ear training hq review

>> all right, good afternoon everyone. welcome to the university of michigansound support's parent webinar series. my name is david clark, i'm the soundsupport coordinator for the university of michigan's hearing rehabilitation center. as many of you are aware, sound support isan outreach grant funded by the university of michigan, department ofotolaryngology and michigan medicaid. the grant is designed to provideoutreach and support to children with hearing loss throughout michigan. we put together this series of webinarsas a response to several parent requests

for additional information on hearing loss, speech and language development,and educational issues. we hope you'll find them to be helpful andwe encourage you to share your topic ideas for future discussions with us on our futureevaluation that i'll sent out at the conclusion of our third webinar whichwill be next week, wednesday. you'll find presentation slides located onthe handout stub located on the toolbar. you're able to download this or printthem directly from your computer device. there's also a question stub, please feel freeto ask questions throughout the presentation. we will address them at theend of the-- of today's talk.

today's webinar is the who, what, when andwhy's of speech and language evaluations. i'd like to take the opportunity tointroduce our presenter today, kelly starr. kelly is a speech language pathologistand a certified auditory-verbal therapist, listening and spoken languagespecialist at the university of michigan's cochlear implant program. kelly received her bachelor's degreefrom michigan state university, and completed her master's in speechlanguage pathology at wayne state university. she has presented nationally on varioustopics related to pediatric hearing loss and development of listeningand spoken language.

kelly enjoys being part of the u of m soundsupport outreach grant supported by the state of michigan and the university ofmichigan, department of otolaryngology, which provides a research-- whichprovides outreach and lectures to educational professionals andstudents in the state of michigan. so, with that, i'll go ahead and hand itover to kelly and we will get things started. >> all right, thanks david. i just wanted to welcomeeveryone to today's webinar. i'm looking at my window at this gorgeoussummer day and appreciate you taking the time to listen to what we have to say.

but, just as david mentioned, i'm oneof the speech pathologist here at u of m's hearing rehab center, andwork with children with hearing loss. so today's topic is the who, what, when andwhy's of the speech and language evaluation. i found this such a valuable topic for parents. the more information you are providedwith, the better prepared we can all be to give your child the best possible care. here, a list to some of the questions i wantto sort through during the presentation. i'll be accepting questions at the end ofthe webinar so please chat down any questions as they come to you so they aren't forgotten.

i know, plenty of time, plenty of times,have gone into an appointment thinking of all things i wanted to askunless with them not answered. so, i want to be sure that we have timefor everyone to get their questions in. and we all know that medical appointmentscan be overwhelming for you and your child. if it's your child's first speech and languageevaluation, there's always the added stress of finding the building, finding where to park, and dealing with unfamiliar trafficbefore the appointment even begins. so, we want to be sure that onceyou're at the appointment with us, you get your questions answeredand concerns and trusts.

these speech and languageevaluations are for you and your child. and while they're big part of our dailypractice, we forget many times the terms that we have used, aren't wordsthat typically are used by parents and almost like learning a new language. my sister and i often joke that we bothspeak different languages in our careers. she graduated with a degree in plantpathology and molecular biology. and i graduated with speech language pathology. so whenever we describe ourdaily routines to each other, we often have to stop eachother and ask questions.

i hope today to decode some of those newwords and words we use in your child's speech and language evaluations and on the reports. not only some of the words we useare unfamiliar to most parents, but also the acronyms that we use. so i wanted to first go over thekind of the abcs of speech pathology. as you notice after our namescomes many letters. without being in the field, i know it'sdifficult to know what they all stand for. so here's just an overview. speech pathology is a master's leveldegree so depending on where you graduated,

it may be a master of arts and show as ma, orit might be master of science which would show as ms. the ccc stands forcertificate of clinical competence which is the internationally recognizedcredential for speech language pathologists through american and speech hearingassociation or asha as they call it. to earn your cs, you have to complete yourmaster's, a supervised clinical experience and then pass the national exam,and also a complete internship. so to keep our cs, we complete onongoing education in our field. slp is the easy one to remember and itstands for speech language pathologist or you might hear us called thisspeech pathologist or speech therapist.

