Life is Bliss - Lily's Cochlear Implant Journey

IEP Goal for Third Grade and Lily update

Lily's just finished her second week of third grade.  It's hard to believe.  When she was born the days were so long.  Now the days fly by and Lily is growing into a "pre-teen." She's continues to be at the top of her class and gets to sit next to her best friend. Lily loves reading and she pours through books as fast as we can check them out.  She is still doing gymnastics and will be starting Girl Scouts and Destination Imagination soon.     

Here's Lily's new big IEP goal that covers many topics.  

Goal:  During discussion of challenging listening or social situations, Lily will use problem solving steps to increase her independence from a baseline of 6 points to 15 points out of 16 point rubric on self-advocacy rubric.  

This year, Lily has a new hearing resource teacher who I think will be great.  Lots of energy, passion and high expectations for kids with hearing loss.  She will check in with Lily for 20 mins a week (3x per month), either in or out of the classroom.  

Lily's new third grade teacher seems terrific.  She's expressed her openness to learn/collaborate about hearing and said Lily has been helping her remember the FM and captions.  She is also pregnant, so hopefully will put all the supports in place with a substitute when she's gone.  All great things. Both teachers have indicated things are going well.

Lily continues to wear an FM and her school classrooms all use sound fields.  We are also experimenting with a Dynamic, connected to the sound field, inside the classroom and the lunchroom.  

Other issues we identified on the IEP that continue to be a focus:

• Helping new teachers know how to use equipment
• Helping subs use the equipment
• Effective small group experiences - use equipment, staying on topic, one person talking at a time, clarification strategies
• Strategies in noisy listening environmnets
• Giving feedback that equipment is being used correctly and consistently
• Social engagement strategies with peers (reading others feedback, greetings, developing best friends)
• Understand how her hearing loss may impact her in a variety of social situations
• Understands characteristics to make or keep friends
• Respects physical space/boundaries of others specifically when trying to hear better.  

Another area we have started to focus on is CC or closed captions. When dealing with videos or TV, captions  help significantly in understanding the content and have helped Lily to become a super reader.  Captions move fast and so your reading practice and speed have to match.  They fill in all those words you didn't even know you missed.

This week when Lily's teacher turned on a Kahn Academy video in the classroom, the captions were in Czech.  Eventually we figured out how to translate them back into English. 

It's all such amazing technology.  We just have to stay on top of the various components to make sure they are working seamlessly.  

IEP Goals - Second Grade

I share Lily's ongoing IEP goals to help other families in their hearing journeys.  

In IEP meetings, parents are always asked, "What do you want your child's goals to be?"  Especially in the early years, it's extremely difficult to know what is possible, what can help my child, or what should be without spending hours researching and contacting outside professionals for guidance.    

I hope by sharing our story, other families with similar journeys can use these goals as a starting place.  Each goal below has a complex matrix to measure progress.  

Goals:

1.   Contribute to discussions without dominating, accept topic of others by adding relevant information to the conversation and ask for clarification or for confirmation if not sure of what was said. 

2.  Given various coping strategies, Lily will have a conversation with her peers on the playground and in the lunchroom.  (These are noisy difficult listening environments)

3. Improve her ability to advocate for herself by increasing her vocabulary and understanding of the functions of the parts of her CI and FM, her responsibility for monitoring her CI and FM system and by communicating her needs with her teachers.

Supporting Success for Children with Hearing Loss

Supporting Success for Children with Hearing Loss is a great new resource filled with information about the learning and social issues of children with hearing loss and what you can do to better support the future success of these children. Resources are at no cost, designed to be easy to understand quickly, and practical to use.

A few nights before Kindergarten

We are to this moment.  A moment I've thought about often.  Lily entering mainstream Kindergarten on time.  While she is young for her grade, she is beyond ready. 

When a person told us four and a half years ago that it was the Gold Standard to enter Kindergarten on time for kids with hearing loss, and then she asked us what our goal was for Lily, we reluctantly said I guess enter Kindergarten on time?  Well..here we are.  Wish we could have seen the future, but then maybe we wouldn't have worked so hard to get to this point. 

