EPISODE 19

[INTRODUCTION]

[00:00:00] ANNOUNCER: Do you enjoy listening to On The Ear, but wish you could earn ASHA CEUs for it? Start today. Speechtherapypd.com has over 175 hours of audio courses on-demand, with an average of 19 new audio courses released each month. Here's the best part, each episode earns you ASHA Continuing Ed Credits. Oh, no wait. This is the best part. As a listener of On The Ear, you can receive $20 off in annual subscription when you use code Ear21. Just head to speechtherapypd.com to sign up and use code Ear21, E-A-R-2-1 for $20 off your annual subscription.

[00:00:48] DS: You're listening to On The Ear, an audiology podcast sponsored by speechtherapypd.com. I'm your host, Dr. Dakota Sharp, Au.D, CCC-A, audiologist, clinical professor and lifelong learner.

Well, I primarily work with pediatric cochlear implants and hearing aids. I am absolutely intrigued by the many areas of audiology and communication in general. This podcast aims to explore the science of hearing, balance and communication with a variety of experts in hopes of equipping you to better serve your patients, colleagues and students. Let's go. We are live and On The Ear, brought to you by speechtherapypd.com.

[INTERVIEW]

[00:01:35] DS: The interdisciplinary team for a child with hearing loss can be expensive, but each member serves a vitally important role. Today's discussion is all about an often misunderstood, but critically important member of the team, a teacher of the deaf and hard of hearing. TODHH is hopefully that's how you pronounce the acronym. I usually say TODs, but TODHHs are able to see the child in the context that the clinicians do not have access to and their insights can truly make all the difference in success for a child with hearing loss.

Our guest today is going to help us understand that role and how to collaborate better with these professionals. Becky Hales is a first year a AuD student at James Madison University, go Dukes. She graduated from UNC Greensboro in 2009 with a degree in Deaf Education and served as a teacher for the Deaf and Hard of Hearing for several years in several different school districts.

As a teacher, she taught in resource settings, inclusion settings. She was itinerant, a self-contained classroom for students with multiple disabilities. She has taught students from preschool to high school, using both ASL and spoken English, depending on the needs of the students. She also has a child who received special education services, so she now has the perspective of a parent of a child with a disability as well. Becky recently started a website, inthewrongstory.com, hopefully, we'll talk about that a little bit today, where she discusses issues affecting people with disabilities from multiple perspectives, and the hopes of building disability awareness, accessibility and collaboration. Hey, Becky. Thanks for joining me.

[00:02:51] BH: Thank you so much for having me. I'm so excited to be here.

[00:02:54] DS: Yeah. Fellow JMU, student/a future alum. I'm actually curious, before we get started, as somebody who didn't do their undergrad there, but is doing – I mean, graduate school is like, it's three years of on-campus, it's four years total. Do you feel you're going to finish with JMU spirit? Or do you feel disconnected since you did your undergrad elsewhere?

[00:03:15] BH: I think I have JMU spirit. I already have a couple of t-shirts.

[00:03:21] DS: Yeah. That's awesome. That’s awesome.

[00:03:22] BH: Yeah, absolutely.

[00:03:23] DS: Okay. Well, I'm so excited to talk with you today. This is something that personally, I've been working really hard on in my first few years as a clinician is connecting with local TOD. Okay, first of all, hold on, clarify that for me. TODHH, I just say teacher of the deaf. What’s the best way to do it?

[00:03:37] BH: I just say, TOD, just because it's easier. When typing I'll do TODHH. TOD is way easier.

[00:03:44] DS: Okay. That's what I normally say. I just want to make sure that's okay. In connecting with some around me in the different school districts, but I live in a city, the capital city of the state. What's crazy about it is that you go 35 minutes outside of that and it's still the city, but it's a whole different landscape in terms of service, accessibility and some schools are just, they are set, they have a couple TODs. They've got an educational one. They have a crazy team and they have a TC classroom.

The other one, they have one kid with hearing loss, and they don't know what to do with them and they're 15 miles away. I'm so interested to learn more about this world, because I feel I haven't really met many TODs in my audiology experience, but it's such a related thing. Could you just kick us off with what is a TOD? What is a TODHH? What is their role look like in the schools?

[00:04:31] BH: Yeah. Well, that's very complicated, because as you said, it's so different depending on what school district you're in. If you're in a big city, you could have a self-contained ASL class and a self-contained oral class in the preschool setting, and then maybe they go out into the mainstream as they get older. You might have multiple TODs and educational audiologist, SLPs who are trained in dealing with deaf and hard of hearing children.

Then yeah, you move further out, and you get fewer and fewer. It's a low-incidence disability. Oftentimes, there's only one TOD in the district. Sometimes, districts get together and compile their resources and contract out with one TOD who serves multiple districts. The model has really changed a lot. Kids used to get served in schools for the deaf, and now, most kids are served in public schools. There's such a wide variety out there and most TODs have to be well-versed in both oral education and manual education and accessing everything, because if you're in a smaller school district, you don't get to pick which one. Its’s whatever is necessary for each individual child and you're going to have a diverse group.

[00:05:55] DS: Yeah, that's so interesting. I'm hoping, we'll be able to talk a little bit more about the geographical divide and how that role changes. I'm curious, okay, once you're in a school, let's say you're in a school that's like, you're the only TOD in the school, but there's other supports in place. They might have an educational audiologist who checks in. What would be your personal role within the school? What would a day look like for you?