something that sets the three of us here,jen, myself and ellen [assumed spelling]. apart from other speech therapistsare the other letters included after our name and that's the lsls, cert. avt. these indicate a specialtycertification for listening and spoken language and working with children with hearing loss. so we differ from our colleagues in speechpathology or other speech specialties and that we are listening andspoken language specialists that are certified auditory-verbal therapists. the ag bell academy oversees thiscertification of professionals working

with children who have hearing loss. so, what it is, is listening, what are spoke--listening and spoken language specialists and were defined by ag bell, a specialistwho work with children who are deaf or hard of hearing and their families seekinga listening and spoken language outcome through the use of technologies suchas hearing aides and cochlear implants. parents and caregivers are supported andempowered in their role through this approach as the child's first and most important teacher. the ultimate goal here is for the child to besuccessful in the general education setting. so, all three speech pathologists here at u ofm have the certification and work with any child

with hearing loss not just thechildren with cochlear implants. you may be thinking, my child alreadyworks with a speech pathologist at school, why do i need to come see you? and in the field of speech pathology, you areprobably learning there are many specialties. for a child that has a hearing loss, we areable to look at that child's abilities compared to what they're hearing inrelation to their language. we have the ability to formally test morefrequently than a school speech pathologist. also, we work closely withyour child's audiologist to ensure your child has thebest possible access to sound,

as we're looking at your child's speechareas and language areas in relation to the specific frequencies on audiogram,which i'll get into a little bit later. this isn't to say that the school'sspeech pathologist isn't needed. in fact, we, many times are pushingfor more speech services from school, remembering that it takes a village and all professionals' certainimportant roles to your child's success. so, yes, we are all needed. why might we refer your child toa different speech pathologist? given our knowledge of language developmentin combination with hearing loss,

we oftentimes see there more thanjust hearing that we're working with. just like no two children are the same. in working with children with hearing loss,we know what behaviors are due to the hearing and have concerns about behaviors thatare not typically seen with hearing loss. research has shown us that there are, manytimes, disabilities that coexist with deafness. with some study showing up a 40% of children with cochlear implants havinganother disability. some of these disabilities,additional disabilities, that we see in our patients might include visionimpairments, autism, difficulties with feeding

or swallowing, and stutteringjust to think of a few. it's important to remember that these differentdisabilities require attention from an input from different professionalsthat specialize in those areas. when recommendations are madeto see another professional? it's a great way to gain more informationto best support your child's needs. so, you probably learn-- excuse me-- thereare many educators and professionals working with your child at any-- at times and probably,it seems like we're all doing the same things. and in the end, we're allworking towards the same goals but we might be getting there a little bitdifferently and might have different roles.

the speech pathologist in the school or theprivate speech language pathologist is working on the development of listeningor understanding of language. and they also may be working on speech or how wesay the sounds in our language and the talking or how we use the words toput sentences together. this can be done in individualsessions or group sessions. the audiologist, the audiologistworks with the child's equipment. when in the schools, they are also likelymanaging the equipment of the fm systems and providing teachers with in-services inhow to use them troubleshooting the equipment. the audiologists at u of m areneeded for monitoring of hearing,

monitoring of the devices the child isusing and programming of those devices. teachers for the deaf and hard ofhearing, there are teachers that have a-- that are specialized in working with childrenwith hearing loss in the school setting. and i want to add that there are possiblymany more people working with their child and some might include and not limited to aphysical therapist, occupational therapist, social worker, interpreter,language facilitator, therapro special education teachers. so this list could go on and onspecific to what your child needs, but we understand that there's a lot of peopleworking with your child, and that means a lot

