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Laying the Foundation for Communication Exchange: Practical Strategies Presented for the CHARGE Syndrome Foundation March 20, 2019 Presented by: Susan M. Bashinski Missouri Western State University WHY THIS WEBINAR? The intro to Hartshorne,
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01
Laying the Foundation for Communication Exchange: Practical Strategies Presented for the CHARGE Syndrome Foundation
March 20, 2019
Presented by: Susan M. Bashinski
Missouri Western State University<br>
March 20, 2019
Presented by: Susan M. Bashinski
Missouri Western State University<br>
02
WHY THIS WEBINAR? The intro to Hartshorne, Hefner, Davenport, & Thelin’s groundbreaking book, CHARGE Syndrome (2011), opens with the words: “Communication, communication, communication. For 25 years, this has been our mantra when asked what it is that children with CHARGE syndrome need….The biggest barrier to ultimate success for individuals with CHARGE is communication” (p. xi).<br>
03
OBJECTIVES Following this webinar, participants will be able to:
Generate at least one example, regarding a familiar learner, of how development of different communication modes for receptive communication and expressive communication might be very helpful.
Develop a pair of receptive and expressive nonsymbolic communication dictionaries for a particular learner with CHARGE.
Describe the aspects of a routine, which can make a critical contribution to a learner’s feeling sufficiently safe and secure to reach out to those around her in a communicative manner.<br>
Generate at least one example, regarding a familiar learner, of how development of different communication modes for receptive communication and expressive communication might be very helpful.
Develop a pair of receptive and expressive nonsymbolic communication dictionaries for a particular learner with CHARGE.
Describe the aspects of a routine, which can make a critical contribution to a learner’s feeling sufficiently safe and secure to reach out to those around her in a communicative manner.<br>
04
ASSUMPTIONS There is absolutely NO learner who does not communicate.
Learners with CHARGE syndrome, who are NONsymbolic communicators, DO primarily communicate using idiosyncratic, nonconventional forms.<br>
Learners with CHARGE syndrome, who are NONsymbolic communicators, DO primarily communicate using idiosyncratic, nonconventional forms.<br>
05
COMMUNICATION REMINDERS Early expression of “memories” will likely incorporate the movement and tactile aspects of the experience the learner is recalling.<br>
06
COMMUNICATION REMINDERS For a learner who experiences CHARGE syndrome, the way in which she receives info. might be different from the way she expresses information<br>
07
LEARNER NEEDS Learners with CHARGE require their partners to take time to…
plan how a learner will RECEIVE information in every activity
plan what a learner will DO in every activity
consider the IMMEDIATE physical, visual, and auditory ENVIRONMENTAL CONTEXTS of every activity<br>
plan how a learner will RECEIVE information in every activity
plan what a learner will DO in every activity
consider the IMMEDIATE physical, visual, and auditory ENVIRONMENTAL CONTEXTS of every activity<br>
08
STRATEGIES FOR FACILITATING NONSYMBOLIC / CONCRETE SYMBOLIC COMMUNICATION DEVELOPMENT<br>
09
Primary Goal:
ACHIEVING EQUAL COMMUNICATION PARTNERSHIP with a LEARNER with CHARGE SYNDROME<br>
ACHIEVING EQUAL COMMUNICATION PARTNERSHIP with a LEARNER with CHARGE SYNDROME<br>
10
PARTNER’S ROLE / REPERTOIRE Positive ATTITUDE
EXPECTATION that learner is communicating
Key response behaviors
(i.e., RESPONSIVITY to subtle cues from a learner)
ATTUNEMENT to the learner<br>
EXPECTATION that learner is communicating
Key response behaviors
(i.e., RESPONSIVITY to subtle cues from a learner)
ATTUNEMENT to the learner<br>
11
COMMUNICATION BEGINS WITH NONSYMBOLIC BEHAVIOR Observe a learner during unstructured time
Follow the learner’s lead
Embellish potential communicative signals
OFTEN…..
Nonsymbolic skills must be directly taught<br>
Follow the learner’s lead
Embellish potential communicative signals
OFTEN…..
