6: Collaborating On Complex Cases
We chat about the TOD’s role on a large IEP team when a student has multiple disabilities. We discuss strategies for collaborating with teachers and other professionals, as well as some ideas that have worked for us.
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episode 6: Collaborating on complex cases
Transcript
Intro: Welcome to the TOD Podcast, or as we like to say, the “TOD POD.” We chat about all things Deaf Education while you drive around. I’m Kimmy from The Hard of Hearing Teacher and I’m Deanna from Listening Fun, and let’s get started!
K: Today we're going to talk about being on an IEP team for students who have hearing loss and other disabilities. We can't really give concrete tips on this topic because these students are so unique, but we can talk about some examples and what lessons we've learned through working with different students with multiple disabilities.
D: Yeah, each of these students are so different and each of the IEP teams are so different. But one thing they all have in common is that when there's more than one disability to consider, and there's more people on the team, um, there's going to be more in-servicing and more collaboration in general. So we're going to talk a little bit about that.
K: So with multiple specialists on the same team it's super important for everyone to work together. One way I've had this come up a few times is that sometimes hearing loss can kind of get lost in the shuffle of the student's other needs. If a student is in an autism support classroom for example and has health needs, and has a TOD, SLP, OT, PT, nurse, classroom aide, special transportation, adaptive PE and arts, etc. I think you get the picture. Naturally, some things are going to get prioritized over others. Like a student's bathroom and eating schedule are clearly going to get priority. But once all these things are in place, our job as TODs is to be the person who focuses on the student's needs related to their hearing loss.
D: Yeah, I feel like we've all been on that kind of team before. Can you give us an example of how you work with the team to prioritize a student's hearing needs?
K: Sure, so I've found that if the student's hearing needs are truly just getting lost in the shuffle, it can be easier to tag team with someone else. The easiest and most natural way this has worked for me is to collaborate with the student's SLP. For one student I worked with the SLP worked in the building every day. She was in my student's classroom multiple times per week for my student and for other students, and she was already part of the classroom's natural schedule and rhythm. As an itinerant TOD serving multiple schools, it's much harder to become a part of that rhythm, but by teaming up with someone who is already part of that, I found that it benefits everybody including the student. And since my student has many language development needs including articulation, learning to communicate with their AAC tablet, receptive language - there was a lot of overlap. Especially, between the classroom specialized teacher, the SLP and myself.
D: Yeah I love buddying up with the SLP. They're usually like the best. When you worked with this SLP what did that collaboration look like specifically?
K: So in this case, she saw the student two times per week and I saw the student once per week so we added a section to the student's SDIs stating that the SLP and the TOD would co-treat 2 sessions per month. As we talked about in our previous episode with teaching versus testing, I would typically use my solo sessions to take data, observe the student, track progress, etc and use the co-treat sessions with the SLP for teaching. This worked well for us because me and the SLP collaborated on our goals as well. So for example, she had an articulation goal for bilabial plosives and I had an auditory discrim goal for the same sounds so when we were working together we did a lot of child-led play incorporating those sounds.
D: I really like that example, like that specific example because I think that's a really helpful way of not adding more to a student's plate but like approaching the same thing from two different sides, which I think is, like, really how you have to approach these ones. And that collaboration is really key when you're working with that many people. When I work on cases where the student has many different goals in many different areas, like I said I kind of approach my sessions more in like a supportive role rather than as an independent actor. At the beginning of the year I talk to the special ed teacher, I tell them that I can support any of the classwork. If they need individual support on something, like, I can be that person. I can work on it during my sessions regardless of what it is subject wise. And then I incorporate my listening or language or self-advocacy goal into that activity and there's a few benefits to doing this.
One is I don't know the student's exact level in everything and it's hard to plan activities if you're unsure of what they know and what they can do like motorically or visually. Um, there's, you know, things you have to consider and that's a lot if you're not there every day. And if you're using an activity from the classroom, all of their accommodations and modifications have already been taken into account and you know the content is on the right level. And also if a student has that many goals they probably need more deep practice on the important skills rather than superficial practice on a variety of things. So I'd rather give them extra exposure and practice to vocabulary that is going to benefit them when I leave as opposed to teaching them something brand new that they might not see again.
K: Absolutely, and I think that's another great way of approaching working with the rhythm of their academic programming that's already in place rather than trying to add, quote-unquote, hearing as another piece on top of everything else. Can you explain more how you address the student's hearing goals when you're working within the context of supporting their classwork.
D: Sure, so as an example I had a student several years ago that was in a self-contained classroom and they had hearing loss as part of a syndrome that resulted in delays in several domains. The student happened to have a fabulous special teacher, who really like understood and valued her students, and I was so lucky to work with her because I feel like I learned a lot from her. And at the beginning of the year I explain that the hearing service was there to support, I could help with the classroom work, all that. And typically she would give me something from the classroom to work on individually during our sessions and I would incorporate the hearing goals into it. So the student had a following directions goal that was like their hearing goal that I was there to work on.
