Episode 4

Show Notes

On today’s episode of All Ears at Child’s Voice: A Hearing Loss Podcast, Tatum and Jessica interviewed Rollen and Laura on their experience with the style of early intervention therapy called “bagless” therapy. Rollen and Laura shared some great insight on their transition to using bagless therapy, the benefits for parents and professionals, and some of the challenges they face in implementing bagless therapy.

 

What we hope families and professionals take away from today’s episode is this:

• We believe that children with hearing loss can learn to listen and talk, and we believe that caregivers are incredibly capable of helping these children achieve that goal.
• We want to empower caregivers, with our support and guidance, to learn strategies and incorporate them into their child’s daily routines to support listening and spoken language development.

 

Show Transcript

Tatum: Welcome to Episode 4 of All Ears at Child’s Voice, a podcast discussing all things hearing loss. We aim to connect families of children with hearing loss with the professionals who serve them. We’re your hosts. I’m Tatum Fritz.

Jessica: And I’m Jessica Brock.

Tatum: And today we have two of our fellow colleagues on the show with us, Rollen Cooper and Laura Straka. Welcome Rollen and Laura.

Rollen: Hi

Laura: Hi

Tatum: We’ll be having a panel discussion today about Rollen’s and Laura’s experience transitioning from bag therapy to bagless therapy and Jessica’s and my experience with bagless therapy. For those of you wondering what those words mean, we’ll define them for you once we get into the main discussion so stay tuned.

Jessica: Rollen is a Teacher of the Deaf and is the director of our Early Intervention program at Child’s Voice and Laura is a speech-language pathologist and head therapist at Child’s Voice. Rollen and Laura, why don’t you tell us about your role here at Child’s Voice.

Laura: So I provide home-based Early Intervention speech and aural rehabilitation therapy and then I also lead our toddler group along with Tatum here at the Chicago center. And then I provide Auditory Verbal Therapy to kids over age three at our center in Chicago. And then I just also help with getting children into our toddler group program and running the center here in Chicago.

Rollen: And my role is really more administrative. So I’m here in Chicago half the time and in Wood Dale half the time. I do initial evaluations every once in a while for families. And then right now I’m not providing any therapy services though I have in the past and may still again in the future.

Jessica: Yeah, cool. Rollen is also our LSLS supervisor and Laura observes some of our sessions as well so we all work very closely together.

Tatum: Yeah, he’s a great mentor.

Rollen: Thank you.

Tatum: Do we want to jump right into our main discussion?

Jessica: Yeah, as we said, we’ll be having a conversation about bag therapy vs. bagless therapy. Why don’t we start by defining those terms. Do one of you want to define the difference between the two?

Laura: So, the way I interpret it is bag therapy kind of means bringing in a bag of toy into a family’s home for a therapy session. So toys to do therapy with the child and with the family. And bagless therapy means not bringing in a bag of toys and instead using the family’s toys and materials and their daily routines to help build listening and language.

Jessica: Awesome, we should probably preface this by saying this is really relevant to the Early Intervention population so this is, we’re talking about when professionals are going into families homes for the birth to three population. So, for those of you who are in EI, you will know this well and for those of you who aren’t, you will learn something new.

Tatum: Yeah, perfect. Rollen, do you have anything to add or does anyone else have something else that goes to the definition? Your definition was great, Laura.

Laura: I’ll just also say we’ll probably say EI a lot and that means Early Intervention.

Jessica: Perfect. Rollen, anything to add about the definition or the difference between the two?

Rollen: Yeah, I think one thing to add to it is I think that when I think of bringing in like a bag of toys I also think of it as the therapy is more therapist-lead whereas bagless, and especially how Laura defined it,  using the family’s resources, using the family’s routines, I see it as more of a partnership between the parent and the therapist.

Tatum: Yeah, that’s a great point. Cause sometimes, admittedly, even I bring in toys, but I feel like there is a way to structure a session that even if you do bring in a bag of toys that looks more bagless if it’s about what the family is doing or coaching the family in using those toys.

Jessica: Definitely, do we want to talk a little bit about the transition that Child’s Voice has made from bag to bagless. Rollen, do you want to talk about that?

