Two methods of intervention with Spanish-speaking families · •Corre trencito •A la rorro niño...

12/6/2018

1

S A R A H R A D L I N S K I , M . S . , C C C - S L P , L S L S C E R T . A V T

A U D I T O R Y - V E R B A L C E N T E R , I N C . A T L A N T A , G A

Maximizing Caregiver Engagement in Auditory-Verbal Therapy for Spanish-Speaking Families

GSHA 2019 Annual Convention: February 16th, 2019

DISCLOSURES

• I am an employee of the Auditory-Verbal Center, Inc.

AUDITORY-VERBAL CENTER, INC.

ABOUT ME

• Grew up in South Florida

• Family background?

• Experience with Spanish

• CF position as bilingual speech-language pathologist

• Initial misconceptions

• Now biggest passion


MY FAMILIES

• 50+ Spanish-speaking families over 4 years

• Mexico, Guatemala, El Salvador, Cuba, Dominican Republic, Venezuela, Colombia, Ecuador, Peru


LEARNER OUTCOMES

• List reasons why it is critical to

provide intervention that is culturally and linguistically

relevant for Spanish-speaking

families

• Gain knowledge regarding

how to provide intervention in Spanish and how to adjust

goals and activities


WHY PROVIDE INTERVENTION IN THE HOME LANGUAGE?

• Evidence indicates that

children with hearing loss can learn multiple spoken

languages

• Learning the language of

the home does not impede

acquisition of the majority language but rather, can

accelerate it

(Bunta & Douglas, 2013)


12/6/2018

2

INCREASED HOME CARRYOVER


• According to adult learning principles, when parents are able to

“say and do” the intervention, they demonstrate improved

retention

Graphic from Caraway (2013)

PARENTS MUST BE THE PRIMARY LANGUAGE TEACHERS FOR THEIR CHILD

We can’t teach them every word they need to know!

• 1 yr: 1-10 exp words

• 18 mo: 50 exp words

• 2 yrs: 300 exp words

• 3 yrs: 900-1000 exp words



(Heavner & Vernelson, 2013)

• Due to the degraded acoustic signal/reduced

bandwidth, children with hearing loss need

three times the exposure to learn new words(Pittman, 2008)


WHY MAXIMIZE FAMILY ENGAGEMENT? SIMPLE MATH.

• Average 2 year old: 4,032 waking hours per

year

• We see families for about 42-45 hours a year

(Caraway & Horvath, 2012)

“If you give a man a fish, he eats for a day. If you

teach a man to fish, he eats for a lifetime”. AUDITORY-VERBAL CENTER, INC.

REMEMBER:

• Families are diverse

• Families inherently want what is best for their child

• All families, given proper support, can succeed

• Meet families where they are

• “Families don’t fail. We fail families”.

• Teresa Caraway


TAPPING INTO CAREGIVER POTENTIAL


Intervention

- “Traditional” speech therapy

- Referred due to lack of

progress

- Started AV at 3.5 yrs

- At baseline expressively

used: “agua” (water), “jugo”

(juice), and “mama”.

- Targeted language of the

home, coached mother

Child profile: 3.5 years old, premature

birth, <3 lbs birthweight, prolonged

NICU stay, lack of oxygen at birth,

ventilator support, brain bleed,

ANSD, recently implanted, essentially

non-verbal, additional diagnoses:

Autism Spectrum Disorder, ADHD

Parent profile: Family income <20K,

limited maternal education level,

monolingual Spanish-speaker

WHAT WAS THE “MAGIC”?


- 6 months later: 150 words, 3

word combinations.

- Assessments showed over 1

year of progress in 6 months

12/6/2018

3

NEVER UNDERESTIMATE PARENTS


“Es mi deber como madre preparar a mi hijo

para el futuro. Tengo que aprovechar el

tiempo al máximo porque ése, cuando se

pierde, no vuelve. Hacer la terapia, para mí,

es tan importante como darle de comer,

porque sé que esto alimenta su vocabulario, su

expresión, y su independencia. Sé que tal vez

no soy la mejor madre, pero creo que soy la

que él necesita. Lo amo con el alma.”