This week we have our final pre-Kindergarten IEP meeting.  Our school's motto is kids get what they need here.  I like that.  Lily enters with very minimal services and good hearing technology support.  We have two IEP goals going forward:

1)  Given an interaction with a teacher or a peer and without adult prompting or support, Lily will improve her social communication skills by maintaining/staying on topic of conversation for 6 or more exchanges and advocating for herself when she doesn't hear or understand a teacher's or peer's comment or question, improving from a baseline of 3 points in an optimal acoustic environment to 4 points in a more challenging acoustic environment as measured by the SLP Social Skills Rubric. 

2)  Given a classroom activity or discussion, Lily will respond to levels of abstraction questions/directions, increasing from a baseline of 50% to 90% as measured by SLP Levels of Abstraction Data Form, Level 3. 

These goals focus on common challenges for kids with hearing loss including social emotional/self advocacy and auditory memory/linguistic concepts.  I'm also very interested in doing some listening in noise practice. 

There is so much to think about and information to share with a whole new set of teachers and administrators.  However, I am confident that Lily will continue to soar. 

AgBell Conference 2012 - Auditory Skill Development: Basics and Beyond

Auditory Skill Development
Betsy Moog Brooks, M.S., CED, LSLS Cert AVEd, Amy Birath, Au.D., CCC-SPL, FAAA, LSLS Cert. AVEd, The Moog Center for Deaf Education, St. Louis , MO

Increased performance expectation because of early hearing aid fitting (They are getting calls from the hospital)

Speech perception test
- early speech perception test
- 18 months should have 25 words, 1 year post implant should have 100, age 3 - using utterances of 3 and 4 words

*****Auditory memory - ability to repeat back items after presentation - attending, listening, processing, storing and recalling.  May produce benefits for kids with Cis

*****Auditory skill development - clef and wisc tests

Activities - 
- digit span - make one presentation, recall numbers in a row
- word span for unrelated items
- words with different number of syllables

Listening in  Noise - value in practicing.  Auditory training in noise improved performance with CIs.   (Og 2011)
- first in quiet
- multi talker babble
     Auditec.com
      Babel babble (app)
- introduce noise at +10 SNR 
- noise should come from behind the child
- studio 6 audio tool - sound level meters 

Activities
- imitating sentences with a picture context
- following directions imbedded in a sentence 1-4 critical elements
- sentences without context 6-8 word sentence in noise
- riddles in sentences in 3-5 words and each riddle has 3-5 sentences 

I have wings
I cannot fly
I can swim

I am at school
I open and close
People read me

Riddles with 6 or more words

I am made of wood but I might be different colors
I have four legs and sometimes I have two arms
People like to sit on me

Stories with illustrations

Nebraska Online Speech Therapy for kids with hearing loss

UPDATE for online speech therapy opportunity for Nebraska kids with hearing loss

If you are interested in high quality listening and spoken language online speech therapy, go to www.ihearlearning.org....or call direct to Cheryl Broekelmann at ihear 636.532.2672.  

The cost per session is $35/half hour for families.  There is some money for scholarships and St. Joseph staff are currently working to see if insurance plans will cover the cost.

Internet Therapy Offered to Nebraska Children with Hearing Loss

Just when things are wonderful in the Cochlear Implant world, they get even better for kids in Nebraska.

We received a note today letting us know about new Internet Therapy for Nebraska families who have children with hearing loss from the St. Joseph Institute for the Deaf.   (see our iHear Nov 2011 blog post)

Our beloved Omaha Hearing School, although now formally closed, has reformed as a foundation and has funded this opportunity to provide speech and language therapy services over the internet to children in Nebraska and Western Iowa.   Services will be provided though St. Joeseph's innovative and groundbreaking internet therapy program called iHear.  

