ROUGH EDITED COPY

EHDI – 2019 Viena for Engaging Parents in Early Intervention Sessions
12:30 – 4:30 p.m. ET
March 3,, 2019
Heather Wilson

CAPTIONING PROVIDED BY:
ALTERNATIVE COMMUNICATION SERVICES, LLC
http://www.captionfamily.com/

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This is being provided in a rough-draft format. Communication Access Realtime Translation (CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings 
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>> Strategies for engaging parents in early intervention sessions.  1‑ 4:30.  
>> We're having some relatively significant technological issues that we're trying to resolve so just bear with us for a few minutes.  
	Okay.  Let me get my clock going.  We're going to go ahead and get started and just know that some time in the next half an hour, some helper person is going to come in and start messing with the computer because the audio cord is not working.  He's going to change it out and we don't need the audio for thirty minutes so he's going to be up here with me doing his thing and then we'll check it after he connects it.  
	Welcome!  This presentation is strategies for engaging parents.  Just do your thing.  Strategies for engaging parents in early intervention sessions and my name is Betsy Moog Brooks and I'm with the Moog center for deaf education in St. Louis.  
	These are the learner objectives.  I'm not going to go over them.  For those of you who want to have a copy of the PowerPoint, I was told in the speaker ready room this morning that the PowerPoint was available.  Has anyone been able to access it?  No, okay.  So he thought it was available.  I'm hoping for you, that it will become available but maybe it won't happen until after the presentation.  Yes?  
	You're asking someone who never goes online to get those presentations so it's my understanding that we upload the presentation and then they become available.  So have you been able to access any other presentation you're going to?  No?  Okay, so it's not just mine.  I apologize for that.  The presentation is not yet available.  All right.  So what I would like to do now is tell you a little bit about myself and then just get to know you a little bit so that it can help me form what I'm going to say as we move through the afternoon.  
	We're going to be spending quite a bit of time together and I'm hopeful as we move through the day, we'll become a little bit more relaxed in sharing information and figuring out ways to better engage our parents.  That's really what this is going to be about.  So as I said, I am at the Moog Center for Deaf Education in St. Louis.  It's a private school that teaches spoken language.  The thing to know is that all of the principles of this work that we're going to talk about today apply no matter what mode of communication you're using.  So there's nothing that I'm going to talk about that wouldn't be appropriate if you were using sign language, no matter what you're doing.  
	So it really is something that can apply to everyone.  So to help me address you, I just want to ask you a few questions about yourself.  Are there any parents, not parents just in general, like I'm a parent, but a parent of a child who is deaf or hard of hearing?  Okay.  I pause and stare so I can remember that in my head to address you.  Sometimes I get really lucky and all of the parents are at a table together but you're right if line with each other so that's perfect!  
	What about teachers of the deaf?  Okay, so you spread out all over the room because you're the people who want to get to know other people.  Okay.  
	Speech pathologist?  Okay, you can raise your hand more than once.  I'll accept that.  Are there any other EI providers, support people that I didn't call on?  And what kind of a provider are you?  Oh, service coordinator, thank you!  Same thing.  Service coordinators and in the back?  Okay, so for the captioner.  Her response is she supervisors the therapist and coordinators.  So some supervisors, yes.  Oh, that's cool!  A teacher consultant for the deaf and hard of hearing.  A state part C coordinator.  Oh, that's kind of exciting that you came to hear me speak.  Anybody else I missed?  You said you were a parent.  Oh, early childhood family liaison.  That's a really good thing you're a parent and early child.  That's great!  That gives you a lot of cloud.  Anyone else?  Another parent with a dual responsibility.  Anybody else?  
	Okay, so I can't repeat all of that.  Just a second.  So for the captioner, tell me again.  Start in the beginning.  Works for the state Department of Education, and a liaison with the part C program, and I support service coordinators, and she has a case load herself, and monitors children with hearing loss.  Thank you!  
	Okay, now I have another question.  How many people in the room are providing service for spoken language?  So the service you're providing is spoken language?  
	How many for sign language?  Okay.  And be what are the rest of you doing?  If you're not using spoken language or sign language?  Did you not understand my question?  Oh, augmentative communication.  Thank you!  I didn't even think about that.  Okay, a few.  So was my question not clear?  So what I'm asking is, in the service you're providing to the family, is that service for the development of spoken language or for the development of sign language?  So I ask, for those who are providing it are both?  I expected you to raise your hand two times.  Sorry, that's really bad semantics on my part.  
	So just, I just want to see the spoken language people.  So the spoken language?  Okay, I said that wrong again.  If you're providing service for spoken language, raise your hand.  If you're providing it for sign language, you will raise it a second time.  
	So if you're providing service for spoken language, raise your hand.  That looks more like I expected.  If you are providing service for sign language?  Okay.  Perfect!  All right.  Thank you!  So it's a good thing that it supplies to sign language or I would be sunk.  
	Next, I want you to write down one thing that you hope to learn today.  I'll give you just a minute.  You can write it in your head, it's okay.  Okay.  Is there anyone who is willing to share and so let me just preface this by saying if you share, the likelihood you will learn it today will increase significantly because I'll know that's what you came here to learn.  So that would be great if anyone wants to share.  
	Yes, thank you!  I need to explain for the captioner.  She said she would like to learn how to engage the parents, specifically so that they stay engaged and they don't get up and move around the room and go and do chores.  Is that fair?  Or just watch.  
	You came to the right talk.  That's perfect!  Anyone else?  Yes?  So she says that her idea is similar but that what she recognizes is the parents refer not to participate.  We're going to talk about that 
>> Same idea but I would like to add the families are given more task with their phone, like using the phone while they're sitting ‑ ‑  a lot of them are typically on their phone and aren't really involved.  They will take a phone call.  I see it happen and it's kind of rude, hello?  I want to get them more involved.  
>> Yes, in the back?  Can you see my face?  If we have time to get into that, I can get really cranky so that might be something we should safe for the end because I might end up on a soap box, preaching why we're doing this, et cetera, et cetera.  
	In the state I'm in, we have a lot of clout.  In our state we, even if we're not the primary provider, we sort of function as such because if we recognize that the child's hearing loss is an issue, then our state has just allowed us to take over.  
	Let's save it for the end and just remind me at the end.  I left a big chunk of time at the end so just bring it back up and then we'll go back to it.  I'm more than happy to discuss it.  Will you speak up a little bit?  
>> I hope to learn today, one, how to engage families who are still working on acceptance, finding out about their child's hearing loss.  And when they do engage and accept early intervention services, they have difficulty choosing a program because it's spoken language and non verbal communication and ASL and it's all brand few to families and it's overwhelming.  
>> Okay, you may find an opportunity to bring those questions back in during the presentation but if not, then at the end, please feel free to bring it back up and we'll talk about it.  Yes?  
>> How to engage families when the child's hearing loss is not so significant that it's affecting other development.  Why is it so difficult for professions to give parents all of the correct information at the same time and we got an amen on that!  
>> Wow!  I think I share your frustration.  I really share it related to pediatric audiology.  It's ‑ ‑  yeah, I'm speechless which doesn't happen very often.  I think we're going to ‑ ‑  you're going to see a lot of video and hear a lot and get a lot of statements from parents, other parents today that I'm hoping will spark some conversation and help professionals in the room understand that parent perspective so I'm glad that the two of you are here to be able to say that and if you're willing to share that perspective, that is fantastic!  So hopefully we can address that a little bit.  I think one of the biggest problems is, professionals don't know.  
	I think that what happens is professionals bring their own bias to a situation and so being honest and being diplomatic becomes challenging because you have a bias.  If you you're not interactive and you don't recognize it, it makes it challenging provide information related to, whatever the topic is, unbiased.  I think that's the problem.  
	And then I think a lot of professionals have difficulty recognizing it's okay to say they don't know the answer to the question.  They start talking and then get themselves in a hasn't hole and it just spirals into badness.  Okay, anybody else before we move on?  Yes, one more.  
>> So her question is related to research to address parents that are teens and or culturally different.  
>> So most of what I'm presenting today is research.  At least it's research based and I think there is not very much written about ‑ ‑  well, I don't know if there's anything written about providing coaching to parents of children who are deaf or hard of hearing.  So there's coaching, a lot of current literature about coaching and we're going to talk about that.  Rush and Sheldon are probably the premier thing that we're following but related to, I did my dissertation work about two or three years ago and when I did it, there was nothing in the literature about coaching families of children who are deaf and hard of hearing.  So my research was about that but it's very ‑ ‑  it was a dissertation project so the research was this big compared to needing to be this big.  
	I did not, because when you're doing your dissertation, you try to focus on the smallest thing you can, I did not do anything related to the different populations.  I just really was looking at how can we change the level of engagement of parents.  So that's essentially most of what we'll be talking about today.  
	I think that the cultural differences, I think one has to just at this point, take what is written about cultural differences and over lay it on to working with families.  
	My personal experience which is relatively expensive because I'm kind of old is that it is the provider's impression that teen parents or poor people are not capable of doing what we want them to do and my personal experience is, and this is a generalization.  So of course, there's outliers of people for whom it doesn't apply is that when I enter a situation with expectations, whoever is in front of me most often, 85 or greater percent of the time, rises to that occasion.  
	So my 16, 17, 18, 19 year old mom, if I put it on her, she rises to the communication.  She might rise with attitude but she rises to the occasion.  I have done quite a lot of work in South America, and the people there are either the poorest or poor or wealthy.  
	So when I was doing work with the school there, they said, you're never ever going to be able to get the poorest of poor to come.  I said, oh, they'll come because that lady from America is coming.  So the parents came and the school personnel said ‑ ‑  we did a support group.  It was very large!  Like 35 people in a support group so the wealthy had to sit in the room next to the poor or the poor next to the wealthy.  Every single person in the room shared and the school people were just shocked.  They said, we have never A, gotten the poor to come and we have never gotten the poor to talk.  My comment was, have you ever asked them to?  
The response is no, because we didn't think they would come.  So I think that of course, it's not always going to work.  Believe me.  I have done it long enough that I have had parents fall asleep when I was speaking to them or parents I couldn't find in the house.  I had a set of triplets and she left me with all of them and I'm like, running around the house trying to find the mom and she's going outside to garden and I'm supposed to be doing a session with her.  
	I can't imagine that you could tell me a story that I couldn't at least relate to but in general, I think, just as we do with the children, if you raise the expectations somehow, the children seem to meet it.  I think it's true for adults.  
	If you raise your expectation, they will ‑ ‑  if you build it, they will come.  If you raise the expectation, they'll rise to it.  I'm not saying every single time but I think for the purpose of today, the thing to think about, always think about the family or the parent with whom you have a reasonable relationship with already and if there's something you want to do to affect change, do with that person or those people.  
	Don't pick your 18 year old mom who is mad that the dad left her and is living with the house with the parent.  She's not going to be the person that you want to practice your new skills on.  
	Practice new skills and be new ideas on the person that you can say to them on the front end, I went to a presentation, I heard this lady speak.  I think she has some good ideas.  They seem crazy but I want to try them.  I want to try them with you but in order to be effective, I need you to give me feedback.  We're going to do this together.  
	You need to do it with someone you have enough of a relationship with, that they will comply.  They'll participate and give you honest feedback to change what you're doing.  Once you have figured it out, then apply it to the 18 year old mom.  You'll set yourself up with failure if you're doing it the other way and you'll increase your likelihood of success if you do it the way I'm suggesting.  
	Let's move from that.  So I have gone through some of this already.  I did any doctoral work in 2017, 2018.  So the ideas and concepts that we talk about today come from that.  They come from information and comments provided by parents and grandparents and other caregivers who have engaged in parent support sessions at the Moog Center.  
	Some of the information is provided by the teachers.  So in our center, we have a birth to three program.  We run at 75 children between birth and three at any given moment in time.  And there are always about 7 teachers who are teachers of the deaf who are providing what we refer to as parent support sessions to our families.  So they're the ones whose comments were included in my dissertation and included here.  
	As well as I did a Webinar for a website, an internet site called hearing first.  If you are not familiar with hearing first, then I suggest that maybe you look it up.  It's hearing first.ORG.  There's a professional community and a parent community.  I don't know a lot about the parent community because as a professional, you're not allowed in.  
