A Conversation with Erika Gagnon & Erin Thompson!

Did you know that one of the most significant predictors of receptive and expressive language for children who use cochlear implants was the age at which they achieved full-time use of their devices?  Achieving full-time use can be a challenge.  Join Dr. Erika Gagnon, Au.D., and Erin Thompson, M.S., CCC-SLP, LSLS Cert AVT as we take a deeper dive into the research, factors that impact full-time use and how to use the counseling concept of Hearing Hours Percentage (HHP) to support families and children who are on this cochlear implant journey.  In addition, we take a deeper dive and a role-play demonstration into the benefits of co-treating (audiologists and speech-language pathologists) and strength-based coaching to improve family outcomes.  

Erin has been working with the Children's Cochlear Implant Center at UNC since July 2004. Erin conducts Listening and Spoken Language parent participation sessions, speech and language diagnostics for children who are deaf and hard of hearing. Her passion has been mentoring students and professionals across NC, the US, and abroad. In 2019 her role expanded to include Family Care Coordinator. She helps manage, facilitate, and coordinate cochlear implant consultation referrals, supporting all families going through the CI consult process at UNC.

Erika earned her bachelor’s and Doctorate in Audiology from the University of North Carolina at Chapel Hill. She is a pediatric cochlear implant audiologist at UNC's Children’s Cochlear Implant Center. In addition, she is the Audiology Clinic Manager and the Program Director of the CCCDP Grant. Erika’s research interests include pediatric cochlear implant device use and pediatric EAS. Erika enjoys teaching and mentoring students, she co-teaches the Cochlear Implant course to UNC’s Audiology graduate students.

For More Information:  https://www.med.unc.edu/earandhearing/

Erin.Thompson@unchealth.unc.edu

erika.gagnon@unchealth.unc.edu

You can listen to this episode wherever you stream podcasts and at www.3cdigitalmedianetwork.com/empowear-audiology-podcast

For more information about Dr. Carrie Spangler- check out her Linktree at https://linktr.ee/carrie.spangler.

For transcripts of this episode- visit the podcast website at: https://empowearaudiology.buzzsprout.com

Transcript

Announcer: [00:00:00] Welcome to episode 59 of emmpowEAR Audiology with Dr. Carrie Spangler.

Carrie: [00:00:14] Welcome to the empowEAR Audiology Podcast, a production of the 3C Digital Media Network. I am your host, Dr. Carrie Spangler, a passionate, deaf and hard of hearing audiologist. Each episode will bring an empowering message surrounding audiology and beyond. Thank you for spending time with me today, and let's get started with today's episode. Today I have two guests from North Carolina with me, and I am going to take a second and read a little bit about their bios. They are an SLP and audiology duo. I have Erin Thompson, who has been working with the Children's Cochlear Implant Center at University of North Carolina since July of 2004. She earned her bachelor's from Appalachian State University and her master's in speech and hearing science from UNC Chapel Hill. She became a listening and spoken language specialist in 2009. Erin conducts listening and spoken language parent participation sessions, speech and language diagnostics for children who are deaf and hard of hearing. A passion has been mentoring students and professionals across North Carolina, the US and abroad. Erin has been a member of the Global Foundation for Children with hearing Loss and has traveled to Vietnam on three occasions and also Mongolia on one occasion to help provide mentoring and training abroad. She has spent time coaching a team of speech language pathologists in Auckland, New Zealand. Erin expanded her interest in 2019 to include the role of Family Care coordinator for the Children's Cochlear Implant Center at UNC. She helps manage, facilitate and coordinate cochlear implant consultation referrals supporting all families through the CI consult process at UNC. I also have Dr. Erika Gannon. She is earned her bachelor's and doctorates in theology from the University of North Carolina at Chapel Hill. She is a pediatric cochlear implant audiologist at the Children's Cochlear Implant Center at UNC. In addition, she is the Audiology Clinic manager and program director of the CDP Grant. Erika's research interests include pediatric cochlear implant, device use and pediatric electric acoustic stimulation. Erika enjoys teaching and mentoring students. She co-teaches the cochlear implant course to UNC's audiology graduate students. So Erin and Erika, welcome to the EmpowEAR Audiology podcast. I'm so excited to have both of you.