[00:06:15] BH: I spent most of my time as an itinerant teacher, which means I bounced around. I had eight schools on my list, that I would bounce around, sometimes five schools in one day. Generally, the teacher of the deaf’s role is to provide accessibility. That is accessibility to the curriculum, accessibility to social opportunities, accessibility to interactions with their teachers, gen ed teachers, or other special ed teachers who don't necessarily understand deafness, including SLPs, because some SLPs have a lot of background and working with deaf and hard of hearing children and some don't.

Providing access to parents to help explain what hearing loss is and supplement what the audiologist does in the office. It's really about providing accessibility. I think, that's what TODs, and really, all special ed teachers are experts in is accessibility.

[00:07:14] DS: Sure. That's such a great way to put it. I'm glad to hear that that role exists, because so often, I feel I had to put a lot of time into an appointment and helping teach the parent all of these advocacy skills that I don't even know the right language to use in the school. I don't know how to get you the best services on your IEP, but there's someone there in some schools who does. That's their role. You talk about a self-contained, like a preschool classroom of ASL. Would a TOD be the person upfront teaching the lesson and signing at the same time?

[00:07:43] BH: Yes, it totally depends. It's so varied. You know how audiologists can have such a wide range depending on, if you're working in a hospital, or private practice, or pedes, or whatever. Same with SLPs. It's so varied. It's the same with teachers of the deaf. You could have a self-contained ASL-based preschool classroom where you are up in the front of the class and you are providing the majority of the instruction, either using sign language yourself, or using an interpreter.

Then, there's also plenty of – a lot of my job was just consultation and talking to gen ed teachers and teaching them about hearing loss and some strategies to use in the classroom. Sometimes it's a push-in service, where a TOD might be standing in the back of the room observing and then going and helping the student during breakout groups or something. Sometimes it's resource, where one period a day they come to the TOD for a small group. Yeah, it just fully depends. Like you said, it really depends on geography and where you're at.

[00:08:55] DS: Yeah. Let's jump into that then. What do you feel some of the barriers you saw, where in that situation? What leads to that situation? I'm sure a big part of it is funding for the school and the need. If they only have one student, it's hard, I guess, for them to justify a whole teacher for one student. What have you seen in that process?

[00:09:11] BH: Exactly. What tends to happen with more rural schools is sometimes, they'll try and just have an SLP provide the services, if they don't have a teacher of the deaf, especially like you said, if there's only one kid, it's hard to justify an entire teacher salary. If you have a kid who needs an interpreter, or a translator, okay, you're talking about two people's salaries for one student. It's hard to justify legally. If that's what the kid needs, you have to provide it.

[00:09:43] DS: Absolutely.

[00:09:44] BH: Sometimes what school districts will do is create a cohort among some rural school districts and either send all the kids to one school that's in a designated district, or something, or like I said, share a TOD who contracts out with each school. That's starting to become a more common situation, where there are private companies who hire teachers, and then contract out with the school districts.

I worked in mostly suburban areas. I was actually lucky in that I was one of two teachers of the deaf, when I was in both of the situations, where I was working in the school district. That was really nice to have that support system. In neither of those cases, did we have an educational audiologist. We were handling the FM systems and doing the in-service to explain those to the gen ed teachers. We had to do everything. That was a little tough. You go an hour away. There's a huge school district and they have an educational audiologist and they have multiple teachers and they have multiple classrooms set up for all modalities and languages. Yeah, it very much depends on where you are.

The other thing is, if a school district has never had a kid with a hearing loss before, they often just don't know what services need to be provided. It's not necessarily that they're trying to skirt around paying the money, it's just, they genuinely don't know. They're like, “Okay. Well, this kid has a communication issue, so the SLP can do everything.” Most SLPs don't have the training. I've worked with fabulous SLPs, so nothing against them at all. If you don't have the background and the training and the knowledge, it can be really tough. If you've never held a hearing aid before and you're trying to manage that, and you have never heard of Ling sounds before, that's going to be hard.

[00:11:54] DS: Actually, I teach master's level SLP students. There's several big ideas that I teach throughout the semester and I'm like, these are the things – If you're going to remember anything from this class, these are the things I want you to remember. One of them is, in some schools, if you're going to be in the school setting, you will maybe be the only communication disorder professional. The school is going to look to you, the first day there's a child with a hearing loss and they're not sure what to do, and you can either try to take it on yourself, or take some of these things that I taught you, or hear the other – we talked about TODs, we talk about educational audiologists, you can look to one of them, but it's definitely a thing. It falls on them so often. Yeah, I feel for them in that situation for sure.

I'm curious, what the process was like to get to this role. You went to UNC Greensboro. Were you studying TOD? Were you studying special ed, and then you focused on that? What does that look like?

[00:12:40] BH: I actually started off in community college, and I took an ASL class, and really liked it and then went through every ASL class that they offered. I volunteered in a classroom, a self-contained classroom, because I was in a bigger school district, and they had their own self-contained elementary school, or elementary classroom for signing kids. I volunteered in there. I absolutely love working with these kids and teaching them. I have no desire to be an interpreter, because I like talking too much and I don't want to just be a conduit for the conversation. I want to actually be a part of the conversation. Yeah, so then I started looking into deaf ed programs. I transferred in with the deaf dd major.