	The two who are parents and professionals can do both but on the professional side, it provides a lot of opportunity for professional development and learning and to the one back here who asked about the multi‑ cultural things, you could pose a question to the community and probably, if you said, is there any research about multi‑ cultural issues related to XY and Z.  People would respond and then you would have your answer and you wouldn't have to do all of the leg work.  
	I just highly recommend if you are interested in a new research with yourself, this would be a nice thing.  So I did a Webinar related to this topic and so some of the information you're going to see is the information you will use in that Webinar.  A lot of the videos are branded hearing first because they captioned them for me.  Okay?  
	So that's where it's coming from.  As I said a little bit, I have more than thirty years working with families.  I still provide direct child service.  I see a few children face to face.  I see a few children via the internet.  I provide at the service ‑ ‑  I'm in the doing the service with the child over the internet.  I work with families and do quite a bit of family support and counseling with families again.  I mentioned my doctoral study and my focus was engaging families in sessions, essentially, for enhancing the development of spoken language for their children.  
	Again, everything I'm talking about will work exactly the same if you were using sign language.  I only know enough sign language to be a little bit dangerous.  
	So the research background for what we're going to talk about today, as I mentioned before, there's a lot of research about parental engagement using what I refer to as realtime embedded coaching during parent child activities.  
	I'm going to explain it in a minute.  There isn't much research or at least none I could find at the time related to specifically working with children who are deaf and hard of hearing.  So I'm having to take what I learned from the research about other children and over laying it on to what we would do for children who are deaf or hard of hearing.  Then as I mentioned before, Rush and Sheldon have done great work.  I was there for providing protocol for providing parent support and we were doing a fine job.  I was very frustrated.  I knew we should be doing something else.  I just didn't in my gut feel perfect.  I spent about a year and a half traveling around the country visiting every program that I could think of and I was sure I was going to go to a parent and say, oh, that's the most brilliant idea.  I'm so mad and didn't think about it and it never happened.  
	I traveled the country and I never saw anything that looked better than what we were doing.  It didn't happen until I was doing my doctoral stories and reading Sheldon.  In 2008.  I started looking for a way to change.  They published their handbook in 2011.  I'm cranky because they have a whole lot of money and I'm back in the same place giving presentations for nothing.  
	So what I did learn from Rush and Sheldon is that one component of their coaching protocol included to what is referred to as reflection.  We're going to talk a little bit about today.  It's something we weren't doing at the time and quite honestly, it made a huge difference once we added it.  We're going to talk about a little bit about the things it includes.  Those are some of the things that causes families to be engaged.  
	So let's just talk briefly about an early intervention session.  Let's start by raising your hand so I can let the captioner know if she can't hear you.  What are some components, when you do a session with a family, what are some components of the session when you lay out your legislation?  Yes, planning!  Anybody else?  Is there anybody else doing sessions?  You may have some ideas.  
>> Working from the outcomes so family based.  And then we make the accommodation from there or match up from a family from there.  
>> All right, so you're talking to the family about the outcomes.  
>> Begin with a review of the session and what we did before and ask them if they tried what we discussed and was it positive or negative.  
>> That's great!  That's a really nice way to start.  Whether or not they tell you the truth is up to them, right.  You can see if they're telling the truth.  If once you're in the habit of doing that, they become accountable.  We're going to talk a little bit about making parents accountable even though it's really hard to do because it's easier to be in charge than you know what is going on.  
	But making parents accountable and one way to do it is if you review at the beginning of the session, what you did last time, and sort of the homework so to speak that you gave to them, then after probably the third time, they know that's what you're going to ask and they don't want to say they didn't do it.  
	So they're going to start doing it, even if they do it the morning after they showed up.  At least they did it one more time than if you didn't ask them.  Anything else?  Any components of a session we didn't cover?  
>> Checking with the family about what they want to do that day so they can focus on what they want to focus on.  
>> Okay, that's a great idea!  Some of the things I would say happen in a session is, if the child is using amplification that you would be checking the device to ensure that before you start doing whatever you're going to do, that the device works.  That you would perhaps, gather information which is what both of you said.  The information gathering could be related to a lot of different things.  What has happened since I was last here?  Is there anything on your mind?  Is there anything in particular that you want to talk about or do?  
	Sharing of information.  You might have information you want to impart on the family or you know, maybe they asked you about resources or they have asked and you said, okay, I'll get those and bring them next time.  Or they have asked you something related to audiology or the device and you need to get more information and bring it next time.  
	You may be doing a demonstration.  Maybe there's a skill or technique or strategy that you want the family to implement and in order to make sure they understand what you mean, you're going to demonstrate what you're going to do or it may be that you're going to observe the family doing something.  
	So I refer to that observation as the coaching session and at the Moog Center, we have some, when we go in the home, we have 60 minute sessions and the teachers in theory are obliged to dedicate 20 minutes of each of those sessions to this, what I'm going to refer to as coaching.  
	Now, they might dedicate more than that.  They need to dedicate twenty minutes and again, there's always the exception.  So to what this woman in the back said, if the family is in a crisis or they need some information or they have another plan, then you might not do your coaching because they have something else that needs to be addressed.  
	If you're going to write a textbook and say this is what we're going to do, that's what the page would say.  So that coaching might look very different than what many of you are used to.  So to briefly explain it, I refer to what I use today do as traditional coaching.  I refer to what I do now as real‑ time, embedded coaching.  
	So by traditional coaching, we have sort of a ‑ ‑  I don't mind to be insulting but an older audience in here.  There's not a lot of 22 year olds, I don't think.  So you all can relate to this I'm sure.  When you did your student teaching or your practicum or whatever you did.  Someone gave you instructions and said, this is what I'm looking for.  You did it and then the person watched on the yellow legal pad and said all of the things you did well or didn't do.  
	They never talked to you while you were teaching.  They just let you go.  When they finished, they turned that pad of paper around and put it in front of you and you looked to see if there was anything good and prayed there wasn't a lot that was bad.  
	At that moment, the person started telling you, things you could do differently.  As that person is telling you in your head, you're thinking, I did that.  In your head, you thought you did.  Oh my gosh.  I need to stand back from that microphone.  
	So I know this because it still happens today.  I have ‑ ‑  we video tape quite a bit and I'll say to the teachers, I will need an example of reflection.  Or an example of coaching because this is true.  An example of coaching where you are making a lot of comments to provide feedback to the parent and a teacher comes running into my room and she puts my disk on the table and says, this is the best example you'll ever get.  
	This is a true story.  She leaves and I put it in my computer and start watching and at in time in the twenty minute video does she actually ever say anything.  The teacher has not spoken a word.  This is a really really skilled teacher who has been doing it for a long time, who definitely believed she had provided feedback.  
	So I'm going to tell you in a minute what was happening.  So I called her back be in my office and said, did you watch the video?  She says, no, why?  
	I said, I'm going to put it in my computer and you're going to watch.  As she's watching, she can't believe what she sees.  What happened is in her head, she was talking but nothing was coming out of her mouth so it looked like this.  Sometimes she would even mouth the words on her lips but no vocalizations.  For twenty minutes, okay?  She said oh my gosh, I wonder how often that happens.  So one of the reasons is that she's not affecting change in her parent is because she's using traditional coaching because she's not saying anything when they're teaching, when they're working with their child and then at the end, she says, how do you think that went and the parent doesn't really know because she doesn't provide any feedback when the parent is doing it.  I think this happens all of the time.  I'm going to show you an example of what realtime embedded coaching is supposed to look like so you can see what it should be is that it while the parent is engaged with the child, you're providing live feedback.  So that the parent can change what they're doing and then see the result of that right away with their child.  Okay?  
	So we're going to see it in just a minute.  So goal of coaching is to identify the skills and capabilities within the person if you actually coach and you ask the person to do something slightly differently, and they do it, then you know they're capable.  
	If they don't do it, it doesn't mean they're not necessarily incapable but in the moment of telling them what to do, they're not capable but it you practice outside of the session, they could become capable within the session, okay?  
	You want to develop the skills that the parents have so they can use those skills to the best of their ability.  And in doing so, you're ultimate goal is to increase the parent's independence so they have less reliance on you.  We all know, if they're providing service once a week, what is happening on the other 6 days and 26 hours.  So if you can get a parent to develop a skill, even if it's one skill and practice it while we're gone, that's way better than only practicing it for the one hour while we're there, okay?  
	This is just a slide that explains how adults learn best.  You can read.  You're going to know all of this.  If you're interested, there's better results.  If you're actively involved.  So if the adult is actually doing it and you're not doing it or talking about it.  If they feel valued and respected.  That's a typo, I'm sorry.  
	If they're successful and they feel safe.  So you're going to have to establish some relationship for them to feel safe.  If they see an immediate application to real use.  So if you're going to do an activity and you're going to explain, let's work on eye contact.  Eye contact is an easy one.  We're going to work on eye contact and you talk about how to achieve eye contact and then while the parent is working with their child, you cause them to get eye contact, who wouldn't come back for more?  
	So when you talk about how we get parents to be engaged, what we really need to be thinking about is, why aren't they engaged?  If you think about why aren't they engaged, so what about the parent that when you get to the house, you know they're home.  You can see the car in the drive way.  You can hear people inside and they don't even come to the door, okay?  
	Your first reaction is, oh, these parents are so frustrating but your real reaction should be, why is it when I come to the house, they don't open the door?  Why aren't they opening the door for me?  What am I not providing that prohibits them from wanting to open the door.  
	What can I do differently that makes them be waiting at the door so that when I knock, they're so excited that I'm there?  And again, what you have to think about is, whatever you're thinking in your head is going to apply to this group of people.  There's always going to be the outlier.  There's always going to be the exception.  There's always going to be the family that you have trouble reaching, okay?  
	But if you put your energy, don't ignore this person.  But if you put your energy into the group over here and you get all of those people engaged, think about the difference you can make.  
	Then you use what you have learned about these people to try on the people that are over here.  Okay?  
	Because there's always going to be the few people that it's not you.  But if you own it and go to the situation knowing it is me, I'm the one who is going to change, then you increase the likelihood of these people coming to your side, okay?  
	Parents also are going to learn better when they make connections and can relate to the experience and this really goes to, I'm not going to ask you to raise your hands but I'll probably know because you'll look on the floor.  Those of you who are still bringing your own items into the house or you're laughing out loud, one or the other.  We're going talk about this, talk about it a lot.  Teachers in school, we have a mandate, you're not allowed to take things in the house.  I'll go to somebody's room to borrow a toy and the toy is missing and I'll text, is the blah blah toy in the trunk of your car?  It's not supposed to be there.  
	They still have anxiety about what if I get there and the parents don't have a plan and what I would say is, then you will sit and look at each other.  If you rescue the parent by showing up with a toy that you're going to play with, with their child, you're not making them accountable and you're not doing them any favors.  If they don't feel a sense of responsibility to interact with their child, then you're not going to make them feel a sense of responsibility by showing up with a toy they don't have it in front of their house.  
	You're probably going to damage the situation more than you're helping it.  And they're really going to learn when they have some influence over their learning and that goes to what is it that you want to do, let's make a plan, those kinds of things.  They're vested and they feel some ownership.  All right.  
	So these are three of the components of a coaching session.  There's joint planning that happens in the beginning of a session so when you arrive at the session and you sort of have a plan.  You have come with a plan.  You explain what your plan is for the day and you review it with the parent.  
	So we're going to look at these three pieces of the session.  So the joint planning, I am focusing on in because I think this in and of itself could change the level of engagement for some parents.  I think traditionally we show up at the house.  We have a lesson plan because we should.  We have an agenda in the head and we know because we planned it, how many minutes we're going to explain on each thing and what our goal is for the day.  
	Many times we're not sharing that with the parent.  I want to suggest to you that if you share your plan for the day with the parent, and you invite their input, you will increase the likelihood of them participating probably tenfold because by asking their permission to do what you have planned, you have opened up the option for them to say, can we do this first instead of that or, instead of me doing it, would you mind demonstrating and then I'll do it after you?  