Rollen: Yeah, sure. I feel like just in the field of Early Intervention in general there’s been a trend of things going from being more center-based services to things being more home-based, from things being more therapist-directed to using more of a coaching model with families. I think long ago, you know, most of the Early Intervention services all took place in the center so the baby  and the parent would come to the center. The therapist would lead the session and the parent may not really have a big role in that. And, just as the years have gone on that’s changed. So it kind of changed initially where services would be in the home, but the therapist still would come in, bring materials, still kind of lead the activity, so it was similar to what was in the clinic but just now in the home setting. And now it’s kind of evolved into the therapist and the parent working together as a team, the therapist really showing the parent how to carryover strategies throughout the week. And I think that’s something that’s just kind of gone on just in the field of Early Intervention in general. And, at Child’s Voice, we kind of followed a similar evolution too with it. Things became very focused on the partnership between the parent and the therapist and the important role the parent plays in developing the child’s listening and spoken language. Most kids with typical hearing that’s how they learn how to talk, just through daily routines with their families, playing with toys, and they just sort of pick up on the language and become fluent speakers.

Jessica: Awesome. Laura, do you want to talk a little bit more about why it’s so important and the value of bagless therapy in your experience?

Laura: Yeah, I mean I think that one of the biggest pros of doing the bagless therapy is that whatever you teach the parents or coach them through, you use their own materials and they still have those materials throughout the week, every day, to practice with their child. And you come in with a special toy that you then teach the parent how to work on a language skill with but then you take it away, some parents may be able to easily translate that into a different activity or find a similar toy  or they might go out and buy the same toy but other families have a hard time with that. And they may not have that same resource to do the therapy with their child. And that could lead them feeling inadequate and not like they are their child’s best teacher, which we feel like they are.

Tatum: Yeah, I get that with my families too, that they think…a lot of my families with ask me about very specific toys or like this shiny, new toy they’ve seen online and it’s like they think sometimes before they fully understand the bagless approach that the toy is like the main thing that’s about the therapy or like the toy almost is what’s going to cause the difference instead of the coaching and the therapist and also the family using the appropriate strategies to help facilitate language development.

Jessica: Yeah, definitely, I agree.

Tatum: I thought about something as Rollen was speaking about Child’s Voice’s experience with the inservices and I remember at the time when Kate, another one of our therapists, and I started working here that we talked a little bit about how it was less new for us. And I know it’s like less new…or like we never really had to switch and I know Jessica never really had to switch either because of…it was built into our graduate program almost and into my mentoring experience in my graduate studies and I’m sure you too Jessica. So while you were in graduate studies or during that mentoring time, was bagless therapy or a coaching model ever discussed?

Laura: We did not do the bagless therapy when I was in graduate school. We did do some parent coaching. When I was working with families with families with hearing loss we definitely did coaching. But it was never something that I learned with like doing the bagless therapy approach. We definitely learned to help, you know, families think about ways they could carryover a skill and might brainstorm with them a similar toy they might have at home to work on a skill. But, it was a totally new thing for me when I switched to bagless here.

Tatum: What about you Jessica? Do you feel like you were coached or mentored?

Jessica: Definitely, definitely. I, well one of my clinical experiences was actually here at Child’s Voice in Early Intervention with a therapist who used to work here, Landon, and she was really good at parent coaching. And so that was definitely built into my training. I think that it’s rare to have an Early Intervention placement in graduate school, especially in the homes. So, it was definitely a part of my training but specifically because I had this placement here at Child’s Voice.

Tatum: Yeah, I almost feel like the coaching model goes so much hand-in-hand with Auditory Verbal Therapy and the listening-and-spoken-language approach that even when I was in graduate studies, if I think back to my placements that were not focused on hearing loss, it was less, a lot less, about parent coaching and a lot more child directed.

Jessica: Yeah, I remember taking one of the Aural Rehab classes with Uma, at Vanderbilt, this was a professor, her name was Dr. Uma Soman, and she had this picture, I vividly remember this, she had this picture on the powerpoint screen that was a jar of marbles and one marble was red and the rest of them were yellow. Or gray or something, I don’t remember. And she said something like if you picture the number of hours of a child’s day that they are spending with their family, those are all the marbles in the jar. And if one of them is the hour that you spend coach-, or doing therapy with them, that has such little impact. Whereas if you teach the parent how to apply these strategies to all of the hours of the kid’s day, think about how much more impactful that is both for the child and for the parent to be an advocate for their kid.

Tatum: I don’t remember that but that’s a good analogy.

Jessica: Yeah. So obviously bagless therapy is really important and coaching is awesome for a variety of reasons but there are definitely challenges that go with it. Do either of you, Rollen and Laura, want to talk about some of the challenges of bagless therapy?

