:10

and my baby can't pay attention to you . Well , I don't want

15:12

your baby to pay attention to me . I want your baby

15:14

to pay attention to you and I'm going

15:16

to teach you how to be their first and best teacher .

15:19

Now , while you were speaking there , I kind of wrote

15:21

down new parent and

15:24

a couple of weeks ago we had

15:27

Valley Gideons on the show

15:29

and she said

15:31

something that really , really profound

15:33

. She says it's a grief for what you

15:35

imagined , but this is true for

15:37

all parents . You do not end up with the

15:39

child you imagined . My gosh

15:42

. The first thing I thought of was some

15:44

of these parents you're working with and caregivers

15:46

you're working with . They might be first time

15:48

parents and trying to navigate this

15:50

, the amount of stress level that

15:53

they must have , but the work

15:55

you're doing is taking their stress levels

15:57

from 100 , maybe

15:59

I don't want to say all the way down to zero , but decreasing

16:02

it significantly .

16:05

That is a primary goal . Yes , those

16:07

early T visits , for sure , the

16:09

early sessions I would say

16:11

most to all of the parents are

16:13

going through some type of grieving process

16:16

.

16:17

Right , whether they're first time parents . Can you stand on that a little

16:19

bit more and talking about ensuring

16:22

that caregivers and parents are

16:25

being heard ?

16:26

Yes , and they often do not feel heard . These

16:29

parents are going to so

16:31

many appointments and

16:33

if they're first time parents , they're also learning

16:36

how to care for an infant , and if they're not first time

16:38

parents , they're learning how to care for

16:40

an infant while they have an older child , and

16:43

it is so overwhelming . The

16:45

vast majority of children with hearing

16:47

loss are born to hearing parents with no history

16:49

in the family . These parents rarely

16:51

saw it coming and even if they did , there's

16:54

a process . So

16:56

there is a grieving process

16:58

, not necessarily unique to hearing

17:00

loss , but for any kind

17:03

of identified issue

17:05

. That was not what you expected at your child's

17:07

birth , right ? I mean , it's very shocking . You're

17:10

expecting this one thing and then

17:12

you fail your newborn hearing

17:14

screening , you refer on it and

17:16

then it's a whirlwind of appointments

17:19

and APRs and all these things . And the

17:21

parents are really , really struggling

17:23

and I have the deepest

17:26

empathy for them because they

17:28

are asked to learn

17:30

an incredible amount of information that is

17:32

literally impossible to learn in

17:34

that short of a timeframe . In very short

17:36

appointments . They're usually seeing people for maybe

17:38

10 or 15 minutes in a million different specialties

17:41

, while they are massively

17:43

sleep deprived , trying to care for their

17:45

infant , who they love deeply but who

17:48

is not the infant they were expecting

17:50

and trying to reconcile all

17:52

of that . We have not set

17:55

them up for success . We have not

17:57

. And that's where I see

17:59

one of our most important roles

18:02

as their ongoing tele-service

18:04

providers , because I'm someone

18:06

they see every week , not like

18:08

their ENT , who they see here

18:10

and there , or their audiologist , who they

18:12

see more at first but then maybe not for months

18:15

or maybe they can't get in touch , or

18:17

maybe they can't get in touch with their early intervention

18:19

service coordinator . There's

18:21

a lot of challenges . So they have a lot of

18:23

questions because they heard this and they heard that

18:26

but they can't quite remember . So

18:28

they can bring all of those questions to

18:30

their provider , who they see every week , because they come to

18:32

really trust you . We

18:34

form this very close bond

18:36

and we do a lot of counseling

18:39

and a lot of education and I want to be careful

18:41

when I'm saying counseling , because we are offering a

18:43

ton of emotional support and

18:46

validating that what they're feeling is very

18:48

much part of the process and is normal . We're

18:50

often connecting parents to other parents

18:53

who have gone through .

18:54

That's phenomenal , yeah .

18:55

And I'll say , oh my gosh , this is so similar to a

18:57

child . It's community . It's community

19:00

and we've done virtual parent groups

19:02

before and we look forward

19:04

to doing more of those in the future . But connecting

19:06

like oh , that's a really unusual thing that happened with your child

19:08

. I had a kid like that three years ago Let me call their

19:11

mom and then , at times , making

19:13

referrals . And that's why

19:15

I was so thrilled to hear about your partnership

19:17

, because parents sometimes do need

19:19

more support than that , because this is

19:21

an incredibly stressful life

19:23

event . Having a child is an incredibly

19:25

stressful life event and having a child

19:27

diagnosed with any disability is an

19:29

incredibly stressful life event . And now we've done them

19:31

at the same time . That's unusual . That's

19:33

unusual . Most disabilities are not diagnosed

19:35

at birth .