	Most of the time we don't actually offer that.  We just sort of show up and say, this is how it's going to be.  What I'll tell you is that based on the work we do now, it changed everything.  So not only do we show up with a plan that we ‑ ‑  like, I might have three or four bullet points on a piece of paper for me but then I'll say to the parent, you know, after we check the device and after we catch up on things, here's what I'm thinking.  You talked last week about really wanting some new ideas for playing with puzzles so we can do it one of two ways.  I can demonstrate how I would do a puzzle and demonstrate three different ways or we can talk about it and then I'll coach you doing the puzzle.  So you tell me which way you want it to be.  Then they get to choose.  So it's kind of like a two year old.  If you make them feel in charge, they're don't feel that way.  So if you give them an option, you get them to participate because they decided what to do.  
	That's what you have to think about.  How can I get the parent to buy in to what they're doing and to buy in, is making them feel responsible for it.  You pick what we're going to do and then you do it.  I think another incredibly effective thing to do is to put a time limit on each of the activities.  So it doesn't have to be exactly 7 minutes but it can be about 7 minutes so if you're going to do what I told you about, that twenty minutes of coaching, the parent needs to know when that is going to happen in the order of events because now, they're going to have to be engaged.  They cannot be passive.  
	They need to know the start time and the end time.  It's really no different than that child that we put ten blocks on the table for and after they complete each task, we throw one block away so we know the time is getting shorter and sorter or the child with a visual schedule.  After you do this, we're going to rip it up and throw it away.  Think about the level of anxiety that a parent has when you ask them to engage with their child in front of you, but what we know is this is the best way to make it work.  The best thing we can say is to have the parent engage with their child.  
	So we have to figure out a way to make that a semi‑ comfortable experience.  If they get to pick the activity, they get to pick how many minutes they're going to do it, and they get to pick when during the 60 minutes it's going to happen, the likelihood of them doing it is going to be significantly greater.  Okay?  
	So I would say add the amount of time to that as well.  Then, be really fair.  Explain to the parent the expectations.  I think this is another thing that we don't do very well.  We know what we're expecting them to do in our head.  So if we're going to demonstrate puzzles, let's say and in our head, we're thinking I really want to focus on repetition, I want to focus on these six words.  Think about, do you tell the parent that's what you're doing?  Have you said to the parent, I'm going to demonstrate how to do puzzles and in this first example, I want you to tally how many times I say each of these six words.  I'm going to do this activities for three minutes and then I want you to tell me how many times I said each of these six words.  
	Most of the time we don't do that.  We do the whole activity, we know we provided a lot of repetition and then we say to the parent, does that make sense?  Did you see what I was doing?  And of course, the only answer they can give is yes.  You have no idea if what they saw was the repetition.  Maybe what they saw is how you manipulated the puzzle pieces?  
	So what I'm suggesting is to engage them, engage them fairly.  Tell them, I want you to observe and this is what I want you to observe.  It can't be four things.  It needs to be one thing.  You're observing one thing.  That's all that I'm expecting you to learn, okay?  
	And then you need to be really clear about when is the parent expected to interact with the child and when are you interacting with the child so they know their role for whatever it is that you're doing.  So I might demonstrate the puzzle pieces and I'll say, I'm going to do the puzzle pieces first to demonstrate.  You observe and then pay attention to the repetition and then if you're comfortable with it, getting permission again, I would like to flip it so you can essentially do what I just did and what I'm going to do is help you use the same six words just like I did.  And then that's what I'm going to coach them on is using those six words and not anything else.  
	So that's really brief joint planning.  I could give a whole presentation on joint planning but I just wanted to give you the idea.  
	This is embedded coaching, it's the act of providing support through reinforcement while the parent is engaging with the activity with the child.  
	So it can occur before the session, during the session, after the session.  The video I will show you is what happens during the session.  So you just have to understand the parent and the teacher have already had a conversation about all of the expectations that I just talked about.  Now they're going to coach and then after this part, they would do a reflection activity and then joint planning for the next session.  Okay, all right.  
	When you do realtime embedded coaching, you want to coach a predetermined lesson.  There's going to be exceptions and in general, let me explain why.  This is very embarrassing I have been doing it for over 30 years because I spent twenty of them doing it in a really bad way which was, you show up at the house, you ask the parent what they want to do and then they do it.  They haven't practiced because you didn't tell them how to practice or we showed up at the house with a toy we brought and they haven't seen before or a book they have never read, and then we told the parent to interact with their child using the thing we brought in the house, that they could absolutely have never practiced because they didn't even have the toy.  
	We're not doing that anymore.  That was really bad.  We're going to forget about that.  It didn't really happen.  Now, we're going to decide in the session we're at right now, is what the parent is going to do in the next session so we use this session to talking about the ideas and strategies so if the parent chooses, they can practice for the next session and when we come and they do the coaching, they have decided what they want to work on.  
	So we're coaching with what they have in their house or if you're in a center, what they have brought to your center, not what you're pulling off your shelf because they forgot something or not rescuing them in the home and say, oh, that farm you had the other day, let's get it out again.  
	We're not going to do it anymore.  We're going to help them figure out what they want to do, that they already do.  It might be the same thing every single week.  I did tele therapy for a year with a mom and for the first nine months, she read books to her child for fifty minutes, all coaching because I couldn't do a demonstration.  Coaching fifty minutes ‑ ‑  twice a week for about nine months and it was never the same book but different books.  The mother essentially taught her child and she is ‑ ‑  it worked out fine.  In my old me, I would have said, well, we have done books before.  Gosh, we need to do something else but the new me says, if that is how the mom feels comfortable working with her child, then I should support that because if she does this well, she can do it well in other situations but this is what she feels comfortable doing in front of me.  She couldn't have done it to the degree that she did if she couldn't do it in other situations.  That's the new me that says let the mom buy into what she's doing, feel vested and comfortable and I'm not going to control what she's going to do.  I'm going to let her decide what she wants to do.  We're going to talk about giving up the control.  
	Then you're going to do embedded coaching.  Have specific goals.  We talked about that.  Do the coaching and in the end, we're going to summarize what was good and provide positive feedback.  Oh, I'm just looking at my notes to make sure I don't skip anything.  
	Part of our job as an early interventionist is to give information to the parents about why we're asking them to do what we're asking them to do.  If you feel that you're working with families who just don't seem connected, one of the things could be they don't understand why you're asking them to do what they're doing.  I tell parents when I'm working with families, I tell them, first I'll ask the question.  Do you like your therapist?  Is it's a very open question.  In an audience of this many, there's be three or four that don't raise their hands and look at the floor.  I'll say to the people who can don't say yes, I'll say, can you identify why you don't like your therapist and most of the time, it's because I don't know what she's doing.  
	I don't understand how what she's doing makes any sense.  It doesn't make sense to me.  So my question is, have you ever asked her why you are doing that?  If someone asks you why are you doing something, you should have an answer.  So if you don't have an answer, you need to find one.  Not only do you need to find one, you need to share that answer with your families.  If you can say to a family, look, the reason I'm really pushing device ware is because research now tells us that for the children who wear their devices, a minimum of ten hours a day, we have better outcomes.  Those children will have better language outcomes.  
	If that child is learning spoken language, all right?  Before we used to say, you just need to wear the device.  We didn't give the other half of the explanation.  If we give the whole explanation now, it's going to be easier to get parent buy in because you have the facts right at the table in front of them.  So no matter what you're doing, if you're looking for eye contact, you need to explain about communication and communication development via eye contact, via joint attention.  We all know how important those things are.  Sometimes we just say, let's work on eye contact and the parent is like, why are we doing that?  
	If you can explain it, it might help them want to do it more, okay?  All right.  Now we get to the fun stuff.  This is going to be a video of Nora.  She's 25 months old in the video.  She has normal hearing in her right ear and in her left ear, it's moderate, sloping to profound.  Her hearing loss is not really important because the purpose of the video is to show realtime embedded coaching but everyone always wants to know the age of the child and what their hearing loss is so that's why I provided it.  
	This video is really the purpose is to just make sure that I have clearly articulated and now given an example of what this coaching looks like so that you can see what I mean and what I have been talking about, okay?  Let's hope for the best.  Sorry.  
	Okay, so you can see the teacher isn't even in the video.  She's not interacting with the child at all.  She's just there supporting the mom.  Now, this obviously is not their first session.  You know, they have their rhythm going.  They understand each other.  I think the teacher actually is seated on the floor and you can tell that she's not using a loud teacher voice so that she's not disruptive to Nora so she doesn't keep turning.  You can see the one time Nora was listening to her, cut it out.  Why are you talking to me?  
	So it wasn't disruptive to the session.  The mom was able to listen to her suggestions and incorporate them and then immediately see how they worked.  So this is really different than the old fashion yellow legal pad.  Does anyone have any questions about this?  Did it make sense?  All right.  
	So related to reflection which is what I told you was the part of the rush and Sheldon coaching model we were not implementing.  This is reflection.  Reflection is going to happen at the end of session.  So after Nora and her mom did that whole activity, then they would give Nora a snack or something so they could talk and she would say, how do you any that went?  What went well, what was tricky or challenging?  What behaviors or strategies do you want to continue or not do?  What about Nora do you want to change?  What about you do you want to change?  All of those kind of questions highlights the positive things that the parent did and summarizing the session.  So it's really about what you would as the mom, or the caregiver or whatever, what did you like to do more of?  What do you think is well?  
	So in the beginning, when you ask parents ‑ ‑  you all go fine, it was good, it was okay.  Once they are use today it, oftentimes they were like, oh, that's the worse session ever because in their heads, they are thinking that the child isn't doing exactly what they want the child to do but the truth is, they have done a fine job.  
	So when I'm doing a session live, I'm not typing on the computer exactly what is happening but when I do tele therapy, I am on a head set so the parent can't hear me timing and I'm typing almost ‑ ‑  I can type fast enough, it's almost a transcript of the session.  So when a parent in tele therapy says, oh, that was horrible, he hardly talked at all.  I can say, oh, no no no.  That is not what happened.  I have the transcript which I'll e‑ mail you.  These are all things that you are able to say and the parents were so shocked.  They were like, oh, they said all of that?  
	So it's like Rhonda shaking her head and smiling.  Oh my gosh, I'm so sorry.  She thinks she's talking out loud.  These parents don't remember that their children were talking because they're concentrating so hard on figuring out how to get them to talk.  So sometimes it's helpful if you are able to let them know, in fact, they did.  That the children did talk.  So you might want to video tape or on your iPhone or telephone, just video tape part of the session on their phone so you can say to them, look at the video.  I promise you, you did a really nice job.  Because they just don't realize it, okay?  We all know what it is like.  In the moment, you I have a different perspective in the person who is watching you in the moment.  
	Then I include this because this is my own personal flaw.  So ending the session.  A great way to gain respect is to do what you say you're going to do.  So if you say you're going to be at the house for one hour, when one hour is up, you should leave.  I have a lot of trouble with this.  I will literally have my keys in hi hand and I'm literally backing out the door.  When I get to my car, I realize, I spent 12 minutes getting from the front door out the front door.  
	It's really not fair.  The parent also has scheduled their day just as you have scheduled yours.  So aside from the fact it might make you late to the next appointment, you essentially have quote, over stayed your welcome.  Trust me, I say it with tongue and cheek because I'm the biggest offender of this.  I'm always rationalizing in my head.  They asked me a question and I can't walk out and answer it.  You should probably walk out and say, I'll talk about it next time.  Send me an e‑ mail.  The truth is, being timely gains respect, gives trust and developing relationships.  
	So in all honesty, if with can be better, that would be great.  At the end, you need to talking about what to practice between this session and the next.  And what you're going to focus on for the next session.  So you can think about it and the person can think about it, okay?  
	Does anybody have any questions about that?  We're going to move on to the next topic.  All righty.  We'll keep going.  
	To learn about the parent perspective, I asked three parents to answer a series of questions.  So we're going to spend some time now listening to their responses to those questions and then talking about them.  So the first questions I asked had to do with developing trust.  The slide as you can see talking about motivating the parents to attend and participate.  My bullet point is you have to develop trust.  That is what is going to get them to come, to stay, and that is what is going to get them to want to participate.  To help us better understand as providers, our interactions with a parent can influence our relationship.  
	I asked the questions, do you have an EI provider with whom you felt comfortable and for whom you developed trust?  And then I followed it with, what did she do to make you feel comfortable and or trust her?  So there's going to be three parents that are going to respond.  We're going to watch their responses and listen to them one at a time and then I'm going to ask you a question to sort of prompt the discussion to help us think about what we do ourselves and to see ultimately about making some change.  