of titles, a lot of names to remember. and that we're all workingtogether in trying to collaborate to get your child's speech andlanguage on the right path. so who needs to come forspeech and language evaluation? the answer is any child diagnosedwith a hearing loss. so this could mean a severeto profound hearing loss. maybe it's a mild hearing loss oreven a unilateral hearing loss. also, we see children that use hearing aids,bahas and cochlear implants for amplification. the question of when, so, prior toany speech and language evaluation,

be sure to have your child's hearing tested. generally, we like to see children thathave been diagnosed with a hearing loss and fit with amplification if appropriate. we see children as young asthree to six months of age and you're probably thinking, why so early? even in a few months, speech andlanguage can be assessed to determine if a child's following anormal developmental pattern. we are also wanting to see how they're goingto progress over time with their amplification and make sure that they stay on track.

to think about hearing is tothink about brain development and that the ears are just the doors in. research has shown that thegreatest time for neuroplasticity of brain development is birth to three. so that development where the auditory centersof the brain is needed most is birth to three for a child to learn language at an appropriaterate following their peers with normal hearing. so, that's another reason whywe're saying earlier is better. we want to make sure that theyfollow a normal developmental path. after the initial evaluation, wetypically recommend return evaluation

or interval evaluations everythree to six to 12 months. and really, it's not so wide rangebut it's patient-specific and based on the therapist's recommendationsfrom the most recent evaluation. so, it may be every six months for youngchildren usually under the age of three and then move to yearly evaluation after that. or it may be every six months for children whohave had a cochlear implant turned on recently. and for that population, when a child receivesa cochlear implant, it's critically important to monitor the listening and language tomake sure that the device is working well and programmed specifically for that child.

for children that do have cochlearimplants, after it's turned on, we recommend evaluationsevery six months to start. i will say that once you see-- i willsay that once you see the therapist, they may change the timeline basedon the results of the evaluation to develop a specific planto fit your child's needs. i can think of times that have createdthe need for more frequent speech and language evaluations including a childmight show a drop in hearing if there's concerns about device function, if there's been recentchange in performance on speech and language, and also the child's cause of hearingloss may increase the frequency.

so, what happens before the appointment? first off, call and talk with ouroffice staff about the scheduling. tell them you'd like a speechand language evaluation. and after the appointment has been scheduled,we want to make sure there's insurance approval. so, our referral coordinator willadditionally work to be sure that a referral or an order is in place for the appointment. you want to make sure that u of m hasyour child's most up-to-date insurance in fall in the system. and additionally, we're on scheduling--we understand that you're trying to--

you may be trying to coordinate multipleappointments with the doctor or maybe with the audiologist, and it's always nice togroup appointments together but keep your child in mind because it may not always be best. sometimes, it can be too much for yourchild to have back-to-back appointments which sometimes ends in rescheduling them. our speech evaluations can lastup to two hours and by the end of which most children are fatigued sosometimes it's nice to take a break for an hour, at lunchtime is an option, beforereturning for a second appointment. these are just things to think about to makethe most start of your appointments here.

also, you may find that we are schedulingfurther out than you would like. we do have a running wait-list forspeech and language evaluations which you can ask to be placed on. and then, our front office staffwill call as we get cancellations. so, what's needed at the appointment? be sure to bring all of your equipment, hearing devices including cochlearimplants, processors and hearing aids. if your child had a recent audiogram,that's great information to share. also, any medical records or documentsincluding information about your child's vision.

these are things that are helpful in formulatingthe best recommendations to fit your child. bring along your child's iep orindividualized education plan, if you have questions orconcerns regarding that. going along with that, we wanted to get updated in educational placement information includingthe people working with your child at school. it helps getting a big picture foryour child's supports and allows for us to make appropriate recommendations. and lastly, bring along your questions andconcerns to be sure that they are addressed. every new child brings onits own set of challenges.

