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Greetings from FIRST YEARS!
by Kathryn Wilson, M.A., CCC-SLP, LSLS Cert. AVT (kathryn_wilson@med.unc.edu)
FIRST YEARS Program Director

Spring has finally sprung - or so we hope where you are! Our students have reported all sorts of winter woes, with school closings and delays. Mélissa Leblanc (class of 2011), from Moncton, Canada, even posted a photo (1/28/11) of her "major workout" shoveling the first snow - and more snow soon followed.

In this spring edition of fyi, we introduce a new feature "Data to back it up!"  The inspiration for the column comes, as so often happens, from our course discussions; and it actually broadens the focus of a question posed in fyi's last issue relating to literacy:  "With all the claims from the various communication options relating to literacy success, what actual research supports those claims?" Specifically:

"How can we be more data-driven when meeting with parents, teachers, and school administrators?" 
Here, we highlight some "Data to back it up!" and, to illustrate, we share two "best ideas" created when students were challenged to produce handouts for parents/administrators. 

We also read about one student's first experience with her mentorship - "This place is amazing!" (Emily Pratt, 3/15/11) What place? The River School in Washington DC.

Finally, we learn about a pilot project – Tar Heel Player – which adds a musical/auditory component to the Tar Heel Reader, co-developed by UNC professor and FIRST YEARS faculty member, Karen Erickson, and UNC computer science professor, Gary Bishop.

Now Accepting Applications
FIRST YEARS is accepting applicants for the Fall 2011 cohort until May 23, 2011. We invite you to "spread the word." Prospective students can find more information on our website – http://firstyears.org


Mentorship: Going Green
Emily Pratt (class of 2012) recently returned from part one of her mentorship with Meredith Ouellette (MS, CCC-SLP), at The River School, Washington DC. Prompted to "let us know how it went" by her classmates, she posted (3/20/11):
It is truly an incredible place that really knows what they're doing! It is a private school that serves ages 18 mos. through 3rd grade. 85% of the population is typically developing/ no hearing loss and 15% is made up of children with hearing loss (for the most part using LSL [Listening and Spoken Language]). There is a family that uses Cued Speech and one family that uses signs as well as spoken language. The class sizes are no larger than 15 students and there is a teacher with a master's degree as well as an SLP in EVERY classroom!! They limit the number of children with hearing loss to no more than 3 to a class to ensure that they are getting intensive input.

They have developed their own curriculum (that I absolutely love) and it is based on the idea of  Developmental Synchrony. This is the idea that the total child needs to be developed all at the same time. They have done a lot of research with their HI students and have found a significantly higher number have motor issues as well as social/emotional issues  ... I have always been extremely focused on the language and audition aspects with the children that I serve and, now looking back, have almost neglected those other aspects. I have always used a very transcribed language approach (Bloom and Lahey and CASLLS1) and hit very specific targets. At the River School they don't really do this. They work on language, of course, but it is in a much more natural everyday way. They test their children with HI every 6 months and use the testing to help guide them in language development. 

The school curriculum also helps guide them in the planning of language. Each class is theme-based and the theme changes, depending on the class, every couple of weeks to a month. They carry this through all the way to 3rd grade and I LOVE it! Once the theme is established, vocabulary, language goals, centers, manipulatives, books, everything in the room changes to reflect the theme. In the 3rd grade classroom that I was a part of, the theme was "Going Green" and the kids had designed and built an entire "Green Town." They had an architect come in and talk about blueprints and city planning, they visited a lawyer's office to discuss the pros and cons about different green energy and then they had to come up with a blueprint (drawn to scale!) of the town they would then build. After they finished the blueprint, they then constructed a town using recycled materials. It was just incredible to see how engaged and interactive the whole process was. And the two girls in the 3rd grade class with CI's were AMAZING. If you didn't know that they were CI users, you would have never known they had hearing loss. Completely age appropriate (and above), reading on a 6th grade level (in the 3rd grade), completely socially appropriate and engaged with the others in their class. 

I think one of the things I loved best about being there was the sense of community as well as an entire facility of professionals that understands and buys into what they were doing ...  and knows how to make it [LSL] work. It felt so good to be a part of that. I cannot wait to go back and experience my other 5 days simply to soak up some of what they are doing :-) I was begging them to come and open a school in NC :-) I hope they will one day!

1 We cover these tools, among others, in our course on Listening and Spoken Language Development and Intervention. The Winter, 2011, fyi issue featured one of these tools, The Auditory Learning Guide.