[00:13:27] DS: Got you. Cool, cool. Our former fourth year was an educational interpreter. He was an interpreter in the schools, and now he's just graduated to be an audiologist. I'm really loving these different perspectives of people who were in the school system and they were like, “Okay.” I'm going to speak for you here. You can tell me if I'm right or wrong. The problems here are so bad, I need to go be an audiologist, so I can get a little bit more into the system in some way. Is that fair?

[00:13:49] BH: Yeah, that pretty much sums it up.
[00:13:52] DS: That was his perspective, too. I think that's really interesting. I think it's going to lead, if there's more clinicians like you guys, which I'm sure there are, there's going to be this wave. So much more compassion, so much more understanding of IEPs and needs in schools and advocacy skills, things like that. I think this is a really cool wave of clinicians. More power to you for.

[00:14:12] BH: I have to say, one of my classmates who graduated with me, with a deaf ed degree, she just graduated with her AuD two years ago. There are some of us out there.

[00:14:22] DS: Yeah. That's awesome. Actually, I want to talk a little bit more about how you collaborated with other professionals. I'm just curious, in your time as a TOD, what were some of the biggest – I don't want to put this in a negative way, but the advocacy gaps. Where did you see the most need for children with hearing loss in schools in your experience?

[00:14:44] BH: Kids with multiple disabilities. Hands down. That is really what prompted me to want to go and get my AuD, because I saw these kids who their hearing loss was just treated like, “Oh. Well, that's secondary to their cognitive issues, or their physical issues. We're not going to give them a hearing aid, because they're just going to take it off. They're just going to bite it.” I'm like, “We give 12-month-olds hearing aids and they just take it off and bite it. Why can't we give – just because the kid is 13 and is still going to do that, doesn't mean that we shouldn't be providing them with amplification, with visual modes of communication.”

I had one student who had a hearing loss and multiple severe disabilities and she had self-injurious behaviors. As soon as we got her hearing aids, those stopped completely. Not that that's going to happen for every kid, but there are so many kids out there who aren't given a chance and hearing is just pushed to the side for them and not given the same value as whatever else they have going on, whether it's down syndrome, or cerebral palsy, or whatever. Yeah. Making sure that those kids have access to communication was really a driving force for me.

[00:16:09] DS: Yeah. That's such a great insight. I didn't realize that they were slipping through the cracks in that way. I think of like, “Oh, my guess would probably be mild hearing loss, because no one really takes it seriously.” It sounds like it's a similar situation, but it's not mild hearing loss. It's that some other disability is beating out with this one and it's a battle for which one gets the most attention.

[00:16:28] BH: Exactly.

[00:16:29] DS: Yikes. Yeah. That makes a lot of sense. On that, and then with your – I was asking you what the day-to-day was, what do you feel you had to do the most in a day? Was it troubleshooting equipment, because you guys didn't have an educational audiologist? Was it literally teaching, or ASL, or was it teaching teachers? What did that look like?

[00:16:46] BH: Honestly, most of it, it was a pretty good mix between pulling kids out and doing resource and teaching teachers. There was definitely some equipment management. For the bulk of my career as a TOD, that was when I was itinerant with eight classrooms. I had the middle and high schoolers and the kids with multiple disabilities, and then the other TOD had the elementary schoolers and the preschoolers.

When kids get to middle school and high school, they don't like wearing their hearing aids, they don't like wearing their FM system. Like I said, the kids with multiple disabilities, often weren't given technology. She had more to do in the preschool and elementary area. I had less to do in where I was teaching. A lot of it had to do with showing gen ed teachers, or sometimes my kids with multiple disabilities would be in a self-contained classroom for other kids with disabilities, and showing even the special ed teachers how hearing loss impacts these kids.

For example, I had one kid who severe hearing loss, refused to wear her hearing aids. They did have a sound field system in every classroom in the district, which was awesome, but the teachers are like, “I'm loud enough. They don't need it.” I'm trying to talk to them about signal-to-noise ratio, and that's just not working. What I would do is I would go into the classroom and observe, and I would take a video. You can see where this student stopped hearing. As the teacher is walking around the class, she's starting to strain, she's starting to strain. Then she just gives up and looks down and starts reading her book. Then showing that video to the teachers and being like, “Look, she can't hear you.”

[00:18:36] DS: That's awesome. That's a really, really great idea. Yeah, thank you for sharing that. I feel like, man, with your experience, your AuD program. I mean, you're going to breeze through a little bit. You've got some background for sure.

[00:18:47] BH: I don’t know. Anatomy is kicking my butt.

[00:18:50] DS: You’ll push through there. You'll push through there. Yeah. Okay. That's really great insight, though. I just wanted to add, to all of the future audiologists listening out there, and all the current ones, too, the kids not wanting to where their hearing aids in the middle school years can be avoided if you start working on it in the elementary and the preschool years. If you start building up that self-advocacy that early, by the time they hit middle school, they breeze. They don't even care. I mean, kid-by-kid basis. Not all work that way.

It's definitely something that can be worked on early. I feel like, yeah. I was always under the impression like, once they hit middle school, that's all we're going to talk about. It's like, if you talked about it before, they have a framework and they can get there.