“It is my duty as a mother to prepare my child

for the future. I have to take maximum

advantage of this time because when you lose

it, it doesn’t come back. For me, doing therapy

is as important as giving him food to eat

because it nourishes his vocabulary, his

expression, and his independence. I may not

be the best mother, but I believe I am the one

that he needs. I love him with my soul.”

HEAR FROM CHRISTOPHER’S MOM


“LANGUAGE OF THE HEART”

• Encouraging

development of the home

language

facilitates family

involvement and

maintains the family-child

bond


WHY BE BILINGUAL?


WHY SPANISH?


• A rising number of children with hearing loss in the U.S are being identified from Spanish-speaking homes--approximately 25% of children with hearing loss

(Gallaudet Research Institute, 2011)

• Resulting in an ever increasing need to provide effective intervention in Spanish

• But concepts can be applied to other languages

LEARNING TO LISTEN SOUNDS

• Use sound-object associations that the family would

naturally use

• Why?

• More authentic for family, less memorization, more home

carryover, other family members already familiar

• How?

• Use guidelines from sample handout

• For sounds specific to discrimination goals, change vowel

• When in doubt, ask the family!


12/6/2018

4


Note: Some

sounds are

pronounced the

same but just

written differently!

OTHER SOUNDS AND EXPRESSIONS


Drum: tun tun/pom pom

Knocking on door: toc toc tocBell: tilín tilín/tolón tolón

Crying: ¡bua, bua!

Bubbles: pum pum pum

Ew: uuu/iu/uy/uf/fuchi/

guácala/puf/puaj/fo

Ow/ouch: ¡Ay! ¡Uy!

Wow: ¡Guau! ¡Uy!

Yay!: ¡Hurra!, ¡bravo!, ¡Eeeeh!Uh oh: oh oh

Mmm: ¡Am!, Mmm

Achoo: Achís

VOCABULARY

• Do NOT just translate early

developing word lists from English

• Length/difficulty of word:

• Pop! → Revienta, explota

• Frequency of use in language

• Pat

• Difficulty translating

• Roll

• Multiple words/concepts for same

English word

• Roll: Amasar, estirar, arrollar, aplastar,

rodar

• Squeeze: Apretar, exprimir, estrujar,

escurrir, aplastar


Resource: Spanish MacArthur-Bates

*But use ONLY as guide!

DIFFERENCES ACROSS DIALECTS

• Many different ways to say some words

• How to approach families:• Be up front about goal: we want the

child to speak like his FAMILY

• Give permission/ask them to correct you

• Be clear that THEY are the experts in their language

• During session, have the family be the first to use the word

• Tell them, there are lots of different ways to use this word (give a few examples). What word sounds best/most natural to you?


HOW MANY WORDS FOR “PIG”??


• Cerdo

• Puerco

• Chancho

• Marrano

•Cochino

• Cuche

GRAMMATICAL DEVELOPMENT

• Do NOT just translate from English norms

• Some grammatical morphemes/structures don’t exist in both languages

• Some differences in rate/order of normal development

• Resource: CASLLS in Spanish

• Examples: Spanish subjunctive tense, plurals (2 yrs Spanish vs. 3-3.5 yrs English), “nosotros” 4-5 yrsvs. “we” 3-3.5


12/6/2018

5

SPEECH SOUNDS

• Vowels: 5• Diphthongs

• Consonants• Differ between languages

• *Careful: Even some consonants that are written the same may be pronounced differently

• Order of typical sound development

• Impact of dual language learning

• Accents


SONGS & RHYMES

• Ask families! Emotional connection to songs

• To supplement the songs families already sing at home, use traditional Spanish songs– MANY choices!

• Avoid translations of English songs• Why?