Literacy Pilot Project: Of Ice Storms and SongBooks
Chris Barton, M.M., MT-BC (cgbarton@sbcglobal.net
Indianapolis, IN

For one week in February, 2011, Indiana was literally frozen in the grip of an ice storm. The plows were unable to break the ice and the whole state basically stayed indoors for a whole week. What to do? Clean house, read a book, cook for a month, or … learn to use Tar Heel Reader (THR)!2 I was hooked with my first book. After my second book I began to wonder if it were possible to add music to them. When I first contacted Dr. Gary Bishop, the THR creator, his first response was "NO." But then, in the next email he said, "Let me think about it some more." And thus, the Tar Heel Player (THP) – and SongBooks – were born! 

This wonderful addition allows me to incorporate music or recorded narration to any book I create, thereby adding the listening component fundamental to listening and spoken language approaches. Here is an example:

Check it outHoppity Hop  (Hit your browser's refresh button to play it again. Note: THP currently works only with the browsers Chrome and Firefox.)3
As a music therapist currently enrolled in the FIRST YEARS literacy course, I began to realize the potential of THP to support the emergence of both language and literacy development through the use of music. Paraphrasing Roach van Allen4, one of the early proponents of the Language Experience Approach (LEA): 

If you can hear, you can listen, if you can listen, you can talk (sing), if you can talk (sing), you can read. It’s called the road to literacy!
Nathan singing the Good-bye song.How powerful would it be for a child to have his own "Music Experience Book" (MEB)5 complete with narration and musical performance? How powerful would it be to have the child writing his own book and hearing his own voice reading his own book? On the music therapy side, it would be a wonderful opportunity to reinforce instrument discrimination, recall the events of our sessions together and provide a snapshot of the child’s development at a particular time. If it were "updated" regularly, it could also act as a measure of the child's progress. 

To create a MEB, I had parents take photos during several sessions, then I roughed out a draft using as many phrases I knew the child used. I then emailed the draft to the parents so they could have their child add more of his own words to the story. Once the parents sent it back to me, we read the draft together and put the final touches on it. Once the story was complete, we spent a session recording the narration and instrument sounds. 

One of my students, Nathan Almack6, is willing to share his "Music Experience Book" with you. As he exclaimed when he viewed the finished product, "I'm going to watch it a million times. Can I watch it after dinner, too?"

Check it outAlmack, Nathan.  (2011). My Music Book - To replay, click the refresh/reload option on your browser.

If you feel inspired to create a SongBook using Tar Heel Player, here are the directions:

Check it outFIRST YEARS: How to Create a SongBook Using Tar Heel Player
I am happy to answer questions or provide feedback to any who want to try this amazing program. THP is still in the pilot stage, so we would welcome your feedback. Chris' email: cgbarton@sbcglobal.net

2 FIRST YEARS highlighted the Tar Heel Reader in its Spring, 2010, issue.
3 If you are interested in hearing more SongBooks they are located at the bottom of my homepage, http://christinebarton.net

4 Allen, R.V. (1968). How a language experience program works. In E.C. Vilscek (Ed.), A decade of innovations: Approaches to beginning reading. Newark, DE: International Reading Association.

What I can think about, I can talk about. 
What I can say, I can write down. 
What I can write, I can read. 
I can read what others write for me to read. (Allen, 1968)
5 "Musical Experience Books" are the musical equivalent of "Language Experience Books." LEBs are books created by the parent, teacher, and/or therapist for and with the child. LEBs record an experience the child has had, typically using the child's own words. Thus, the child learns that spoken language can be written down and read right then, as well as later. Incorporating audio, in the form of recorded narration and/or music, adds the listening/LSL dimension to LEBs. 

6 Nathan has moderate-severe bilateral sensorineural hearing loss. Aided, he falls into the mild, 20-30 dB loss.


Data to back it up!
A topic recently came up in the literacy course on "long-term outcomes," which ultimately figured into exercise challenges for our upcoming graduates. The challenges? To create jargon-free, data-backed handouts to give to parents and administrators.

The original question came in from Dara Breitkopf, a soon-to-be-graduating FIRST YEARS student. We include some text from the subsequent forum postings/emails, not only to provide some context, but to illustrate the typical flow of ideas among faculty and students in our courses. Dr. Lyn Roberston is the author/facilitator for our literacy course, but the behind-the-scenes discussion ultimately involved other professionals as well.