Erin: [00:03:03] Thank you so much for having us. This is really great.

Carrie: [00:03:07] Yeah. So I know before the podcast started, we spoke a little bit and I had heard Erin talk at, I believe, the AmErikan Cochlear Implant Alliance Conference as well as the EDHI conference. And then as I reached out to Erin, she also looped in Dr. Gannon and Erika. And we to talk about two important topics today. And I am really excited for our listeners to hear all about their work with full time use of hearing technology and its impact on language development, as well as the importance of co-treatment and strength based coaching to impact device where time and probably many other things with strength based coaching. So I am glad both of you are here and because this is kind of a audiology, professional and related services podcast, I always like to find out from my guests, how did you actually venture into the field of audiology and speech language pathology? So I don't know. Erin Do you want to start with your venturing into speech language pathology?

Erin: [00:04:23] Sure. This is kind of funny because I think it's kind of a throw out to like all the moms out there who encourage their kids or think, Hey, you'd probably be really great at X, Y or Z. And my mom in high school was like, Really I think you'd be great as a speech pathologist? And I took one of those, or she had said that and I had taken one of those personality typing, What should you be when you grow up kind of thing? And speech pathology and audiology were in the top three and I was like, Oh, absolutely not. My mom wants me to do this. No way am I doing this. So I went in. I went to Appalachian, undeclared and undecided. And my roommate at App my freshman year was in the speech pathology program. And so I got to see what she was doing and I was like, you know what? Maybe I do want to take some intro classes. And so I did and loved it and then had the challenge when I graduated from APP. On whether I wanted to go into speech or audiology. I was really torn and then found my my perfect match at UNC as a speech pathologist working with kids with hearing loss. So kind of a perfect fit. So that's a.

Carrie: [00:05:43] Great story about my mom's, right? Yeah. I was just going to say, your mom's always right. Right? Yeah. Um, Erika, how did you venture into audiology?

Erika: [00:05:55] I knew I always wanted to be in health care. I originally thought I wanted to be a nurse and figured out quickly that I don't do needles or blood. And so as I was trying to explore other options that still left me in health care, I had a friend who was in the audiology program and recommended I observe a little bit and I was volunteering at the hospital and got to observe someone like two weeks out from their cochlear implant activation. And I was I was hooked ever since.

Carrie: [00:06:26] Another great story, too. So both of you are at UNC. Do you want to do you want to share a little bit about the Children's Cochlear Implant Center? There you have a lot of great people that are part of your network. So one of you wants to take that lead.

Erika: [00:06:46] Sure. So the Children's Cochlear Implant Center at UNC. We've been seeing children with hearing loss in North Carolina for over 30 years and have performed over 2000 pediatric cochlear implants. We are a part of a multidisciplinary team and we have both pediatric cochlear implant audiologists, speech language pathologists that specialize in listening and spoken language. We also have a pediatric research group in the office as well, and we are a teaching clinic for both audiology and speech language pathology grad students, and we work with a greater interdisciplinary team at UNC, with our pediatric pediatric diagnostic team and our ear, nose and throat physicians.

Carrie: [00:07:30] Yeah, lots of opportunities to see lots of kids and be involved in a lot of research, which kind of is a great segway into the things that both of you are interested in, and that is that language development and how that impacts kids who are deaf and hard of hearing. And I think when you think about the world of pediatric deafness, a lot of the studies talk about the importance of early identification. We have newborn hearing screening, all of those important things. We talk a lot about technology and early interventions as part of language development, but one of the things that is typically not talked about that your group has spent a lot of time on, is that focus on on wear time can you one of you start sharing a little bit about your research and clinical experience in this in this area and why this is really important to consider?

