ROUGH EDITED COPY

UTAH STATE UNIVERSITY – CASEY JUDD

EHDI 2019 – TOPICAL SESSION 6, 7, & 8 – INTERNATIONAL F
MARCH 5, 2018
2:15 P.M. ET

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	(Writer standing by.) 
>> SPEAKER:  Hello, everybody.  How are we doing?  Last final stretch.  I was really grateful to see them passing out something sugary before we started.  My name is Pam Dawson.  I'm the director of an option program in the state of ‑‑
(Need speaker closer to mic please.)
>> SPEAKER:  In exploring the topic of ‑‑
(Need speaker closer to mic, please.)
>> SPEAKER:  I think I don't have to spend too much time on this.  Coaching is a practice of a provider giving parents the knowledge and skills that they need to support their child's development by letting the parent take the lead as much as possible during an intervention session with the support of the expertise and the specialty of the provider.  Um, so, why do we use it?  Well, because it's evidence‑based.  I just pulled some, um, some definitions from some federal, um, some federal organizations.  So, the early childhood technical assistance center, um, tells us why it's evidence‑based, and then it also follows the key principles of early intervention that was put out in 2008.  A third reason to use tele‑intervention is because it can increase coaching behaviors and family engagement.  There was a study that was done a number of years ago, and in the resources section, there will be a citation for it, that, um, was a comparative study with children that were receiving traditional in‑home therapy and also through tele‑intervention, and, um, the sessions were recorded and then rated, and using the home visitor rating scale, um, it was found that there was more facilitation of the parent‑child interaction by the provider, that there was more parent‑child interaction and parent engagement, and that was statistically significant, um, change, and it was also more, um, child engagement.  
Also, um, another study that is more ‑‑ mic out ‑‑ about the child's behavior.  Probably a lot of you have seen this, the five principles, the five components of coaching by Russian Sheldon.  Another wonderful resource, the early childhood coaching handbook.  At the end of this presentation, there will be a list of resources, and that will be included in it.  Um, very briefly, joint planning, observation, action, or modeling, reflection, and feedback, and now each of the other providers and members of the, um, learning community are going to give you actual examples of three different, of these three different of the five components.
>> SPEAKER:  So, joint planning, obviously, we're going to be most successful in our visits and in our, using our coaching strategies if we're involving the family.  So, as a coach, we want to keep everything as simple as possible, whether it be where's the placement of the child, are we going to work on greetings, a specific toy to motivate the child, and just incorporating something that's already happening in the daily life of these families.  Um, the coachee's job during this time, during joint planning, is to describe a difficult part of their day, but sometimes, that can be difficult for them to figure out, so, um, the coach and the coachee are going to work together to come up with something and plan together and both agree upon.  Um, so, when we're thinking about this, we're thinking about the specific activities that are already a part of daily life, and some upfront planning is required for this, so it's easier, you know, when you're in the home, you can do this pretty easily, but when you're doing tele‑intervention, it's really important to think about the next visit, planning this together, so that we can get this together before the, um, actual tele‑intervention happens, so that's a little bit different.  Um, asking leading, open‑ended questions, so what would you like to work on between the next visit, what's a struggle for you right now, what is something you'd like to see them moving towards, and then just picking a few things to target.  It could be one thing, it could be several things, depending on what you're thinking.  
Um, being very specific with your examples, with these families, is key as well.  This is going to help them setup for success.  Writing down the joint plans, so if you're in the session, writing it down with the family and leaving it, but we know that our families love to text, so I always text afterwards, whether tele‑intervention or in‑person, and then send a message, a new strategy during the week and checking in to see how things are going.  Um, then, like I said, following up.  So, I have two videos to show.  My first video is an example of joint planning while in the family's home, and I really love the back and forth communication here.
>> SPEAKER:  So, you have lots of cupboards here.  Does she have access?
>> SPEAKER:  They're open, but she honestly doesn't ask for them that often, which I've been okay with.