	This is going to be Melissa.  It's a short clip.  It's sixteen second.  She's the mother of three boys now.  When her oldest son, the one profoundly deaf with bilateral Cochlear implants was a baby, he was the only one.  They lived an hour from school.  She drove three or four times a week for services when he was a toddler.  
	In addition to the providers at our center, she was receiving other early intervention services that were being provided in our home, especially the days she wasn't coming to us.  
	So she had providers not only from our agency but other agencies and that's important because that's why I chose to interview these three people.  They all have a variety of providers, not just us.  
	So she's going to provide the questions, do you have an EI provider with whom you feel comfortable and develop trust and if so, what did she do to make you feel comfortable and gain your trust.  After you watch the really brief clip, I'm going to ask you to consider just what are you thinking.  Like, what is your response to what you hear her say?  
	You might want to jot down a few words so you can be able to remember what it is you thought right after it happened.  Again, that goes to our, not 22 year old audience, just kidding.  Here we go.  So that's really brief with a lot of information.  
	So now, I want you to write down one statement that makes you think about it.  So let's just share.  What is your immediate reaction to that?  Very generalized, uh‑ huh.  What was she being generalized about?  
	About the providers.  Can anyone recall what she said about the providers?  They knew what they were talking about.  So whether they did or they didn't which goes to what this woman said earlier.  She thought they did.  They could tell her why they were doing what they were doing.  Anybody else?  It makes you a little nervous and makes you cringe a little bit.  
	I have a whole section about giving advice.  We'll get to that.  They actually have advice for us is what it is.  I think that what she's say, the message is, I trusted them because they presented as if they knew.  
	She perceived them to know.  I think it's really really good but it also can be really bad if they don't actually know and they're presenting it as if they know.  So that's something to think about, okay?  
	And I think my comment to that would be, if you don't know, just say you don't know.  That is going to build much more trust than bad information.  Yes?  
	So at the end of that, are you making a statement or is there a question?  In the very beginning, when you don't know anything and everything you are told is new and the provider is giving you information, is the question is, how are you sorting that because how do you know what's good and what is not?  
	Well, I think this goes to this woman's statement which is, how would you sort it?  You don't have any capacity to.  It's no different than if you go online.  If you go online, you're going to get some good information and some bad information.  
	The unfortunate truth is, a naive provider thinks she's helping you by giving you information that is not necessarily one hundred percent accurate but maybe she perceives it is.  
	That is the true problem.  If the person giving the information thinks they know what they're talking about, then they're going to say it with confidence.  I think one of the problems is, just from the very beginning, just the EDHI system and part C, every state has a different way to do it.  How you get in, what the qualifications are and what makes you eligible and all of those things.  
	So if you ask somebody, like, oh my gosh, this just happened to me.  I had a family who came ‑ ‑  we do essentially rule out hearing screenings for our part C in Missouri because in Missouri, if you have a hearing loss of any degree, or any kind in either ear, you qualify automatically for part C services.  Okay?  That's great!  
	So they send us children who are speech and language delayed with their fingers crossed if they didn't qualify because you have to have a 50 percent delay in speech and language, then maybe they'll have a conductive hearing loss in one year that will qualify them.  
	So the provider who did the speech and language evaluation told the family you're not going to qualify because his speech and language is too good because you have to have a fifty percent delay.  I'm guessing she didn't explain the fifty percent delay.  
	If you had a 48 percent delay, you should still get speech and language services.  Even a 25 percent.  So when I scheduled the call, she said, the speech pathologist said there's no need to do that because we aren't going to qualify any way.  Then I tried to explain ‑ ‑  she said, well, the speech pathologist doesn't think he has a hearing loss.  
	In all honesty, I don't know what happened.  That's what we have to remember.  I don't really know what the speech pathologist said.  That's what the mother understood the speech pathologist to say.  The speech pathologist was being honest.  She worked with the child and didn't think he had a hearing loss but it caused the mom to not accept the hearing evaluation.  
	So I don't think people are doing anything deliberate.  It's just unfortunate that what happens is, and parents perceive the information the way they perceive it.  That's a whole other topic.  We can't control how the parent is perceiving the information.  
	Can everybody hear her in the back?  Do you want me to say it for the captioner?  No, you're okay.  Right, so she was distrusting.  Even though two people said it that way, she needed you to confirm it and then everything changed?  
	Yeah, it's just ‑ ‑  it's understandable.  It's understandable that the parents are confused.  The hospital and the audiology at the hospital is a medical place and a clinical environment.  They don't have the same opportunity to sit and explain things and answer questions and you're intimidating and they're giving you essentially only ‑ ‑  quote, bad be news so to speak.  It's not necessarily bad news.  It's not the news you were expecting.  So it doesn't matter to any of us.  As soon as we enter into a hospital like environment, we're all just waiting for the doom and gloom and once we get it, whatever we perceive that to be, we're not listening anymore.  
	So it's no wonder we can't understand what is going on.  It's no wonder that the parents can't.  I know from anecdotal information, we do a lot of what we refer to as informational meetings.  So every week, we have meetings for our parents ‑ ‑  I'm going to cut off my left arm ‑ ‑  meetings for the parents, just to continue to educate them about topics in general.  
	We spend a lot of time doing audiology and the protocol in our building is, when the child as an audiology appointment, the audiologist then explains whatever the results are to the parent.  It is the obligation of the person working with the family who is the early interventionist to then, at the next appointment they have with the family, to re explain whatever the audiologist said.  We see our children at least once every three months but really, the babies we're seeing once every month or once every six weeks.  
	In the course of a year, that baby has been seen at least six times minimally which means twelve times, the audio gram and hearing results have been explained to the parents, okay?  
	So after all it happened, I was doing a meeting.  There was about ten parents in the room and I said, we're going to go over the information that would be in an audiogram.  It was like school.  I had an outline.  They had to fill in the blanks and then I said, after you fill out the outline, then we're going to take a test and the test was exactly the outline but it was blank.  
	They all get nervous.  I said you guys, like, we're not turning this in.  This is not for me, this is for you.  So we go through the whole thing and it comes time for the whole test.  
	They say, well, will you leave the room?  And I'm like, leave the room?  And they're like, yeah, we want to be able to talk to each other.  What?  This has been explained to you twelve times minimally and we just went over it.  I mean, it's things like X means this, O means that.  Red is this, blue is that.  The speech banana, all of how we read the audiogram.  After all of that, they did not have the confidence to take the test even though it was for themselves.  So it just tells you how many times the information has to be repeated before it really is processed.  So in my experience, I have never had a situation where a parent said to me, you have explained that audiogram to me fourteen times.  Why are we still talking about it?  Every time, they're like, I'm so glad we're doing it again.  
	Every time I explain it just slightly differently or I add something new, they learn a little bit more.  Our teachers for our children under the age of three are teachers go to all of the audiology appointments with the children for this exact reason so they can gain a better understanding and so, I've been doing it for thirty years.  
	So for thirty years, I'm probably in an audiology appointment, a minimum of three times a week for thirty years.  Think about how many times I have heard it explained.  It's inevitable.  No matter how many times I have learned something new, or I learned how to explain something slightly differently or I ask a question because the parents look confuse so I ask the question on their behalf and then sometimes I'm surprised by the answer.  
	So there's so much information to learn that there's just so way that parents could have it.  And then if you think about that, that is one piece and then it's the speech and language?  They don't have the background in speech and language.  They don't have the background in language development.  Think don't have a background in child development.  
	If they have good parents skills, that's great.  But what about the parent who doesn't?  They don't even know what toys to buy or have in their house.  
	So you're saying, why aren't they engaged?  Because they're overwhelmed.  We have to bring it down to a level that can help them not be overwhelmed so they want to come and they feel you're coming to support them.  
	All right?  Okay.  So we did that one.  This is going to be Lonnie.  Yeah, I'm sorry?  So our children under the age of 3 have scheduled appointments about once every month for audiology.  So direct services from us.  
	In our program, it's a little bit complicated.  So our children who are eighteen months to three years old, we have a center based toddler class.  So those children, we run at about 25 or 26.  We have about 25 or 26 children that actually come to school for three and a half hours a morning, anywhere from two to five mornings a week.  That sort of depends on a lot of other factors.  
	We have about 35 percent of our location relocates to get to us.  So if a family moved across the country, they're going to push to come to school more than two days a week.  So typically our eighteen month olds are coming twice a week until age two.  Then they might change until three days a week.  By the time they're two and three quarters or almost three, they're coming four or five day most of the time.  
	Now, it's also based on their performance.  So if we have a child with a unilateral loss who really needed to figure out they were supposed to be paying attention, they might only come for two days a week until they're three and then we never see them again.  Or they go to a regular preschool.  They not entering into the school program.  
	Our children who are under 18 months old who do not come to the center, we're seeing them at the beginning.  So let's say they were identified through a newborn screening.  A lot of times the parents will call us from the hospital or from their car in the parking lot.  
	Those families are going to have audiology once a month for sure at the beginning.  Because our teachers for the deaf go to all of the audiology appointments, since they're teamed with the family, subsequent to that appointment, when they come to the center for it, she will do a parent support session.  She'll do one of these sessions.  Just like we do at the home or at the center.  
	She'll do another session in the home.  This is twice a month.  It can be whatever we want it to be but essentially for babies under 10 months old, it's often only twice a month and most is just giving parents information.  
	Somewhere between ten months and fourteen months, somewhere there, depending on how the child presents, meaning what's the hearing loss and where they live, what's the availability and access to the child, then it can increase to once at school and twice at home.  
	We'll start trying to get the child ready to learn to be able to come to school.  When the children turn 18 months old, a percentage do come to school and a percentage don't.  If a child comes to school, they might continue with one visit a month at home and sometimes increase to two.  If the child doesn't come to school, then we can increase the visits at home to once a week because we need to provide some of that sixty minute session now, it's going to be direct child service that we're going to control so we can make sure that the child isn't developing some skills and some of it is going to be the coaching, okay?  
	Does that make sense?  We're going to take a break in 18 minutes if I stay on schedule.  This is going to be Lonnie.  She's answering the same question, did you have an EI provider with whom you felt comfortable and with whom you developed trust and if so, what did the provider do to make you feel comfortable or gain your trust.  She's the mother of two boys.  Her older son is a bilateral hearing aid user.  Her younger son is a bilateral cochlear implant user.  
	They moved twice before they came to St. Louis.  So they had service providers in four different states by the time ‑ ‑  we were the fourth state by the time they came to us.  She has a lot of varied experiences.  When her clip is finished, I'm going to ask you to just think about posing a question to relate it to what she told you.  So we're just going to mix it up and get your thinking a little bit differently.  So think, what is a question related to what you heard.  
	So any questions on what did the early interventionist do to help them?  Oh, being better sticks out, yes!  Right, so the question to think about is, like, do I do that?  Do I say, oh, your child is doing so well?  Oh, we had a really good session today.  These sort of vague statements that don't define what was good and don't necessarily push the parent or the child to the next level.  
	Does anybody else have a parent?  Yes, so the question there is, am I honest?  What she identified is the thing that made her trust the provider was they were honest.  They didn't just come in and say, the provider should trust ‑ ‑  they didn't just say, it's all great!  You're doing fine, it all looks good.  They identified it.  You're going to have some struggles but you're doing these things well now.  We need to work for these things and I'm going to support you doing that.  Is that, when you think about yourself, your question so yourself is, am I being honest?  Does somebody else have hand up?  I knew I saw one.  You can make a comment, yes.  
	Yes, no yes, the honest from what you're saying has to do with acknowledging that there's struggles because it's going to take hard work and not just saying, you're doing fine, it's going to be okay.  It's really only going to be okay if you do the hard work.  
	So the honest piece is, acknowledging that there's hard work to come and not just being satisfied with how it is today.  
	I think that's what Lonnie was saying.  Look, I feel good about what I'm doing but I know I need to do more.  Don't just keep saying, oh, it's fine, it's fine.  We all know those children who someone said it's fine until kindergarten and then all of the sudden we have a huge problem because the parents were trusting that it was going to be fine.  
	We know it's not good right now but you keep saying it's fine and all of the sudden it's kindergarten and I'm realizing, I can't send this child to kindergarten but all along the way, the people were saying it's good.  Had they been honest, and said, this child has made progress from point A to point B, but we still need to get to F.  We have more work we need to do.  Be gracious and celebrate everything that happened but we need to be honest in moving them forward.  I think what Lonnie is saying, those providers that were honest, moved her forward more than those who were placating.  Anybody else?  