And one day the teacher gave me a worksheet where the student had to practice writing sight words like "see" and "said". Um, and I got a bunch of different color markers and like teacher pens, which, like, kind of made it fun. And the student picked a word they wanted to practice first. Um, and then I gave them a direction, "Write said with the red marker", and then they would do it. They'd get the red marker and they'd write their word. And then - I like to take turns with students. Um, I didn't really get into this when we did our teaching and testing episode, but one of the other ways that I like to do that is by going back and forth and letting the student give me directions because it - it practices expressive language, but it also gives them a break from like doing the task over and over again. And it gives me an opportunity to model the strategies that I would like them to use. I want to model good following direction strategies. So when they told me what to do, they're like,"Write said with the blue marker" or something like that, then I repeat to myself, "Write said with the blue marker. Where's blue? Okay, here's blue. Okay, S-A-I-D, said."
So, like, I'm modeling the following direction strategies on my own turn. Um, and this - we like went back and forth. We practiced a bunch of times. Um, and the student felt really successful because they're following directions successfully, plus we're practicing that academic skill that they needed to practice. And this framework of using activities from the classroom and incorporating the listening goals help me make sure the session was like productive. Like, I know they got the practice they needed and I got, you know, work on my goals that I also need to report on.
K: I love that. I also really love how you talked about in that example, giving the student the opportunity to be the teacher, so to speak, within that turn-taking and modeling. I've found that, especially with my older students who have multiple services and providers and are in a special education program, that they have really packed schedules and they don't have a lot of say in their programming because they need to meet certain goals and standards within their scope of ability. And those academic areas tend to be a little more prescribed, so to say, within the curriculum or within the standards that the teacher needs to show that progress on. So with my older students, especially, I'd say like upper elementary through high school, I like to use their hearing sessions as an opportunity for them to be involved in the decision-making with me. Yes, we also have standards and goals that we want them to meet, and they need to know how to take care of their equipment or follow examples, for example, or whatever it is that they're working on at their level, but there's also some flexibility within that and we can work on other skills that the student might want to work on more.
D: Yeah, I think that's really valuable too because when we think of like advocacy and self-advocating, sometimes we have like a narrow definition of what that means. But when we're working with children like this that have a lot going on, just having some agency is like kind of the most basic form of self-advocacy of like having some control over your day. And if we can offer that in our students, that's really like the basis of self-advocacy, which is one of the things we're probably working on anyway. Um, so can you speak more to that about how you can put that flexibility in the decision-making and how you would actually do that with a student?
K: So, in short, I tried to do as much in partnership with the student as possible. I did this with a few of my students last year and I found that they were much more invested in our sessions after we did. So, for example, I might start with a self-assessment. And either walk through it with them to make sure that they understand what is being asked or use a modified version of a self-assessment. And I might have to modify it myself to meet the student where they're at. Then as we're talking through their responses, I start asking questions about what areas they want to work on. Obviously, this approach needs to be adapted for each student when other disabilities are present. So you might use a choice board instead of direct questioning. But the general idea is the same.
The general idea is to talk with the student about what their responses were and where you can go from there. So then I use that conversation, based on the student self-assessments and what they want to learn or what skills they want to build, to write their next IEP goals, and then in-turn, to plan our activities, which I also try to adapt to meet their interests as well. So, I'm meeting their interests, I'm meeting their goals, and the student is having a lot of say in what is happening. So as a quick example after going through a self-assessment with one of my high school students, who also has autism, I picked out a few points from the expanded curriculum standards that were in natural progression from where the student was currently at, and we talked about what each one meant. And then I let the student pick the top 2 to 3 that they wanted to work on. Because it aligned with their goals for after high school, they actually got really excited about learning about ADA and workplace rights, and that led into really productive sessions afterwards as well. And doing it this way accomplished a few things.
One, it gave the student ownership in their upcoming learning goals. Two, it allowed them to review their own progress on their current and previous goals, and that was done constructively and together, and I was able to use their feedback on their current goals to highlight their accomplishments on those goals during their IEP meeting, which also allowed for a positive more- ah, moment with the parents. And, third, this also covered my transition planning basis as we were talking about ADA and the workplace rights. So in the span of 3 sessions for this student, we were able to cover all of those points while the student was interested and actually eager to learn about these things and apply it to their life.
D: I love that. I think that's such a good example. Especially, I find with this population, like, working towards their interests is huge and such like a helpful thing to do. And it also ties back to using the student's time well. When they're in all of these services and all these programs happening, like, you really want to make sure you're using your time wisely and I think that that's like a really nice example of it.
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D: I have another example too of kind of like a different situation but similar idea. Where sometimes like you can actually use that technique to highlight their strengths and when you're working with these students sometimes, like, you really need to highlight their strengths to them and their parents. So I've had situations that I've run into a couple of times where a student has multiple areas of disability and listening can really emerge as a relative strength for the student. Meaning, like the audition skills, maybe they're lower than typical, but they're higher than the other skills, and I always keep my eye out for this because it can be really rewarding to work on strengthening a child's strength. Um, and it could provide wins for the student and the parents that they might really need.