[00:19:26] BH: Yeah. A lot of my middle schoolers, sometimes it was more the FM system that they didn't want. They didn't want to pass the microphone around. They understood the value to their hearing aids, most of them. Every once in a while, I would get a kid that just wasn't –

[00:19:38] DS: I still haven’t met a –

[00:19:41] BH: Yeah. The FM system is the big one that they don't want to be perceived as different, so they don't want to pass the microphone around. Then you also get the teachers who are like, “I'm loud enough. It's fine.”

[00:19:52] DS: Yeah. Oh, my gosh. That would drive me crazy. I don't know how you handle that.

[00:19:56] BH: Lots of patience. Going home and screaming into pillows helps.

[00:20:01] DS: Sounds like what it needed. Okay, so it sounds like you had another TOD working with you and an SLP in the school and probably a special education teacher. Who else were you collaborating with at that time, or I guess in your time being a TOD, like other professionals?

[00:20:17] BH: Yeah. We definitely had a lot of OT and PTs that we would also work with. Again, especially, because I have a lot of kids with multiple disabilities. It's really helpful. It's really helpful to work with other people who are already on a special education team. Even if they don't understand deaf ed, they understand the need for accessibility and the need for communication access and the need for adaptations and modifications.

Yeah. Lots of collaboration with SLPs. Lots of collaboration with other special ed teachers. It was also really important being an itinerant teacher, I wasn't always there. Having a relationship with a special ed teacher who was based in that school who never left that school was really helpful, because then, I could tell my student, “Okay, I need you to go talk to this teacher if your battery's die.” Or, I could train this one teacher. Because the gen ed teachers who have a 100 kids that they're teaching, they don't have time to learn how to change batteries.

A special ed teacher is more willing to do that, because they understand. I built a lot of great relationships with fellow special ed teachers, even if my kids didn't have multiple disabilities, just to help utilize, to have somebody have eyes on me, or on my kids. If they were supposed to be using the FM system, sometimes the special ed teacher could tattle on the gen ed teachers, but they’re not using it. Then I have to come in and tell them that they need to use it and show all my demonstrations and do another in-service. That was really important.

Occasionally, I would work with an audiologist. Honestly, we didn't work with audiologists all that much. That was probably partially my fault. I probably should have reached out more. We're so busy and overwhelmed. I did go to one of my kids’ appointments when he was getting earmolds for his new hearing aids, because this was a kid with multiple disabilities, and he didn't really understand what was going on. His dad asked me to come and help explain it to him as they were doing the molds.

The audiologist just ignored me. Didn't really know why I was there. That left a bad taste in my mouth. I did one time get to work with an educational audiologist who came from another district. That was just a wonderful experience, because she gave the in-service, and I didn't have to. That was awesome. That's definitely something that I would like to do more as I enter audiology is reaching out to the teachers of the deaf and seeing how we can collaborate more, because that is something that I wish I had had.

[00:23:14] DS: Sure. Yeah, that's actually one of my biggest questions for our time together is how do you see audiologist build, and SLPs too, I guess, build that – I mean, I guess SLP might be in the schools. That's a little unfair. They've got an advantage there. For audiologist who aren't in the school and they don't really have access to the school, how do you recommend they go about building that relationship? I have a couple of kiddos on my caseload, who have been able to say, “Oh, my TOD teacher is Miss Becky.” Even if they don't know their last name. I can go into the school. I can search Becky. I can find her. Then I can email her and say, “Hey, I'm an audiologist. I can send you reports. What do you need from me?”

I've been able to do that with two of the many, many kids that I see. Fortunately, they're the one for that school, or whatever. First of all, what would you hope for that relationship? What would be the ideal form of that relationship and how do you think we get there?

[00:24:05] BH: I think, the ideal relationship is that we treat each other as professionals and as experts in our field. Like I said, the one time I got to go to the audiologist office, she just ignored me and was like, “Okay, whatever. I don't understand why you're here.” Teachers are experts in accessibility and have a lot of value to the audiologist. Not just for that one particular patient. Also, in terms of they know about assistive technology. Sometimes more so than the audiologist might. If you want to know which FM system works better with Max and which one works better with PCs, teacher of the deaf probably knows that, because they've had to go into all of these schools and figure that out.

If you're not using that technology on a daily basis, you may not have the insight. Also, caption telephone. Teachers of the deaf, especially as you get into the older grades, part of what we all special ed teachers have to do is come up with a transition plan for our students to build independent living skills and vocational skills and things like that. We get really good at knowing what is out there in terms of alerting devices, or telephone devices.

I think that teachers can be a really valuable resource for audiologists that way. Then obviously, there's the resources they can give for a specific patient telling you, “Okay, I know he's not going to tell you what's going on in class, but let me tell you what is going on in class.” Okay. Well, I really don't think they're hearing those high-frequency sounds. They're missing all of the S’s on the spelling test. Or, I know one thing as my kids got older and they needed – they didn't need new ear molds as often, is their tubing would get cracked and old and hard and everything.

At the time, I was like, “Okay, this is just what it does.” They need to go to the audiologist to get it fixed. I didn't realize that I could have prevented that if they had gone a little bit earlier. If you're noticing, hey, this kid always comes in and their tube is cracked. Can you send the parent a reminder to come visit me when that happens? Yeah. I put scotch tape on tubes just to keep them from feeding back, because they had cracked.