19:36

You cannot see the picture when you're in the frame

19:39

, and empathy is a

19:41

. It's so essential to just

19:43

to implement empathy

19:45

, because you don't know what someone's going

19:47

through , and I personally can

19:50

only imagine what that is like .

19:52

Right .

19:53

And really sharing all of that really .

19:54

My pleasure I have to say it's , it's one

19:56

of my favorite parts of my job is working

19:58

with new parents . They always apologize

20:01

and cry and I say they all cry . Everyone cries

20:03

Like it's and you

20:05

know , every parent I meet with Christ , I do all

20:07

of our intakes , so I meet all of our parents through

20:09

the first time . There's never a dry

20:11

eye and that's okay . I'm here

20:13

to hear you through that .

20:15

It's essential to to measure

20:17

progress , if you will and

20:20

I remember when I was in graduate

20:22

school , you had your pen

20:24

and maybe your soap notes and your

20:26

your- marks . And

20:30

then you're , you're , you're calculating how well

20:33

they did in the session , and that's important because

20:35

you know you don't want piece of technology

20:37

that's going to distract the child you're working with

20:39

Right , so you need to implement

20:41

a writing . Implement if you will , but

20:44

what strategies or tools

20:46

do you and your team use

20:48

to assess and monitor

20:51

a child's progress through

20:53

telehealth ?

20:54

Yeah , so we definitely still do that . I'm definitely

20:56

still marking down as I go taking , you know

20:58

, taking data points . Yes , so we

21:00

do do that . For sure you

21:02

know how many childs , et cetera , using

21:05

our old school markings . But we

21:07

also use a combination of assessment

21:10

tools at regular

21:12

intervals and then an ongoing basis , because

21:14

it is critical to

21:16

to measure progress and

21:18

to make sure the child is hitting expected milestones

21:21

and then to adjust our our program

21:23

if they're not right . Our goal is

21:25

to close the gap Right , so we need to make sure

21:27

we're doing that . The way we do that is we

21:29

use norm reference assessments to

21:32

compare the children to their same

21:34

age hearing peers so we can

21:36

see how much of a gap is there when

21:38

we start and are we working

21:41

toward closing that gap ? Are we making more

21:43

than month for month progress ? If there's a gap , you

21:45

need to make more than one month progress in one month's

21:47

time , but there's always going to be a gap . So

21:50

those we do every six months to ensure

21:52

we are closing the gap or maintaining

21:55

appropriate functioning or

21:57

exceeding right . Our goal is for the child

21:59

to meet their full potential , not just

22:01

average right . It's for

22:03

the child to meet their full potential , but that keeps

22:06

us really making sure that they

22:08

are hitting the level of their same

22:10

age hearing peers so they can join a mainstream

22:12

setting as early as possible . We

22:15

also use a lot of criterion

22:17

reference assessments . This is giving you

22:19

flashbacks to grad school

22:21

.

22:22

Yes , yeah , I felt my

22:24

BP just go up a little bit there . Yeah

22:26

, a little bit .

22:28

I won't go into all of them , but of course we use

22:30

the language measures , but we use

22:32

a lot of measures for specific auditory

22:34

skills and then we use a very

22:37

detailed progress monitoring tool that

22:39

looks at every domain of listening

22:41

and spoken language , social communication

22:43

, audition , speech . That

22:46

breaks it down in three month developmental

22:48

intervals and we do that with the parents

22:51

to see which skills

22:53

they have , which are they missing

22:55

, and then with the parents , we jointly

22:57

select from those missing skills what

23:00

are our current goals , and

23:02

when the child has mastered those we just update it again

23:04

and pick new goals . So the

23:06

parents really feel ownership in

23:09

the evaluation , progress monitoring

23:11

and goal setting process and we

23:13

ensure that everything we're working on

23:15

is functional for the family . And then

23:17

for the school age students it's a little different , but

23:20

we monitor progress on IEP goals

23:22

, academic performance , and then we

23:24

assess in accordance with every district's

23:27

requirements . So whatever that district requires

23:29

, we find a way to do it via tele-service .