Nonsymbolic skills must be directly taught<br>
12
Experiences that involve movement and action
Multi-sensory exploration, including touch
Interaction with objects / activities that are highly preferred by the learner
Interactions that occur during play
Implementation of regular routines
Highly responsive adults!!! COMMUNICATIVE INTERVENTION: FACILITATION OF SYMBOLIZATION ABILITY<br>
Multi-sensory exploration, including touch
Interaction with objects / activities that are highly preferred by the learner
Interactions that occur during play
Implementation of regular routines
Highly responsive adults!!! COMMUNICATIVE INTERVENTION: FACILITATION OF SYMBOLIZATION ABILITY<br>
13
TRI-FOCUS MODEL (for Teaching Nonsymbolic Communication) Siegel-Causey & Bashinski, 1997<br>
14
Enhancing (Partner’s) Sensitivity
Augmenting Input
Structuring Routines
Increasing Communication Opportunities
Modifying the Communication Environment TRI-FOCUS MODEL (for Teaching Nonsymbolic Communication)<br>
Augmenting Input
Structuring Routines
Increasing Communication Opportunities
Modifying the Communication Environment TRI-FOCUS MODEL (for Teaching Nonsymbolic Communication)<br>
15
ENHANCING SENSITIVITY:
Being aware of, and receptive to, the subtle cues of others
Strategies associated with this guideline target PARTNER skills! TRI-FOCUS STRATEGIES<br>
Being aware of, and receptive to, the subtle cues of others
Strategies associated with this guideline target PARTNER skills! TRI-FOCUS STRATEGIES<br>
16
TRI-FOCUS STRATEGIES ENHANCING SENSITIVITY:
Consistent responses to a learner’s potential communication signals facilitates growth in the direction of conventional, intentional communication.<br>
Consistent responses to a learner’s potential communication signals facilitates growth in the direction of conventional, intentional communication.<br>
17
Attention shift
Reluctance to initiate behavior
Persistence
Change in form or quality of behavior (i.e., “recasting”)
Termination of behavior(i.e., once a change is made & goal is achieved)
Display of dissatisfaction ENHANCING SENSITIVITY<br>
Reluctance to initiate behavior
Persistence
Change in form or quality of behavior (i.e., “recasting”)
Termination of behavior(i.e., once a change is made & goal is achieved)
Display of dissatisfaction ENHANCING SENSITIVITY<br>
18
ENHANCING SENSITIVITY: Nonsymbolic Signal Dictionary<br>
19
ENHANCING SENSITIVITY: Nonsymbolic Signal Dictionary<br>
20
Process steps for building a signal dictionary for a learner:
Observe the learner in a variety of activities and with a variety of partners
Generate a listing of potential signals by identifying any volitional movements and responses the learner has
Analyze this listing to identify any patterns that exist ENHANCING SENSITIVITY: Nonsymbolic Signal Dictionary<br>
Observe the learner in a variety of activities and with a variety of partners
Generate a listing of potential signals by identifying any volitional movements and responses the learner has
Analyze this listing to identify any patterns that exist ENHANCING SENSITIVITY: Nonsymbolic Signal Dictionary<br>
21
Process steps for building a signal dictionary for a learner (CON’T.):
Select a few of these as core signals
Assign meaning to each of these
Determine corresponding partner behavior (DO, SAY, & SCAFFOLD)
Stress to all partners the importance of consistent, immediate responding ENHANCING SENSITIVITY: Nonsymbolic Signal Dictionary<br>
Select a few of these as core signals
Assign meaning to each of these
Determine corresponding partner behavior (DO, SAY, & SCAFFOLD)
Stress to all partners the importance of consistent, immediate responding ENHANCING SENSITIVITY: Nonsymbolic Signal Dictionary<br>
22
ENHANCING SENSITIVITY Benefit to Learners:
Repeated interpretation of unintentional behaviors (i.e., “signals”) might shape intentionality
Learner begins to impact her environment and experience the power of communication
Partners’ acknowledgement of (potential) communication signals shows respect for the learner’s dignity<br>
Repeated interpretation of unintentional behaviors (i.e., “signals”) might shape intentionality
Learner begins to impact her environment and experience the power of communication
Partners’ acknowledgement of (potential) communication signals shows respect for the learner’s dignity<br>
23
ENHANCING SENSITIVITY— WORKING WITH TEAMS (IPCP) Collaborate to identify how to know when the learner is ready to interact
PT & OT: Identify movements that show readiness & responsiveness—unintentional & intentional movements can be shaped into intentional communication
Increase consistency of partners’ responsiveness to potential communication signals
Collaborate to enhance how a learner with CHARGE communicates differently across partners and environments<br>
PT & OT: Identify movements that show readiness & responsiveness—unintentional & intentional movements can be shaped into intentional communication
Increase consistency of partners’ responsiveness to potential communication signals
Collaborate to enhance how a learner with CHARGE communicates differently across partners and environments<br>
24
ENHANCING SENSITIVITY
KEY: Accept the learner’s message!