If I had known better, I could have said, “Okay, go to the audiologist now, when I'm noticing it getting yellow and getting hard,” which now I know, now that I'm in the AuD program. I didn't fully know that at the time. I knew plenty about hearing aids, but not that specific thing. We're all experts in this field. I think, treating each other as professionals and as experts and seeing that we all have value to contribute is important.

[00:27:07] DS: What do you feel like would have been good information to have from the audiologist? Because I'm assuming when it comes to things like an IEP, the TOD is the person fighting for audiologicesque services for the child. Would it be good to have data from the audiologist? Are you guys taking that data on your own? What would you hope to help them through the IEP process?

[00:27:30] BH: I think it would be helpful if an audiologist was involved, especially in the eval part of it, when we're first – granted, most of our kids are born with hearing loss. They were identified a long time ago. I didn't actually go through the eval process very often, but occasionally, I would. Having an audiologist there to explain the hearing loss. Sometimes it's not that the TOD can't. It's that the TOD isn't respected enough to do so. I was told by administrators like, “You're the expert in hearing loss.” We totally trust you with everything. Then they would go in for an eval meeting and say, “Oh. Well, mom said that the kid has a hearing loss, so we decided to give them the HI label.” I'm like, “Did anybody in there know how to read an audiogram? No. Why did you –”

I was like, “A week ago, you told me that I was the expert, and that you totally respected me. Then this week, you're going behind my back and none of you have any idea how to read an audiogram.” I also would have found it helpful. I had a couple of kids who had ABRs. I didn't know how to read an ABR. I stil., I haven't gotten to electro Phys yet. I still don't know how to read an ABR. I just got this graph with some squiggly lines on it and just mild hearing loss. I'm like, is this bilateral? Is this sensory nerve? I don't know what any of this means. I can read a regular – I can read the X's and O's in the brackets and everything like that. I have no idea how to read an ABR. 

I would call the audiologist and not get a return phone call. I was just like, “I guess, we're going with the kid has a hearing loss.” Now, I just have to observe and try and figure out what they're hearing and what they're not hearing. I don't know. Yeah. I mean, I think TODs definitely have a basic understanding of how to read an audiogram. Yeah, there's definitely some more in-depth stuff. I didn't really understand speech scoring, or WRS, or anything like that, and how that affects things. All I knew was X's and O's. I knew sensory, neural and conductive.

[00:29:49] DS: Yeah. For some of that clinical knowledge, especially on the more complex tests and things, that I feel like, now that speech and noise testing is becoming more than norm, it can be really helpful. If you're going to go to the IEP meeting and say, “Look, they tested them in background noise and they fell apart. They cannot perform. They need this microphone.” I'm curious, in that IEP world, what do you feel is one of those services? I feel like, probably FM systems, remote mics in general are like, you probably got to fight hard to get that. Maybe not. I'm curious, in that IEP process, what often doesn't get approved, or you wish was approved more kind of a thing?

[00:30:22] BH: FM systems, it depends on the district. The district I was in, every kid who was going oral route, actually, honestly, most of the kids. They all got FM systems. That was easy peasy for us.

[00:30:35] DS: Awesome. That’s awesome.

[00:30:36] BH: Yeah. It was great. Then after a couple of years, every classroom in the district got a sound field system, too.

[00:30:43] DS: Cool.

[00:30:45] BH: The problem is getting teachers to wear the microphones for both, and especially asking them to wear two is just – That part was frustrating. Honestly, the thing that we had to fight for often the most is either an interpreter, or transliterator. Or sometimes they're called oral language assistance or something. Getting the kid any one-to-one aid is always a struggle, because the district doesn't want to pay another person's salary.

That's when all of a sudden, “Oh, I was no longer the expert in the field.” It's okay, well, we're going to have to consult with somebody else. Oh, but they have an eight-month waiting list for their consultation services. Districts want direct proof that a kid needs an interpreter, or a transliterator. If you're asking the question, they probably need it. Because if you're asking the question, then they're probably missing information.

Yeah. All of a sudden, the teacher of the deaf does not become the expert when it comes to asking for another person to join the team. That's always a big struggle. That's really unfortunate and something that should change. Again, that's another thing kids with multiple disabilities, it's okay, well, what's the point in teaching them any – giving them language? Because their cognitive ability – I’m like, if you would give them language, their cognitive ability would be better. Their behaviors would be better.

Another common one that I would put on every kid's IEP, regardless of modality or language is preferential seating. Then, I would put in parentheses, explaining what preferential seating means. Because for most people, they would think preferential seating, okay, center, middle front row, and that's good. What I would do is say, preferential seating, and then in parentheses, away from noise sources. If you have a radiator in the classroom, you don't want the kid sitting next to that and close to the source of sound.

Most of the time, teachers are presenting from the front. Every once in a while, you'll get a teacher who likes to project a PowerPoint, and they stand in the back of the classroom and lecture from the back. In that case, it might be better for the kid to sit in the back. Or if there is a sound field system, sit by where the speaker is. That's one that I really think needs to be specific and needs to be in every single kid’s IEP.

Then, the other one that I often put in IEPs and put in my own kid’s IEP is tennis balls on chairs, or some sound dampening thing. My son has ADHD, and he has hyperacusis, or sensitivity to sounds is one of the symptoms of his ADHD. When we were going through his IEP, I was like, I really think dampening the sounds, reducing the noise in the classroom would be helpful. I suggested that they do this.