“By 
working 
with 
St 
Joseph
 Institute 
for 
the 
Deaf, 
the 
mission 
of 
the 
Omaha 
Hearing 
School
 Foundation 
to
teach
 young 
children 
with 
hearing 
loss 
how 
to 
listen 
and 
speak 
remains 
vibrant,” 
says
 Britt 
Thedinger,
 MD,
 an
 otologist 
and
neurotologist 
and 
a 
board
 member 
of 
the 
Omaha
 Hearing
 School 
Foundation.
 

SJI’s 
ihear 
program
 enables 
children 
with 
a 
range 
of 
hearing 
impairments
—
from
 cochlear 
implant
 recipients
to 
those 
who 
use 
hearing
 aids
—
to 
work 
with
 skilled 
listening 
and 
spoken
 language
 specialists 
via 
the 
secure
internet 
link.
  

Essential 
to 
the 
program’s
 success 
is 
its 
collaborative
 coaching 
model,
 in 
which 
the 
ihear 
staff
 coach
 a
 parent 
or 
educator 
present 
with 
the 
child
 in 
each
 ihear
 session.  
The 
coaches 
are 
then 
able 
to 
reinforce
 the 
exercises 
and 
lessons 
learned 
in 
between
 the 
therapy 
sessions.  
Children
 enrolled
 in
 the 
program
 typically 
are 
scheduled
 for 
two, 
half‐hour
 therapy
 sessions 
per 
week.

Thanks Dr. Britt 
Thedinger for your commitment to Nebraska's kids.  We'll provide more details on this program as we receive them.  

For
 more 
information
 about ihear,
 visit www.ihearlearning.org

 

 

Music changes our brains

Excellent article on how music changes our brains.   We've long been a believer in incorporating "music therapy" in all forms in Lily's auditory rehab, as there is growing evidence in its impact for listening and language.    

I'm often reminded of the person who told me "there was no proof, I was wrong in believing this, and that they wouldn't even consider this as a part of LIly's therapy."   Glad we didn't listen to this advice.  

$1 in EI Services = $2 of Benefit

Social and economic benefits of early intervention for deaf children far outweigh investment cost says new report.

"Every dollar invested in early intervention services for deaf children produces almost two dollars worth of social, educational, vocational and economic benefit"

IEP - 4 years old

At 4 years old, the following are Lily's IEP goals for the next year.

- Given visual/verbal cues, Lily will improve her speech production of /l/, /l/ blends and initial and final /th/ from the baseline of 10% accuracy in imitation of single words to 80% accuracy in sentences and structured speech as measured by the LPS SLP Articulation Data Collection Chart.

- Given a structured activity, Lily will produce phrases/sentences with correct use of comparatives and superlatives, words denoting time, nouns with two descriptive adjectives, and a variety of prepositional phrases (at least 12 each) improving from a baseline of 25% to 80% as measured by the LPS ECSE Grammar Rubric.

- Given an interaction with a teacher or a peer, Lily will improve her social communication skills (maintain/stay on topic of conversation for 3-4 turns, advocate for herself when she doesn't hear or understand a peer's comments or questions), improving from a baseline of 2 points to 4 points,as measured by the LPS SLP Social Skills Rubric.

 

Wrightslaw Boot Camp for parents - Advocacy Training

Providing advocacy training for parents of children with special needs (Wrightslaw Boot Camp)

July 29 & 30, 2011

9:00 a.m. to 4:30 p.m.

Scottish Rite Temple
332 Centennial Mall South
Lincoln, NE 68508

All children qualifying for special education services are required to have an Individualized Education Program (IEP).  The IEP specifies the special education and related services necessary to ensure the child a free appropriate public education.  The IEP process can be overwhelming for parents due to complex federal laws and regulations.  Down Syndrome Association for Families (DSAF) is hosting an intensive, two-day Wrightslaw training on special education and advocacy.

If you are a parent or guardian of a child receiving special education services, or a professional wanting to better serve kids with disabilities, you don't want to miss this 2-day training!

Participants will learn about:

• special education statutes and regulations to get answers to their questions
• tests and measurements to measure educational progress
• charting out test scores
• writing SMART IEP goals and objectives
• using No Child Left Behind as a tool to open doors to services
• creating paper trails and writing effective letters
• advocacy strategies to negotiate for appropriate special educational programs

For a Schedule and to Register

Music Therapy Research - CI Rehab for Toddlers

We receive emails and comments from people all over the world on our blog.  The most common topic people have thoughts or questions about is Music Therapy. 