(Laughing.)
>> SPEAKER:  Um, but yeah, I wonder if we could put, you know, some toys or something that she can play with in there.
>> SPEAKER:  Where would it be ideal for her to play?
>> SPEAKER:  Right here or right behind you.  So, that one right behind you is the trash, but then the two right there,that's where we have all of our food storage right now, but we could definitely shift some things around.
>> SPEAKER:  Would that give you space to keep her away from the oven but still let her be near you?
>> SPEAKER:  I think that one would probably be okay.  This one would be a little bit better, but she tends to, if she goes after one, it's usually that one, so that's why I thought maybe that one would be good, because she already kind of, if she's going to open a cupboard, that's the one she opens.
>> SPEAKER:  Obviously, this video is an ideal situation in the home, awesome back and forth communication.  I love how the coachee is leading with more and more open‑ended questions, trying to pull out, like, let's get super specific about what area of the kitchen we're going to use for this child.  The next video I have, um, is a, um, video of a tele‑intervention session.  This family had a joint plan together to work on wait time and imitation, and this just shows how the provider is able to completely interact with this family, even though it is through tele‑intervention.
>> SPEAKER:  Good job.
>> SPEAKER:  Good job.
(Applause.) 
>> SPEAKER:  Yay.
>> SPEAKER:  Jackie, that was awesome.  You guys have been practicing that.  Yay.  Oh my goodness, you are controlling the materials, you're getting him to look at you, you're getting that eye contact, and he's repeating after you.  Jackie, that is awesome.
>> SPEAKER:  That's an awesome example of how the therapist is still totally engaged in the situation, giving that feedback, there's that back and forth interaction, you can tell she has a good relationship, um, and, so, again, just some examples of joint planning.
>> SPEAKER:  And now I'm going to talk about modeling.  This is, um, an aspect of coaching that actually should be used in a very limited fashion, according to, um, Russian Sheldon, and it's really important that the, um, provider make sure that the parent is not getting the message that they are unable to do the task, but rather helps the parent see that there are alternative methods for doing a particular strategy, um, and when modeling is strategy, the provider needs to really talk about what are we going to do, what is the purpose of this strategy, and what is it supposed to accomplish, so that the family really understands, um, what is supposed to happen.  So, I have two videos that I'm going to show.  Um, the first one, and don't cue it up yet, is, um, provider modeling via tele‑health.  Now, the difference with modeling in‑person versus modeling in tele‑health is tele‑health, obviously, the provider is not present, and, so, the family has to be the one doing the strategy, and, so, that's an area where, um, modeling via tele‑health is actually better, because the, um, provider isn't actually doing it for the family.  One aspect of modeling, though, via tele‑health is the provider has to use props, because they don't actually have the child there, and, so, in this video, you will see that the provider, which is an occupational therapist, is using a great, big, huge mouth to show the parent where she wants, um, the parent to put the spoon to help with lateralization of the tongue.
>> SPEAKER:  So, Arlene, I'd like to see if we could try a new technique today and just see how Charlotte does with it.  Is that okay?
>> SPEAKER:  Yes.
>> SPEAKER:  So, can you see my demonstration, my mouth here?
>> SPEAKER:  Yes.
>> SPEAKER:  Okay, so, what I'm going to ask you to do with your spoon is I want you to try to see if you can do some side spoon, so you're going to be coming in a little bit from the side, to see if we can get her tongue to move a little bit to the side.  Does that make sense?  Let's try that.
>> SPEAKER:  All right. 
>> SPEAKER:  That one didn't work so well.  You didn't see her mouth, but her mouth is something she uses on her hand, and while she has the mouth up, she is bringing the spoon and showing exactly where she wants the parent to put the spoon, and the parent is copying what the provider is doing, and it's very effective.  So, the other video I have is of an in‑person session, and what you will see in this video is the provider says she is going to model something for the parent, um, and explains why and what she's hoping to accomplish, but then as she starts actually doing it, the child is having none of that, and, so, she doesn't actually get to model anything, but the parent couldn't, can see what the provider is trying to do, and as it turns out, the child actually does what she wanted, what they wanted her to do.  And hopefully, this one will work. 