Erika: [00:08:26] Sure. So wear time or getting the objective data from the speech processor regarding device usage for cochlear implants is a lot more recent than it is for hearing aids. We've only had access to this since maybe around 2014 or 2015. And so as this as a clinician, as this information became available, we felt like this was really a game changer because we're like, is this explaining why somebody isn't doing as well as we would want or not making the progress that we'd expected? And so we just we had all of this new information about patients we were seeing, you know, different where time and trends for babies versus teenagers. And it felt like we really had this key piece to something important. And so we really wanted to dive harder into that. And so we've looked at some some wear time information for this youngest group of babies, like birth to three. We have several articles on that. And also have looked a little bit about where time and the single sided deafness population.

Carrie: [00:09:32] So when, as you said, you know, for cochlear implants, this is been about 2014, 2015 that we've been able to have this data logging and hearing aids was a little before that. But again, a lot of great information. Do you as practitioners, whether from speech pathology, audiology? Do you ever ask parents like, Hey, how often is your child wearing the cochlear implant? And then do you ever see kind of a mismatch between what you're pulling up on the computer and what a parent might be reporting?

Erika: [00:10:09] Yes. We always try and ask the question, How's it going? How? How is wear time device use, especially, you know, use of like retention Aids. And unfortunately there is a trend that. Over or over reporting device usage. Parents often say they're wearing it more than the objective data shows. This is a trend in more than just cochlear implants. It's also present in hearing aid literature as well. And I think it's likely just little ones are so dynamic with eating and napping and multiple care providers. I think it's I think it's easy to overestimate the usage.

Carrie: [00:10:47] And that's kind of another way that you started thinking about looking at this was looking at this concept of hearing hours percentage. Can you share or explain what this is and why this might be a better way of looking at things rather than like kind of full time usage?

Erika: [00:11:10] Sure. So full time usage in the literature, it wasn't consistent. We were seeing, you know, 8 hours or 10 hours or clinicians were using phrases like eyes open ears on, which is a wonderful phrase and a and a great goal for parents. But sometimes, you know, that vague term isn't concrete. And then 8 or 10 hours, we were just seeing that, you know.

Erika: [00:11:34] It.

Erika: [00:11:35] Sleep wake time is so different for babies versus teenagers that.

Erika: [00:11:41] You know what is.

Erika: [00:11:41] Actually the best way to talk about wear time. So we noticed trends are like teenagers are wearing their equipment, more toddlers are wearing their equipment a little less. And we started to incorporate the sleep wake into how we define full time use or this hearing hours percentage. This was first published and Lisa Parks age at full time use predicts language outcomes better than age of surgery. In children who use cochlear implants and essentially the takes where time as a percentage of wake time based on the age of the child. So an example is a 15 year old is awake 15.5 hours a day on average. A 12 month old is awake 11 hours a day. If you take eight hours, if we were using, you know, full time use at eight hours for the 12 month old, that's 73% of their waking hours. But for a 15 year old, it's only 52% of their waking hours. So HHP better reflected the age of the patient.

Carrie: [00:12:43] Wow. Just out simple example right there with the difference of the age and the average sleep time really is telling of the you know, what we want to achieve. Is there a. I guess, percentage that as audiologists and speech language pathologist you would like to see for the hearing hours percentage.

Erika: [00:13:09] We would always love it to be 100%, but we are practical. Our research has found 80 to 100% is really the goal.

Carrie: [00:13:19] Okay, that makes sense. So it kind of factors in maybe bath time, shower times, those waking up and just kind of getting started with your day and then kind of going to bed having a couple of hours right there.

Erin: [00:13:33] Yeah. And that's where we really saw the research to show that kids had typical language scores when they hit that 80%. And that's where we were really seeing kind of the magic number kind of all align. 80% equaled some of those those stellar language scores.