Rollen: I would say for me, one of the challenges goes back to with what Tatum was saying about not being, you know without having the formal training that way and having been trained so many years ago, so much of my time was always very child-directed and now switching from being really child-directed to being more parent-directed is a harder switch, I think, for me because I had worked for so long the other way.

Laura: Yeah, I think, I mean a lot of our families also see outside therapists too that might still do bag therapy and so I think sometimes those can be more challenging families because they’re seeing different forms of therapy. So that can be kind of hard.

Jessica: What do you, what do you…So I’ve had families say to me, “Well this other therapist brings in toys and, you know, my kiddo responds really well to that?” Do you have a good response for that that doesn’t, that doesn’t take away from what the other therapist is doing but does help support what you’re doing?

Laura: I usually kind of give that explanation, not necessarily of like the marble, specific marble explanation, but like the amount of hours of like input that the family can then do if they know how to use their own toy to help their child versus me bringing in something and then taking that away. So I really try and build that up, that that’s what the research has shown now is like if parents are teaching their child and using those strategies throughout the day, that can be more effective.

Tatum: So, I think it might be good to discuss what a typical bagless therapy session might look like and maybe while we’re discussing talk about how the coaching fits in. So maybe, some listeners who are not familiar with this style of therapy can kind of imagine what it might be like.

Laura: Well, I think that can look different session to session and it can probably look different therapist to therapist. Even if we’re all using the bagless approach. Usually, or generally within my sessions, I’ll have a listening, a speech, and a language more focused activity, and then, depending on where the family’s at, if it’s a new skill or an older skill they might already kind of know how to work on the skill. And we might bring out a similar target, let’s say we want to work on the child producing the “oo” sound, like one of my families, last week we played peek-a-boo and really inputted the “oo” sound. But this week we stayed with the “oo” sound and worked on dropping blocks off of our heads and saying “oo.” So, using a skill like they already kind of seen what the goal is but then changing it so they have a new way working on it. That might be one thing that we might do. So there can definitely be carryover from one week to the next. A lot of times, I’ll also ask a family for our language-based activity, what type of words do they want their child to be understanding or using. And if they’re having a hard time coming up with that off the top of their head, I might show them a list of common early words that kids use and we might brainstorm together what might be good words for their child to start to learn, and what could we do next time to work on this skill.

Tatum: Yeah, for me I feel like it does vary by family. Some families are at the level with the bagless coaching where I can come in with just a goal. Say I want to work on the /p/ sound today, and then they can come up with a list of activities. Or I might, at the level below that I might say, I want to work on the /p/ sound, these are five words I can think of that start with the letter “p,” or the sound /p/, not letter, and then they might be able to come up with toys that go with those words. So they need some more level of support. Or if I know that the family really isn’t like at that place where they can brainstorm that far on their own, I might provide a second level, or another level of support, and have a list of toys that I already know the family owns. So, like, let’s work on the /p/ sound, we could use your ball-popper, bubbles, or push cards. Which one do you want to do? And it just kind of depends. Some families get to the point where they can be really, really in charge of the session and then some families just don’t get to that point.

Jessica: What barriers do you see to families getting to that point?

Tatum: I mean, partially I think some of it is me. I think some families I might just better understand how to coach certain families than other families, so…just because we might mesh a little better. So I give them more opportunities to get that point cause I’m more willing to take their support away or the scaffolding away. And then some families, I definitely feel like the families who don’t tend to get there are the families where other therapists are coming in with toys. And again it might be me because I know in my head other therapists are coming in with toys and that therapist, a therapist who comes in with toys might look more prepared because they’re not coming into the session and asking, “What toy do you want to use?” or “what activity should we do?”

Jessica: Yeah, that’s definitely hard. Can you think of any other barriers?

Rollen: I think just to add to what Tatum was saying, I think with some parents they really see the therapist, be it a teacher or a speech pathologist, as the expert and don’t, you know, maybe that’s like their own history when they were educated themselves or they hold educators and school professionals in very high regard. So they really feel like you should be the one doing it. They don’t feel confident in their own skills. So sometimes i think that’s a hard thing to get past sometimes with families.

Laura: I think some families too, like if they’re earlier in the diagnosis like stage of things, they’re just finding out that their child has a hearing loss, they might not be as excited about therapy as like a family that’s maybe like six months in where they can start to see their child making progress and get excited about having fun with their child to work on listening and language. So I think those families that kind of see the fun in therapy and working with their child kind of take on the responsibility a little bit more than some of the families that just aren’t quite, you know, there yet.

Jessica: Yeah, definitely.