Then, I found out that there was a girl in his class who has bilateral cochlear implants. I said, “Okay. Well, now I'm really pushing for this, because my kid needs it and this kid needs it.” Most preschool parent – by the time you get older, they might know to fight for these sorts of accommodations. I'm like, preschool parents who are just getting started in this whole special ed world don't know about that. I fought for acoustic treatment of my son's classroom for another kid.

[00:34:31] DS: This is one of the things I was hoping you would share, like these really specific things to tell people, because I think clinicians listening, whether it's an SLP, or an audiologist, or whoever, they can be like, “Okay, I'm going to jot this down. The next time I have a kiddo who's starting school, and there's no TOD, there's no educational audiologist, I might have to tell the parent, “Hey, these are the things you need to fight for.” That's some really great insight. Yeah, I'm really glad you shared that. That's good to know.

[00:34:51] BH: Yeah. Those are things that people don't generally think of, but that's what a teacher of the deaf does think of all day.

[00:34:59] DS: That's a great point, that why that collaboration is so important, because they know. They are in the school. They know that that classroom is the bad one, because it's right next to the open window, or the reset. You know what I mean? They have all of that insight. Yeah, that's awesome. Wow, you have really helped me a ton already in my understanding of everything. I'm curious, how you feel is the best way for these professionals to connect. Because, like I told you, with the two that I have been able to establish a relationship with the TOD, it was them telling me the TODs name, me searching on the school website, and fortunately, it said like, “I had to go in the special ed department, and then they had that teacher’s name.”

It didn't say like, teacher of the deaf. It just said, Special Education team. It was four people and I happen to know her. How do you feel, because there's so many kids, there's so many schools. How do you feel is the best way to actually connect? What's our solution here? I know I'm giving you a hard question.

[00:35:49] BH: Well, I think obviously, the onus should be on both parties. I do think that the audiologist, this is selfish, but I do think the audiologist should make more of the effort. The reasoning behind that is one of the things we like to brag about our field is that it's consistently rated as one of the least stressful fields. Then consistently rated, one of the most stressful jobs is being a teacher, specifically a special ed teacher. I think, audiologists just out of kindness, should initiate that. There's actually a really easy solution. If you know you have a kid who's receiving special ed services, ask the parent to bring a copy of their IEP to their next appointment.

[00:36:39] DS: Wow, that’s a great idea.

[00:36:40] BH: That's going to have their present levels. You might not get all of that information in your case history in a short appointment period. You're going to get so much information from their IEP. It'll have a list of the team members. It'll have the TOD’s name on there. It'll have the SLP’s name on there. That's just a great resource, both in helping you clinically and then helping you reach out and know where to go.

Also, if you have, you know where a kid lives, what district they're in, you can reach out to that school district and ask, who is your teacher of the deaf? You know that they're probably going to have all of your kids. Doing it that way. Obviously, teachers can reach out, too. Again, when I was teaching, I had eight schools across all grade levels and trying to talk to gen ed teachers and talk to administrators and doing all of this.

I personally would have loved if the audiologist had reached out to me and said, “Hey, how can I help? Is there anything you can tell me?” Because again, the teachers can give you a lot of insight. If you're like, the teacher may know, “Hey, mom and dad are splitting up. Maybe they need batteries at both houses, or a charger at both houses, or whatever.” That's something you may figure out by the end of the appointment. It might be good to know beforehand.
Another benefit that reaching out has – obviously, we’re in it for the patients and to help them, but from a business perspective, too, every teacher in that district who has a hearing problem, or has a family member with a hearing problem is going to ask the teacher of the deaf for a recommendation for an audiologist. I'm not going to send them to the one who didn't call me back.

[00:38:42] DS: That's a great insight. That's awesome. I never considered that. One thing, too, that I think is so great that I'm like, I totally come up once clinically for me so far. When you have these families that usually, the child is multiple involved – well actually, I shouldn’t say usually. I've had a couple where they were multiple involved, but a loss to follow-up family. They haven't come back. They've been called and called. They didn't come back for two years. It's like, what happened in the meantime? You know where they did go? They went to school. You got to go to school, or you're in big trouble.

If you have that relationship with the TOD, or if you establish it, then you can maybe get some insight into what happened in these. Why did they not come in? Some of that stuff could be great insight from the TOD.

[00:39:22] BH: Yes. Also, in that case, it might be more the SLP. If they haven't actually been identified yet, if they don't have an audiogram, or the parents didn't bring it in to the appointment, they may not have been identified by the school. They may be getting speech services without realizing that they also need hearing services. The TOD has all the connections to the – Even if they don't know that kid, they can figure it out and help and help you out in that regard.

Also, another way that I think we could collaborate is, teachers are really good at explaining things. I know some audiologists are great at explaining things and some struggle. That's okay. We all have our strengths and our weaknesses. If you're an audiologist who struggles to explain things to the families in a way that they understand. They don't seem to be getting it. Having a teacher, the school can contract out with an audiologist to come help out. Audiologist could contract with a teacher to come do some group services.

[00:40:26] DS: Family education. Yeah, yeah.