Carrie: [00:13:52] Okay. And yeah, I would love to dig a little bit deeper into that as well. One of the other questions I know, Erika, you had mentioned that you there was some different research, too, with single sided deafness. And, you know, we're seeing younger kids get cochlear implants who have maybe typical hearing in one ear and a profound hearing loss in the other ear. Does the hearing hours percentage matter for those kids, too?

Erika: [00:14:25] Yes.

Erika: [00:14:26] So. The information we have for the single sided deafness. Population isn't for language scores on the whole, but we have that linked with single word scores for CNc, and so the higher the hearing hours percentage, the better the CNC outcome. There's also a positive correlation with HP and spatial release of masking scores. So a true measure of binaural hearing. So we are seeing that HP is a factor for those things in that single sided deafness population.

Carrie: [00:15:00] Okay. Do you see that? This is just a sidebar question to more acceptance of the cochlear implant if they increase their wear time to. What have you not looked into that.

Erika: [00:15:14] For.

Erika: [00:15:15] Patients or in.

Erika: [00:15:16] General, just.

Carrie: [00:15:18] Patient? Because I know sometimes they may not always kind of acclimate to the cochlear implant, but do you find that with the increased hearing hours percentage, they may acclimate or be better users of the cochlear implant?

Erika: [00:15:34] What we saw was.

Erika: [00:15:35] That as kids got into their teenage years wear time dropped. And we think that's just a matter of calling attention to something and kind of those really vulnerable teenage years, but started to see an uptick as patients got a little bit older. So I'm hoping once they get past some of those teenage years, we can expand our data and and look a little bit more into that. But honestly, a lot of it was related to age.

Carrie: [00:16:01] Okay. That makes sense too. So I know that article that both of you authored with some of your colleagues titled Age at Full Time Use predicts language outcomes better than age of surgery and children who use cochlear implants. And you kind of touched on this a little bit, but you found that for both receptive and expressive language, age of full time use was found to be a better predictor of outcomes than than the age at the surgery. So in your literature, you also found that it took an average of 17 months for children to establish that use, and only 52% reached that milestone by the age of three. So as you guys are thinking about where you're at in a big cochlear implant center and co treating and certain occasions and thinking about that whole child and the family and everybody else that's involved. Educators, early interventionist. What are some of those factors that might contribute to that statistic? Because I feel like. That is kind of a lower statistic overall.

Erin: [00:17:13] Yeah. So a couple of things there. I'm going to take over for a second and kind of jump in. Um, one of the things is that I want to touch on because I always stress this in our presentations as well whenever we're talking about this. We were finding that full time use is a better predictor of language outcomes at age three than age of surgery. We are just clear, always clarify. We are not questioning or saying that they shouldn't have surgery later, that we still absolutely you know, are proponents and promoting earlier is better. We aren't questioning that. We aren't looking we're not changing that at all. But they do have to wear it after surgery. You can have surgery at any time at six months. Not that we're doing them at six months right now, but eight months, 12 months. But if they aren't wearing it, then it does impact outcomes. Um, but back to the, you know, it takes an average of 17 months to reach full time use and only 52% did that by age three. It's almost, you know, the question of what are the factors that contribute to this.

Erin: [00:18:20] It's almost in reverse of what doesn't impact this. Everything impacts it. Um, some of the first things that we that I think folks notice or think about are any additional diagnoses. Are there other things that are even more of the higher priority for a child's health and well-being is and taking care of of those other health factors. Um sensory needs we find impact where time we of course see differences with different socioeconomic factors, parents schedules, um, kids at home versus in daycare potentially pending what education or what the what the what the the families or the child care providers have been taught about the importance of where time not that they aren't educated, but what have they been taught about where time and how important that is. Um, distance from school, distance from clinics, those kinds of things. Then the access to that education about the importance of, of wear time and then sometimes just the differences in counseling techniques and coaching techniques and, and how have their school providers, clinic providers, private providers, audiologists, um, pediatricians, ENTs explained the importance so many things have have impacted and can impact this these statistics.