Rollen: I think one thing too that I was thinking about before when Laura was talking, and I think this is something that can prevent some barriers, I think when… One thing I remember Kristen talking about a lot in the beginning was when you first started working with the family, you know, and it’s a new family, you’re gonna spend a lot of time in the beginning talking about what are the family’s goals, what do they want their child to be doing at home. Laura said this, Laura had said earlier about asking the family what kinds of words do you want your child to use, so I think a lot in the beginning is just really to get to know the family, getting to know what their goals are for their child, getting to know what are their baby’s favorite things to do, or what are the family’s favorite things to do, what routines do they have. And then, doing kind of an inventory of what they have. What toys do they have at home, what books do they have at home? And I think sometimes if you can get to know the family, again this is again from really observing the therapists and just sort of thinking about this, I sort of think if you can do all that in the beginning and get to know them and get to know the goals, that’s gonna help you to come up with good bagless activities for them.

Jessica: Definitely. I think in the beginning too, sometimes I’ll say, like before I’ve even met the family, when I’m scheduling with them, just so you know I don’t bring in a bag of toys cause I really want you and your child and what you have already. Just so that they know before I even get there that I’m not gonna come in with a bag. I don’t know if that necessarily helps or not but it makes me feel better about going into the session without a bag of toys and then doing all of those things that you just explained in terms of asking a lot of questions and trying to get to know the family.

Tatum: Yeah, I try to define, I don’t know if I use the word “bagless,” but just define what therapy will look like. I haven’t started with a new family, so I haven’t done this in a while, but I think I also ask them, “What are you expectations for therapy,” and see what they say. And a lot of times, “Oh you’re going to come in and bring toys and work with the child in the corner,” … Well not the corner, but it comes off like that. I’ll just be over here with the kid, and sometimes it’s even been with babies and I’m like I can’t be with your baby in the corner. And then just contrasting their expectation versus you know this is what it will actually be like. So I’m kind of validating what they thought it might have been and talking with them and having a discussion about what it will be like, and I find that that helps with most families. It’s much harder when they’re already in EI or Early Intervention and they have another therapist. When it’s like that, I’m more so when I’m starting to schedule I mention right away that I’m not going to be bringing a bag and do less about the expectation. Cause I don’t want to contrast my therapy too much with the other therapists on the team because I don’t want it come off like I’m judging other kinds of therapy styles. Sometimes, I just say like, “Oh there’s more than one therapy style and I do this way.”

Rollen: And that’s, I was gonna say to give the parent what the expectation is in advance.

Tatum: So we talked about the difficulties of not bringing in a toy, being bagless, do you guys find any difficulties with the coaching aspect itself? I can think of one for me, just being a younger therapist who does not have kids, sometimes I worry that I’m going in and telling the family how to change their way of interacting with their child when I myself do not have kids. Can you think of…are there any challenges that you run in with that?

Rollen: I would say yes in the sense that I think working with an adult is so different from working with a child. How a child learns is so different from how an adult learns. So I think that for those of us who weren’t really trained in adult learning styles, it’s hard cause you really have to think about things much differently. It has to be things that are very practical, things that they can really incorporate right away, so I think, I think that is one thing that is challenging as well about the parent coaching.

Laura: Yeah, I mean I think that no one wants to be told for an hour what to do too. So, the more I feel like I just try and give families lots and lots of positive reinforcement for even the littlest thing, just so you can really build them up, so that when you do give them a change to make, you know, they can feel confident in doing that too. So I think that just takes a while to kind of build that rapport with families too so that, you know, the more positive they feel about therapy that the more they’ll want to kind of come up with their own ideas and participate more and more. So like I think that’s one change I’ve kind of made with the coaching is trying to, you know, give more positive feedback with it too. So that you don’t feel that you’re just telling them what to do all the time.

Jessica: Yeah, I learned that for me specifically and I’ve seen it be really beneficial to the therapy that I’m providing. It’s just like praise, praise, praise, so that when you do have a piece of feedback, it won’t seem like you’re saying, “Oh, you’re not good at this; you’re not supposed to be good at this, nobody…you’re not born with a manual on how to be a parent and you’re certainly not born with a manual…or don’t have a child with a manual on how to teach them how to listen and talk. Sometimes, I’ll ask families a question and they’ll get concerned that they didn’t know the answer and I try to tell them you’re not supposed to know the answer, that’s why I’m here. SO taking off some of that pressure and really giving them a lot of positive feedback is helpful. I think too one of the things that I have a hard time with is the…the sort of standard for how to do coaching is you explain the goal, and then you explain the activity, and then you do the activity, and then you have the parent try to do the activity, and then you talk about how it went afterward, and it’s a lot of talking. And in Early Intervention, kids get distracted because they’re two. So I find that’s a struggle that I am constantly coming up against is trying to figure out how to pace myself in terms of when to talk more and when to just put it aside and come back to it later when the kiddo is more distracted and at the end of the session.