while there are no-- whilethere are similarities, there are no two children that are the same. so, prior to your arrival, we have likelyreviewed your child's medical chart. and this provides us with a little case historyand what tests to select for the evaluation. the goal of the evaluation is to determineif the child has access to speech needed for ongoing development oflistening and spoken language. in fact, your child's initiativeevaluation allows for a benchmark to compare future evaluationsand track progress. this gives a picture of theircurrent language level

and current hearing-- withtheir current hearing. and make sure-- we make sure to use avariety of tests including language, speech or articulation, vocabulary, andliteracy based on the age of the child. prior to starting the evaluation,it's important to verify that the child's amplification's workingproperly so that us, the speech pathologist, will do a visual inspection of the equipmentand may do a listening check, in addition. it's a good time during that listeningcheck to talk about how the child is doing with the devices and hear theirconcerns about the device function. if the cochlear implant processors

or hearing aids are not being utilized duringall waking hours, it's the time for discussion about the child's daily routine to help understand why they might notbe wearing the devices consistently. and also, we want to get update inmedical history and developmental history, and discuss current school placement. once the-- once in the evaluation, we wantto set up the child for success to be-- to do that, be sure to bringalong all devices for hearing. also, if the child uses glasses,be sure to bring those. i know coming in for speech evaluationmay throw off the typical daily routine

so sometimes, these things can be forgotten. keep the gum for later. so, it's fine to have a drink or waterwith you in the evaluation but many tests that we're doing is asking themfor verbal responses and want to remove eating and chewing for older children. if your child's a little one,it's fine to bring snacks. we will be working and asking with youfor many of the questions about your child and we understand that snacks may be helpful way to keep your child engagedfor a longer period of time.

depending on your child, you may be inthe session as an observer or you can wait in the waiting room during the testing portion. this again depends on eachchild and the age of the child. we always have the parents present forthe review portion of the results to go over the results and also for thediscussion of recommendations. some of the reasons a child might come backon their own include there may be siblings with the parent that needed to stay inthe waiting room to reduce distractions or some children frequently look totheir parents or won't talk, are shy, and i think sometimes are less shyif the parent is not in the room.

they can't look to the parent forthe parent to answer for them. and we just want to set it up for the childto get the best possible score in the testing. parents, if you are in the evaluation, you may find yourself bitingyour tongue during the assessment when your child misses certain items. we, as the speech pathologists may not be able to provide repetitions given thetest instructions which is all part of the assessment processso that's completely normal. it's also important to know thatwe don't want to teach the test.

we don't want to teach just the specificwords that are missed on the test, as that would skew the resultsover time especially. and then finally, it's important to be sure-- and stop us during the results discussionbecause many times, we use these words in terms in a day-to-day without realizinghow quickly we are talking and how often we are using newwords that we haven't explained. i wanted to highlight theaudiogram just as a review. so, at the top, going from leftto right, we have low frequency up to high frequency like a piano keyboard.

and then on the-- going from top tobottom, it goes from quiet to loud. so, what's nice about this one here, you seein the middle a banana-shaped looking figure, and that is what we call the speech banana. and the speech banana holds all thesounds of spoken language for english. and that's really what, usthe speech pathologists, are after to make sure you haveaccess to all of those sounds. down here at the bottom, you will see thex's across and those represent the left ear. and that would be without anyamplification so that would be without a hearing aid or an implant.

then, you see ha, that wouldbe with a hearing aid. and then, you could see ci whichshows if they have a cochlear implant. so again, we would want child-- a childto have access to all of the sounds in the speech banana using amplificationeither a hearing aid or a cochlear implant. without having audiologist in our appointments,we want to be sure that they have access to all the frequencies of speech andone way we do that is through a daily or before the assessment of ling six sound test. and what this is, is we are checking to seeif they have access to all the frequencies of speech by looking for a reactionfor ah, eee, oo, sh, ssss, mmm.

these are spread across thespeech banana on the audiogram. so for a new listener, we'relooking for behavioral response to each sound or for them to look at us. and for a more advanced listener, we'relooking for them to imitate the sound after we say this through listening. when we achieve imitation, we knowthat they not only can detect the sound but it's loud enough to understand the sound. so, detection might be like if the tv's onin our house but it's not loud enough for me to understand what's beingsaid, that would be detection.