Carrie: [00:19:58] Yeah, which is, I think, a great way to kind of get into what your team at UNC has really looked at to try to maybe close some of those gaps and increase the number that reached that milestone by three years of age. And I think our conversation about hearing hours percentages is really an important factor in that too. But one thing that you have shared is that you have talked about the need for strength based coaching, and that's really helping with working with families. Can you share a little bit more about this model too, of co treating with audiology and speech and how this really impacts families as a as a whole?

Erin: [00:20:46] Absolutely. So the the quick, easy definition of co treating is audiologists and speech pathologists working together in an appointment and treating a child and family at the same time. Um, it's something that has kind of been brewing at UNC since 2011 when we actually got to hear Dimitry Dornan and the Hear and Say crew from Australia talk at the AG Bell Conference in Scottsdale, Arizona back in 2011. But then we weren't able to kind of put it into practice at UNC until a few years later. We had our director at the time had to work to find some grant money to help us be able to account for our time because you couldn't bill for coach reading. Um, and so we were able to, to put that in into play in 2015. But in depth it's speech pathologists and audiologists collaborating. We talk ahead of time before an appointment to see what are the needs of that child and family. What are some things that we want to work on together? Um, make a goal. Make a plan. We collect information during the appointments about auditory skills, we use our functional listening index to track audiological audiology skills, audition skills. Um, we are providing caregiver support and that's where our strengths based coaching comes in. And then we are also communicating afterwards. We're talking to local providers, sharing, updating school professionals, educational audiologists, early interventionists, private therapists. So we're all kind of working on the same page. Um. And then that kind of leads into that strength based coaching. Yes.

Carrie: [00:22:44] So share a little bit more about that and how your team's kind of been trained and how that impacts family connections.

Erin: [00:22:53] Um, yeah. So we have all and Erika has done this as well. Think all the audiologists have had some level of training exposure to the formal, um, program, which is through the Center for School Transformation. Um, and it is an Evocative Coaching, strengths based coaching program that we have all been through. Um, and it is looking at things and very asset based, strengths based taking what is important and a strength for a professional, a parent and building off of that. Um, in all very positive ways. Um, it is learner driven. It's what is important to the family and it's based on evocative coaching and positive psychology, adult learning theory, appreciative inquiry and nonviolent communication so that you should do versus how could you what would you want to do? What would that look like moving forward with your family?

Carrie: [00:24:02] So if I would put both of you on the spot here as kind of thinking about all of the topics we've talked about in particular, like maybe you have a family who comes in and says, hey, you know, I'm wearing my child's wearing this device all the time. And as your co treating together, you realize this really isn't what's happening. Would you be able to roleplay maybe a short conversation that you may be having to discover, um, maybe the hearing hours percentage or, um, you know, what are some factors that might be happening that is reducing that  time? Could you use some of those strength based skills to kind of role play for listeners?

Erika: [00:24:53] Sure.

Erin: [00:24:56] All right. I'm going to be the clinician and Erika is going to be our parent or guardian in the clinic. And so I'll take that start of the scenario, Carrie, of, you know, looking at. Okay. All right, Erika, it's good to see you guys today. Pierce is now six months out from getting his implant. You know, you talked about coming in that you're feeling like things are going well and that you're looking at full time. You know, he's wearing it a lot and wearing it all the time. And, you know, we we looked at the data logging and and it looks like it is up from your last appointment. Last time it was around three hours a day of an average and now we're up to four hours. Um, and based on his awake time, um, of about 11 hours a day, that gives us a 36% HHP. And again, that's up from last time. Tell me something that has gone really well over since you were here last time.

Erika: [00:26:05] Yes.