23:32

Again , you cannot manage

23:34

what isn't measured .

23:37

Exactly .

23:38

And to share this data with the parents is so important

23:40

, because any progress is progress

23:43

and especially , to your point we were just

23:45

talking about new parents when they see this progress

23:47

being made and these progress reports

23:49

. They're so important .

23:50

You're tracking they're so important

23:53

and that's why I love I can send them a PDF

23:55

that shows , when I check the dates , that I checked

23:57

off new skills . So even if we've

23:59

only been working together a couple months and I probably saw

24:01

a bunch of random new skills here- and there , right

24:03

, or we talked about it . Then I can send them a PDF

24:05

and say look for all of the October ones . That's

24:08

everything new that he

24:10

did just this month and

24:14

they can really see that in context of

24:16

typical development .

24:18

And if you think , let's just say , within this

24:20

month maybe they've had , let's just say

24:22

, one session per week , but the carryover

24:25

that they're implementing , that's a huge

24:27

win for the caregiver

24:29

. That's so exciting . So we know

24:31

where we are today with telehealth

24:33

services . Let's talk about the future

24:35

. In your opinion , professional

24:38

and personal , what does

24:40

the future of hearing , health care and

24:42

speech services look like

24:45

in terms of accessibility

24:47

and advancements ?

24:48

What do you see the future is really

24:50

bright , but it's going to take work to

24:52

get there . That's what I see . I

24:54

see more and more adaptation of

24:56

an adoption of tele services

24:59

across our field . I

25:01

think that audiologists and manufacturers

25:04

have really been at the forefront of

25:06

this and I can't wait

25:09

to see the developments that keep coming

25:11

out of those spaces , to see some

25:13

of the distance technologies and

25:15

the apps that are being used

25:17

by audiologists and manufacturers now . I

25:20

don't see that slowing down .

25:22

I have to dovetail there . The caregiver

25:24

is very important and what

25:27

I think is really cool . So Starkey

25:29

does have a caregiver app , which

25:31

is wonderful and really it brings

25:34

the caregiver along the

25:36

journey with whether it be their

25:38

mother or father or whoever , so

25:40

it does create that accountability as well to

25:42

walk with that individual on their road

25:45

to better hearing . So I love that you

25:47

brought that up because , yes , it is incredibly

25:50

bright . We need to create greater

25:52

access , but the access

25:54

needs to ensure that the professional

25:57

is still part of that equation , in this

25:59

instance , the speech language pathologist

26:02

very important .

26:03

But also the audiologists we're very

26:06

aware of that because I cannot do my

26:08

job without optimal audiological

26:10

care . I cannot . If we don't

26:12

have optimal access , we will not have optimal

26:15

speech and language . It's not possible . So

26:18

I think to ensure

26:20

that the future stays so bright for

26:22

both audiology and tele-services

26:25

, in terms of teachers of the deaf and speech pathologists

26:27

, we really need to unite . I

26:29

mentioned in last week's episode Ash's Interstate

26:31

Compact . That's really important , but

26:34

I also think that lobbying for insurance

26:36

reimbursements for

26:39

different states recognizing

26:41

tele-services , recognizing out-of-state

26:43

licenses we're going

26:45

to need to do a lot of work

26:47

in our professions jointly

26:49

to ensure that

26:51

we can use these amazing tools

26:54

with appropriate

26:56

reimbursement , legal backing

26:58

, et cetera . That's where I see

27:00

the biggest need and the biggest opportunity

27:03

.

27:04

And I think that we're going to make a lot of noise

27:06

now as we and

27:08

fellow professionals continue to

27:10

raise awareness of the importance of

27:12

communication sciences and disorders

27:15

. But before we sign off , today

27:17

you brought up a really cool

27:19

statistic about tele-services

27:23

. You had a third-party

27:25

run a survey . But this question has

27:27

to do with maintaining strong rapport

27:29

. I remember in grad school our professors

27:31

would always ensure you build

27:34

a strong rapport not only

27:36

with your clients but also the

27:38

caregivers as well . How

27:40

do you do this during a tele-health session

27:42

, because maybe the first session you

27:45

might be meeting this person for the first time and

27:48

everyone has a different personality

27:50

style . Do you have any tips for

27:52

other practitioners in establishing

27:55

this connection ?