K: I am so excited that you're talking about this because it can be really easy for the adults involved to fall into the trap of deficit thinking. And when there are so many areas that the child is being marked as "under-developing" or "below grade level", but then it becomes so much more important for the professionals to help the parents and the family and even the student to see those positives about themselves and to see the areas that they are growing and that they are - that they have a strength in.
D: Hundred percent. Um, I had a student who, uh, they had a diagnosis that involved vision loss, hearing loss, motor issues, and for this child their hearing devices did provide full access to spoken language. The technology available for their vision and motor could not provide that same level of access. So this student also felt a lot of frustrations at their limitations and it was really important for me to show them how much they were capable of, how strong their auditory skills could become, with a little practice and hard work. Um, and this student was particularly interested in like science-y topics. So I use that special interests as like content for our listening activities. I picked out some like nonfiction books on their reading level, and read them aloud to the student for them to practice like auditory recall, auditory closure, listening for details etc.
Um, I also use the WOW in the World podcast, which is a kid science podcast from NPR. And I really like that one. We would listen to it together and then we pause it and talk about it. And sometimes there are sound effects or like children's voices that are like pretty hard to hear, like pretty challenging, and we would pause we would talk about it, rewind, and we would listen again. Um, and slowly over time we were able to build up their listening skills. Like, they could tell that they were improving because they could hear those kids voices better on the podcast like things like that. And they would feel frustrated when they misheard something or it was too noisy. But we were able to work on the strategies from the special education teacher to like work through those like emotional difficulties. And, once the student actually improved, they got really clear evidence that, one, they could do hard things. And, two, that like carried over into other areas because they knew that they could do it. And at the IEP meeting, I was able to bring progress to the parents. It didn't matter that the child's listening skills are still below age level, it mattered that they made progress and had success.
K: That story literally gave me use bumps, and it seems like it was so impactful for the student and their family for you to highlight that they were making progress and that they had a strength. And I think as an outside provider focusing on a student's strengths and interests like that is important and something we should focus on because - to bring this kind of full circle to what we're talking about throughout the episode - as someone who is kind of on the outside and can view the student without the overwhelm of being their classroom teacher or their parent have 8,000 other things to consider and to balance for this kid. We have the opportunity to support the staff through collaboration while still working on their hearing goals. We have the opportunity to incorporate the student's interests and give them some choice. And we have the opportunity to highlight their areas of strength and all of that is really meaningful to the student and the whole team and something unique that our position allows us to bring.
D: Absolutely. I was actually thinking while you were talking sometimes people will ask me questions about students with multiple disabilities, a lot of things going on ,who are non-talkers and they're just not sure what to do with the student when they don't give a lot of indications of understanding. Like, we're - but we've talked about students that have multiple disabilities but generally like can speak, can explain things, and what do you do with the students who are not at that level? And I just wanted to like throw out a quick tip that I thought of while we were talking is that music is a relative strength for a lot of kids with disabilities. Um, if they have some level of listening skills because of technology, like I said the hearing technology, I know not for every kid it doesn't gives full, full access, but it gives a lot for a lot of people compared to like the technology available for vision and motor and other things. Um, and if they have access to at least pattern perception, they can probably perceive music.
And a lot of kids can really enjoy music so I've had - I've worked on auditory goals that are purely music-based. Sound starting and stopping. Identifying songs, like I play a song and they eye gaze towards a picture card or I teach them little dances, and I mean like simple dances like arm flops, like body shakes, like rocking back and forth, things that are in their like motor capabilities. Like, you don't want to pick something they can't physically do, um, but like the different motions go with the different songs. So then I have auditory identification for songs based on their movement so you can bring it to that level if you use music. Like that's like a really powerful way that I've worked on auditory skills for children that are non-speakers and also may have other things going on. Um, and maybe, maybe spoken language is not their primary form of communication. But it's something that they need to work on just for like awareness purposes. So that's just something while you were talking I wanted to bring up that like music sometimes - that's it, like that's the strength that you can work on, to - to help these kids.
K: Absolutely. Now that you're saying it, I'm picturing several of my students within this population that music is always when - when I'm doing an observation - that's when they're getting up and they're participating in their classroom and they're going up to the smartboard and they're following directions and making choices. Even if those are like routine, visual directions or something like that, but they're really involved during that music time and it's a time to highlight a lot of their strengths and skills that they do have.
D: Absolutely. I feel like if you're feeling stuck with a kid on your caseload like that I would try that first. So, I really enjoyed this episode. I hope you guys did too. And please make sure that you guys are subscribed to our show on Apple Podcasts or Spotify, wherever you listen so you get notifications. And a full transcript and show notes can be found at listentotodpod.com, until next time.
Both: BYE!