Erika: [00:26:05] So since the last time we were in, we've started using a headband and I have found that that has been helpful. I find that the the easiest time is in the morning. It's a little hard to get it on when we're trying to get breakfast and everybody awake and out the door. But once once it's just he and I in the morning and we have some time to really have one on one interaction. I'm finding that we're we're more successful at that time, especially with the headband.

Erin: [00:26:34] I'm really glad to hear that the headband's been helping. I know that we talked about that last time and you were going to try it out. So I'm really I'm really glad to hear that that has been has been a benefit. Um, and that it sounds like some one on one time together in the morning has is is good as well. So what tell me about a time that's a little more challenging. What is a time of the day that's more challenging but also kind of something that feels important to you where there's a lot of language or just a special time with family? What where is a time like that during the day currently?

Erika: [00:27:12] Yeah, I.

Erika: [00:27:13] Think maybe the hardest, the hardest time of the day, but the time that we could all get the most benefit from is like the dinner prep and then dinner time. It's hard with older sister and then playing and maybe being kind of far away from me in the kitchen when I'm trying to cook and that their interaction together, it's just hard for me to keep it on them during that time. But there's lots of talking and as we're talking about dinner and you know, how is your day? I feel like that that would be a time that we could improve on. That would be important.

Erin: [00:27:45] Dinner, that dinner time after work, school time is so language rich. A lot of times that is at my house as well. So with my guess, he's probably already you're probably trying the headband after dinner right now would be my guess. Okay. Well, that's good. That's good. I'm wondering, what do you think it is about the morning time that's going so well that maybe we could add in and kind of brainstorm a way to add that into that dinner time.

Erika: [00:28:16] Yeah, he's he's playing with sister a lot, and they're in the living room and I'm in the kitchen, which are kind of connected, but, you know, a little bit farther away. I don't know. I'm wondering if while they're playing, if we could kind of try and bring them a little closer to me and have her maybe not put the devices on him, but just maybe help me monitor it more or just her interaction one on one interaction with him. Um.

Erin: [00:28:41] I like it. I like that idea. So that sounds like some one on one attention is what's been helpful and how do we create that around dinner time? And maybe, maybe Emmy, um, who knows, She might be able to put equipment on at three or so. She's four now, isn't she? How old is five? Oh, my gosh. Okay. She's five. Um.

Erika: [00:29:04] But she.

Erika: [00:29:05] Could probably.

Erika: [00:29:06] Play with him. And he loves books, so I'm sure she could sit with him and he loves to be read to. So if she could sit with him and maybe flip through some stories and books, I think he would really enjoy that time. And maybe that would help distract him.

Erin: [00:29:18] Yeah, maybe he wouldn't. Yeah. Leave him. Leave him be. I think that's a great idea. How do you feel about trying that out between now and our next? Um, next time you guys are here?

Erika: [00:29:31] I think that feels reasonable.

Erika: [00:29:32] We've got, like, a basket of books that we could kind of position in a spot that would kind of be close enough to me, but they could still have their their place to play and I definitely think that's something we could implement together.

Erin: [00:29:45] All right. Let's try it out. Let's see. Let's see if taking what we know has been helpful in one part of the one part of the day and see how that kind of can maybe carry over and and maybe Emmy won't be ten by the time you come back.

Carrie: [00:30:04] But that was fabulous role playing Erika and Erin. And and I love it. But I guess just listening and thinking about what you guys did and I want you to jump into I loved Erin, how at first you kind of laid the facts down, right? I mean, in a very good like, you know, easy to understand way. And then right after that you were able to ask or like what, you know, celebrate those small successes. So even though it wasn't where probably you would want to see it, it had increased since the last time. So, you know, celebrating those small, you know, successes all of the time is probably really a critical piece of that strength based coaching. Um, but I love how you always reflected too, on what the parent said. So you would just kind of, you know, letting Erika share and then you would just really rephrasing or reflecting and what she said. So you would. And then from there you would kind of jumped into like, can you tell me some of those challenges? You told me your successes. Tell me your challenges. And, you know, she brought up the dinner time and things like that, but then you went right into, you know, validating, you know, oh, this would be a great time to, you know, try out some more language and maybe help with that.