27:56

I do , because this is the cornerstone . Without

28:00

that strong rapport , you're going

28:02

nowhere in tele-health . I have to

28:04

be honest with you . But here's the great

28:06

news it is actually

28:08

pretty simple to establish that rapport

28:10

if you know what you're doing . So

28:12

, as I mentioned before , you do need

28:15

to get that education

28:17

in adult learning theory and in coaching

28:19

. You need that before you can

28:21

start this . You cannot dive into teleservice

28:24

without some type of training

28:26

in that . Specifically . Now

28:28

, in terms of establishing rapport , I

28:31

believe the most important step is to

28:33

set appropriate expectations from

28:35

the very beginning , regardless of who

28:37

you're working with . So that may be a school-based

28:39

team , that may be parents

28:42

or other caregivers , whoever

28:44

it is . I always hold

28:46

an introductory session without the

28:48

child present because I want

28:50

to set up that family or that school team

28:53

for success . If they don't

28:55

understand that we're going to be using a coaching

28:57

model , well , that first session is going

28:59

to be pretty rough , because

29:02

they're looking at me like when are you going to start screen

29:04

sharing for this two-month-old ? And I'm looking

29:06

at them like why don't you have toys out

29:09

? So it's explaining

29:12

in depth why do

29:14

we use a coaching model ? What

29:16

is a coaching model ? What is my role

29:18

? What is your role ? Giving them ample time

29:20

to ask questions about that . They ask a lot of questions

29:23

like what does that look like ? What happens if the baby

29:25

falls asleep ? Or , like in a school , what

29:27

happens if the para is out sick

29:30

? What do you think , Because he's seven , could he do it on

29:32

his own ? Talking about talking

29:34

through all of those things and

29:36

really making clear what each person's

29:38

role is going to be anyone who might be participating

29:41

so that could include a grandparent or

29:43

a nanny , and so the child's

29:46

family or indoor school team truly

29:48

understands what is this session going to look

29:50

like ? And so there are not surprises

29:52

. If you go into this thinking

29:54

like I'm going to do a parent coaching model

29:57

, but you don't set the stage , it

29:59

really falls apart and you

30:02

want to get really granular . Where is

30:04

this going to happen ? I always do this

30:06

on whatever platform we're going to use , like

30:08

Zoom or whatever platform a school

30:10

may require , and say , okay , let's go

30:12

to where we're going to do this session , because the

30:15

school may realize , oh , we don't have a

30:17

room with high-speed internet connection

30:19

that's not really noisy , and so then we're

30:21

going to troubleshoot that . Or we may be in

30:23

the home and we say , okay , we're

30:25

right , by a window unit , so

30:27

let's take a look around . And you

30:29

troubleshoot all those technical and logistical

30:32

issues before the kid is even there .

30:34

That's excellent . Now that

30:36

probably saves you and the

30:38

caregiver so much time and frustration

30:40

, because it is setting those realistic

30:42

expectations . Now I want to

30:44

thank you so much for joining us on

30:46

this two-part series . We have

30:48

to have you back on the show in the near future

30:51

. Before we sign off , what

30:53

advice can you give to speech

30:56

language pathologists , audiologists

30:58

, who aren't there yet

31:00

implementing telehealth , but

31:03

want to take the next step ?

31:05

Don't be afraid , but do your homework

31:07

. This has opened up a whole new

31:09

world to me and , in fact , a whole new role

31:11

for me , and it's been an incredible journey

31:13

and I think this is the future of our field

31:15

. I would strongly encourage

31:18

you to learn more about tele services

31:20

. We have on our website which

31:22

we can send to you for your show notes , with

31:25

a lot of resources for parents and

31:27

for professionals . We have a recorded

31:29

webinar that my colleague and I

31:31

did on tele services across

31:34

the age span from birth all the way

31:36

to graduating high school . That can give you some more

31:38

insight and there's

31:40

a lot of related resources there that can

31:42

set you up in the right direction . And

31:45

if you are a pre-service professional

31:47

, look for those tele service

31:49

opportunities , look for those counseling

31:51

and adult learning classes , if you can

31:53

take them , to be ready when this

31:56

comes your way , because this has

31:58

been an incredible honor

32:00

to be part of this movement and it is

32:02

the future of our field .

32:04

You're tuned in to the Hearing Matters podcast

32:06

. Today we had Nell Rosenberg

32:09

, who is the National Director of Tele

32:11

Services at Clarke Schools for Hearing

32:13

and Speech . Until next time , hear

32:15

life story .