“Cuando canto esta

canción, me recuerda de

cuando era niña en

Guatemala”

“When I sing this song, it

reminds me of when I was

a girl in Guatemala”

HEAR FROM AYLIN’S MOM


SONG EXAMPLES

• Los pollitos dicen• Una vaca lechera• La vaca lola• Tres pececitos• El pato patito

• Pin Pon• Saco una manito• Había una vez un avión • A la rueda de San Miguel• Cú cú cantaba la rana• Mariposita

• Corre trencito• A la rorro niño• El barquito chiquito• Debajo un botón• Arroz con leche


RHYME/FINGERPLAY EXAMPLES

• Aserrín, aserrán

• El gato de trapo

• Sana que sana

• Tortillas/Papas

• El sol es de oro

• Este dedito

compró un

huevito

• Esta hormiguita

• Caballito blanco

• Pito, pito, colorito


LET’S LISTEN!


12/6/2018

6

MUSIC

• Music assists with early language and auditory skill development

• BabyBeats• Short, repetitive pieces of music• Can be adapted easily for speakers of

other languages• Songs without words• Animal sounds song

• Comes with a Spanish guide; can make adjustments

• App is currently only in English but families can still use music• Spanish version of app should be released

later this summer

• Future thoughts: music with more culturally relevant music?(Salsa, Tango, etc.)


BABY BEATS EXAMPLES


CULTURALLY RELEVANT THEMES/HOLIDAYS

• Don’t make any assumptions! (Goes both ways)

• “Memorizing bullet points about cultures reduces people to

stereotypes. Cultural humility says I don’t know it all but am

willing to learn.” – Elizabeth Rosenzweig


DON’T MAKE ANY ASSUMPTIONS

• Even within the same country, some holidays are celebrated differently, or not at all

• Ask families to teach you, show interest in their culture and holidays

• Ask: Tell me about holidays/celebrations that are important to your family this time of year• What do you do to celebrate in your home?

Any special foods, songs, activities, or other traditions?

• In general, stick to neutral seasonal themes

• If doing our job, families should have skills to teach language at home


CULTURAL DIFFERENCES AROUND READING TO YOUNG CHILDREN

• Reading to young children is culturally

not typically done in many Latino

households (but not universal)

• Parents may not have been read to as

children

• My own assumptions: Originally viewed this

as difference in socioeconomic

status/education level and didn’t

understand that it was truly a cultural

difference; changed the way I approached

reading. Significant difference in buy-in and

carryover.


STRATEGIES TO PROMOTE DAILY SHARED READING

• Ask caregivers about their own

childhood experiences with

reading growing up

• Open-ended questions

• Non-judgmental

• Share other families’ experiences

• Make benefits explicitly known

• Adult learning principle

• Plan jointly with families • Set specific goals

• Read together/discuss frequently

• Families may need more explicit

coaching/guidance on strategies


12/6/2018

7

ENCOURAGE FAMILIES TO READ IN THEIR NATIVE LANGUAGE

• Facilitates involvement and maintains the family-child bond

• Validates the home language

• Family can better provide a full and complete language

model

• Can more easily comment, expand, and converse about the story


WHEN TODAY’S LATINO PARENTS WERE CHILDREN…

• Fables/fairy tales (European origin)

• A few classic children’s authors such as

Rafael Pombo (Colombia, 1833-1912)

• Creation stories/legends

• Oral traditions/storytelling: sharing of

narratives, sayings, advice, folktales, and

family stories

WHICH BOOKS TO READ WITH FAMILIES?

• Best books and stories are those that the family grew

up with and are familiar with (emotional connection)• Challenge: limited number of toddler/preschooler books available

written originally in Spanish (and most available now weren’t

around when today’s parents were children)

CURRENT AUTHORS STARTING TO FILL THE GAP

• Antonio Rubio• Author from Spain

• De la Cuna a la Luna series

• 2003 to present

• Amazon (but not all ship to U.S)

• Patty Rodriguez & Ariana Stein: Lil’ Libros• First generation Latina women

• Goal of encouraging parents to read from infancy, on familiar subjects: strong ties to Mexican culture– know the child’s family/county of origin!

• 2014 to present, Amazon/Target

• Limitations: Books are VERY simple

WHAT DO YOU NOTICE?


• When possible, target

culturally relevant

stories and books

• What do the

characters portrayed

in books look like and

experience?

(different for different

families!)