Listen with your eyes,
and hands,
and heart…. TRI-FOCUS STRATEGIES<br>
KEY: Accept the learner’s message!
Listen with your eyes,
and hands,
and heart…. TRI-FOCUS STRATEGIES<br>
25
AUGMENTING INPUT:
Enhancing meaning and facilitating retention by pairing verbal input and alternative modes (forms)
ALL COMMUNICATION SHOULD BE MULTI-MODAL! TRI-FOCUS STRATEGIES<br>
Enhancing meaning and facilitating retention by pairing verbal input and alternative modes (forms)
ALL COMMUNICATION SHOULD BE MULTI-MODAL! TRI-FOCUS STRATEGIES<br>
26
TRI-FOCUS STRATEGIES AUGMENTING INPUT:
Learners who express in forms other than speech have fewer receptive opportunities
Need for communication models and the knowledge expressed by partners
Pairing of communication forms-speech, sign, gestures, pictures, objects…<br>
Learners who express in forms other than speech have fewer receptive opportunities
Need for communication models and the knowledge expressed by partners
Pairing of communication forms-speech, sign, gestures, pictures, objects…<br>
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TOUCH CUES<br>
28
A TOUCH CUE consists of
tactile contact,
made in a consistent manner,
directly on the learner’s body,
to communicate with him. WHAT IS A TOUCH CUE?<br>
tactile contact,
made in a consistent manner,
directly on the learner’s body,
to communicate with him. WHAT IS A TOUCH CUE?<br>
29
The PURPOSE of a touch cue is to communicate a variety of a partner’s intents.
The use of touch cues may reduce a learner’s startle, or challenging behaviors, by helping him anticipate what is going to occur.
Touch cues are intended to support comprehension. WHY USE TOUCH CUES?<br>
The use of touch cues may reduce a learner’s startle, or challenging behaviors, by helping him anticipate what is going to occur.
Touch cues are intended to support comprehension. WHY USE TOUCH CUES?<br>
30
GUIDELINES FOR USING TOUCH CUES Does the learner have any severe neurological disability? (This might affect his ability to perceive the touch cue OR he might have significant tactile defensiveness.)
Solicit input from the learner’s family
Collaborate with all professionals on the learner’s team
Talk with the learner’s physical therapist and / or occupational therapist!<br>
Solicit input from the learner’s family
Collaborate with all professionals on the learner’s team
Talk with the learner’s physical therapist and / or occupational therapist!<br>
31
GUIDELINES FOR USING TOUCH CUES Consider the learner’s preferences when selecting both the type of, and placement for, a touch cue.
NEVER force a learner to accept a touch cue, or to engage in mutual touch “conversations.”
Touch cues should be easy for the learner to differentiate from routine physical contact<br>
NEVER force a learner to accept a touch cue, or to engage in mutual touch “conversations.”
Touch cues should be easy for the learner to differentiate from routine physical contact<br>
32
EXAMPLES OF TOUCH CUES Slight lifting of learner’s hips (in supine), then pausing - “I’m going to lift your hips (for diaper)
Gently pulling up on the child’s upper arms - “Get ready to stand.”
Touching the preschooler’s left elbow - “This is the way I say ‘HI,’ so you know who I am.”
Rubbing the middle of the toddler’s back - “I like that.”<br>
Gently pulling up on the child’s upper arms - “Get ready to stand.”
Touching the preschooler’s left elbow - “This is the way I say ‘HI,’ so you know who I am.”