>> SPEAKER:  There you go.  Wow.
>> SPEAKER:  So, when she comes up to standing, I want you to watch how I am going to help her shift her weight over, so she can just bring that foot down.  That's okay.  If she's not going to do it, that's okay, just read her response.  There she goes.  Yeah, good job.  She's like, I'm not going to let you help me, I already know how to do it.  Don't try to fake this.
>> SPEAKER:  And you'll find, too, I think when she's motor planning and working hard physically, she'll be real quiet, but then once she's kind of relaxed, and then you can do more talking with her.
>> SPEAKER:  So, the last component of coaching that we're going to talk about this afternoon is the reflection, and I've been really fortunate in several of the sessions I've attended over the last couple days that references to Russian Sheldon and these components of coaching have been presented as parts of several different talks, so you may have already heard about this several times.  This is on reflection at the end of a session, but reflection can happen throughout a session also, and according to Russian Sheldon, the definitions for what the coach does during reflective, um, reflection at the end is to help support the family, um, in analyzing the events that have happened during the session, so that we can encourage them to try new strategies, make adjustments, um, you know, a variety of different ways of thinking about what they've been doing through the session in order to meet the outcomes that they have, and a lot of the reflection that you'll do at the end of a session will circle around and be part of what you're going to do as your joint planning for the next session, so you hear some similarities in what those components look like.  
Um, what the coachee is going to do is to determine, according to the conversation that the coach and the family or the coach and the coachee have, they're going to determine, um, what has worked well for them or what didn't work well and try to figure out, um, why things went well with them or what is going to be, um, helpful for them as they're trying to work on the strategies and work towards the outcomes that they're looking for.  So, I gave you the actual page in the Russian Sheldon, um, handbook.  There's some examples in there of reflective questions that you can use, but there's all different kinds of questioning that you can use.  One recommendation they do have is to try to stay away from yes/no questions, which is really hard, but we try to encourage parents to stay away from yes/no questions too a lot of times, so, um, that works well together, and then here's just a few examples of some ways that you can help encourage the families to think about what's happened during the session and to come up with, um, what their plan is going to be between then and your next session, things like what would you like to focus on between now and then, um, considering everything that we've talked about today, um, what do you think is going to be a plan for you that's going to work over the next week, what do you think worked best for you today, maybe what, um, seemed to be a little bit more challenging, and what was helpful for you today.  So, those are just a few examples of questions.  So, um, the first video that I have is, um, at the end of a session, I have to apologize, because Shelby, the, um, provider and the parent are down in the corner of the picture, but they did a really nice job, and this is an in‑home session, so they kind of got moved out of the frame, but, hopefully, the conversation will be valuable for you to listen to as they are reflecting at the end of their, um, activity and session for the day.
>> SPEAKER:  What is that?  That was great.  What did you like best about today?
>> SPEAKER:  Yeah, I really liked the idea of using the instruments.  Like I said, I want to bring them into every‑day life more often, so that was good, and I see that you put ‑‑
>> SPEAKER:  Yeah, and we can go over those too another time, or we can continue with these and then wait another time to do those.
>> SPEAKER:  Yeah, you know the happy and you know it song?  We have not used it with instruments, so I think it'll be interesting.
>> SPEAKER:  Okay, maybe, I know that you have book time, so maybe, like, every other day.
>> SPEAKER:  Right, yeah.  A reason I did not use these instruments is because I didn't know what to do.  Now that I do ‑‑
>> SPEAKER:  The last line didn't get captioned, she said I'm going to be flexible with the whole thing.  Didn't get that last line captioned on there.  The, um, virtual session that you're going to watch is, um, the very first time this family did a virtual session with this particular provider, and you do not see Ashley in the picture, the, um, provider who's doing the service in this, um, session, but some of the reflection she's reflecting on is what her plan is, that what she's going to work on it, and then she did have a couple of comments about how she felt at the end of the session, her very first session, doing a virtual, um, session with Ashley.