A few weeks ago we received a note from Felicia, a music therapist from Australia, who is interested in working with children who are deaf and hard of hearing.

She found this great article supporting our argument for including Music Therapy in rehabilitation. The article discusses that a Music Therapist in Israel, working with children with CIs, found that spontaneous communication was more frequent and prolonged when music was used.  This is a rapidly growing field of study and one which should be immediately implemented in rehabilitation strategies.  

We didn't know what to do with Lily and music.  Our approach was a gradual one.  According to this research, that seems to be the right approach.   Now Lily demands music in the car, in the house and pretty much anytime she can get someone to turn it on.  She's had a music therapist, been to Kindermusik and now she has music in preschool.  She sings, she twirls, she makes up songs, she picks up words and says "don't turn it off yet.  I want to listen to the whole song."  

Music is critically important to language learning. 

IEP - 3 Years Old - Goals and Objectives

Lily's first IEP, at three years old, includes the following goals and objectives.

Goal 1

When asked a question or given verbal directions, Lily will demonstrate an increase in her auditory and receptive language skills by mastering the following benchmarks, improving from a baseline of 25% to 80%, measured by observation, data collection and language sampling collected quarterly.

Objectives

1. Perform 3-4 step directions correctly that demonstrate understanding of at least 5 phrases each, probing for:  Order or sequence, Words of description, Comparatives and superlatives, Adverbs of time, Regular and irregular past tense verbs, Prepositions showing place, and Conjunctions
2. Perform a requested action by correctly identifying the one word, phrase, sentence, song/fingerplay which matches the requested 4-8 word stimulus item in 10 opportunities
3. Provide an appropriate verbal response to 10 each of "Wh" questions (who, what if, where, why, when, how) when asked a question about a story, recent or past experience or about adult instructions.

Goal 2

Given a verbal model, Lily will imitate and produce phrases and sentences using correct syntax and grammatical structures, listed in the benchmarks that follow. Progress on these benchmarks will be measured in four quarterly language samplings, showing improvement from a baseline of 25% to 100%

Objectives

Correct use of 8 auxiliaries and/or copulas, 8 words showing negation, 8 irregular past tense verbs, 5 conjunctions, 8 prepositional phrases, 5 indefinite pronouns, 5 adverbs of time, 5 comparatives or superlatives, 8 descriptive adjectives with appropriate nouns, and 5 nouns accompanied by 2 descriptive adjectives.  

Goal 3

Given visual/verbal cues, Lily will improve her speech production of targeted sounds /v/, /k/, /g/, initial /l/, /l/ blends from a baseline of 0% accuracy in any context to 60% accuracy in imitation/consonant-vowel combinations/vowel/consonant combinations and single worlds as measured by the SLP Articulation Data Collection Chart.  

Objectives

1. Use of listening activities to achieve correct production of targeted speech sounds
2. Auditory discrimination of paired words contrasting error vs correct sound productions
3. Auditory discrimination of correct/incorrect targeted sound productions in verbal models
4. Auditory discrimination of correct/incorrect targeted sound productions in her own speech

IEPs and a LIttle Reflection

We are knee deep in IEP (Individualized Education Plan)  planning, our first one since Lily turned three.  An IEP lays out what Lily's goals and objectives will be for the next year and the services that will be provided to meet those goals.  It also describes any technology the school will provide to help her meet those goals. 

Last week we received all of Lily's test scores from our public school.  To say she did super fabulous, would about capture the results. 

Are there areas that still could use our focus?  Sure.  Has she built a foundation on which to grow and thrive for the future. Yes!  Do I wish I could have seen this day when I spent months crying about Lily's future.  Yes.  Did I realize this moment would come when she was three?  No. 

Do I remember vividly our "CI expectation counseling appointment" when they asked us our goals for Lily and we said mainstreamed by kindergarten, secretly hoping that it would be much earlier. 