From Dara Breitkopf (forum posting, 1/25/11): Dara had recently talked with a teacher who had noticed that a student with hearing loss was having difficulty understanding information and remembering vocabulary, concepts, etc. The teacher's answer to this problem was to request a sign language interpreter. The boy had never had a sign language interpreter before. Dara continued: "I remember reading somewhere that introducing any kind of manual sign system makes the child rely on the visual and the auditory input stops (and speech becomes less clear, audition weakens, etc.)  Does anyone remember where this was written?  Or does anyone know of an article where it can be found?"

Lyn Robertson followed up by emailing questions to Dara (2/6/11), then commented on the "evidence." Dara's answers are embedded in green

Dara, here are my thoughts:
I think before anyone can answer this, much more needs to be said about the child's situation.  How old is the child?  He is 7. Does the child in question already know sign language? No. If not, then it's a whole new language to learn.  I have already told them this but it is falling on deaf ears, which is why I would like to have some research to back me up.  How much spoken language and/or sign language does the child have at this point? He has very little language but is making slow but steady progress. Are people speaking with the child consistently and expecting the child to listen and respond?  His parents speak Spanish at home and do not enforce that he wear his processor at home and on weekends.  Does the child use hearing aids/CIs all day, every day?  No. Does the child have any obvious disabilities?  No. (I'm not counting the hearing loss as a disability.)  What outcomes do the parents want for the child? They want him to listen and speak...  they mentioned they do not want him to sign during other meetings, but I'm not sure if it was ever spelled out for them what the expectations were …

In general, our anecdotal experience tells us that it's easier for children to learn sign language, but once that becomes the mode of communication, it's really hard to switch the child to listening and spoken language.   Many teachers are convinced that sign language is superior as a communication mode, and so they push for that, and of course it's much easier for them in their classroom for that school year.  But, ultimately, the child doesn't learn spoken language and lives with that indefinitely. This isn't something that one could set up a controlled study for because of the obvious ethical problems.  For all these reasons, I would fall back on the evidence about academic outcomes.  The children with whom listening and spoken language are used are much more likely to be in "regular" classrooms with peers with typical hearing, and they are far more likely to read and write at levels comparable to these peers.  The median reading levels of children who sign have stayed around 4th grade for students who are 16 and 17 years old.  I found this in my own work, and so did Geers and Moog, and the more recent work of Dimity Dornan in Australia.7

Another email (2/6/11) from Carol Flexer to Lyn provided the lead for locating some of the most recent research. The needed article was supplied to our students.
You must get a copy of this Ear and Hearing Journal edition that just came out. It is Supplement 2011, Volume 32, Number 1, "Long-Term Outcomes of Cochlear Implantation in Early Childhood" ... This entire volume is the detailed reporting of the longitudinal study conducted by Geers, Tobey and Moog … One very important finding is that "the use of sign to enhance spoken communication negatively influenced verbal rehearsal speed, which was a strong predictor of all early outcomes, which in turn strongly influenced later outcomes. These analyses suggest that early communication mode exerts a powerful influence on early outcomes that persist into later years." Please read the whole study because there are many important and complex findings. There is a strong science to support what we do! 
We stepped into gear to locate the article and distributed it to both cohorts. As Clay Renick (class of 2012) emailed when we shared the findings: "I see the improvement in my students already, but it's great to have the data to back that up!" (2/8/1)

And now … in meeting the "exercise challenges" to the literacy course students …

The best ideas …
… come from our students.

Two parent-friendly handouts - to explain how using the best available hearing technology will prepare a child for literacy success - illustrate how to use research data to "back you up." The authors, Dara Breitkopf and Patricia Eitemiller (class of 2011), have given us permission to share their work.

Check it outEitemiller, P. (2011). Thinking about Literacy: Supporting Infants & Toddlers with Hearing Loss
Breitkopf, D. (2011). Best Hearing Technology = SUCCESS IN SCHOOL AND LIFE!

And Dara (3/21/11) reports success: "I just came from a meeting and used my assignment from Unit 1 to support removing an interpreter and increasing TOD services for one of my students. I can't tell you how important it was to have the research to back what my recommendations were."

7 The article: Geers, A. E.; Strube, M. J.; Tobey, E. A.; Pisoni, D. B.; Moog, J. S. Epilogue: Factors Contributing to Long-Term Outcomes of Cochlear Implantation in Early Childhood. Ear & Hearing. 32(1):84S-92S, February 2011.

Copyright restrictions prevent us from distributing this article. However, you may purchase the article itself (or the journal issue) from http://journals.lww.com/ear-hearing/toc/2011/02001 (The whole issue is relevant.)