Carrie: [00:31:27] And then I love what you say, too, that you're like, I'm wondering. So you kind of get that wonder piece in. But for the parent and how you know, how I wonder if you, you know, can you know, and kind of help them wonder, too, in that situation. And then that really led into mom coming up with her own solution. Right? Like her own goal for what that next step was. And then Erin validating again and rephrasing, um, that was helpful, you know, for think, Erika, to kind of process that and then just asking, how do you, you know, how do you feel about this? Do you think this is something that you can do and, you know, kind of how are we going to check in next time? So does that mean feel like that was kind of what you guys were sharing?

Erin: [00:32:19] That was our hope. That was our hope. And that's always kind of our hope. And we know that families really are trying. We don't have a single family that's really literally not ever trying to keep devices on. So we know there's always something to celebrate. There's always a success in there. And pointing that out because we could focus on the hard part and the quote unquote negative, but that's not going to refresh them to keep trying harder. So finding out what is what went well for them, their success, what was great for them might not be what we would have picked out as being a success and what is motivating or an important time of day. I might have all kinds of ideas of what would be a great the most perfect language, rich time of day to focus on. But if that's not the important motivating part for the family of what is important in their home and important to them, then it might not be as motivating for them to go home and try. So we do try to to focus on what is important to the family and it is their goal for their child. This is not my goal. It's what they have they're choosing to pursue. And so I do reflect back on a lot of those things. And we do. We all do so.

Carrie: [00:33:39] And if it's their goal, I'm sure they're more likely to implement it and follow through with it. I mean, that's the hope of it as well. What happens when you have a family that you've been doing co treating with and they aren't moving as quickly as you want? Do you see that more often? Do you bring them in more often? Do you connect with them virtually more often? Like how does that work to kind of keep the, I guess, ball going in the right direction?

Erika: [00:34:11] Yes.

Erin: [00:34:14] I think and again, you know. Erika, please jump in. Um, think I think we do think it always is just very dependent family to family on why or what seems to be the hurdle or hurdles. And then if it's distance or scheduling, then we might not try to get them in more often. It might be more phone calls or touching base or connecting with their local early interventionist or school provider or something like that to or phone calls or emails or. Kind of trying to figure out what the hurdle is and then not creating more of a hurdle, but some sort of bridge. What do you think, Erika?

Erika: [00:35:00] For sure. And if there's.

Erika: [00:35:04] I don't want.

Erika: [00:35:05] To put a bigger burden by having more appointments, but I also would want to be mindful that if we're not meeting the goals that we that we'd hoped, you know, continuing to touch base and maybe having like a shorter duration between appointments if that was feasible. Um, there's also some good feedback from the cochlear implant manufacturers on the apps so you can kind of help point the parents towards that and some goal setting and letting them have some reflection of that at, at home and really just talking through, you know, what are the barriers. We tried this, okay? That didn't work. You know, let's brainstorm again. You know what? What can we continue to brainstorm through and how can we work together?

Carrie: [00:35:50] The great. So one other question kind of before we wrap up. I know that you have said that you implemented this co treat model not just a few years ago. And so have you noticed that by implementing this, you have seen, you know, greater success with just whatever you're trying to measure, whether it's hearing hours, percentage and goal setting and things like that and moving in the right direction.

Erin: [00:36:24] Do we have that data?

Carrie: [00:36:27] Or maybe you just it doesn't really need to be data, but just as clinicians in general, like do you just feel like from that family perspective and working with families over time since implementing this co treat? Do you feel like you're making a lot more progress than if you were just kind of in your own silos of like speech pathology over here and audiology over here?

Erin: [00:36:50] 100%.