but if the volume's up loud enoughfor me to understand, that would be-- it would allow for comprehension. and that's what we're after. so, why so many tests? we're looking at an audition orwhat they are hearing just like-- one way that we might do that is againthrough the ling six sound check. we're looking at speech. and speech is typically thoughtof with the speech therapist which includes articulationor how we say the sounds.

speech can also mean how we useour voice or our voice quality. we also test language. language includes how we understand whatis said to us or our receptive language. this would mean understanding therules of grammar of our language. it might mean showing me understanding offollowing directions that i say to the child. we then test the child-- how a childuses language or expressive language which is our ability to put wordstogether to be understood by others. so, how is the child talking? what are they saying?

and how are they putting the words together? as-- we also, then, want to test vocabulary. and vocabulary, the same thing, we're lookingat are they words they are understanding, that would be receptive vocabulary, and wordsthey are saying or expressive vocabulary. this might be done on the understandingtest might be a picture pointing task or the expressive task maybe having them name pictures. also, we look at reading comprehensionas part of our test, probably. so in babies, we might use a combination ofnorm-referenced or criterion-referenced test which is more about informal observations.

so, with this-- with a young group, wemay rely on you as the parent for input about what your child does at home. we also gain information throughwatching your child and playing with your child during the assessment. at young ages, we're assessing languagebut we're also making observations about the child's play skills and theirsocial interactions or their behaviors. for older children, we're doing moreformal testing whether it's a test booklet or maybe using the ipad and askingthem to point pictures or participate in naming pictures or describing pictures.

formal tests are used because theyallow us to compare to other children with the same age with typicalhearing abilities. i want to mention that there arenumerous tests and options available to use during the speech and language eval. and they'll be selected basedon your child's need. so what do the scores show us? consistently, we are using standardized testswhich are tested or administered or given in a set manner for all test-takers. so this is another reason why based on the test,we may not be allowed to provide repetitions

to your child or prompting upfor them to give their response. i know this is difficult to-- for parents. as you find yourself, you might see a childmissing item, you know that they understand. and this is something to remember anddiscuss with the speech pathologist after the testing has been completed. so it can be noted in theevaluation and they do a discussion of maybe why did they miss that item? was it due to the length of the direction? possibly, was your child fatiguedor maybe was it a combination

of the words that were used in the direction? raw scores? raw scores give us the number of correct items. each year, we want to be surethat this number goes up, that they are progressingand gaining new skills. we take that raw score andconvert it into the standard score. standard scores are commonly usedfor test to provide the comparison to other children that are at the same age. and standards scores are plotted alongthis bell curve that you see here

with 100 being the average score. so moving 15 points each way gives usthe normal range of abilities from 85 to 115 which are highlighted in green. this also gives us a descriptorand the description is provided. and the evaluation report describesthe child's performance compared to children at the same age. so this may read something like averagerange, mildly delay, moderately delayed, above average range, severelydelayed or profoundly delayed. we've got percentile ranks whichcompares a student's standard score

to another child his or her age. if a child has a percentile ranking of 80,it would tell us that 80% of the students who took the same test receivethe same or lower score. under the chart, you see a little box,a gray box which might look familiar if you received one of our reports in the past. and this box is on all of our reportsand just gives a quick overview of what each one of those shows us. i'm a visual person and when i came across thischart, it really helped create a visual for me to better understand the standard score.

it again shows the bell curve inwhich standard score is plotted. and we see the 100 is the average for the-- it's the average for thechild's age that we're testing. and you can see that's where most of thechildren would fall at any given age. if the descriptor is something that mightread mildly delayed or moderately delayed, this might lead to a discussionabout a recommendation for therapy and more support services. we also have different agesthat we discuss and show. we have the child's chronological agewhich tells us how old your child is.