Then the counselor said "Well...that is the Gold Standard" and implied that it was not very likely.  Then she showed us a scale that had "All Signing" on one side and "All Auditory Learner" on the other, and implied that the chance for us to have an all auditory learner was slim.  

So to her I say meet Lily, an all Auditory Learner who is busting nearly every talking and listening curve.  As Carol Flexer says, "It's all about the brain."  Give these kids good access to sound and they should thrive.  

Don't tell parents to set your expectations low.  Did I say that loud enough.  Don't tell parents to set your expectations low.   Tell them to set their expectations high.  It's better to shoot for the moon and miss, than to shoot for the lamppost and hit it.  However,  we also need to tell parents 'this is what it is going to take (eg 30,000 words a day)" and "here are all the tools to help your kid achieve the unachievable."  

Post Mother's Day Post

I read the following last year on Cochlear Implant Online, and loved it.   Elizabeth, the writer, is a young grad student who has the insight and sensitivity of an old soul.  She will be a terrific SLP or hearing resource professional very soon. 

Mother's Day was very special this year.  Lily's Dad and I think about how lucky we are daily.    (My personal edits below are in italics)

May 8th, 2010 by Elizabeth

HERE’S TO THE MOMS

Here’s to the Moms who may not have “signed up” to parent a deaf or hard of hearing child, but do so anyway with grace and love.

Here’s to the Moms who narrate every second of every day, not caring what others may think.

Here’s to the Moms who put miles on their cars driving back and forth to countless therapy sessions, doctor’s appointments, hearing aid fittings, cochlear implant mappings, and more.

Here’s to the Moms who work hard to be their child’s best advocate and primary language role model.

Here’s to the Moms who have had to learn a new language too fast full of Auditory Verbal/Auditory Oral terms and audiological jargon.

Here’s to the Moms who face the “experts” and fight for their child’s best interest in IFSP/IEP meetings and in those meetings where you are just trying to make the system better. 

Here’s to the Moms who can wrestle two CIs or HAs onto a squirming toddler… and replace it 20-40 times each day, even in the car, without loosing their cool.

Here’s to the Moms who can cook dinner, answer the phone, and change a CI/HA battery without breaking a sweat.

Here’s to the Moms who constantly have to explain their child’s “equipment” and answer the question are those forever?

Here’s to the Moms who have ever felt the pain of having a child who is “different”.

Here’s to the Moms who never take a single word for granted.

Here’s to the Moms who never fail to astound me with their capacity to persevere… and to love.

HAPPY MOTHERS DAY!!!
Originally posted May 9, 2009

IEP Goal Bank

Here's an IEP Bank full of ideas on writing language and listening goals for kids.  As Lily approaches three this summer, we are starting to think about this transition. 

IFSP Goals - 2.6 years old

Here are Lily's latest IFSP goals at 2.6 years old.  

Lily will demonstrate increased listening/auditory skills by:

1) Showing recognition of a song, nursery rhyme or finger play being sung or stated by pointing to the correct picture or object (given a set of 6-10 pictures or objects) with different voices presented taped or live.

2)  Showing understanding of verbal messages presented at greater distances (6 feet, 9 feet, other rooms)

3)  Identifying a word/phrase or sentence stated by her teacher or parent (given a set of 4-8 pictures or objects)

4)  Self-advocating when her CI is not functioning or she does not understand a verbal message.

5)  Identifying an object from several related descriptors in open-set tasks. 

Lily will demonstrate increased understanding of language by:

1)  Following 10 directions containing 3-5 critical elements.

2)  Showing understanding of "First, next, last" when given directions/requests.

3)  Answering basic /wh/ questions about short stories that have been read to her.

4)  Showing understanding of negation (not, didn't, don't) and preposition (around, beside, over, etc.) in directions given to her.

Lily will demonstrate increased expressive language by:

1)  Increasing the mean length of her utterance and the complexity of her language in two spontaneous language samples collected over the next six months.  