• Keep in mind family’s

country of origin

• Provide choices for

family to select from

12/6/2018

8

• Translations• Very valuable resources for birth to preschool population due to

limited books available written originally in Spanish

• Good vs. bad translation

• Look for non word-for-word translation– one that maintains the rhyme and integrity of the author’s original story

SUPPLEMENTING WITH TRANSLATIONS EXPERIENCE BOOKS

• Allow family to tell stories about their own

experiences, using their own language

• Puts child and family at the center of narrative

• Also use: Photo albums of family members

“READING THE PICTURES”

• Books in non-Spanish print • Often much easier for families

to acquire in stores/libraries; state/social services programs send home children’s books in English

• Wordless picture books • Teaches parents to focus on

conversation/language input that books can provide

• Especially good for families with limited literacy in Spanish

TAKEAWAYS ON BOOKS

• Culturally, Latino families may have less experience reading books to young children• May need more coaching/guidance

• When possible, use stories families are familiar with

• Finding books originally in Spanish can be challenging

• Supplement with tools such as translations, experience books, and picture books

• Guide families on how to maximize the linguistic input and conversational narrative, regardless of which type of books families are using

• Don’t make assumptions

• Have dialogue and partnership AUDITORY-VERBAL CENTER, INC.

OTHER CULTURAL OBSERVATIONS


• Perceptions of school/government agencies (less likely to argue and

advocate, completely trusting, may fear due to legal status)

• Perceptions towards disability

• Latino mothers may exhibit more depression when they have a child with a

disability (Lobato et al., 2005).

• Some have belief of disability as result of wrongdoing in past (or in that of ancestor)

• Confidence in healthcare professionals

• Unlikely to question authority

• Issues with pediatricians and newborn hearing screeners

CULTURAL OBSERVATIONS CONT.


• Amount of parent-child talk; comments vs. commands; more closed

set questions (DesJardin, Ambrose, & Eisenberg 2009)

• Women as primary caretakers; may have more healthcare

knowledge (Caballero, 2011)

• Television/technology use in children

• Voicemail

• Greetings: may include side kiss. Follow families lead.

• Perceptions of young child as a “baby” (language, behavior,

attitude toward child)

12/6/2018

9

“FAMILISMO”

• Central Latino cultural value

• Dedication, commitment, and loyalty to family

• Role of family, importance of extended family

• Decisions regarding treatment of disability may involve many family members (Caballero, 2011)


IMMIGRATION STATUS

• Some families may be undocumented and live in fear of deportation

• Incredible source of family stress

• Living under the radar: may seek less assistance

• Identification cards to enroll in services

• Driving without a license/transportation worries

• Impossible choice facing some families: leave your child or take your child to a country where he might not have access to services. May decide to separate to stay.

• Need to be cognizant of the added stress that this places on families

• Immigration status is NOT a challenge for every family: don’t make assumptions


BELIEFS AROUND PRESCHOOL

• Preschool/kindergarten preparedness • Latino children at age 4 are enrolled in preschool at

substantially lower rates (37%) than any other race (Casey, 2013)

• Common misconception that Latino families don’t value preschool

• Studies have found that Latino families largely support preschool/believe it provides an advantage prior to starting kindergarten (Garcia & Gonzales, 2006)

• Lack of access of high quality preschool: spaces in programs, affordability, high cost of private preschool, limited spaces in publicly funded preschool, transportation, schedules, language-barriers, fear of immigration status

• Note about school: Perceived role of a teacher vs. parent. May lead to belief that parents are uninterested in child’s education--disconnection between cultures (Ramirez et al., 2016).


BARRIERS & STRENGTHS

• Barriers: • Advocating, communicating, difficulty

navigating systems, unfamiliarity with social

services/educational rights of their child,

transportation, disproportionate level of

poverty, impact of lower SES/lower maternal

education, literacy level of parent, increased

stress, are basic needs being met?