then we have the language age whichprovides us with an approximation of age given the child's performance on a test. another way this term is said is language ageequivalent, which we also list on our reports. and then there's also thehearing age to consider. so here's a chart you'll findat the top of our reports. this child has two cochlear implants. it lists an internal device which was freedomand then the processors which were n6. and then, it was the dates,the surgery and the activation. if a child-- if it was a child with a hearingaid, it would also say the date it was--

they were fit with the hearing aid. so let's just say the child had a profoundhearing loss before receiving cochlear implants. so, i look at the dates of activation or the dates the cochlear implants wereturned on to determine the hearing age. so, for this child, it would tell us thatthe right ear has a hearing age of two years, nine months and the left ear has ahearing age of one year, 11 months. it's just a good reminder that, keep in mindthe length of time they've had access to sound. this is an example from our reports and itjust shows that we also add in, if appropriate, the previous scores so wecan track progress over time.

and here, you see this is a languagetest that shows the raw scores, standard score, age equivalent, and description. i want to add that even if a child is inthe normal range, it is essential for them to continue to come back forevaluations to make sure they stay there. we know it only give them point, that somethingmay change and this might not always stay within the normal range, grade levelsget harder and content gets harder. if we don't have baselines forcomparison, it's really difficult to know the reasons why the progressmight not be where we expected. overall, we're looking to close that gap betweenthe language age and the chronological age.

so here, we have from zero to 35, it'ssupposed to be months, age and months. and then we have scores at pre-op so blueshows us their language understanding, the orange shows us their languageexpression or how they say the language, and then the gray shows ustheir chronological age. so here, we see a big gap betweentheir language, understanding, and use between their chronological age. now, after six months of device use,we see those gaps getting smaller. and then after a year and a half, wesee that they have closed the gap. so, what does that all provide?

you're not leave with the reportin your hands but we are able to tell you your child's currentspeech and language levels. we'll go over some school recommendations andalso areas to target a home with your child. you, as parents, are the primarymodels for language development. and we hope to give you some goalsand strategies to help facilitate that development if there are delays. i'm sure you've heard the term hipaa floatingaround there from past medical appointments. and hipaa stands for health insuranceportability and accountability act which is a privacy rule to protectpatients and his or her health information.

and what it means to us is yourchild's speech and language evaluation and medical documents are private and notbe shared unless consent has been given. so, if you want us to sharereports with schools, please let us know duringyour child's evaluation so we can have you sign arelease to share those documents. even if you have signed a release to communicatewith the school and share with your school-- the child's school, it doesn't meanautomatically, evaluations will be sent to them. they can call and request them but again, letus know if there is somebody that you want to receive a report so that we cantalk about that in appropriately route

that while you're at our appointment. i just want to take a second to say ifyou counting recommendations for children with hearing loss and it's ironic to thinkthat the child's learning environment, if it's a general education classroom, maybeone of the most acoustically noisy environments for them, students with hearing loss areworking harder than their peers to get into the normal range with their spoken languageand they're working harder to stay there. so, if we don't access their bubbleor what they're able to hear, we might as well be talking to the walls. we need to give them access.

and a lot of times, that might include fm. so, we can be sure that we geta clear signal to the brain. you listeners may require more repetitionsto retain the message in its entirety, children's auditory systems are notfully developed until late teens. so we know as adult with developed auditorysystems, we may be able to fill in the blanks of lost information especially when-- if it's a child with a hearingloss, they might not be able to do. so, repetitions are essentialand talking to the teacher to help them understand whythey are so important.

we want to make sure that tomaximize the auditory signal by placement and preferential seating. also remind educators to seat on the sideby to child, not across the table from them, so that their voice is closerto the child's microphones. think about desk placement. keep them away from open doors or window. during assemblies, making sure that your child'sat the front for better acoustics and also to help with the reading and visual access. i also want to say that vocabulary frequently isa topic that we bring out for recommendations.

and pre-teaching of vocabularymay be needed for a child. many children with hearing loss, if they hear ina noisy environment, they may mishear the word. and then if they mishear the word, they'renot going to comprehend the meaning. so for older children, we may providewritten visuals of new words for the child to see the correct spelling to assistwith the accurate production of the word. for younger children, have the teacher providea list of words to you to review the week prior to the introduction in the classroom. this will allow your child to feel confident as they can spend more energyin learning the lesson.