2)  Using the following syntactic elements in two spontaneous speech samples:  adjective + adjective + noun is verb+ing, simple and past tense -ed verbs, five irregular past tense verbs, articles, conjunctions, negatives, words marking time and quantity, use of "who" and "why" question forms, answering "where questions using prepositions (e.g. in, on under, over, around, behind.)

New Resource on IDEA for Parents

The Let Them Hear Foundation has launched a resource center for parents and professionals working with children with disabilities to provide a fundamental understanding of the key concepts of the Individuals with Disabilities Education Act 2004 (IDEA 2004).  

While the information will be useful for parents and professionals dealing with a child with any of the thirteen disability categories defined by IDEA 2004, the primary focus is to provide information to parents and professionals on issues related to the specific category of hearing impairment (including deafness). 

The Let Them Hear Foundation was formerly the group that battled the insurance companies to cover Cochlear Implants.  Now taking on the issue of appropriate therapy and treatment for kids with hearing loss is a very logical extension of their great work. 

Fun with Gpas, Santa and the New Year

We've been pretty lucky to see Grandpa Bruce and Grandma Carla a number of times over the past few months.  Lily loves seeing them and talking about Grandpa BRUCE's hat, beard and houses.  (Thanks for all your hospitality.  Grandma Carla somehow escaped our camera.)

Lily also met a Santa in Florida that was about her size.  She couldn't get enough of him.  She held his hands, gave him a squeeze, and looked deep into his eyes.  Santa's belly shook, but he never left the restaurant he was standing in front of.  Lily also found the elves below that she couldn't resist hugging.  

On this New Year's Eve, we are so happy with the progress Lily has made over the past year.  We are excited for the coming year and are currently in the process of setting goals for her next IFSP.  Each time we go through this process we are amazed at the progress she has made and all that we have to look forward to.   What will she be doing in six months?  It is hard to predict. 

Lily's IFSP Goals - 2.1 years old

We just finished our IFSP goals for Lily.  She is now 2.1 years old and and has 14.3 months of hearing.  At our next IFSP we will be thinking about preschool and the process of moving to an IEP.  However, this IFSP lays it all out and really provides us with a great guide and benchmarks for the next six months. Thanks to everyone who worked on it. 

• Lily will identify and discriminate between at least 10 word pairs that differ by voicing and by place of production in both final consonants and initial consonants of words.
• Lily will identify and discriminate at least 10 phrases with two key words in context/three key words in context, shown by following associated directions correctly.
• Lily will increase her auditory awareness and discrimination of sounds/words presented at greater distances (6 feet, 9 feet, directions coming from another room) and produced in environments with more background noise.
• Lily will be able to do the actions and recite or sing some words of 6-10 songs or finger plays.
• Lily will self-advocate when her C.I. is off or not functioning and will let adults know verbally when she does not hear or does not understand a spoken message.
• Lily will learn to use a louder and stronger voice when calling to others from distances farther away.
• Lily will take 2-3 conversational turns in an adult social-communication interaction.
• Lily will demonstrate an increase in auditory processing and language comprehension skills, shown by: Identifying 10 pictures or objects by function or action and by naming objects or pictures upon request. 
• Respond appropriately or verbally answering 10 each of simple /who/, /where/, /what doing/, and /yes-no/ questions.
• Follow 10 two/three step directions 
• Show understanding of personal pronouns: me, mine, you, he, she 
• Lily will add to her verbal vocabulary: 10 words from the concepts of Quality (descriptors such as color, size, taste), Position/Space(under, in back of, in front, etc.) 5 words from the concepts of Quantity (some, all, a few, numbers), Time (now, later, tonight, tomorrow) 10-15 present progressive verbs (is+verb+ing), e.g. playing, running, eating, sleeping, At least 5 pronouns: me, my, mine, you, your 
• Lily will increase her communication skills by using this vocabulary in 3-5 word phrases for various purposes: naming("that big dog"), notice or greeting("Hi Mommy), recurrence ("more yummy cookie, Daddy") non-existence or negation ("no go bye-bye," "water all gone," "Monkey not happy"), action ("Lily go down slide." "Me (or I) running fast."), location ("apple juice in cup"), possession ("my red ball"), questioning to gain information("What's that?" "Where___?" "What, Mommy?" ), and attributes ("big blue ball"). 
• Lily will use age appropriate speech sounds in all positions of words and will produce speech that is 80% intelligible to familiar listeners.