• Strengths: Resilient, hard-working, loving • Same desire as all parents– to want what is best

for their child

• Eager for resources, community, support

• Most incredible families I have had the true

privilege of working with

• Families are doing the best they can


CREATE A LOCAL SUPPORT GROUP


ONLINE GROUP


12/6/2018

10

SPANISH RESOURCES

• John Tracy Clinic

• Listening Room/Listening Tree

• Cochlear’s “Sound Foundation” program

• Oir para Aprender

• Talk Around the Clock

• AG Bell International (Formally CLAVE and Fundación Oír Es

Clave)

• CI companies Spanish resources

• “Hearing First” now in Spanish

• Including Spanish Auditory Learning Guide!


TAKE HOME POINTS

• Children with cochlear implants can become and are bilingual

• Sounds, words, traditions, and songs can be different for many Spanish-speaking families. Can’t

just translate! Use what is most natural/authentic for the family.

• Increased home carryover

• Don’t make assumptions

• Don’t correct the grammar or vocabulary of families

• Don’t use direct translations from norms for language development in English

• Be aware of cultural differences as well as additional family stressors: have compassion

• Express how much you value their language and culture- the FAMILY is the expert. Honor families.


REFERENCES

• Annie E. Casey Foundation (2013) KIDS COUNT Data Center. Available: http://datacenter.kidscount.org/.

• Bunta, F. & Douglas, M. (2013). The effects of dual-language support of the language skills of bilingual children with hearing loss who use listening devices relative to their monolingual peers. Listening Speech and Hear Services in the Schools, 44(3), 281-290.

• Caballero, A. E. (2011). Understanding the Hispanic/Latino patient. The American Journal of Medicine, 124(10). doi:10.1016/j.amjmed.2011.07.018

• Caraway, T.H., & Horvath, J. (2012).FAQ 7: What is the importance of coaching and guiding parents in auditory- verbal therapy and education? In W. Estabrooks (Ed.),101 Frequently Asked Questions About Auditory-Verbal Practice: Promoting Listening and Spoken Language for Children who are Deaf and Hard of Hearing and Their Families. (pp. 1-5). Washington, DC: Alexander Graham Bell Association for the Deaf and Hard of Hearing.

• DesJardin, J.L., Ambrose, S.E., Eisenberg, L.S. (2009) Literacy Skills in ChildrenWith Cochlear Implants: The Importance of Early Oral Language and JointStorybook Reading. Journal of Deaf Studies and Deaf Education 14:1

AUDITORY-VERBAL CENTER, INC. AUDITORY-VERBAL CENTER, INC.

• Douglas, M.(2011). Spoken language assessment considerations for children with hearing impairment when the home language is not English. Perspectives on Hearing and Hearing Disorders in Children, 21(1). Available at http://div9perspectives.asha.org/content/21/1/4.full

• Gallaudet Research Institute (April 2011). Regional and National Summary Report of Data from the 2009-10 Annual Survey of Deaf and Hard of Hearing Children and Youth. Washington, DC: GRI, Gallaudet University.

• Garcia, E.E. & Gonzales, D.M. (2006) Pre-K and Latinos: The Foundation for America’s Future. Pre-K Now Research Series. Washington, D.C. Pre-K Now

• Lobato, D. J., Kao, B. T., & Plante, W. (2005). Latino sibling knowledge and adjustment to chronic disability. Journal of Family Psychology, 19(4), 625-632. doi:10.1037/0893- 3200.19.4.625

• Pittman, A. (2008). Short-term word-learning rate in children with normal hearing and children with hearing loss in limited and extended high-frequency bandwidths . Journal of Speech, Language, and Hearing Research, 51,785-797.

• Ramirez, O., Mccollough, C. A., & Diaz, Z. (2016). Creating a model of acceptance: Preservice teachers interact with non-English-speaking Latino parents using culturally relevant mathematics and science activities at family learning events. School Science and Mathematics, 116(1), 43-54. doi:10.1111/ssm.12150

THANK YOU! ¡GRACIAS!

“Tell me and I forget, teach me and I may remember,

involve me and I will understand.” – Chinese ProverbAUDITORY-VERBAL CENTER, INC.

http://div9perspectives.asha.org/content/21/1/4.full

Two methods of intervention with Spanish-speaking families · •Corre trencito •A la rorro niño...

Documents

Transcript of Two methods of intervention with Spanish-speaking families · •Corre trencito •A la rorro niño...