>> SPEAKER:  So, out of the things we kind of talked about today, is there something that makes the most sense for you to, um, to incorporate this week?  Is there something you want to work on in particular?
>> SPEAKER:  Um, maybe we'll do the blocks and then just ‑‑ inaudible ‑‑
>> SPEAKER:  Okay, cool.  Yeah, the blocks will be interesting.  I think, maybe, if you, I think since there's enough interest for her, even if you only do it three or four times, um, that's a really, like, kind of natural repetitive game that you could play that she might enjoy.  So, yeah, that's great.
>> SPEAKER:  Probably a little more vocal that way.
>> SPEAKER:  I feel like we got a lot more out of her today than when I'm there actually.
>> SPEAKER:  She gets very quiet, for some reason, when people are here.
>> SPEAKER:  Right.  Yeah, I feel like it was very successful, if you guys felt like it was fine.
>> SPEAKER:  Yeah, it's good.  Yeah.
>> SPEAKER:  Cool.
>> SPEAKER:  So, we've had different, um, children over the course of the years, um, who are receiving some, um, tele‑therapy, where the children are much more interactive when they're, um, participating in a virtual session than they are when the provider's actually in the home.
>> SPEAKER:  One of the last things that the, um, learning community has been working on is, um, exploring together what's out there in terms of supports for best practices in coaching and early intervention, and then looking for fidelity measures that providers can use to evaluate, um, their own practice, and then we took it a step further and tried to see if we could find any fidelity measures that were specific to tele‑intervention, and we didn't find very many.  So, um, one of the things that we're working on right now is, um, surveying providers, um, in terms of tele‑intervention, best practices in, um, in early childhood intervention, and seeing if providers feel as though it's harder to do through tele‑intervention, easier, or about the same, um, and we've got a fairly good number of providers that have given us that information, and, so, um, at our next meeting, we're going to be taking that and deciding what that means, how can we take that information and perhaps turn it into some sort of a tool or fidelity measure that might help us with our practice.  So, as I mentioned, um, these are some resources that we, um, talked about today.  In particular, I'd like to highlight the second one, the learning to listen coaching model.  
This is a relatively, um, new resource in coaching specific to children with hearing loss, and Nan Thompson and Christie Yoshinaga‑Itano have been working on it.  It's now available for us to, um, to use, and you can actually contact Nan at that e‑mail address to find out more about it.  Since we couldn't find too many actual tools or resources in tele‑intervention, we actually started looking for some studies, and these are the studies that I mentioned earlier on in the presentation.  So, we hope that you will join us.  I'm assuming you're here because you have an interest in tele‑intervention.  We're a great group of people, and we have a lot of really interesting conversations, um, and the more experiences we have, the richer that conversation will be.  So, I encourage you to contact me, my address is right there, and then all the other presenters' contact information is there as well.  Questions?  Comments?  This is a question related to, I guess when I look at the description of the session, I was thinking a more general communication, but this is more spoken communication.  Have you tried any signing coaching for parents, that you sign and use that for early language communication?  Or is this just for spoken?  That's a curiosity.  So, that's one side, but I'm thinking you probably should offer all different choices.
>> SPEAKER:  Sure.  Um, so, the presenters here that volunteered to do this, um, work in programs that use, um, primarily spoken language, but we do have members of the learning community, um, that work with families through sign, so, um, all people are welcome.
(Off mic.)
>> SPEAKER:  No, not in this presentation, but there are people that are part of the conversation and the discussion that work in programs that use sign. 
>> SPEAKER:  Okay, that's all the time we have. 
(Applause.) 
(Off mic.)
>> SPEAKER:  That's a really good idea.  So, we meet the second Thursday of the month at 1:00 p.m. virtually.  Eastern time.  

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.