[00:40:27] BH: Yes, exactly. That is something that a TOD would, I'm sure love to do. That goes for, even if you're not in pedes, if you're working with adults, one, these kids are going to grow up and eventually need an adult audiologist to go to. I feel like, most private practices usually have one pediatric case, or at least a couple. Even as the kids get older into middle and high school, if their hearing loss is stabilized, they're not needing new earmolds every couple of months. If the children's hospital is an hour, hour and a half away, by the time they get to middle school, they may be ready for an adult audiologist, just because they don't want to have to drive all that way anymore.

[00:41:11] DS: Sure, sure. That's great. I like that that was specific to the whole span of it. Because do you have any insights into that – you used a term and I definitely learned – I had a special ed minor. I remember, when they're a transition plan out of school, out of the school system, because I know they can go till 21. Is there anything that you feel like, if that school doesn't have a TOD, if the audiologist is the only one who's going to be able to share information with that family, if you want to say, “Hey, audiologists, or SLPs out there, here's something you should try to get on that transition plan that I've seen it be really helpful for these kiddos to adults with hearing loss.”

[00:41:46] BH: Yeah. I assume it's in every state. I know. It's in Virginia, but the Department of Rehabilitation Services, DRS, very crucial for helping those kids. For some kids, it may be the transition plan is I'm going to go to college, and they need very minimal support. Other kids are going to need job training, and they're going to need independent living skills and everything.

Yeah. I think hooking up with DRS, or it might be – I think it's DARS now. Department of Aging and Rehabilitative Services. Making a connection with them is a great idea, because they can really help find some other resources. I mean, there are lots of resources out there. Of course, it all depends on a kid's ability level and language level and whatnot. DRS or DARS is going to have a lot of those resources that they can send you and guide you. We actually had in our area, a DARS counselor who was deaf. She had all of the Deaf and Hard of Hearing cases. As soon as my kids were 17, I signed them up onto her caseload and got their families in contact with her.

[00:43:00] DS: That's awesome. Yeah. Some place it’s called vocational rehabilitation. Yeah, I think one of the hardest parts in that process, because I've had several children become adults in this process. One of the hardest things is they see people with a wide variety of abilities. It's not just hearing loss going to vocational rehabilitation. Oftentimes, it feels like, they see that the least or something. Because I feel I'm having to explain things and like, why this is necessary and why they continue needing care. It doesn't stop when they hit 18, or 21. Yeah, so that can be really tricky. Yeah, I appreciate that. That is really great advice that all audiologists out there, establish care with your state rehabilitative agency, because your kiddos who are about to graduate out and insurance isn't going to pay for anything anymore, they need to have this connection. Get the job training. There's so many resources that they have if you just take advantage.

[00:43:50] BH: Yes. Also, connecting with your state Department of the Deaf and Hard of Hearing, or Department of Health and Human Services. I know that Virginia has a dedicated department for the deaf and hard of hearing. I don't know if every other state does, but yeah. I mean, that should definitely always be part of your collection of resources that you're handing to people. 

[00:44:13] DS: Yeah, that's awesome. Okay, so we're getting close-ish to the end of our time here. I have a couple more questions, though. This one is like, because I know personally, I didn't have a lot of – I think, I'd maybe met one TOD ever and I've talked on the phone with a few. What do you feel are some of the big misconceptions about TODs? What should we know? How do we correct those misconceptions?

[00:44:35] BH: I think, probably the biggest is just people don't know the whole scope of practice. Like I said, it's so different, depending on where you are. Most people think of a TOD as working in a self-contained deaf classroom. Then once the kids are graduated from that classroom, then they're just out in the mainstream and they're doing just fine. No. The TOD follows that. There is a TOD who follows them.

The fact is that most TODs are itinerant at this point, which people don't always understand how itinerant works, but it's a lot of consultation. Because most of these kids are in the mainstream, or in public schools, in general education classrooms. It's not always just five deaf kids sitting around a bean-shaped table, and either working on oral skills, or ASL skills.

[00:45:31] DS: Yeah. All signing.
[00:45:32] BH: Yes. That's the other thing is that TODs have to be experts in everything. Because again, unless you are lucky enough to work in a self-contained class, where there is one dedicated mode of communication, and that's the one you prefer, you're going to get kids from all across the spectrum of needs. Yeah. I mean, just having a base knowledge of everything is important.

Yeah. Most people just don't understand what TODs do. I got asked if I was the speech teacher so many times. Everybody thought I was an SLP. One time, I got confused with the hearing officer who deals with the kids who get suspended and expelled. Yeah. Mostly, the biggest misconception is just nobody knows what we do.

[00:46:28] DS: Yeah. I can just picture that like, “Where are your handcuffs?”

[00:46:33] BH: Yeah, exactly.

[00:46:33] DS: Are you supposed to have those on a hearing person?

[00:46:36] BH: I think, one of the biggest misconceptions in deaf education, not necessarily about teachers, but in deaf education is the fourth-grade glass ceiling literacy. Myth is really, it's based on statistics, it’s based on data. We hear this so many times. Deaf kids don't read past fourth grade, or the average reading level for deaf kids is fourth grade, or kids who go to deaf schools. It's been mutilated into a lot of different things.

Current data doesn't show that that's the case. The old data that did show that was from 20 years ago, based on kids who were 18 at the time. People who are now 40 is are who we're basing this off, who didn't have early intervention, who didn't have newborn hearing screenings, who didn't have the technology that we have today and the resources that we have today, and were still spreading this myth about deaf kids can't read past fourth grade.

