Two methods of intervention with Spanish-speaking families

S A R A H R A D L I N S K I , M . S . , C C C - S L P , L S L S C E R T . A V TA U D I T O R Y - V E R B A L C E N T E R , I N C . A T L A N T A , G A

Adapting Auditory-Verbal Therapy: Culturally and Linguistically Relevant Intervention for

Spanish-Speaking Families

CI 2019: July 13th, 2019

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

DISCLOSURES

• Employed by the Auditory-Verbal Center Inc.

AUDITORY-VERBAL CENTER, INC.

MY FAMILIES

• 80+ Spanish-speaking families over 5+ years • Mexico, Guatemala, El Salvador, Cuba, Dominican

Republic, Venezuela, Colombia, Ecuador, Peru, Panama


LEARNER OUTCOMES

• List reasons why it is critical to provide intervention that is culturally and linguistically relevant

• Gain knowledge regarding how to adapt, not just translate, LSL intervention


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Regardless of whether you can provide intervention directly in Spanish or use an interpreter, or are doing your best with what is available to you…..

WHY PROVIDE INTERVENTION IN THE HOME LANGUAGE?

• Evidence indicates that children with hearing loss can learn multiple spoken languages

• Learning the language of the home does not impede acquisition of the majority language but rather, can accelerate it(Bunta & Douglas, 2013)


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Because family is able to more effectively carry over intervention = increased linguistic input

PARENTS MUST BE THE PRIMARY LANGUAGE TEACHERS FOR THEIR CHILD

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

• 1 yr: 1-10 exp words• 18 mo: 50 exp words• 2 yrs: 300 exp words• 3 yrs: 900-1000 exp words• 4 yrs: 1500 exp words• 5 yrs: 2500 exp words(Heavner & Vernelson, 2013)

• Due to the degraded acoustic signal/reduced bandwidth, children with hearing loss need

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


WHY MAXIMIZE FAMILY ENGAGEMENT? SIMPLE MATH.• Average 2 year old: 4,032 waking hours per

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

(Caraway & Horvath, 2012)

“If you give a man a fish, he eats for a day. If you teach a man to fish, he eats for a lifetime”.


WHY SPANISH: INCREASING NEED


•25% of children with hearing loss are identified from Spanish-speaking homes

(Gallaudet Research Institute, 2011)

• Higher rate of HL in Hispanic children (Meghra, Eavey, Keamy, 2009)

• As English (or majority language) proficiency decreases, positive healthcare outcomes also decrease(Squires, Peng, Barron-Vaya, Feldman, 2017)

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Since 1960, the nation’s Latino population has increased nearly ninefold, from 6.3 million then to 56.5 million by 2015. It is projected to grow to 107 million by 2065, according to the latest Pew Research Center projections. Which makes sense right? Because if patients are not understanding the information that is being presented, or maybe not understanding it completely, then it is difficult for them to follow instructions or recommendations given to them. For this reason it is important that you as healthcare providers connect these families with resources that are in their native language. Squires, A., Peng, T., Barron-Vaya, Y., & Feldman, P. (2017). An Exploratory Analysis of Patient-Provider Language- Concordant Home Health Care Visit Patterns. Sage Journals, 29(3). Retrieved February 02, 2018.

TAPPING INTO CAREGIVER POTENTIAL


Child profile: 3.5 years old, ANSD, ASD, ADHD, premature

Parent profile: Family income <20K, limited maternal education level, monolingual Spanish-speaker

Prior Intervention: Speech tx in English3 words expressively at 3.5 years

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Example about the difference parent engagement makes in child’s intervention Child profile: 3.5 years old, premature birth, <3 lbs birthweight, prolonged NICU stay, lack of oxygen at birth, ventilator support, brain bleed, ANSD, recently implanted, essentially non-verbal, additional diagnoses: Autism Spectrum Disorder, ADHD Parent profile: Family income <20K, limited maternal education level, monolingual Spanish-speaker Intervention “Traditional” speech therapy Referred due to lack of progress Started AV at 3.5 yrs At baseline expressively used: “agua” (water), “jugo” (juice), and “mama”. Targeted language of the home, coached mother

WHAT WAS THE “MAGIC”?


- 6 months later: 150 words, 3 word combinations.

- Assessments showed over 1 year of progress in 6 months

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Nothing truly magical that happened during that 1 hour a week. The magic was in that I was able to teach Mom how to work with her child in her home language.

NEVER UNDERESTIMATE PARENTS


“Es mi deber como madre preparar a mi hijo para el futuro. Tengo que aprovechar el tiempo al máximo porque ése, cuando se pierde, no vuelve. Hacer la terapia, para mí, es tan importante como darle de comer, porque sé que esto alimenta su vocabulario, su expresión, y su independencia. Sé que tal vez no soy la mejor madre, pero creo que soy la que él necesita. Lo amo con el alma.”

