AT Basics

AT Cycle

Voices From the Field

Meet Sarah

Sarah is 18 years old and attends a school for students with special needs in Rockville, Maryland. Sarah has an extensive medical history, but now she is healthy. Various psychological assessments over time place her in the borderline or mildly deficient range. She has a moderate to severe bilateral sensorineural hearing loss that was diagnosed at age four for which she wears hearing aids. Her local education agency provides a personal FM system for use during the school day. The purpose of the FM system is to augment her hearing aids by bringing the speaker’s voice into the foreground. Sarah is an excellent speech reader and also uses sign language. Her speech and language expression is usually intelligible. She reads at a mid third grade level. She receives one hour of audiology services per week, one hour of speech/language therapy services per week, and consultative OT and PT services. Sarah is known throughout her school for her outgoing personality and cooperative attitude. However, her teachers are concerned because she often misunderstands or does not comprehend spoken information, does not indicate when she does not understand, and forgets to bring or use her personal FM system.
 

Sarah’s Educational Environment:
    This is Sarah’s first year in the post high school, a non-diploma, school-to-work functional life skills program for students ages 18 to 21. The post high school curriculum requires students to navigate several types of environments as independently as possible. In addition to working at a job site outside of school, students participate in community activities, and in school classes such as functional math, functional reading, language arts, daily living skills, transition skills, and social skills.
    In school, two common types of teaching environments are large group and small group. Large group instruction usually involves six to 13 students arranged in clusters of four. Students face each other and must turn to face the teacher. In addition to the teacher leading the group, one or more assistant teachers and 1:1 teachers are usually present to assist individual students. During small group instruction, two to five students and one teacher are seated together. At school, Sarah interacts with a wide variety of staff at different times. At her job site, she interacts with supervisors and co-workers.
 

Current IEP Goals and Objectives for Sarah:
    The IEP goal relevant to this discussion is that Sarah will demonstrate ability to manage amplification. Specifically, she will carry her personal FM system with her throughout the school/work day independently. Without cues, Sarah will give the microphone to the main speaker at the beginning of each large group, small group, or work related activity, 80% of opportunities over one month’s time.

 

Strategies and Tools for Sarah:
As the above discussion reveals, an appropriate tool was in place, but Sarah was not using it. The previous year’s strategies included frequent verbal or gestural reminders from teachers to bring the FM system to class or to hand the microphone to the main speaker. The staff reviewed past strategies, and generated a specific list of problems and solutions.

Problem #1: Although Sarah is supposed to be responsible for handing her personal FM system to the teacher; she often forgets to bring it or neglects to give it to the teacher.
Solution: Staff expects Sarah to take responsibility for her FM system:

  1. Carry it with her at all times
  2. Hand it to lead teacher/staff person for each activity in school and to job coach/supervisor at job site as needed
  3. Help staff position it appropriately.
  4. Tell staff if system is not working.

When Sarah does not meet expectations, staff does not give direct verbal cues. Instead the teacher waits for her to realize what she needs to do. If that strategy is not successful, the teacher gives an indirect cue (e.g., is everyone ready to begin?)

Problem #2: Teachers’ use of the FM system is inconsistent or incorrect– e.g., the teacher forgets that Sarah is supposed to give her the microphone; the teacher may hold the microphone in order to facilitate giving it to group members during discussion and move it while speaking, thus distorting the signal; the teacher may position the microphone incorrectly.
Solution:

  1. Plan and implement an in-service for key staff (head teacher, job coach, speech therapist) by the audiologist to teach proper operation of the FM system, how to troubleshoot problems with the FM system, and reasonable expectations for Sarah. Trained staff can then model how to properly use the device for other staff members.
  2. Sarah and the audiologist work individually on mastering operation of her personal FM system so that Sarah can instruct staff, job coaches, and job supervisors in its proper use. Sarah and the audiologist also work on following discussion as it moves from person to person.
  3. The audiologist will provide staff with updates on new skills Sarah is learning.


Problem #3: Sharing the microphone during large group lecture/discussion is awkward and slows the flow of discussion, especially during larger groups where distance between participants requires someone to stand up and walk to another person to transfer the mic.
Solution: The speech therapist will practice generalizing use of scripts and following discussion from person to person with both teachers and peers during small and large groups, helping Sarah use her skills in different settings and also providing a model for other staff.

Problem #4: Sarah is often looking at the printed material and misses the discussion, especially if it moves from one speaker to another and she has to turn her body to see the speaker.
Solution:

  1. Rearrange desks in long C shape for large group activities: This facilitates seeing teacher without turning and the teacher’s ability to judge if students are attending to the discussion. Sarah can observe the teacher hand the microphone to another speaker during discussion. She can follow the teacher’s eye gaze and body orientation to signal who is speaking. She can see her teacher and her peers without turning.
  2. Sarah, the audiologist and the speech therapist work on scripts to use when Sarah does not understand (e.g., Please use my microphone, I didn’t understand. Please say it again; I didn’t understand. I need to see your face; I didn’t understand. Please say it slowly).
  3. Staff expects Sarah to use pre-practiced scripts to request explanations, clarification, and repetition with teachers and peers.


Problem #5: Although she is a very good speechreader, Sarah has difficulty speechreading video material.
Solution: Place the microphone by the TV speaker during video tape presentations. The teacher should stop the tape frequently to check comprehension.
 

Checking Sarah’s Progress:
The staff used several types of progress checks, both formal and informal, throughout the rest of the school year.

  • During Sarah’s regular staffing, with classroom and related services staff present, the staff shared observations and adjusted expectations accordingly.
  • The speech therapist observed and collected date regarding whether Sarah had microphone with her and handed it to lead staff during large group instruction.
  • The speech therapist routinely collaborated with classroom and job coaching staff.
  • Discussion of Sarah’s IEP goals in the spring confirmed that Sarah was routinely taking responsibility for her FM system.
  • Informal observation during small groups revealed that Sarah was assertive with peers regarding the importance of speaking more slowly and facing her.

 

Insights:
Several factors were keys to a successful outcome for Sarah:

  1. Staff was expected to attend in-services and to communicate with each other.
  2. Staff set the expectation for Sarah that the FM system was her responsibility. By waiting or giving only indirect cues, staff let Sarah know what was expected developing her independence.
  3. Because her communication environment and her behavior around her FM system were positively reinforcing in that she understood much more of what was going on around her, Sarah began to take greater responsibility for using her FM system.