Rubbing the middle of the toddler’s back - “I like that.”<br>
33
See Project SALUTE: Successful Adaptations for Learning to Use Touch Effectively
http://www.projectsalute.net/Learned/Learnedhtml/TouchCue.html
“What We’ve Learned-Information Sheets” TOUCH CUES<br>
http://www.projectsalute.net/Learned/Learnedhtml/TouchCue.html
“What We’ve Learned-Information Sheets” TOUCH CUES<br>
34
OBJECT CUES<br>
35
An OBJECT CUE is an object,
or a part of an object,
that is used to REFER to
a person, place, thing, or activity. WHAT IS AN OBJECT CUE?<br>
or a part of an object,
that is used to REFER to
a person, place, thing, or activity. WHAT IS AN OBJECT CUE?<br>
36
OBJECT CUES Object cues are critical for REFERING to a particular person with whom the learner is working...
PERSONAL IDENTIFIER
Examples:
(shown here, sequined bracelet for TVI)
kisses: Mom – right cheek,
Grandpa – top of head
Daddy – tip of nose<br>
PERSONAL IDENTIFIER
Examples:
(shown here, sequined bracelet for TVI)
kisses: Mom – right cheek,
Grandpa – top of head
Daddy – tip of nose<br>
37
OBJECT CUES Object cues are also critical for REFERING to a particular setting—one to which the learner is going, or one in which she is working
Examples:
Colored tape (on floor) – to indicate pathway to follow to reach a particular destination
Variably textured carpet squares / vinyl tiles (on floor) – to guide the learner to the door, etc.
Tangible identifier (on desk) – to indicate 6th grade room, art area, etc.<br>
Examples:
Colored tape (on floor) – to indicate pathway to follow to reach a particular destination
Variably textured carpet squares / vinyl tiles (on floor) – to guide the learner to the door, etc.
Tangible identifier (on desk) – to indicate 6th grade room, art area, etc.<br>
38
The PURPOSE of an object cue
is to provide a concrete means of supporting conversational interactions
AND
facilitating communication development.
Object cues are intended to support comprehension. WHY USE OBJECT CUES?<br>
is to provide a concrete means of supporting conversational interactions
AND
facilitating communication development.
Object cues are intended to support comprehension. WHY USE OBJECT CUES?<br>
39
Does the learner have sufficient motor ability to actively explore / manipulate the object?
Does the learner have sufficient sensory ability to process the object’s features?
AVOID the use of miniatures
with a learner who has
a significant vision loss! GUIDELINES FOR USING OBJECT CUES<br>
Does the learner have sufficient sensory ability to process the object’s features?
AVOID the use of miniatures
with a learner who has
a significant vision loss! GUIDELINES FOR USING OBJECT CUES<br>
40
GUIDELINES FOR USING OBJECT CUES NEVER force the learner to accept an object cue, or to engage in exploring one!
Demonstrate how to explore the object cue’s surface, guiding the learner to do the same
(i.e., use “tactile modeling”)
Offer object cues to the learner, gently--especially initially<br>
Demonstrate how to explore the object cue’s surface, guiding the learner to do the same
(i.e., use “tactile modeling”)
Offer object cues to the learner, gently--especially initially<br>
41
EXAMPLES OF OBJECT CUES WHOLE objects
bag - to mean, “Get your things to go home.”
bubble wrapping - to mean, “Take a break.”
PARTS of objects
top of plastic bottle – to mean, “Lunch! Go to the table.”
partial zipper – to mean, “Time to get dressed.”<br>
bag - to mean, “Get your things to go home.”
bubble wrapping - to mean, “Take a break.”