	Okay.  So now we'll go to Deanna.  Deanna has two boys and her child with hearing loss is her second child.  She only was in St. Louis but his hearing loss was diagnosed secondary to autism.  So she had all of these providers to manage his behavior and speech pathologist, because he wasn't talking at all and all of those things but didn't know about the hearing loss until he was two and a half, almost three.  Can you believe it in this day?  I know it was progressive.  
	Maybe in the beginning, he passed his newborn screening and then probably when the focus became on his behavior, they might have done a hearing test that he passed, that was inconclusive because he wouldn't participate because of his behavior and then eventually, one of the therapist that were working with him for his behavior said maybe we should check his hearing.  He does truly have autism and hearing loss so we got there eventually.  And then for this, it's like, she has a lot to say.  My comment here is like, what is your one take away from what she says.  
	Okay, so what is a take away?  She was not my friend.  Can you all hear her in the back?  Absolutely.  You would have an easier time going to someone who is not your friend if there's a problem.  
	What I said to parents is, to keep from crossing that line is look, if we have gone to high school together, we would be such good friends but this isn't high school.  So you can call me after you're out of part C and I'm not providing service anymore and I'm happy to have a drink with you but until then, we have to watch this balance.  
	You can't be baby sitting the children.  You can't be going to their school events because the ‑ ‑  it's not because you don't want to develop the relationship.  It's because how are you going to say something that's not one hundred percent positive, to someone you developed a friend relationship with?  That you're providing a service to?  That just doesn't make any sense?  
	It's hard enough to say bad things to people but then to say something that isn't the most pleasant to somebody you consider a friend, we just avoid that when we have friends.  It's just sort of what happens.  So yes, she made a great statement and your follow up to that is great.  Does anybody else have a take away from what Deanna said?  I know we talked about it so it's hard to remember what she said.  
	Yeah, they clearly had a relationship.  The thing that made it easy is Deanna was saying, we're not going to be friends.  The parent was saying, you're not going to be my friend because you have to provide a service to me and my child and I really like you and trust you.  She said she trusts her because they were always able to have conversations and that in those conversations, the person was able to respond, essentially is all she was saying.  She always responded.  
	All right, anything else?  Let's keep going.  So then I asked the question, do you have a provide with whom you did not feel comfortable or did not develop trust?  If so, what did she do to create that lack of trust?  We're going to look at the three parents again and talk about it like we did before.  This is going to be Melissa.  Her clips are very short.  This one is only twelve seconds long.  She's responding to the question, did you have somebody she didn't trust and what did she do to create that.  
	What is your immediate reaction to what she has said because you're going to have one.  It's going to be really interesting.  All right, so I heard ouch.  I heard oh, a gasp.  Oh, so sorry.  So the lesson is, don't be rude.  Don't be mean.  Don't be cruel.  
	Oh, right!  How could anyone say, this is usually how it goes when there's nothing the same when you drive even to the next door neighbors?  I have never thought about that.  That is a great point.  There isn't anything unusual.  Uh‑ huh.  It's really easy to go with your own bias on a whole lot of levels but culturally for sure.  Each family has a culture.  It's almost like, when you were talking, it's like, you I have to put your car in park.  Count to ten.  Look at the front door.  Remember whose house it is.  Think about how you should manage yourself in this particular house and then get out of the car.  Yeah, when you were talking, that's kind of the visual I created which I never thought about.  You have to step back, start over, clear your slate and start over before you go into each house and really think about what does this family need because it's going to be different than what happened in the previous visit.  
	It's different every single time.  It's different based on what is happening when they opened the front door.  Then you open the door and there's no telling.  Right, exactly!  Okay.  So then this is going to be ‑ ‑  we're going to watch this and be ready for our break.  This is going to be Lonnie.  Again, just think about the questions that you want to ask yourself.  
	So what's the question you sort of want to think about in your own head?  Are my goals appropriate?  Uh‑ huh.  Yes!  
	Right, their goals are clearly unrealistic.  So I think when you come across a family that has really high expectations that you are concerned are not going to be realistic long term, a way to avoid shooting down their goal, is baby steps.  Exactly.  It's to say, okay.  I understand that is your goal long term.  So what age, right now, we're talking about a one and a half year old or a two year old.  How old do you think a child is, reciting the Gettysburg address.  You say, probably fourteen.  So let's think about things we can do between now and 14 to have to be accomplished to be able to site the Gettysburg address.  Then you bring it down because if you do that and go backwards, if you go backwards, you can get to what should come next which is where you want the goal to be or maybe two steps from now.  
	Oh, dear Lord, this is ridiculous.  So the poor captioner is probably just getting this in her head every time I hit the microphone.  So I think there is a flip side to it.  I think there's a strategy for being able to bring a parent down without having to be outwardly critical.  Which is exactly what you were trying to say.  
	This is going to be Deanna and then we're going to think about our one take away.  
	So what is your take away from that?  Oh, she said too, she really had two completely different things.  The second one was she had a provider she trusted who had to tell her something bad or not good news by her perception.  She didn't want to hear it so that was hard to accept.  
	But what was the first thing she said at the beginning?  Yes, the lack of communication related to the provider that would say, oh, this was good but she wasn't seeing good or she wasn't seeing progress or she wasn't seeing ‑ ‑  right!  She didn't know what was going on.  She was just saying it was fine, okay, good, without what we talked about earlier explaining what you mean by that, giving specific examples so that the parent has something to hold on to.  Okay?  
	All right, let's take a break until 3 o'clock so about a twelve and a half or thirteen minute break and then we'll start back at three.  
>> Okay, I think we're going to go ahead and get started.  I want to begin before we get back into the presentation by just reminding everyone, I am showing a video that I only have a release to use for this presentation.  So if you have video taped any of the video, please delete it.  If it were to end up somewhere else in another presentation or on the internet, I am actually liable for that and could be sued.  Please do not video tape any of the video.  If you're taking snapshots of the slides, that's completely fine but I do not have permission for you to be taking images or videos of the parent's photos or any of the videos.  Please respect that.  Thank you.  
	So the slides, I thought they were available.  Well, everyone else who tried to get them said they're not.  I went to the speaker ready room before I presented asking specifically if when you came into this room, could you go online and access the slides and I was told yes.  So the helper man in the room perceived that whatever he did was going to give you access to the slides but people have said they don't have access to anybody's presentations so there must be something ‑ ‑  maybe they won't be available until tomorrow or something.  I don't know why.  
	I have to go back to the speaker ready room because I have another presentation tomorrow.  So when I go back, I'll ask.  Just know I'm trying to make them available.  
	The version I have given you though, is ‑ ‑  oh, you know what I did?  Oh, gosh!  I need to go back and check to see if I gave you a PDF otherwise you'll have all of my notes and that would be weird.  
	I'm giving you a version with all of the images taken out and doesn't have the video in it.  You'll have the slides but minus the things I can't give you.  Yeah, you can have my e‑ mail address which is on the last slide which you don't have access to (laughing).  Sorry about that.  It's B Brooks at Moog center.ORG.  
	So now we're going to look at developing relationships.  I think we figured out at this point, relationships are one of the things that make parents engaged and we want to participate and be a part of what is going on.  
	So we're going to look at the parent perspective related to the concept of developing relationships.  So when I looked at the work for my dissertation, there's four patterns this appear within an over riding theme of establishing a climate conducive to learning.  
	If we just think about those words, establishing a climate conducive to learning, that might cause us to think about is the environment, whatever that is, that environment, is that environment conducive to parent's engagement?  Is it conducive to child learning or parent learning?  
	I think when you think about that environment, one of the things is, if you have a screaming child, that is probably not going to cause the parent to engage with you and it might not have anything to do with anything that you have done or are doing but it's the situation that the parent is in.  
	If the parent learned last night or two nights ago that she has a family member who is terminally ill, she's not going to want to engage with you and you might not know that.  
	So you need to think about the physical environment but also the emotional environment related to what is going on with the family and try to create one that is conducive to everyone's learning, okay?  
	So these are the four sort of buckets that in my desperation that the teachers ‑ ‑  that the parents came up with.  Establishing a relationship is important to the environment.  Mutual respect is important to the environment.  Being non judgment is important and feeling supported.  So when we looked at some things that the caregivers said, the first comment goes to establishing a relationship.  
	Can the people in the back read it?  I'm going to give you a minute to read it.  I don't need to read out loud to you.  So my experience is engaging in support and coaching session as well as my experience in teaching other people how to implement realtime embedded coaching, have given me the impression that the relationship between the parent and the coached actually influences the coach rate of learning.  
	That relationship is so important it's worth taking the time to develop a relationship so it might mean in your first visit, you're not doing very much except getting ready to know each other.  The time spent in that visit doing that is worth it because the benefit long term will make up for the time that wasn't spent doing coaching or imparting information or doing whatever in that first visit.  So when we look at this comment, just consider how this parent aligns developing a relationship with trust, and how having the relationship relates to participating in this session.  
	Does anyone have a comment about this particular comment?  I'm going to take it that you all agree with me.  The next we talked about is building mutual respect.  So here's another comment that is related to building mutual respect and again, I'm just going to give you time to read it.  If anyone has a comment about this, and about what the message it sends.  
	So this supports what we talked about before.  Does anyone have any additional comment related to this?  You're not 22 anymore.  Yeah, I know.  
	Yes, so to your comment, you want to begin to continue and go in the direction you'll be going while accomplishing rapport, while developing a relationship, yes, I think that's true.  It's an ongoing thing that you need to be intentful and by being intentful and have a plan is going to establish respect and trust but you want to meet the needs of the family emotionally as well as what the child needs.  Anybody else?  
	So this is related to mutual respect as well.  Caregivers are more likely to engage in coaching activities and the learning process when they feel respected.  So I think this really sort of tells you something here.  I think we are going to end up having some conversation about this be because the word expert gets used in here.  I'll let you read it and then we can talk about it.  So it's really an interesting comment.  It's great!  Does anybody have a response to that?  
	I think first, do you have like an emotional response to the fact they're calling you the expert?  That you're being referred to as an expert?  How does it make you feel?  Uncomfortable, a little bit, yes.  
	Here's what I can tell you.  I think it's great that you explained, I don't want to be stepping on your toes and I don't know what you know.  If I say something you already know, let me know and I can move on.  I have said it a billion times.  No one has ever told me to stop talking.  
	No matter how ‑ ‑  so the people I gave the audiogram to, I would explain it to them twelve times.  They never said, don't explain it to me again.  It just never happened.  I think it's because they're waiting for you to give them one more nugget of knowledge.  So even if you're repeating yourself, you're not repeating in the exact same way you did the first time because you don't have a script.  
	So it's okay.  I have literally never had anyone say to me, yeah, you told me that.  Yes, you told me ‑ ‑  say it again.  Yeah, just go on.  That has never happened to me.  
	So that's different.  I already do that.  This is already different than I know that.  You see?  That's a little bit different.  So you're giving a suggestion and you say, I have already done that.  That makes you walk on a tight rope.  You're watching them and you're not doing it so you're suggesting it.  Here's what you learned.  
	In their head, they think they did it.  That's what you have to think about.  If the parent is a little bit resistant and perceives they're doing something, they're not saying, don't do it.  They're saying, I feel confident I'm doing it.  That might be the opportunity to talk about video taping on their iPad and not yours or their phone and then using the other ten minutes to look at it together to help them identify what they're doing.  Video taping is a great thing as long as the person being video taped isn't offended by it.  
>> Yes, so I'm not a coach myself but I want to know how much involved in EI is involving deaf culture or exposure ‑ ‑  I'm wondering, using these communication tools and sign language, I can't really understand this without understanding what is your agenda.  I mean, are you following a checklist?  Do you mind helping me understand?  
>> No, I don't mind at all.  My quizzical face is because I'm not exactly sure I understand your question.  I can try to restate it.  
>> So I'm not a coach.  You're teaching parents who don't know anything, you know, so the majority of the people in here are EIs.  I'm just wondering if you're providing not just the speech aspect of it but just communication tools.  Like, is sign language ‑ ‑  deaf culture being exposed.  