Tatum: Yeah, that’s a huge thing. When I’m coaching families, I think about…back to…I had this one really good supervisor in graduate school named Stacy Adams at Sunshine Cottage School for the Deaf and I just think about how she coached me to do therapy, and the level of support she used in the beginning, and how she gradually took that support away. At the very beginning she did a lot of embedded coaching. While I was doing an activity, she was giving me minor things to change or at the very beginning she might even be telling me literally what to say as I was about to say, which some families I do think need that level of support sometimes. Obviously with our families we never take the coaching away. But I just think about how I learned because she was by far my best supervisor…in grad school.

*Everyone laughs*

Jessica: Rollen was glaring at her across the table.

Tatum: I’ve had several good supervisors.

*Everyone laughs*

Tatum: Is there any other topics that we should cover?

Rollen: The one thing I was gonna add to it, and Laura made me think of this when she was talking about coaching the parent, really like building up their confidence. I heard one other therapist that I used to work with talk about it when she first started to work with a family she’d spend a little bit of time really talking about the partnership that was gonna take place between the therapist and the parent, and the way she explained it, which I always really liked, she told the parent, “You know, you’re the expert on your child and you’re gonna tell me everything I need to know about your family and your child’s likes and your child’s strengths. And I’m the expert on hearing loss, so I’m gonna teach you about what you might need to know about hearing devices, listening skill development, language development, and we’re gonna take both those areas of expertise and kind of combine them together while we’re doing this.” And I thought that was a really great to explain it and kind of like a good way of starting off that partnership with families.

Laura: Yeah, I like that a lot. I’m gonna start using that.

Rollen: Aw, perfect!

*Everyone laughs*

Rollen: The one other thing that I’ve seen that’s different that I think that’s a really good change is that I noticed that with our therapists, even their work in the center has changed and become more parent-focused. For example, I get to see Tatum doing a variety of home-based sessions and I’ve seen Tatum do a lot of sessions as well in the center, and even though in the center it’s more, it is more therapist-directed in the sense that it’s using the toys that we have, and things like that. Tatum still does it with the parent playing a big part of the process. So even then, you’re still coaching the parent through how to do some of these activities, having the parent be a part of it, and then I know you always spend time with a parent asking how can you carryover this at home.

Tatum: Yeah, that took longer to learn how to do that in a center-based session. Just because when you’re at home, you can look around and literally see what the parents could come up with and you’ve seen more of their daily routines and know what they look like. So it took me, probably only recently did I start probably start remembering to do that.

*Everyone laughs*

Tatum: Cause it’s a lot…

Jessica: It is a lot but hopefully it’s empowering parents and that’s really our goal is that they walk out of the center feeling like they learned something too and that they are able to help their child more than they’re already doing by being awesome parents. And so that’s really the goal.

Tatum: I think that is a good note to end on.

Jessica: I think so too. Should we wrap things up?

Tatum: Sure. Rollen and Laura, thank you so much for joining us. This has been a great discussion and I think we all learned something.

Rollen: Yeah, it was great. I enjoyed getting to be a guest.

Laura: Me too.

Tatum: Yay

Jessica: Listeners, we would love to hear from you. So from our parents who are listening, please let us know what style of therapy your children are receiving. And for therapists out there, tell us what your experience is with bagless therapy, what training or education have you received when it comes to going bagless or is this all new to you. So, we’d love to hear from you guys. Thank you to everyone for joining us for another episode of All Ears at Child’s Voice.

Tatum: We’re your hosts. I’m Tatum Fritz.

Jessica: And I’m Jessica Brock.

Tatum: And, as always we’re on instagram and twitter. I’m at @TatumFritzSLP and Jessica is at @JessicaBrockSLP.

Jessica: You can also email us at podcast@childsvoice.org and find episode shownotes and archived episodes at Child’s Voice’s website childsvoice.org.

Tatum: And if you’re interested in learning more about Child’s Voice the program, Child’s Voice is on facebook as well as twitter and instagram with the handle @childs_voice, no apostrophe.

Jessica: We will see you next time. Thanks everyone.

Laura: Bye

Tatum: Bye

Rollen: Bye

Jessica: Bye