Ellen Rhodes and Jill Duncan have written an excellent new book:  AUDITORY-VERBAL PRACTICE: Family-Centered Early Intervention, 2nd Edition; published by Thomas, 2017. It will be appreciated by all clinicians in auditory-verbal practice, and others working with families. Even clinicians with many years of practice will find useful information in this book. The book is different than other books that deal with auditory-verbal practice in that it does not deal with specific therapy activities to build skills but presents in detail the issues we need to review to have a true family centered practice.


Diverse cultures

There is a good chapter on the available research about AV practice and suggestions for what needs to be done to improve data collection in this field as well as a good discussion reviewing published data on results of AV practice. The chapter on servicing families from diverse cultures is wonderful. We are all good at serving families like ourselves but serving those with different culture, language or values is more difficult. Families from different cultures bring different perspectives on parenting and disability. As clinicians, we need to understand and accept parenting differences and work with them. If we cannot do that, we are not providing families with the support they need to help their child succeed.


Family focused vs family-centered

I believe the most valuable parts of the book are those related to really developing a family centered practice. Auditory-verbal practitioners are family focused, but we are not all family centered, at least not all the time. While I thought I understood the difference, I certainly understand it better now that I have read the book. There is good discussion about developing a positive framework for families. There is a good discussion about giving families hope. As a clinician, I think giving families hope may be the most important thing we do. By giving hope we enable them to move forward. Once families develop hope there are no limits. Rhodes talks about how the family center practitioner is not directly responsible for a child’s progress. This is an important thing for us all to understand and remember. We can help families build the skills but, unless we take the child for our own, (not an option), we are not directly responsible. There is a good discussion about the different family based models, how they differ, and how we need to use that information in our own practice.


Facilitating parent decision making

There is a good discussion about facilitating parent decision making and our role as clinicians in this process. For example, when families are deciding whether or not to have their child receive a cochlear implant, what is our role? Certainly to provide information and to be sure that families understand their choices and the consequences of selecting to implant or not, but it is not our decision to make. Any clinician who has been in this field for a number of years has had the experience of having families make decisions that we did not agree with. It is not easy to sit silently when a family chooses against an implant when our experience tells us that an implant would be appropriate. But, as we all know, it is not our decision.


Family relationships

There is good discussion about family relations: mother-father, parent-grandparents, siblings etc. and a very good discussion about parent-child interaction and how we, as clinicians, can provide assistance. The third section of the book discusses the family centered early intervention AV practice. There is a good discussion about home therapy, and a very good discussion about evaluating families characteristics and looking at their needs, and another about supporting and engaging families. The book ends with a chapter from Mary McGinnis with specific clinical examples about becoming more family centered which I think will be valuable for students and new clinicians, and even for some of us older clinicians


I strongly recommend this book. It is long and will require some thinking when reading it, but it will improve our practice.



What do parents need to do to help make the school year successful? First, parents need to remember that they are the experts. You need to be involved in all decisions about your child. Professionals know a lot, but you know your child. In addition, you are the person who has the most invested in being sure that your child succeeds. Get all the information you can get from everyone around you but you are your child’s advocate.




Every child who has a hearing loss is entitled to be evaluated to determine what services are needed. Parents are a critical part of every IEP meeting. IEP decisions cannot be made without parent participation. In order to make a determination about what services a child needs it is important to have current diagnostic evaluations. Every child should have a current audiological evaluation which includes testing with technology including speech perception testing at normal and soft conversational levels in quiet and in noise. A current and complete speech-language and listening evaluation by a listening and spoken language specialist or a speech-language pathologist with experience in evaluation and management of children with hearing loss using spoken language will provide critical information about management. Psycho-educational evaluation will provide information about and learning issues which are critical for management. Academic evaluation will tell us what needs to be planned.

Unfortunately most school districts only provide evaluations every 3 years. The ridiculous of this should be obvious. What is appropriate for a child at one point is not necessarily appropriate two or two and a half years later so how can we be using an old evaluation to plan management. Every effort should be made to get the school to at least provide an annual speech-language-listening evaluation to help plan.

Helping school staff understand hearing loss

You cannot assume that the school staff understands what your child hears and what he is missing. Most people assume that once a child has hearing aids they hear. They assume it is like eyeglasses. We need to help school staff understand that even though hearing aids and cochlear implants are terrific, the child is still listening through a damaged auditory system. Here are some points it is helpful to make

  • Hearing aids are terrific but they work best when the child is within 3-6 feet of the person talking and when it is quiet
  • When the talker is more than 6 feet away it will be difficult to hear
  • When there is competing noise it is difficult to hear
  • FM/RM systems will make it much easier to hear in a classroom. EVERY child with a hearing loss will benefit from using a remote microphone systems
  • Hearing comments and questions from other students is very important. If there is no pass around microphone the teacher should repeat other students comments.
  • Keeping the classroom quiet helps a lot. Only one person should be talking at a time. All movable chairs and tables should have footies to reduce noise.


Make absolutely sure that your child is hearing in the classroom.

  • Make sure your child sees her audiologist on a regular basis – how often s/he recommends.
    • My recommendations – every 3 months before age 4; every 6 months for as long as possible. When a child reaches the point where he can consistently report technology problems it is possible to move to annual evals. It is NEVER alright to go longer than a year to have hearing and technology check with a child.
  • Technology in school
    • Who is going to check the technology every morning? It needs to be checked BOTH at home and at school.
    • Who is going to teach the teacher/nurse/SLP how to check the technology?
    • Who is in charge of selecting and making sure that the FM system is working?
    • Who is going to teach the teacher how to use the FM?
    • Be sure this is all worked out before school starts or you have a few days or weeks where hearing may be difficult

Monitoring progress

Don’t assume everything is moving along as it should. It is important to know how a child is doing in all areas. Children with hearing loss are entitled to be the best they can be. You want to be sure that teachers have appropriate expectations. “Good enough for a deaf kid” is not good enough. Deaf kids have just as much a right to succeed as their typical hearing peers. But they will only succeed if we are measuring progress and then providing what ever assistance is needed to help our kids succeed. Good enough is not good enough.