“It is my duty as a mother to prepare my child for the future. I have to take maximum advantage of this time because when you lose it, it doesn’t come back. For me, doing therapy is as important as giving him food to eat because it nourishes his vocabulary, his expression, and his independence. I may not be the best mother, but I believe I am the one that he needs. I love him with my soul.”

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This is a mom who got it. She had so much potential that was wasted during those 3 years while she sat in a waiting room and someone went back and tried teaching her child English. If you only take one thing away from this presentation, please don’t ever let happen to this family happen to another child. There are still many misconceptions out there and beliefs that it is already hard enough for deaf children to learn one language, why would we try teaching two. But that is not true. Evidence says that is wrong. This is a child who in addition to HL, has multiple disabilities, this family has limited resources, but once the home language was valued his language took off. He started preschool the following year and was able to also quickly learn English; and over the years his development of one language supported his progress in the other language. His still has some language and pragmatic delays related to his autism but he is fully verbal, communicates in English and Spanish and can even correct his mother’s accent.

“LANGUAGE OF THE HEART”

• Encouraging development of the home language facilitates family involvement and maintains the family-child bond


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Bond is already disrupted by dx of hearing loss. Imagine how you would feel if told that the best thing you could do for your child was to only speak to him in Japanese. How limited would you feel? How much would you be able to talk to and sing to your child? We have no right to take that away.

LING 6 SOUNDS


Same sounds but written differently

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With that cultural framework, let’s now dive into intervention itself.

CULTURALLY MEANINGFUL ROUTINES

• Coach families on LSL strategies to build language around routines they are already doing

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Tell story about making hojaldres in Panama. Power of using routines that are culturally relevant to family. Show me how to do it. Let the family be the expert in their own routines/culture. Their routines may be different than your own. Don’t have to learn/memorize routines. Your job is to coach families on strategies to enhance LSL outcomes. Build the language around what they are already doing.

CULTURALLY RELEVANT THEMES/HOLIDAYS

• Don’t make any assumptions! (Goes both ways)• “Memorizing bullet points about cultures reduces people to

stereotypes. Cultural humility says I don’t know it all but am willing to learn.” – Elizabeth Rosenzweig


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Even within the same country, some holidays are celebrated differently, or not at all Ask families to teach you, show interest in their culture and holidays Ask: Tell me about holidays/celebrations that are important to your family this time of year In general, stick to neutral seasonal themes If doing our job, families should have skills to teach language at home

LEARNING TO LISTEN SOUNDS

• Use sound-object associations that the family would naturally use• Why?

• More authentic for family, less memorization, more home carryover, other family members already familiar

• How?• Use guidelines from sample handout• TIP: Ask the family!


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For sounds specific to discrimination goals, change vowel


Note: Some sounds are pronounced the same but just written differently!

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*Put new chart *Have video examples of sound?

OTHER SOUNDS AND EXPRESSIONS


Drum: tun tun/pom pomKnocking on door: toc toc tocBell: tilín tilín/tolón tolónCrying: ¡bua, bua!Bubbles: pum pum pumEw: uuu/iu/uy/uf/fuchi/guácala/puf/puaj/foOw/ouch: ¡Ay! ¡Uy!Wow: ¡Guau! ¡Uy!Yay!: ¡Hurra!, ¡bravo!, ¡Eeeeh!Uh oh: oh ohMmm: ¡Am!, MmmAchoo: Achís

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Your pain response may be automatic, but it's immediately filtered through your language before you even finish saying it.

SONGS & RHYMES

• Ask families! Emotional connection to songs • To supplement the songs families already sing at

home, use traditional Spanish songs– MANY choices! • Avoid translations of English songs

• Why?


“Cuando canto esta canción, me recuerda de cuando era niña en Guatemala”

“When I sing this song, itreminds me of when I wasa girl in Guatemala”

SONG EXAMPLES

• Los pollitos dicen• Una vaca lechera• La vaca lola• Tres pececitos• El pato patito• Pin Pon• Saco una manito• Había una vez un avión • A la rueda de San Miguel• Cú cú cantaba la rana• Mariposita• Corre trencito• A la rorro niño• El barquito chiquito• Debajo un botón• Arroz con leche


RHYME/FINGERPLAY EXAMPLES

• Aserrín, aserrán• El gato de trapo• Sana que sana• Tortillas/Papas• El sol es de oro• Este dedito

compró un huevito

• Esta hormiguita• Caballito blanco• Pito, pito, colorito


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Have rhyme/fingerplay video?

VOCABULARY

• Do NOT just translate early developing word lists from English

Why?• Length/difficulty of word• Frequency of use in language• Difficulty translating• Multiple words/concepts for same

English word


Resource: Spanish MacArthur-Bates*But use ONLY as guide!