There is a web version of the Dornan article: Dornan, D., Hickson, L., Murdoch, B., Houston, T., & Constantinescu, G. (Fall 2010). Is Auditory-Verbal Therapy Effective for Children with Hearing Loss. The Volta Review, 110(3), 361–387.


From FIRST YEARS Reference Library
Students in the course on Audiology Interpretation and Hearing Technologies have recently been discussing functional listening measures in connection with analyzing audiograms and audiological reports. As Kristine Ratliff (class of 2012) commented in a forum:  "I love the idea of functional listening data to be included in an audiological assessment; though I have never seen it myself, either.  As a teacher of the deaf, I have not been asked by an audiologist to complete one.  I am thinking that I may complete one on my own, and give it to the parent at the IEP, and recommend that they take it to their next audiological exam.  The audiologist may choose not to use the data; but I think it's nice to have for the overall picture of the child's listening." (3/8/11) Heather Porter (AuD),  co-instructor for the course, responded with a few questions that we all might ponder (3/10/11): "Great idea to complete a functional assessment and send it to the audiologist. Which makes me think of a few questions to get us thinking ... Who can give functional measures? What situations could benefit from the type of information functional measures have to offer?"

Faculty member Anne Marie Tharpe contributed the FIRST YEARS reference document below, one of several assessment compilations students cover during the course of their certificate work. 

Check it outFIRST YEARS: Functional Assessment Tools

And a followup illustrating how to document using functional assessments: Tracy Vale (class of 2012) posts (3/11/11): "I have twin girls new to my caseload.  Activated 8/27/10 and their mother is still working towards full time use:(  I have only seen them a few times but they detect certain speech sounds (/m/, /a/, /u/) but do not acknowledge sudden loud noises at all.  Prior to this unit, I might have said 'oh, you should mention that at their next mapping.'  Today I started a page for these observations in the habilitation binder we created and explained I would fill out a functional assessment prior to their 4/6/11 mapping appointment."

PREVIEW: In an upcoming fyi issue, we'll continue the Reference Library series on Focus on Learning to Listen; Listening to Learn and highlight our compilation of Tests & Measurements:  Auditory, Speech, Language and General Developmental.


Names in the News
Recent publications by FIRST YEARS faculty, students, and mentors
A new monthly newsletter - Talking Tips -  is available from faculty member Karen Rossi, creator of Learn to Talk Around The Clock®. To subscribe, send an email to: learntotalk@cox.net
  1. [current issue] Talking Tips, March, 2011.
  2. [previous/first issue] Talking Tips, February, 2011.
Coming Summer, 2011: The Volta Review will release a monograph edition analyzing results from a survey questioning all 50 EHDI state coordinators on the strengths and needs in EHDI programs. Several articles by faculty member Gayla Hutsell-Guignard will appear in the monograph.
  1. Bradham, T.S., Hoffman, J., Houston, K.T., & Hutsell-Guignard, G. (2011). Fostering Quality Improvement in EHDI Systems.
  2. Houston, K.T., Bradham, T.S., Muñoz, K.S., & Hutsell-Guignard, G. (2011). Newborn Hearing Screening:  An Analysis of Current Practice.
  3. Bradham, T.S., Houston, K.T., Hutsell-Guignard, G., & Hoffman, J. (2011). Strategic Analysis of Family Support in EHDI Systems.
Upcoming workshops by our faculty, students, and mentors
  1. Breitkopf, D. (class of 2011). Achieving a Successful Transition into a Mainstream Setting: From Early Intervention thru College. The Children’s Hearing Institute. Beth Israel Medical Center, NYC. May 13, 2011.
  2. Heavner, K. & Vernelson, S. Bloom & Lahey II / CASLLS II: Roadmap to Language Development. April 7-8, 2011. LSLS credit.
At the upcoming LSL Symposium in Washington DC, July 21-23, 2011:
  1. Goldberg, D. M.  Listening, Language and Learning for Infants and Children Who are Deaf or Hard of Hearing, July 21, 8 a.m. – noon.
  2. Teagle, H.F.B &  Roush, P. Auditory Neuropathy Spectrum Disorder, July 21, 8 a.m. – noon.
  3. Alberg, J. & Wilson, K. Longitudinal Research on Outcomes for Children in North Carolina, July 22, 9:30 – 11:30 a.m.
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© 2011, The University of North Carolina at Chapel Hill FIRST YEARS Certificate in Auditory Learning for Young Children with Hearing Loss. All rights reserved. May be reproduced in any medium for non-commercial purposes.
Publication date: March, 2011