>> There's a lot of questions in there.  I will sort of try to tick them off.  If I miss one, just ask it again.  Okay.  So when you talk, most of the people who are EI providers have a background in like, I'm considered a teacher of the deaf but under EI, that makes me a developmental therapist for the hearing impaired.  So it suggests I have some knowledge base in general child development.  So that's different than your question about communication but most of the people who are providing in theory, people who are providing early intervention should have some background about child development and about language development just in general.  Okay?  
	Now, when I'm providing a service for children who have elected to use listening and spoken language, as the person providing the service, so it's twofold.  
	I am not talking about deaf culture.  I might talk about sign language because it might come up but at that point, when I'm providing the service for someone who has selected listening and spoken language, I don't really have an obligation.  I could talk about deaf culture but I would be talking about it.  
	I don't have enough knowledge to be able to represent deaf culture.  Now, that's different than over here where, when I'm meeting a family because in our facility, I happen to be the person that meets the families.  
	At the point in which I meet a family, then I have on a different hat.  So when I am meeting the family, again, in theory, they have chosen listening spoken language but I do have a professional ethical obligation at that point to inform families of other options.  
	So where I am in St. Louis, we're not the only show.  I tell families there's other places to go.  The resources that are available but again, I'm not delving into deaf culture because when I receive a family, they have actually chosen listening and spoken language.  Does that answer some of those questions?  
>> Yes, but I do have one more question.  She has her hand up.  I'm just wondering if EI is aware of deaf mentoring services?  Are there deaf mentors out there?  
>> I misspoke.  So in Missouri, for instance, because I can only talk about Missouri, we have deaf mentoring.  We have what is called families first.  We have whole child.  These are all programs that bring providers into the home to work with families and teach them about sign language and deaf culture and all of that is introduced to families.  So as part of my job, the families are given those opportunities and resources.  
	Then in our particular program, we bring those resources back up over time because in our particular program, we feel strongly that if there's this many children who are deaf or hard of hearing, who are learning, listening to spoken language, there is for sure a proportion of those children who will need visual communication to access the general education curriculum to learn academics because for a plethora of reasons.  They have a secondary complicated factor.  They don't have good auditory access, whatever the reason is.  
	So we actually, in our program, provide an after school program to help parents understand deaf culture and all of those things but I'm not the one providing it because that would be wrong.  
	So we do it for me, well, but in EI there's not like a rule.  In EI, we're supposed to be objective.  That objectiveness happens at the very beginning of the system.  It's not.  By the time these providers are receiving the children, the parents in most cases have chosen a mode of communication.  The provider is providing what the parents asked for.  
	If the parents asked for more information, then the provider has the obligation to provide it.  The parent can choose to change modality or a second modality.  Do you all agree with me?  I'm not misspeaking am I?  So if I screw up, yell at me.  
	It should be happening that way.  That's what someone has said.  I hope I'm not stepping out of turn here.  My guess is, this is a room of people who aren't 22.  So these people have more confidence to be more objective.  A young practitioner who has a bias and doesn't have life experience may not be as willing to step out.  That's a generalization.  
	I just want to set it out there.  The same thing is true as an aged practitioner who thinks the best thing she's doing is the best thing to do.  It can go either way.  
	In reality, we're supposed to be open minded and objective, yes.  Right, I think that's true.  If we wrote a textbook or we had a handout, that's what the handout would say.  
	Now, whether or not people are following the handout is a very different story.  That is the problem.  Sorry you had to wait.  
>> So I used to be a deaf mentor and now I'm a student again.  In my experience, I see an emphasis on expert and I would really like to encourage and make sure both the provider and the deaf mentor, be it spoken language or sign language, be emphasized.  I will often come in and talk to the parents and talk to them about sign language, you know, and sometimes I feel like spoken language, sometimes they will give an attitude and they'll say, you know, sign language will delay their speech.  Sometimes they're direct and sometimes indirect.  
>> When you say they, who is they?  Parent or some other provider?  
>> The provider.  The provider.  So they'll talk about language use.  Providers will talk about language use and that affects how parents perceive spoken language versus sign language.  That gives them uneasy feelings so I no longer become an expert.  That has been taken away from me.  
	So I think we need to meet each other in the middle to say, spoken language, sign language, needs to support each other and you can work together but I think it's how we talk about it and how people then perceive one option over another.  One becomes superior over another.  
	In my experience, I do feel like I'm having to compete and prove I'm an expert and I shouldn't have to do that.  We should be advocating for each other.  We have the same goals as the family.  So I am an expert coming in and this person who is a spoken language expert is also an expert and we need to be working together.  
>> I have this face that's not looking at you because I'm like trying to process what you're saying and figure out what to say.  I'm speechless.  So I ‑ ‑  
	I don't have that situation either because each person is going in as the expert.  Like, we're recommending to a family, you need a deaf mentor but then we wouldn't go into the home with the deaf mentor because that's their time.  
	Hang on one second because this woman has her hand up.  
	I don't want to cut anybody off, but if we stay on this topic, I might not get through my slides.  Let's keep going.  If question get finished in a timely manner, we can circle back around.  I feel like we were trying to solve one of the world's problems, I don't know if we would, but we can raise awareness within the fifty people in the room and that's positive.  I don't want to discount it in any way shape or form.  I want to make sure those who came to hear my slides get to.  
	Does anybody else have a comment related specifically to me or experts?  
	I'm the expert and whatever knowledge I come up with.  You have to come with your expert information about your child otherwise my expertise is worthless.  I don't either but they said it.  Yes, it boils down to a matter of semantics but words matter.  It's a great point to think about how you're defining it.  I don't think I use the word expert very much but this person did so I was stuck with it.  Their unique knowledge, yes.  
	Yes, I agree with you.  This person perceived that the provider came in with unique information that would benefit her but she ‑ ‑  but the provider did not beat her over the head with it.  She just allowed her to know she could trust what she was going to say, yes.  All right, yep.  
	Oh, that's a great.  To say, I'm a member of your team, just as you are a member of the team.  I think the good news is, under the ISP it matters but under the IEP it doesn't.  So you are a member of the team and people respect you as one.  I'm going to the next.  
	So this has to do with ‑ ‑  uh‑ oh, with being non judgment.  So I think another component that is really important is that somehow you convey without saying I'm not going to judge you, that you convey that you're not being judgmental.  
	So let's read this quote.  So I think when the caregivers feel safe asking questions and when you provide honest responses to those questions and they sense their comments and questions aren't being judged, that they're going to be more likely to accept new ideas and try new things because you're helping to build that trust.  This quote sort of summarizes that whole idea.  
	If you ‑ ‑  I want to talk about this whole idea of being non judgmental.  So if you think in your own self, do you find yourself making judgments or ‑ ‑  like, I make the judgment in the back of my head and hide it be back there because I can't move forward if I don't make a judgment.  
	I have to somehow size it up.  If I say I'm not making judgments, that's not being honest.  It's different to make a judgment than to be judgmental.  
	Those are two very different things, okay?  So I think it's fair that in any situation, your story, you're collecting judgments and storing them but you're not using them to evaluate the people.  You're assessing the situation and making determination on how you're going to act next?  Does anybody have a comment?  
	Right, I think those challenging home situations are the place where you just have to sort of figure out how to make it work, uh‑ huh.  Try to keep your face the way as it was in the last house.  
	I think if you have a lot of home visits, you become less judgmental.  Does anyone have a comment about this?  So this is related to feeling supported.  So many of the parents and caregivers reference the support they received while in that joint planning.  So if we go back to what we talked about with the components of a coaching session, joint planning is when you're talking together about what is it you're going to do, what you're going to coach, how many minutes it's going to be.  
	So the parent is comments on how the joint planning is what made her feel supportive.  I'll let you read that.  So you can see, it's giving you an idea of the conversation.  How the conversation flowed and the parent wasn't exactly sure what she should say.  The provider didn't tell her what to say but guided her so she could come up with it on her own.  That's a huge piece of it.  When the parent floundering sightly, we want to jump in and rescue.  If we can make ourselves take a step back, if we help them, they can become accountable because think of how proud this person is when she figured out what she needed to say and then the teacher was able to just go with her idea and didn't have to give her an idea.  Any other comments about that?  Yes.  
	I think the scaffolding is what it is.  The problem is, as providers, it's not our nature.  Our nature is to say, oh, we don't know how to help you.  Oh, you have a problem, let me fix it.  
	I don't know why it happens.  I think part of it is our maternal intent to just take care of it.  
	That's a great analogy.  Yes, I'm going to steel it from you.  Here, let me say it so the captioner gets it.  His analogy related to scaffolding is taking the child to the playground.  If you always pick them up and put them on the top of the slide, you never have to teach them how to climb the leader.  If you let them climb the ladder and allow the support that the child needs on the way up to the ladder, you're doing for the child at that moment which is what we should be doing for parents.  That's a great analogy.  Thank you!  
	Let's go to the next one.  So now we're going to move to the comments that the teachers made.  So you're probably going to be able to relate slightly a little bit more and maybe be a bit more surprised.  
	So when we looked at teacher problems relates to the realtime embedded coaching.  It had to do with learning principles, some of which we talked about in the beginning when I showed you a slide but my dissertation was on this application of adult learning principles.  My emphasis was in ‑ ‑  which is like pedagogy for adults.  So it's the study of adult learners.  
	So those learning principles were applied to the work that we were doing.  So it was trusting the learner.  That's probably one of our biggest problems is we don't trust our learners.  Our parent learners, we don't trust they're going to rise to the occasion.  So one of the challenges for the teaching staff is, they had to learn to trust the parents so things like, the mandate, you're not allowed to bring a toy in the house anymore.  Don't do it.  
	It's against the center law.  If the parent doesn't talk, sit in silence and wait.  They will process the question and then they will answer it, okay?  So those kinds of things, that will help to build the relationship and so so this first slide just has to do with the changes of the implementation of providing coaching.  
	So going from the old approach, we're going to tell you what to do, you're going to do it and then we'll talk about it afterwards to the embedded approach.  And then the teacher's perception of the coach.  They were seen as experts and they had to change their attitude about teaching adults and that allowing them to feel comfortable.  
	Going back to accomplishing a climate conducive to learning, I just said developing the trust of the learner and then changes in caregiver behavior because if you really think about it on the most serious level, what we're trying to do, all of us in our early intervention is change the behavior of the caregiver.  We're trying to get the caregiver to behave and interact in a certain way with the child that we perceive as going to aid in the child's over all development.  Okay?  
	So that is sort of what we're trying to do.  And then did the parents demonstrate a readiness to learn.  So this first quote, can you read it in the back?  Yeah, okay.  So I'm sorry, go ahead with your question.  Yes, uh‑ huh.  We're going to talk about it.  What happens is, in the old coaching approach, the whole point here is in the old coaching approach, they did perceive themselves as experts because they had to be because they were telling people what to do.  
	They had to change their mind set to recognize that really, they were equal players.  They brought ‑ ‑  as she said, the teachers bring something to the situation and the parents bring something to the situation.  In adult learning theory, like in this room, the reason we're doing this conversation is because in theory, you have as much to offer in the conversation as I do because you have an experience that would assist others in their learning but if you think about, until ten years ago, you wouldn't come to a presentation where somebody would engage you because they perceived that you were here to learn from them and that you didn't have anything to offer.  
	So it would just be, I stand on the podium and spew.  Now, what adult learning theory is telling us is that every one who comes in the room, no matter what your situation is, you have something to offer.  So this person's offer is not the same as the person sitting next to her and everyone in the room has something to bring to the situation because you come to the situation.  
	My job is impart information and interact and share.  Okay?  All right.  So let's go ahead and read this.  Okay, so this is very specific.  This comment is very specific to the idea of bringing toys in the home which goes back to what we talked about in the beginning as the traditional way of coaching.  If you really read and think about what this teacher is saying, what she's saying is, we were putting the parents in a situation that could not be successful for them.  We were making it so we caused ourselves to be the expert.  
	We were setting up the situation and saying this is what you're going to do.  This is how you're going to do it.  This is the goal.  If they didn't meet our standard, then we just were constantly correcting them.  
	This for some of you, maybe it's not this extreme but for some of you, this could be a reason why your parents aren't opening the door.  So this could be a reason.  I'm not say it is.  This could be a reason why you get started, maybe you're doing it or they're doing it and they will just say, can you just show me?  That means they can avoid doing it.  If a parent is avoiding doing it, there could be some degree of, I don't feel comfortable but it could also be, they're not doing it because they don't know how.  