PARTS of objects
top of plastic bottle – to mean, “Lunch! Go to the table.”
partial zipper – to mean, “Time to get dressed.”<br>
42
OBJECT CUES: Whole & Partial Objects<br>
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PREPARATION OF OBJECT CUES Mount the objects used in these supports for the development of symbolization to help the learner distinguish:
when the object is an object and
when it is a representation (of the object)<br>
when the object is an object and
when it is a representation (of the object)<br>
44
See Project SALUTE: Successful Adaptations for Learning to Use Touch Effectively
http://www.projectsalute.net/Learned/Learnedhtml/ObjectCue.html
“What We’ve Learned-Information Sheets” OBJECT CUES<br>
http://www.projectsalute.net/Learned/Learnedhtml/ObjectCue.html
“What We’ve Learned-Information Sheets” OBJECT CUES<br>
45
AUGMENTING INPUT: Dictionary Elements<br>
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AUGMENTING INPUT: Dictionary Elements<br>
47
Process steps for building an input dictionary for a learner:
Select tangible symbol identifiers (OBJECT CUES) for key persons / activities
Match features of these to the learner’s sensory skills and preferences
Choose TOUCH CUES for each of the requests routinely made of the learner AUGMENTING INPUT: Dictionary Elements<br>
Select tangible symbol identifiers (OBJECT CUES) for key persons / activities
Match features of these to the learner’s sensory skills and preferences
Choose TOUCH CUES for each of the requests routinely made of the learner AUGMENTING INPUT: Dictionary Elements<br>
48
Process steps for building an input dictionary for a learner (cont.):
Target touch cues to body parts learner can volitionally move
Assign a unique meaning to each TOUCH and OBJECT cue
Determine corresponding partner behavior and what is expected of learner
Stress to all partners the importance of providing consistent cues to the learner AUGMENTING INPUT: Dictionary Elements<br>
Target touch cues to body parts learner can volitionally move
Assign a unique meaning to each TOUCH and OBJECT cue
Determine corresponding partner behavior and what is expected of learner
Stress to all partners the importance of providing consistent cues to the learner AUGMENTING INPUT: Dictionary Elements<br>
49
AUGMENTING INPUT Benefit to Learners:
Repeated pairing of touch cues and object cues with speech might, over time, facilitate understanding
Provides the learner with CHARGE with the experiences to support comprehension (i.e., receptive communication)<br>
Repeated pairing of touch cues and object cues with speech might, over time, facilitate understanding
Provides the learner with CHARGE with the experiences to support comprehension (i.e., receptive communication)<br>
50
AUGMENTING INPUT WORKING WITH TEAMS (IPCP) SLP may lead the team in determining appropriate modes/forms of communication
TD/HH will support team to understand how hearing influences need for augmented input
TVI/TCVI will contribute information on enlargement, foreground-to-background contrast for visual representations, and expertise on touch cues & object cues<br>
TD/HH will support team to understand how hearing influences need for augmented input
TVI/TCVI will contribute information on enlargement, foreground-to-background contrast for visual representations, and expertise on touch cues & object cues<br>
51
AUGMENTING INPUT
KEY: Enhancing meaning and facilitating retention (i.e., “comprehension”) by pairing verbal input with alternative modes (forms)
Talk with more than your mouth…. TRI-FOCUS STRATEGIES<br>
KEY: Enhancing meaning and facilitating retention (i.e., “comprehension”) by pairing verbal input with alternative modes (forms)
Talk with more than your mouth…. TRI-FOCUS STRATEGIES<br>
52
STRUCTURING ROUTINES 52<br>
53
INTRODUCTION Partnering with a learner with CHARGE syndrome involves…
INVITING THE CHILD“OUT (of her body)…”
to join you in the world, and to build levels of connections with her<br>
INVITING THE CHILD“OUT (of her body)…”
to join you in the world, and to build levels of connections with her<br>
54
Definition of “routine”:
A related series of activities, organized into a predictable format
Consistent implementation of routines serve to organize a learner’s activities—and world!
A LEARNER NEEDS TO LEARN
TO ANTICIPATE STRUCTURING ROUTINES<br>
A related series of activities, organized into a predictable format
Consistent implementation of routines serve to organize a learner’s activities—and world!
A LEARNER NEEDS TO LEARN
TO ANTICIPATE STRUCTURING ROUTINES<br>
55
WHAT MAKES UP A ROUTINE? Partners need to organize and utilize a sequence of experiences, which include:
The same number of steps
Implemented in the same order
Implemented consistently, each and every time a learner is engaged in the activity<br>
The same number of steps
Implemented in the same order
Implemented consistently, each and every time a learner is engaged in the activity<br>
56
STRUCTURING ROUTINES Other types of skills should be embedded within EVERY routine:
Communication skills
Choice-making
Social skills
Utilizing sensory skills
Optimal positioning and movement
Using hands and arms
Problem solving skills<br>
Communication skills
Choice-making
Social skills
Utilizing sensory skills
Optimal positioning and movement
Using hands and arms
Problem solving skills<br>
57
STRUCTURING ROUTINES: What are the primary components of any routine?