Moog Center's Parent Workshop - We're in Love! Part 1

We spent the last few days at the Moog Center's Parent Workshop.   We are in love with this place.  The workshop had about 15 families with children from one to five years old who had hearing loss.  Some kids wore hearing aids, many wore Cochlear Implants and a few wore both.   

The families were from all over the country and seriously committed to helping their kids learn to talk and listen.  The last question of the seminar from the parents was when can we come back?

The workshop lasted four days and covered topics such as Modeling and Imitation, Simulated Language Learning, Audiology, Benchmarks, Capitalizing on Routine Activities, Mapping, IEPs, Teaching Family and Friends about Communicating with your Child, Parents Share and a Kids Panel made up of first and second graders and their Moms.  Betsy Moog Brooks delivered most of the sessions and seemed to have an answer for every question that the parents asked.   She meant business and was clearly there to make an impact on kids with hearing impairments.   

Bestsy’s mother, Jean Sachar Moog was also there and presented research on Early Educational Placement and Later Language Outcomes.  She highlighted the significant impact two-year-old classes for D/HOH kids can make in later language outcomes.  These two women are leading the way in helping children learn to talk and listen.  What a thrill to be a little a part of their lives.

The research they gave us about the Moog Center says that at three years old 81% of their kids were at or above their age level in receptive vocabulary and 86% were at or above their age level in expressive vocabulary.  At age five, 94% were at or above their age level in receptive vocabulary, 97% in expressive vocabulary, 91% in receptive language and 77% in expressive language.

It seemed nothing at the Center happened by accident.  Everything was recorded, strategic and intentional.  We would move to St Louis in a minute if Lily was not thriving from the services in our area.   Lily had an hour of speech therapy everyday with Laurie, a Moog SLP, and spent the rest of the time talking with Moog teachers in the toddler room.  At the end of the workshop, we knew everything Lily worked on and where they believed we should put our “language and speech” energy.  

They said we should focus on requiring Lily to use two and three word sentences every time she talks.   Lily has a huge receptive and expressive vocabulary, but just needs to move towards more complex sentences.   If Lily doesn’t attempt a two or three word sentence after we model it, they said we shouldn’t give her what she wants.  

This is their model of modeling and imitation.   It seems to already be working.  Lily is talking non-stop and we don’t know where she is coming up with some of the words and sentences she is putting together.  Some of that started before we got to St Louis, but the "strategy" seems to definitely be accelerating her language.  

The facility itself was beautiful, incredibly quiet for the best learning environment and run with an eye for detail.   We are re-energized!!!

Here are some photos of the Moog Center.

(Note the metal slide and static-free play structure)

Additional IFSP Goals

One of the great things about working a lot of different professionals, is that you get lots of different ideas.  Sometimes we have tried to coordinate our IFSP goals, but this go around we seem to have created lots of different goals.  You can never have too many ideas or goals that you are working on at this point, because it is all part of the bigger puzzle. 

I thought I'd post some of those additional goals that we've set in the Omaha Hearing School IFSP, for the interest of others that may walk in our shoes.

From the beginning, the professionals have been asking us, "What are your goals for Lily?"  Goals?  Do all parents set goals for their children every six months from the time they are born?   Yes big life goals like go to college or travel around the world or marry someone fabulous, but not many have goals like families in some kind of special education do, for every developmental area of their child's life. 

For some parents, this may have been an easy question, but for us I am not sure that still today we can answer this question with any confidence or authority.  My primary goal or vision for Lily has always been to have her talk and listen as well as she can and love doing it.  I look to the professional on the steps to get us there. 

Here are some of those additional steps we are working towards - from now until Lily is 2.1 years old. 