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Length/difficulty of word: Pop! Revienta, explota Frequency of use in language Pat Difficulty translating Roll Multiple words/concepts for same English word Roll: Amasar, estirar, arrollar, aplastar, rodar Squeeze: Apretar, exprimir, estrujar, escurrir, aplastar Can do “pum pum” for “pop!” Rueda Hazlo rodar. The verb “rodar” is intransitive because the ball rolls on it’s own (it inherently rolls) and what you do is you make it roll. La pelota rueda. Technically CORRECT. Haz lo rodar: CORRECT You make it do something it does on it’s own. Even though I’m the one making it do it, I’m not the one rolling– I am making it roll. Mama rueda la pelota: NOT correct. Statement: Mama hace rodar la pelota Command: Mama, haz rodar la pelota. BUT some families say that “Mama rueda la pelota” sounds fine, even though technically according to the Royal Spanish Academy (and most families) it doesn’t sound grammatically correct. However, many families don’t really frequently use “rodar” at all, and actually don’t actually distinguish between a ball rolling on a surface vs. tossing it in the air. Example “avienta” or “tira” o “lanza” (toss– a little more vague). So an activity that I may do with an English speaking child (discrim between roll and throw) wouldn’t do with a Spanish speaking family. Instead would do bounce “rebota” or “bota” Rock: Acuna al bebe (to “wedge” a baby), mece al bebe “Amasar” focuses on working the dough (most vague could work for playing with playdough but not a direct translation of roll) If playdough, might be amasa for both rolling with rolling pin, rolling a snake out of dough, rolling ball in hand But could be estirar for rolling pin. Arrollar: making it into a roll Aplasta: flatting it (could be with hand or rolling pin) Estirar: to stretch (could be with a rolling pin or pulling it) Exprime: squeeze from fruit etc. (focused on what getting out of it– trying to yield liquid ) Escurre: focusing on getting rid of liquid Estruja: another way to say exprimir Aplastar: like with playdough, making it flat To add to the fun: Aprieta is how you would say “push” on button to turn on a toy, jack in the box, hand sanitizer

DIFFERENCES ACROSS DIALECT


• Cerdo• Puerco• Chancho• Marrano• Cochino• Cuche• Cocho• Gorrino

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Grass, sheep, throw, pour

HOW TO APPROACH FAMILIES

• Be up front about goal: we want the child to speak like his FAMILY

• Give permission/ask them to correct you

• Be clear that THEY are the experts in their language

• Have the family be the first to use the word

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


GRAMMATICAL DEVELOPMENT

• Do NOT just translate from English norms

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

• Some differences in rate/order of normal development

• Resource: CASLLS in Spanish


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Plurals: Develop shortly after turn 2 in Spanish-speaking children; 3-3.5 yrs in English-speaking children In English, the subjunctive form of a verb often looks identical to the indicative form, and thus subjunctives are not a very visible grammatical feature of English. Except for “to be” and 3rd person singular where you drop the /s/. Examples: Spanish subjunctive tense, plurals (2 yrs Spanish vs. 3-3.5 yrs English), “nosotros” 4-5 yrs vs. “we” 3-3.5

SPEECH SOUNDS

• Vowels: 5• Diphthongs

• Consonants• Differ between languages• *Careful: written vs. spoken

• Order of typical sound development

• Impact of dual language learning

• Accents


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Example: Mom who asked “Well do you want him to say the English “t” or Spanish “t”. Diphthongs– impacts number of syllables, stress marks Voiced

TAKE HOME POINTS• Children with cochlear implants can become bilingual. We have no right to take away that

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

just translate! Use what is most natural/authentic for the family.• Don’t use direct translations from norms in English (vocabulary, grammar, speech sounds etc.)• Express how much you value their language and culture- the FAMILY is the expert. Honor families.


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Fall 2019: “LSL in Spanish: Impactful Intervention to Support the Home Language” &“LSL in Spanish: Delving Deeper into Intervention for Spanish-Speaking Families”

https://community.hearingfirst.org/learning-experiences

Interested in Learning More?

https://community.hearingfirst.org/learning-experiences

REFERENCES

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

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

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

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

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



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

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

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

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

• Meghra, S., Eavey, RD, Keamy, DG (2009). The epidemiology of hearing impairment in the United States: Newborns, children, and adolescents. Otolaryngology – Head and Neck Surgery. 140:461–472.

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

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

• Rodriguez, Y. & Allen, T. (2018) Exploring Hispanic parents’ beliefs and attitudes about deaf education, Journal of Latinos and Education.

• Squires, A., Peng, T., Barron-Vaya, Y., & Feldman, P. (2017). An Exploratory Analysis of Patient-Provider Language-Concordant Home Health Care Visit Patterns. Sage Journals, 29(3). Retrieved February 02, 2018.

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

THANK YOU! ¡GRACIAS!

“Tell me and I forget, teach me and I may remember,involve me and I will understand.”

– Chinese ProverbAUDITORY-VERBAL CENTER, INC.

Documents

Two methods of intervention with Spanish-speaking families