	So I had a mom once who had a little boy with down syndrome and a hearing loss.  I can't even tell you what was wrong with this situation but there was something wrong.  Like, you know how you feel it in your gut?  There's something wrong and you can't figure it out.  
	So we were at the center for this particular visit and I decided I was going to leave the room and then tell the mom to play with the boy.  Like, in every session she figured out a way not to have to play with him.  So I was ‑ ‑  this was before we switched over to this new way of doing things.  
	So what I decided is, I decided that I was going to pretend like I had to go fax something.  I just jumped up, oh my gosh, I have to fax something.  I was supposed to send it to someone.  Here's a toy and maybe you can just play with him while I'm gone.  I fly out of the door but then I don't go anywhere.  I stand outside and I'm watching.  
	She sits on the floor.  She did move from the couch to the floor and just started crying.  So I'm outside of the room and am like, oh my gosh, now what do I do?  I felt like there was enough time to pass and I fling the door open like I'm running back in and I go, oh my gosh, what is wrong?  
	She's quiet and she's quiet and I just knew, don't say anything.  Don't say anything and finally she looked at me and says, he's two or two and a half, I've never played with him before.  Uh‑ huh, okay.  So that's a discussion for a whole other day over here.  But this is a mom who was never engaged.  I could never get her off the couch and on the floor with the child.  
	I was always thinking, you know, I'm mad.  All of the things you would be.  I'm mad at the mom.  What is wrong with her?  Why won't she play with her baby?  It dawned on me to leave her in the room and see what happens and then of course it came out.  So that was fine.  Once it was out there, then I was able to say, oh, okay.  Well, let's start with that and then do all of the things you need to do.  
	For the parent that is not engaging, probably what I should have done in hindsight is just asked her.  I have noticed that when we do these sessions you seem to be uncomfortable getting down on the floor.  Is there something I can do to make you feel more comfortable.  I'm guessing in a back and forth dialogue she would have eventually told me she just didn't know what to do.  
	I was naive and I didn't know how to make it happen.  I just left her with the child to figure it out.  
	I think if you have a family who is not engaging, this is something to really think about.  It could be they don't actually know what to do.  This is not the only thing for which this has happened.  Yeah!  So it's just something to really really think about.  Okay?  So does anybody ‑ ‑  could everybody relate to this slide here and understand like, yeah, try not to take your toys.  Any comments?  This is another idea about related change.  I don't want to beat a horse but I think it says something.  
	Okay, we went from, you're not doing it right to, oh, this is something you can do.  We're doing great job.  We went from ‑ ‑  I don't know what was wrong with it but being incredibly negative and always making them feel like they weren't adequate to figuring out a way to work with them so they would be adequate.  That is really what our job is to empower them to do well, not to criticize them for not doing it our way.  
	I mean, many of us went to graduate school and who knows what else to learn what we do and then we show up in the parents house to have all of the knowledge in our head plus more.  It's really pitiful it took us hundreds of year to figure out we're doing it all wrong.  
	Okay, so let's just look at quote number one.  Let's read quote number one.  I think those who are looking for new ways to engage parents and new tricks to try, quote number one might be your go to.  That might be the thing that helps your parents get engaged.  Let's read quote number two.  
	All right, does anybody have a comment about that?  This is what we're looking for.  We're looking for the parents to be the ones figuring out what to do.  That's when we know we have done a good job.  
	Our success should be measured about how independent the parents are.  Quote number three.  I think it goes right to the comment about, we're a team.  This is an ISFP team.  We're all in it together.  I'm not a peer, you're not done here.  We're all at the same level.  Yes.  
	Okay.  So you know, I can spin this any way you want me to.  I will spin it a couple of different ways.  Any new current initial reaction to that is, don't bring the books.  Here's the thing.  There's a lot of schools of thought on this.  You could bring the books and leave the books.  That's one way to do it.  To me, if you're a family that can't afford books, you're making a judgment.  Your judgment is, you need books and you can't get them yourself so I'm going to get books and let you borrow them.  They could go to the library and get books.  If they can't get to a library, maybe you can figure out a way together that they can pick books and pick them up on their behalf that are from the library.  I think that the danger in bringing something even if you leave it, like, I have a teacher who will not give it up.  It's the same one.  I always go be in her room and the toy is not there.  
	She will say, I went to a garage sale.  No!  You don't get to go to a garage sale and buy the toys that you think the family should have and then deliver it to their house.  That's not okay.  Again, you're picking the toys for the family.  
	If the family doesn't have toys, then I would rephrase how you're asking them.  Don't ask them to play with a toy.  Like, do they eat?  They must eat.  So if they eat, you could do a session around a meal or around a snack.  
	The child, if the child is in diapers, the diaper gets changed a certain number of times a day and you could do a session around that.  The child wears clothes so you can do it from changing from PJs to clothes or from clothes to another set of clothes.  
	All of those things that happen, if you're going in the home, all of the things that happen in the daily routine are things that you could be doing.  
	So if they have dishes and they're washing dishes, you could put the child in a highchair next to the sink or the child, depending on their age, could sit on the counter with their feet in the water and you could be doing the dishes that way.  
	I think you just ‑ ‑  the laundry, you just have to think about it.  Like, if the child is under the age of three, I child can't be without the parent.  So even if they're in an apartment, and they have to go to place to do laundry, you could go to that place and do the laundry, there's so much language in all of those routine activities.  
	Also, within the home, what I say to the parent is, what does the child play with?  
	Like, I said to a colleague the other day.  I think I'm going to a session some time on things to do with the toilet paper roll and the paper towel roll.  Can I fill thirty minutes with different ideas of different things to do with the role.  I'm really determined to do it.  Everyone has a problem and no one realizes that it is just not fair.  
	One of the teachers, I couldn't find the quote to put in here but one of the teachers literally said, she said, I had an a ha moment and realized we literally throw the parents under a bus.  We show up at the house.  We give them the toys.  We tell them what to do and say and we tell them all of the things they didn't do and say correctly and then we leave.  The how can that be positive in any way, shape or form?  
	So when we first had the mandate and when the federal government said that services had to be provided in the natural environment and all of the coaching stuff and you're not supposed to bring the toys in, you would all laugh at my prior self.  
	I came up with every single way that we didn't have to follow the rules.  I wrote documents and sent them to the state and explained to the state how these rules didn't apply to our field.  
	I have been there.  I have done that and made a big excuse about how we need today have these very specific toys so we could assess the speech, language, and auditory skills, blah blah blah.  It's such BS.  There's toys in the house, even if they don't have toys.  There's a spoon and a pot and a pan and there's a sink.  Yeah.  You could assess the child's auditory skills without bringing whatever the heck it is you need to bring in.  
	The vocabulary of your toys that you're bringing in, the child is never going to know those rules if they are not items in their house.  So that's how I address it.  
	I mean, like I said, I have a teacher who is a great teacher and she's hiding stuff in the back of her car because she knows it's wrong but she can't figure out how to get around it.  She can't embrace it.  
	Do you see what I'm saying?  I'm going to do it for you all.  Next year, I'm going to submit to EDHI, a presentation on what to do with a toilet paper roll.  Will you come?  I'm going to do it.  I'll have a video and everything.  Right, what would you be doing if I'm not here?  Now, the bad thing is some people would say, what do you mean?  In the same homes, they would have no toys but a TV screen as big as this.  
	They might have four iPhones and an iPad.  They just might be watching TV.  So if they say, we're watching TV, then I have to go in my little thing about, well, when you're watching TV, you need to stand up here next to the screen and point to some words and then run around the house and find those things in the house.  
	There are ways to be creative and think about it.  The same people who have the TVs also have TEVO so you can just pause it.  At my house, when I don't have a TV that size, we don't have it.  It would be gone.  People who don't have money don't have TVs ‑ ‑  somehow.  How do they get those and they drive brand new cars.  We have people who can't play tuition in our school with TVs that look like this, brand new cars and cell phones.  I'm like, I don't get it.  It's all credit, you're right.  
	Okay.  Anybody else?  Let's go to the next one.  So this is about teachers as experts.  We did that.  We created that situation.  We presented ourself as experts.  We presented ourself as the one who knows what to do:  We presented ourself as doing something different than they could do.  
	All of the messages we sent were, you need me to come here to work with your child because you're not sufficient.  That's what has to go a way.  So for those of you who ‑ ‑  when you think and you say, help us figure out strategies for getting the parents who won't engage, you need to think about all of these things but then remember, you have a population of people over here who this isn't going to work for because there's something else going on, okay?  
	So if you can think of a family where you're like, oh, you know what?  She does sit on the couch and smile.  She must not feel comfortable or safe.  You can fix all of that.  You have learned enough today and talked enough today about strategies for changing that.  So those families, you can make a difference for, all right?  
	All right, here's a comment from the teachers about being non judgmental.  These are the adult learning theories.  I know, you're like, duh.  Of course, we had so much time together.  
	It seems so simple, doesn't it?  I'm embarrassed, it took our society hundreds of years to figure it out.  What were we thinking?  Of course, the person is like, did I do it right, did I say it right?  We created that.  I think it's really not that hard to make it go away once you can buy into the idea that it will work.  
	Once you can let go of control and trust the parents.  If you have a family you currently work with and you are going to try some of these things, you should be really up front and honest and say, this is going to look different than the past.  Otherwise, they will not know what will happen.  
	If you change ‑ ‑  they will think you have a stroke or something and showed up as a different person.  Just be careful and explain what it is ‑ ‑  why you're changing and what your expectations are for them.  
	Here probably one of the biggest keys of all.  We did not go to school to learn how to teach adults.  That didn't happen when we went to school.  We learned how to teach children.  Although some of the principles are similar, we don't think about it that way.  We're kind of actually petrified because we're trying to teach adults and we might know how but we don't know we know how.  Read those two.  So what's your response to that?  
	Does it sound like what you believed or what you believed before one o'clock?  Yeah.  I mean, it just is what it is.  This is what we were taught and what we learned in school.  So we have to let go of that and begin to trust that the parents can rise to the occasion.  
	Okay.  Oh, I'm sorry, thank you!  
>> One of the challenges when it comes to families is we only see them once a month, for some families, I might only interact with them one hour, once a month so of course, I want to plan that.  I want to be in control and run through that.  
	I do think we need to have more engagement with families and you're absolutely right.  
>> So you could start by you plan thirty minutes and then you ask permission for their thirty minutes and then once you have success, you won't want to plan anymore.  You have to still plan.  Don't think it's okay to just show up without a plan.  
	Your plan though is the things you would like to do, asking permission to do them and allocating time and then the right thing to do really is, watch your clock and set your timers so that if you said we're going to do coaching for ten minutes that when ten minutes is over, you have to stop.  
	Or if you're going to discuss information for five minutes.  When the five minutes is up, you need to stop to get to the whole plan.  That's not me.  I don't know where it's coming from.  
	So baby steps.  Baby steps, especially when you're only seeing them for an hour a month.  And then, that's ‑ ‑  we have about six different presentations we have to have.  That's a whole presentation here.  How can an hour a month make a difference in a person's life?  We're not going there.  
	Okay, now we're going to talk about the tips from the parents, I ask the parents if you could give advice to early intervention providers, what would it be.  Wouldn't this be fun?  
	To help us better understand how we can influence our relationships, I asked the question, what's one piece of advice or something you would like to share with EI providers about interacting with parents or providing service?  So first, it's going to be Melissa.  So if you have a child you're working with has a secondary complicated factor and it's not just hearing loss, because we know that if 40 percent have something else going on, you cannot have a case load where there's children with nothing else going on.  
	You could not possibly learn about every secondary complicated factor you're going to run into.  I actually think this is a great way to empower parents.  I learned in school, this can cause a child to have hearing loss but I don't know much about it.  What do you find to be the greatest resources?  You right there are saying, we have to partner on this because you have knowledge and I don't have any knowledge.  I don't know anything about.  Okay?  
	So I really like she says learn about the child and ask questions and does anyone have a comment about that?  All right, let's look at Lonnie then.  