prepare your child for the classroom byreviewing these accommodations with them. these are skill set we'll continue to valueand develop throughout their lifetime. so depending on their age, they'll needto be aware of their equipment names. you know, for younger children, makingsure they can say the devices are working. for an older child or a more advanced listener, knowing how to troubleshoot theequipment when there is a breakdown. so examples might be changingbatteries or adjusting volume. and these are things to be reviewed at home sothat they feel comfortable with the equipment and how to name and label the parts of theequipment to the teachers, as required.

another important skill is practicing whatto do when the information has been missed, so we don't want them sitting there if theydidn't understand the teacher's instruction. we want to practice-- at home, we'll play thesedifferent situations so that they feel confident in being able to ask their teacher for arepetition or a classmate for clarification. have your child practice describingtheir hearing loss to others. again, depending on their age, sothat they're confident in doing so when they're asked about it in the classroom. we want to prepare the classmates. you know, you might want to havethe teacher review how we hear,

review what hearing aids are. we find this to be a really fun and positiveexperience for children in the class. so, what's next for children? we might have recommendations fortherapy given after their assessments or their speech and language evaluations. we might have recommendations for themto return for followup evaluations. and we want to make sure that those arescheduled before you leave or at least so you know who to contactto get them scheduled. also, be sure to make sure you're scheduledwith the audiology as it's been recommended.

i also-- at this point, we, sometimes duringour recommendations discuss sound support which is our grant that provides thisoutreach across the state of michigan. we also do school visits so that is anyone ofus that is on the hearing rehabilitation team, and it could be an audiologistor a speech pathologist. what that might be is manytimes, it's a classroom visit. we might be observing your child in a classroom,do assist and recommendations or meeting with all the team members aftera speech and language eval. to review the results. it might be just a one-on-one meeting withthe school speech language pathologist.

it's all tailored to what your child might need. how this happens is a requestis made during the appointment. you can tell us if you would like a school visitscheduled and then, we go out for any child with hearing loss, it doesn'thave to be a youth patient. other things that sound support does beyondthe school visits and webinars include training and mentoring of other professionalson the state, in-services and lectures. there might be roundtable discussions. we also do events where wecan get families together and parents can meet other parentsof children with hearing loss.

those are some of the fun thingsthat we get together to do. i hope i've answered more questions than ihave created but now, i would like to see if any of you have questions for me. >> all rights. thanks kelly. yeah, we'll give you guys a couple of minutes ifyou want to type in your questions, feel free. there is a questions pane locatedon the gotowebinar toolbar. so, go ahead and type in your questions. we'll give you, guys, a few minutes.

i just want to do a small recap here. we just want to remind you that the post-courseevaluation will be sent-out at the conclusion of our three-part webinar series. so next week, august 17th, next wednesdaywill be our final part of our series. so we just ask with the course evaluationso you take a few moments to provide us with good feedback and suggestions which can include feature topics,format, time of day, et cetera. anything helps as we go forwardwith these parent webinars. so as i mentioned, our next and final of ourparent webinar series will be next wednesday,

august 17th at 9 o'clock in the morning. so go ahead and grab your earlymorning coffee and log in with us. the topic will be tips and resourcesfor navigating the educational system. this will be presented by dr. anita verebwho's an audiologist here at the university of michigan here in rehab center. so, we'll wait here aboutanother 30 seconds here. we'll wait to see if any questions pop up butwe'll close things out if nothing comes in but we'll give a few folksanother 30 seconds or so. all right so, i don't see any questionspopping up so, we just want to thank kelly

for taking the time to present todayand for those of you logging on. again, be on the lookout forpost-course evaluation which will be sent out at the conclusion of our three-part series. and we look forward to continuingour series next week. again, that's wednesday, august17th at 9 o'clock in the morning. so with that, we'll conclude today's webinar. thanks again for logging in. have a great day everyone.