They also didn't take into – a lot of things don't take into consideration the kids with multiple disabilities. Those kids exist. I hate to say it like this, but they do bring down the average. You have deaf people who have doctorates, who have multiple doctorates. It’s fine. We need to get over this misconception.

[00:48:03] DS: Yeah. That's a great insight. I feel like that's – we're so fortunate that we have TODs who are in the school system advocating for kids in this way, who understand the potential of children with hearing loss of any degree, and that potential is limitless. I think it starts at a young age and it really helps when the professionals are all on the same page and understand each other's roles. I think that was a great point that once you know what a TOD can do, which you have totally enlightened me with tonight, once you know that, and now I know what I can put on their plate and what I can help them with by taking off their plate, too. Yeah, this has been extremely eye-opening. I really, really appreciate it.

[00:48:39] BH: Oh, good. That was the goal.

[00:48:41] DS: I wanted to ask you a little bit. You had mentioned you have a child who has special needs, so you've been in the IEP process. Is that what in the wrong story is about? Could you share a little bit more about what that is?

[00:48:52] BH: It actually started, in addition to being – to having ADHD, he also has a food allergy. It originally started as a baking blog for his food allergy and teaching people about food science and baking science. Because I'm a science nerd, that's why I'm going into audiology.

[00:49:08] DS: Yeah. That’s awesome.

[00:49:11] BH: He's actually grown out of his food allergy to an extent. It just wasn't sustainable for me to keep making recipes and stuff. I've always been super passionate about disabilities. I was like, “Okay, so now, I have the educator perspective. I'm getting the health care perspective in my AuD program. I now have the parent perspective.” Just trying to gather all those perspectives together to try and build that collaboration. I'm actually really excited. I have my first guest blog is going up probably tomorrow, maybe this weekend, but from another AuD student, who has a hearing loss herself. She's writing a first-person perspective. I really want to get in more people with different perspectives and bring them all together to try and understand and build that collaboration amongst all of us.

[00:50:03] DS:  That's so cool. That's so cool. Honestly, I just so appreciate your coming from the school's perspective into the audiology perspective. I think it's so, so valuable. I think, honestly, in a lot of AuD programs, there's just this big gap in terms of the educational piece. Somebody, they're just going to go on to be educational audiologist in the schools, and I guess they just – they got to learn how to do an IEP on the fly, because you learn some of the lingo. I know the term 504. In practice, what does that look like? I think that perspective of bringing people from a variety of backgrounds together is really cool.

I really appreciate you sharing, like I never considered that TOD is closely aligned to special ed. Those worlds are – you're going to be either sharing an office with them, or whatever. They're very closely aligned. There's going to be so many children who are multiple involved. I'm picturing all of my super mainstream kids in school, and their TOD comes in and checks and they might do a listening check and they might say, “All right, teacher. You know what you're doing? All right. You guys are good to go.”

I'm forgetting that there's also the other kiddos on my caseload, who they're non-verbal with autism. I mean, all kinds of different things, cerebral palsy. They also have that TOD, and that person is really fighting for them in those situations. It's given me so much to appreciate and think about of who this person is in that student's life and how important it is to have a relationship and a connection with them, because it's going to ultimately be the make or break in their school performance. I mean, I guess, I shouldn't say make or break, but it's going to help them a lot if they have somebody who's fighting for them in that capacity and who understands their hearing loss really.

[00:51:41] BH: Yes. I just have to give a shout out to all the SLPs, too, because they really do – Especially the SLPs who work with those kids who are saying – who are helping the TODs say, the hearing loss is important and is vital, and we need to be addressing that as well.

[00:51:59] DS: Absolutely.

[00:52:00] BH: Yeah. I love my SLP colleagues. They’re the best.

[00:52:02] DS: Agreed. Agreed. I love the SLPs. I do teach them, so I have a little bit of a bias, but I do love the SLPs. This has been such a cool conversation. I'm so glad to have talked to you, Becky. You're going to be an amazing audiologist. You're a quarter of the way there.

[00:52:18] BH: Yup. Just finished the first year.
[00:52:20] DS: Yeah, congrats. How long ago did your semester end?

[00:52:23] BH: Like a week ago.

[00:52:24] DS: Oh, wow. Okay. Yeah, you’re fresh.

[00:52:25] BH: Then we go back next week.

[00:52:27] DS: I was going to say, I’m pretty sure you start back crazy. Yeah. Enjoy this time. For those of you listening inthewrongstory.com, @InTheWrongStory. Anywhere else people can find you?

[00:52:38] BH: Yeah. @InTheWrongStory on Instagram and Facebook at the moment. I would like to eventually make a YouTube channel. At the moment, that's just between grad school and family and I'm going to be teaching an undergrad class next year. I just don't think that's feasible at the moment, but maybe after I graduate. We'll see.

[00:52:57] DS: Fair enough. Fair enough. Awesome. Well, it's been so great talking to you. Thank you so much.

[00:53:01] BH: Yeah, thank you.

[END OF INTERVIEW]

[00:53:05] DS: That's all for today. Thank you so much for listening, subscribing, and rating. This podcast is part of an audio course offered for continuing education, through speech therapy PD. Check out the website if you'd like to learn more about the CEU opportunities available for this episode, as well as archived episodes. Just head to speechtherapypd.com/ear. That’s speechtherapypd.com/ear.

[END]
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