Warren Estabrooks Presentation 1/21/2011

On Friday, I had the pleasure of attending a presentation on Auditory-Verbal Therapy by the esteemed Warren Estabrooks, M.Ed., Dip.Ed.Deaf, LSLS Cert. AVT, President and CEO of WE Listen International, Inc. Like all great presentations, I came away enlightened, challenged, and full of great ideas to incorporate into my practice of the art and science of AVT.  The course covered a wide range of topics which I hope to do justice in my summary.  Here’s what I learned…

 

Estabrooks used the analogy of a ship to describe how we can “Chart the Course” to success for children with hearing loss:

• It is only with parents that we truly chart the course.

• The parent is the captain of the ship, who hires the crew.

• The therapist is the navigator.

• The children are the precious passengers carried by the crew.

• We all sail together, charting a course for the future.

• We drop anchor at many ports along the way.  Each port is a transition to a further destination.

• At each port, we may rest, study the maps, and prepare travel plans for the next destination and take on supplies and more crew if needed.

• The ultimate goal is to reach the final destination where the child will take up sailing the waters of life on his own.

• Along the way, it will not always be clear sailing.  The winds of hope and fear may collide to create storms, but the weather will improve and beacons will guide parents along the shores.

• The vessel is made of the essence of love, care, loyalty, and virtue and through storms it will grow stronger.

 

Estabrooks gave a great run-down of how to craft lesson plans that are airtight and efficient.  He advocates having session targets (included in the lesson plan), short term goals (monthly or bimonthly), and long term goals (measured by evaluations every six months).  Session goals should address audition, speech, language, communication, cognition, and behavior.  Remember the acronym KISS: Keep It Simple and Specific.  Goals should be specific, measurable, attainable, realistic, and timely.

 

Throughout the day, Estabrooks spoke of “raising the bar,” saying, “Why would we ever compromise when so much is possible?”  Ways to raise the bar include:

 

• Help parents learn not to “rescue” right away — give the child time to process, think, and come up with his own answer or solution.

 

• Professionals should be familiar with Erber’s hierarchy of detection, discrimination, identification, and comprehension.  All steps are important, but, from the beginning, we have our eyes on the prize of comprehension — of complex spoken language — through audition.

 

• Say it ONCE and wait.  Then wait some more.  Then wait until it hurts.  Then ask, “What did you hear?” and give the child a chance to fill it in for himself (auditory closure).  If you repeat it fourteen times with gestures, how on earth do you know if the child understands the sentence auditorily in the first place?

 

• If the child has a speech or grammar error in his sentence, model only the incorrect part and have him fill in the rest himself (more auditory closure practice).

 

• Present the stimulus (word, phrase, etc.) with normal intonation several times before going to acoustic highlighting.  Give the child a chance to decipher it himself before breaking it down and making it more audible through highlighting.

 

• Wait to see if the child spontaneously alerts to sound instead of constantly pointing and asking, “Did you hear that?”

 

• Limit or discontinue use of noisemakers.  They are processed differently than speech in the brain, and our goal is hearing SPEECH, not the ability to find a rattle.

 

• More services in the mainstream is not always better.  Sometimes, for a child who is on-target with his or her hearing peers, more is just… MORE, and it may not be helpful if our ultimate goal is a child who is able to independently transact with the world through listening and spoken language.

 

Many times I attend a presentation and learn a few new things but come away essentially unchallenged in my overall philosophy of practice.  It is a rare and exciting time when I get to hear some new information that forces me to confront some of my beliefs and current habits and evaluate how I can push myself to the next level as professional.  This presentation did just that.  Some of the new ideas introduced were:

 

• Write session targets for the child, the parent, and the therapist.  (I usually write objectives for the child and what I want the parent to learn and do, but rarely put my goals for myself in writing — usually just in my head.  What a great way to hold myself accountable for growth as a therapist!)

 

• For the parent guidance portion at the end of every session, ask the parent, “How do you think you might do this at home?” and have him generate several suggestions BEFORE offering your own.  (I do this sometimes, but not nearly enough.  I tend to be too quick to offer suggestions, thinking parents might be too nervous to come up with their own.  I should have more faith in parents’ abilities and take myself out of the “teacher” role to act as more of a “guide.”)

 

• Don’t teach colors, numbers, or shapes explicitly.  It isn’t the best use of time if you have just one hour sessions each week.

 

• Keep in mind the hierarchy of development of localization — are your goals for the child’s localization abilities in sync with his hearing age?  (I knew of this chart but did not consistently incorporate it into my work on localization with new listeners — bad me!)

 

• Don’t teach clarification strategies.  Children will learn these on their own because parents naturally use them when trying to understand their young child’s unintelligible speech.  (An interesting premise, one that I think would certainly be true for young children who have early, excellent access to sound.  I would love to do some research on incidental learning of conversational repair strategies to test this out with older children!)

 

• And… THE HAND CUE.  One of AVT’s most recognizable, and controversial, tenets.  This deserves a post of its own… stay tuned!

 

Overall, it was a wonderful, enjoyable, challenging day.  I came away laughing, full of information, and inspired to continue to strive to RAISE THE BAR!