	So what do you think about that?  Lonnie sort of has a theme going.  Obviously each of them has sort of a theme because they're relating to their own experience.  She clearly had providers who told her everything was fine and it wasn't fine.  She is saying, just be careful about defining good and fine.  
	Here's the issue, when we were doing embedding coding, don't just say good, nice job.  But you have to say what she said, I like the way that you asked the question or, that model was perfect.  Because if you don't, what you think you're talk ‑ ‑  what you're intending to mean and what the parent perceives you to say are not the same.  This is the same thing.  As a provider, you're like, everything is going well and I'm really excited about this.  
	You mean it in some way.  You probably mean from point A to point B, the child is making progress but the parent is expecting point F and that's where you think, oh, he's fine and he's ready for kindergarten and you don't mean it at all.  You mean, it's better than last week.  That's a great point.  
	Now, here's Deanna.  Does anybody have a take away from that?  It's getting late in the day, uh‑ huh.  We'll move on.  I'm not insulted.  So now, we're going to tie everything up and look at ourselves and how we're providing information to parents.  I want to talk right now about when you're communicating with parents.  So people receive and process information in different ways.  We're going to see in just a minute when I take a, raise your hand poll, we're not all the same.  We don't want information the same way and don't all give information the same way.  So it's important to keep in mind that the way that we prefer to receive information may not be the same way that the family on elm street wants it but it night be the way that the family on Brown street wants it, okay?  
	So it's the same thing we were talking about earlier.  Park your car, sit back, look at the front door and remember where you are and think how you're going to interact when you get to this particular house.  
	So for most of us, the most common go‑ to for delivery of information is the way we like to receive information and that may not always be the most effective way.  
	So this is sort of a list of the things to think about.  Some of us prefer to have the basics.  Maybe we just want an overview.  We don't want to be bogged down with every detail.  We just need to have a general understanding of the concept.  These parents want the provider to give a general idea of the expectations but that's in contrast to the person that wants the details.  
	They want a thorough explanation.  They want a step by step guide.  These parents want a detailed list of the milestones and what activities will occur during the session, et cetera, et cetera.  
	Those are two different ways of looking at it.  Related to auditory information, some people prefer to have new information provided orally so they can listen to and absorb the information while the others may not perceive they ‑ ‑  oh, they may not have time pro‑ ‑  don't give my a handout, we don't have time for it.  They might not feel obligated to read it because you might ask them about if the next time.  
	While other people want written information.  They want it in writing and want to be able to go back and review the information.  These are the parents who are highlighting, making comments.  It's like they have a school assignment.  They're highlighting and an annotates and they want to share the information.  
	Some people want everything explained to them, whether it's oral or written.  The important piece is they want it explained.  They don't want to figure it out for themselves or second guessing.  
	Then there's the people that want to be shown.  They just want the provider to demonstrate for them.  They have learned by observing.  
	They want the provider to show them what they should do.  They don't want it to be explained, all right?  
	And then there's the hands on people.  The parents who want to dig in and try it themselves.  They learn best when they're hands on.  So it's important to remember this is kind of a problem for us.  This is a lot of different things to think about as you're sitting in your car before you go to the front door.  You need to be thinking about it because it might be that for some of the families you're having trouble engaging, it's because you have been using the wrong one of these things and basics versus details is different than auditory versus written or visual which is different than the explanation of all of that.  
	So we have different categories so you might be right in two of the categories and wrong in the third and if you switch the third, maybe all of the sudden they're like, oh, now I understand what you want me to do.  
	Yes?  I think you should absolutely ask them.  Yes.  I think it's absolutely legitimate to ask them.  Now, you may not ask at the very first visit but you might.  You might say, is the best way to contact you, e‑ mail, text?  What phone call?  What is it?  
	That's one part of it.  If I'm giving you information which may might want that in a different way than this.  We need to be cautious, we're not imposing our preferences on the families in which we work.  It goes back to just in general, our biases.  
	So now we'll do a short activity.  I just want you to reflect and think about yourself.  So my first question is, when you're learning something new, do you want to receive it?  Do you want the basics or do you want the details?  So who wants the basics?  One person, a couple of people.  Who wants the details?  
	My God, I want every detail you can give me.  That's a huge difference.  So if we're working with one of the people that raise the hands, we would be dying.  That would hurt us in our heart.  
	The next is, do you want to receive information by listening it to, reading it or by combination?  Who wants to listen to it?  Of course not unless it's a pod cast.  Who wants to read?  Who wants the combination?  Think about it.  Are we giving information in one way or more than one way.  
	The last is, when you want to process information, do you want to do an explanation?  Who wants a combination?  
	Who wants to have someone show you?  I want someone to show.  Who wants to do it themselves?  Right.  Who wants all of the above?  Exactly.  Do you see how different it is?  It's different depending on what it is you're doing.  
	So Deanna, does a really nice job helping us understand about how people receive information.  Oh, why is this happening?  Come on.  Where did my thing go?  
	Okay.  She did a nice job.  So the first comment is, determine what type of information the parent needs to hear.  I think now we might feel comfortable doing is asking them some questions so we can figure it out.  
	Then she said, help them see it in the clearest way possible.  So that is sort of ambiguous to me.  I don't know what it will look like but we need to keep asking the parents, is that clear?  Would that be okay?  
	If it's not clear, then asking for more information.  I modeled it a little bit when this woman was asking me questions.  I couldn't figure out what she was looking for.  Instead of answering, I'm saying, I'm not exactly sure what question it is.  Do you want me to clarify and restate it and see if it's correct?  She wasn't offended.  That allowed me more opportunity to get more information.  It's okay.  
	It's okay to say, I'm not exactly sure what I have given you ‑ ‑  or I'm not sure what you do need.  So if you can explain it to me, that would be great.  Does anybody have any ‑ ‑  uh‑ oh.  Thank you.  
	Right, and you're using some great strategies.  Your have showing them what you have written up.  You're asking for clarification.  Sometimes just restating what you heard the person say is enough for them to clarify that you didn't actually understand.  
	That's why I said, do you want me to restate your question and see if I have it right because I'm comfortable with that.  I am comfortable with them restating.  That would be fine with me.  Restating is a great strategy for making sure you are communicating clearly.  
	Now, I would like to do a minute of personal reflection.  Then we'll go back if you have any questions.  I want you to take just a minute.  First, I want you to think about, did you learn what you came here to learn?  Although two of you didn't because we haven't gotten to your questions yet.  
	Are you satisfied with the time you spent here.  What is your when take away?  If you're willing to, I think it would behoove you to take the time to think about what your one take away is and to write it down.  Write down one thing that you will do to change or improve the manner in which you're engaging with parents.  Is there anybody willing to share and expose themselves related ‑ ‑  you don't have to tell us what you're doing now that you're going to do differently but anything you want to do to make change.  That's a great idea, targeting two families that you feel are more sophisticated.  
	Great idea!  That's a great commitment.  If you can make yourself leave the bag at home and quote, start over again and see what they come up with.  
	You should be careful who you pick.  That's completely legitimate.  You're going to piggy back on that.  That's completely legitimate.  If it works, then you'll have the confidence to start working your way down the list.  You see them once a week, that's great!  And you have each other, and your friends?  Great.  You can say, I'm going in.  I'm not taking the bag.  Give me some support.  Perfect.  Does anybody else have something they can share they want to change or think about?  
	Oh, so they're not in the room?  
	Here's strategy, it didn't work when I was working with a family of triplets but it should have worked.  It was triplets.  One had hearing loss and one didn't.  The mom was in a bad place emotionally.  Everything is now great but when I was the in home provider, that was not the case.  I would literally leave work, call the colleague and the whole way there, the colleague would talk me into going into the house, okay?  So it's going to be okay.  You're going to be fine.  It's not going to be a problem.  I'm like, I'm sweating and I'm five minutes away and I'm sweating because she's the woman I couldn't find.  What if I can't find her?  
	So one day, another colleague said, I'm going with you.  This is ridiculous.  If you can't make her do this, there's something wrong with you.  Really making fun of me.  
	Now, there's two of us.  The moms, and there's three.  So I would always say to the mom, I'm going to sit in the chair with this child.  Do you want to sit here with these two?  Do you want to, instead of, sit your sorry, you know what down because we're going to do this together, okay.  
	So this friend of mine is there.  So we line up the three highchairs and she takes one of the children and I take the child with the hearing loss and we say to the mom, here's the chair for you and she's says, I'm going to sweep.  My colleague looked at me and was like, I told you ‑ ‑  no, no, I'm fine, I'll watch from here.  
	Like I said, it was a total disaster.  Then we moved from those chairs to the living room and we put the three children on the couch and then we had a book.  So my friend Carry talked to the first child.  Then I did the child with the hearing loss and we gave the third child that was typical.  
	So I get ready to pass the book to her and she picks up the child on the couch and says, we're not doing this.  We're the peanut gallery.  
	So even ‑ ‑  she wouldn't even interact.  She was in such a bad place she couldn't even be with her children who were typical.  Okay?  
	You know, I was young and naive back then.  It wasn't that long ago but more than ten years ago so I was younger.  It all turned out fine but the truth is in hindsight, I probably shouldn't have been doing any activities with her.  I should have been going to the house and just talking.  
	Emotionally she was not ready for it.  She's doing it to avoid interacting.  
	So here's a family I would say, I need to spend a year with providing support, really, probably, with a baby on my mouth and every once in a while, interacting with my child but I needed to get the mom to interact with her child.  I'm not going to be any good with ‑ ‑  I think that's too open ended of a question.  I think we have to go backwards.  Explain you have a new strategy and with the new strategy, these are the expectations.  You have to be very clear.  You can do it for one little piece.  Like for five minutes, this is what I want to have.  If you haven't had a parent do quote, an assignment while you're working with the child.  To start, bring the parent in and say, while I'm doing this activity, I want you to observe whatever it is.  So if you're working on ‑ ‑  that's the way to start to get them back in the room.  You have an assignment and they have to show up.  
Does anybody else have anything they want to add to this?  Does anyone have anything?  She's going to yell at me, the room monitor but with a building ideal family, it's come completely ‑ ‑  let's not do the bilingual family but with an interpreter.  
	So you're working through the interpreter.  You have to have the mind set you can accomplish 50 percent of what you went there for.  You can't ‑ ‑  in twenty minutes of coaching, you're going to go ten minutes of coaching in because you have to be through the interpreter if you don't know the language at all.  So if I'm doing it through a Spanish speaking interpreter, I know enough.  I just can't speak it fast enough.  I know enough, if the interpreter said it wrong, I can say, wait, that's not what I said.  When the mom talks, I can understand her but if that were in Russian, I wouldn't have any idea what is going on.  I would have to trust the interpreter which would be another presentation about whether the interpreter knows what she's saying and it's going to slow everything down.  
	You need to be careful about what you're picking as your objective to make it, at the beginning, simple enough that through the process, it's going to be effective.  
	Okay, our time is up.  I'm sorry, according to my watch, we have three more minutes but according to her watch we don't.  Thank you!  You have been a great audience and it was a lot of fun.  You're very welcome.  It was a lot of fun interacting with you.  I learned a lot from you.  I hope I can remember by the time I get to my room, to write down all of the things you taught me today.  So I wouldn't start with five sounds because I think the best thing to do is to ask the parent what is something they enjoy doing the most.  Like, not even related to the child.  What is your favorite thing to do.  Then they tell you so you have an idea.  Then you say, what's your favorite thing to do with your child.  Whatever their favorite thing to do is what they should do.  
	We teach our parents how to do the link sound check but not until the children are able to do it for us.  That's an issue.  When you're doing a skill like the link sound check, do you want to be the one who teaches the child to do it?  You can dedicate five or eight minutes of your session where you say to the parent, if you need to put a load of laundry in, now is a great time.  I need eight minutes with the child.  I need to work on this skill because the child needs to have it for audiology.  That's completely fine, yes!  
	I really have to stop talking.  I'm here all day tomorrow and the next day.  Are you coming to my presentation tomorrow?  Tomorrow, I'm talking about vocabulary.  I'm going to talk about the importance of single word vocabulary development.  And again, it's the exact same thing if you're using sign language versus spoken language.  It doesn't really matter.  It applies to both.  It's about learning single words to put words together to be able to express ideas.  Tomorrow, 11:15.  It will be great.  It's really short.  I can't say a lot.  I can't even introduce myself in 15 or 25 minutes.