1.  Lily will name familiar things in response to the prompt "What's that?"  Continue with "Where's...?"
2.  Lily will respond to more novel directions outside of her regular routine.
3.  Lily will respond to familiar 2-step directions.
4.  Lily will say 75 new words to label and to intentionally have her needs met including her own name, 10 action verbs, 5-7 descriptive adjectives, 2 prepositions of location
5.  Lily will use 2-word combinations: N+N, N+V, V+N, A+N, P+N, Question + N, N+N
6.  Lily will sing songs with a sustained voice and pitch changes
7.  Lily will imitate all Ling sounds
8.  Lily will look at people when they are talking to her and will look at people when she is talking to them, unless it is in a natural situation when she is working side by side with another adult or child. 

IFSP - 19 Months Old

The follow is a sample from our most recent IFSP.  We post this so you can see Lily's progress and see what we will be working on next.

Current Abilities

According to the infant toddler language scales Rossetti, REEL2, Lily is currently demonstrating receptive language skills at the 24 months level and expressive language skills at the 18-20 month level. She has a receptive vocabulary of approximately 400 and uses about 35 words expressively.  Lily is using developmentally appropriate consonant sounds correctly, plus some later developing sounds w, h, m, p, b, d, k, g, s, sh and a number of vowels all short vowels plus long a, o e, i.  Lily is engaged in vocal imitation and is heard to refine her words or sound productions following an adult model. Lily occasionally uses a gesture with a word to indicate a two-word phrase for requesting; she also demonstrates jargon along with true words in her vocalizing. Lily uses her vocalizations and word approximations for a variety of communication purposes. She varies her sound productions by place and manner of production, varies her voice appropriately, and uses her voice for both talking and for singing. 

New Goals

Lily will increase her auditory awareness and discrimination of sounds/words presented at greater distances, produced in various manners and produced in environments with more background noise. 

Lily will increase her receptive vocabulary for new vocabulary outside the home to 100 words, including 15 verbs and 5 adjective pairs. 

Lily will demonstrate an increase in receptive vocabulary by doing the actions to 5-7 songs when adults begin to sing the songs without doing the actions. 

Lily will demonstrate an increase in her understanding of language by following two/three step directions and by naming objects or pictures upon request. 

Lily will demonstrate an increase in her receptive language by showing appropriate response to humor with words, in books and in various situations.

Lily will add to her verbal vocabulary; her own name, 5 names of people, objects or animals, 5 action words, 5 early modifiers, 2 pronouns, 2 social words, and 2 words of existence/nonexistence or recurrence.  Lily will increase her communication skills by using this vocabulary in two-word combinations in various ways; naming (that dog), notice or greeting (Hi Mommy), recurrence (more up), non-existence or negations (no bye, water all gone), action (daddy go), location (in cup), possession (my ball), questioning to gain information (what's that), and attributes (big ball).

Back to School Tips

While Lily is a few years away from going to school, it's never too early to start planning and advocating for your child. Tonight we're going to a parent meeting with Lincoln Public Schools (LPS) where they're supposed to inform parents about the changes to the curriculum and services for the upcoming year. I'm sure we'll give more rundown once we know more.

In the meantime, here's a link to and article "Deaf or Hard of Hearing Child? What to do BEFORE School Starts" from the Hearing Exchange website with helpful tips for what to do before the first day of school to make the year go better.

IFSP

Here are the highlights of our IFSP (individual Family Services Plan).  In six months Lily will:

- Know 30 nouns, 5 verbs, 2 adjectives, 2 prepositions
- understand - Go get your ...
- Point to named pictures in books
- Increase jargoning
- 2-3 conversational turns with jargon
- Say - What's that and Where's...
- Say 10-15 words and know how to use them
- Say Mommy, Daddy, Gma, Gpa, and Tango
- Knows LIng sounds (mmm, shh, ssss, Ahhhh, eeee, ooooh)
- Does actions to a few songs
- increased practice of learning to listen in noise and from increasing distances
- Increase enjoyment and singing with music.

There are about 30 other goals on the list.  Who knew all of this development was happening so fast.  Too bad parents of normal hearing kids don't get to see and document every step of the way.