Initiate – How know it is time to begin?
Prepare – What need to do to be ready?
Perform Core – What do to participate, at least partially?
Terminate – How know when over?<br>
Initiate – How know it is time to begin?
Prepare – What need to do to be ready?
Perform Core – What do to participate, at least partially?
Terminate – How know when over?<br>
58
STRUCTURING A ROUTINE: Dictionary Elements<br>
59
STRUCTURING A ROUTINE: Dictionary Elements<br>
60
Process steps for building a structured routine for a learner:
Identify the times of day a partner predictably completes with learner daily (or several times each day)
Select one of these activities
Write each step of the activity, in sequence
Incorporate OBJECT / TOUCH cues from the learner’s augmented input dictionary STRUCTURING ROUTINES: Dictionary Elements<br>
Identify the times of day a partner predictably completes with learner daily (or several times each day)
Select one of these activities
Write each step of the activity, in sequence
Incorporate OBJECT / TOUCH cues from the learner’s augmented input dictionary STRUCTURING ROUTINES: Dictionary Elements<br>
61
Process steps for building a structured routine for a learner (cont.):
Identify the response the learner will be expected to make at each step, to participate at least partially
Anticipate the amount of time the learner will need for response (i.e., TIME DELAY)
Determine corresponding partner behavior (SAY, DO) STRUCTURING ROUTINES: Dictionary Elements<br>
Identify the response the learner will be expected to make at each step, to participate at least partially
Anticipate the amount of time the learner will need for response (i.e., TIME DELAY)
Determine corresponding partner behavior (SAY, DO) STRUCTURING ROUTINES: Dictionary Elements<br>
62
STRUCTURING ROUTINES Benefit to Learners:
Provide the learner with security and a feeling of safety in a given context
Create predictability for the learner—when provided in the context of the natural environment(s)
Assist the learner with CHARGE to develop the skills of anticipation—what she can “expect” to happen next<br>
Provide the learner with security and a feeling of safety in a given context
Create predictability for the learner—when provided in the context of the natural environment(s)
Assist the learner with CHARGE to develop the skills of anticipation—what she can “expect” to happen next<br>
63
STRUCTURING ROUTINES— WORKING WITH TEAMS (IPCP) Collaborate with FAMILY about daily life activities and home routines
Collaborate to identify motivating activities—both at home and at school
Develop routine steps for both “within” and “between” activities
Communicate to identify the most reasonable response a learner will be expected to make to actively participate at each step of routine
Each professional contributes unique expertise to the planning of routines<br>
Collaborate to identify motivating activities—both at home and at school
Develop routine steps for both “within” and “between” activities
Communicate to identify the most reasonable response a learner will be expected to make to actively participate at each step of routine
Each professional contributes unique expertise to the planning of routines<br>
64
KEY: Create predictability for the learner!
MUST have a clear: beginning,
middle, &
end! UTILIZING ROUTINES<br>
MUST have a clear: beginning,
middle, &
end! UTILIZING ROUTINES<br>
65
Listen with your eyes,
and hands,
and heart….
(to develop learner’s expressive skills)
&
Talk with more than your mouth….
(to develop learner’s receptive skills) ESSENTIAL TAKE-AWAYS: COMMUNICATIVE INTERVENTION (with learners who are NON-symbolic or use CONCRETE representations)<br>
and hands,
and heart….
(to develop learner’s expressive skills)
&
Talk with more than your mouth….
(to develop learner’s receptive skills) ESSENTIAL TAKE-AWAYS: COMMUNICATIVE INTERVENTION (with learners who are NON-symbolic or use CONCRETE representations)<br>
66
THANK YOU! Susan M. Bashinski
816.271.5629
sbashinski@missouriwestern.edu<br>
816.271.5629
sbashinski@missouriwestern.edu<br>