Erika: [00:36:51] Absolutely. I feel like the family feels more supported as the audiologist there. They want to hear so they can talk. So I'm the hearing piece, but having the talking piece there is so important. So, yes, I definitely I feel like there's been a lot of success with that.

Erin: [00:37:09] We get a lot of positive feedback from families. We get a lot of positive feedback from the professionals that we talk to that they're local professionals. We are tracking their auditory skills. So we have a lot of children that we see. There's a red dot on the graph every time we see them and we can see things going in the right direction is going in the right direction, even if it's very slow. We do get a lot of. Positives from it.

Carrie: [00:37:41] Yeah, I do. I've always believed that, that the relationship between the speech pathologist and audiologist is so critical and is like what you just said, such a valued input for the families to, to have everybody kind of working together to. But as we kind of wrap up with today's episode, is there anything that you would like to add that I didn't ask you?

Erika: [00:38:11] I think it just.

Erika: [00:38:12] Really takes a village in that communication with the entire care team and the family is is vital, especially with these young ones. There's a lot of dialog with the early interventionists. Other resources, family caregivers. I think just the open communication with everyone is just really important.

Erin: [00:38:33] I definitely agree. And there's no one size fits all approach to where time or retention aids. There are so many different companies out there on Etsy and and different things to help and just, you know, figuring it out on what works best for each individual child and family. And if one doesn't work, that's okay. Try another one. And connecting families, we connect a lot of families to talk to each other because we can talk all day about things that have worked or we've tried or have tried worked for other people, but we haven't, you know, haven't experienced it ourselves. So.

Erika: [00:39:21] No.

Erika: [00:39:21] I've also reframed some of my counseling, at least from the beginning, as someone is starting the cochlear implant process to at least say the wear time on the front end will be a challenge just so it's not a surprise. And so if we easily move past it, then great. But sometimes I think parents are a little surprised by the need for the retention aids and the things like that. So I'm just kind of trying to set up the. The brainstorming.

Erika: [00:39:49] Later.

Carrie: [00:39:51] Yeah, which is probably helpful when you go through the the strength based coaching with the families. You've already kind of planted that seed before they've even started that journey, so they expect you to be asking about it later on.

Erika: [00:40:05] Yeah, and.

Erin: [00:40:06] We talk about it ahead of time, so it's not a surprise when it's a challenge later like.

Carrie: [00:40:14] If our listeners want to get a hold of you or do you guys have any resources for for just the topic that we talked about today, like hearing hours, percentage or anything that you guys use in your toolbox that's out there for others to use?

Erin: [00:40:35] You can definitely reach us via our email addresses. I think we've shared. You have those, please. You know, we are fine with sharing those. We definitely have social media for our clinic, um, and Instagram, Facebook and Instagram for the clinic. Um, Erika has designed some infographics, don't know how where those technically live, but.

Erika: [00:41:02] I'm happy to share infographics with anybody. You can reach out to me via email. Um, is it helpful to go ahead and state my email now?

Erika: [00:41:10] Is that something you want.

Carrie: [00:41:11] To go ahead and do that? And then I can definitely link it in the show notes as well.

Erika: [00:41:16] Sure. My email isErika, Erika dot Gannon g. A g n o n. At Unk Health unk.edu. And I'm happy to share any infographics and resources we have to help with this dialog.

Erin: [00:41:32] And my email address is is the same as Erika's. Except Erin. Erin Dot Thompson. Thompson.

Carrie: [00:41:45] All right.Well, Erika and Erin, I want to thank you both for being wonderful guests and participating in role play and and the EmpowEAR Audiology podcast. That was in wonderful conversation. And I'm sure all of our listeners will be very excited to hear all of the information and hopefully they will reach out if they would like more. So thanks again for being a guest.

Erika: [00:42:09] Thank you so much. Thank you.

Erin: [00:42:10] So much.

Announcer: [00:42:11] This has been a production of the 3C Digital Media Network.