Better Hearing for Better Learning. Roundtable Discussion on Improving Auditory Assessment in Schools

{Dave} All right, everybody, and welcome to another episode of This Week in Hearing. Today, we are joined by three awesome women – Dr. Jacqueline Scholl, Dr. Nina Kraus, and representative Meloyde Blancett. So thank you all very much for being here today. We are going to be talking a lot about how our kids are being tested. Their hearing is being tested in schools, maybe some of the shortcomings and talk through how that could be changed into the future. So I’ll kick it over to Dr. Scholl here. Jacque, if you want to maybe kind of give us a high level overview of how you see the problem as it is today, and then maybe we can talk through how this could be improved.

Sure Dave, thanks So much for bringing light to this attention. I’m not going to say that I’ve known that this has been a problem for a long time. It actually affected me personally. I have a son who was diagnosed with ADHD medicated and had some sensory issues. Really all things that cross over between ADHD, auditory processing, reading, difficulty, all of those things. I didn’t think the child would ever learn to read. And he got this diagnosis when he was probably about five or six. And it wasn’t until he was 13 years old and I was norming some new equipment that I had received in the clinic and oh, my gosh, my equipment is broken. What’s wrong with my equipment? It. And so I called in one of my colleagues and I said, would you run this P 300 on my son? Because I think the equipment is broken. And what I found out was that my son has a significant processing disorder. He never had ADHD. it’s why he didn’t like taking the medicine He doesn’t have a P 300 on his right side. It wasn’t the equipment was broken, he didn’t have it. And the reason the child started learning to read was dumb luck on my part. Because everything that we know through a lot of Nina’s work, Dr. Kraus’ work and her colleagues is that timing, that keeping a beat, all that rhythm. And when I found out he had allergies to horses, I decided he wouldn’t be the boy in the bubble. So I enrolled him in horseback riding lessons. And through that learning that whole using all those big proprioceptive. Muscles. He actually started learning. He actually started reading. Fast forward. When I sold my clinic about three years ago, I started a nonprofit. Up until that point, I had lived in my little glass house, and my people came to me. I had no idea that in the state of Oklahoma, we did not require hearing screenings. I had no idea. And I have been living in Tulsa as an audiologist for 25 years. So what I doing was like, well, this can’t be. I mean, we have mandatory vision screenings. We have reading scores that are continuing to plummet no matter how much money, how many great programs we throw at it. It’s not moving the needle, but yet we’re not even testing hearing. So I started looking at, okay, well, I’m from Missouri. I’m going to see what they do in Missouri, because I’m sure in. Missouri. We do it better. We do not. The numbers are terrible in Missouri. And then I went, okay, well, Texas, they’re all that in the box crackers, right? So I’m going to look at Texas and Texas. No, even worse. And then I got obsessed with looking across the country and looking at the fact that that if we are testing our children in the schools, we are using the same methods that we used 50 years ago. It hasn’t changed. And those states that have mandates, their numbers aren’t any better than the states like Oklahoma that don’t even have mandates because they’re not catching the kids. So I really to be honest, Dave, I couldn’t believe it. You know, I’m a huge fan of Dr. Kraus’ work. I have been. For many, many years. And what I realized is that we are doing a terrible injustice to our children. They’re never going to learn to read. My son was read to. We have a whole library of children. I love children’s literacy. There was no child that was read to more than my son. But yet people want you to believe if you don’t read to your kids, they’re not going to learn to read. Reading to your kids does a lot of really great things. It does bonding, and it shows them a love of books. But if they have an auditory processing problem or a problem along the pathway, that’s not going to teach them to read. And they’re being diagnosed for everything under the sun. We’re medicating them for ADHD. They’re behavior issues. They’re dyslexic. They’re this, they’re ODD. DDD. Whatever. And I honestly believe a very large majority of those children have auditory pathway problems, and they’re not going to learn to read if they don’t get the right instruction. Well, thank you for yeah, thank you for kind of giving us a high level overview. So you said a couple of things there this method of testing children has remained the same for about 50 years. And, you know, perhaps there’s a better method in which you can do this. And that’s why it’s great that we have Dr. Kraus here. I have your book, actually, Nina, right here of Sound Mind, which was very informative for me as I read that, to kind of get a better understanding of what’s really going on here. And so when you’re talking, Jacque, about the auditory pathway, maybe we can start to get into when you really understand what’s happening, what would be potentially a better method or just approach. You could start to identify things like auditory processing disorders, knowing some of the constraints that exist in today’s schools and the constraints that they’re running into. One of the things about testing a pure tone is that it only tells you if the brain hears something. It doesn’t tell you the quality of that sound. It doesn’t tell you if the brain is hearing the right sound. It just hears something. And if you look at a lot of the research, there’s not anything right now that says, hey, this is how you should do it. But if you start extrapolating the work that Dr. Kraus has done and her colleagues and all the other people that are doing this, you start realizing something even as easy. Within our three and four year olds, and they keep a beat. How do they keep beat- ya know
something that we can? I’m not saying a pure tone doesn’t have some valid redeeming qualities. It does. It’s just not what’s going to catch these kids who have these auditory pathways. Nina, maybe you can kind of highlight and go into that more, because this is clearly your area of expertise. Well, thank you. And I think you’ve really identified a key and a very important issue in our society because it really impacts all of us and all of our kids and their and our future. I think that traditionally, hearing has been looked at as something that the ear does in isolation, and in fact, the hearing brain is vast. You know, pure tones are completely out of context. When you think about how it is that we use sound every day. So I’m a biologist, and I can tell you that biologically, our hearing brain engages the information that is going from the ear into the brain. And then it is informed by multiple systems, informed by what we know. So our experience really matters. It is informed by what we know, our memory, what we pay attention to, how our emotions, how we feel, how we move. Sound itself is movement. It’s movement of molecules, and we produce it by moving. And we need to also incorporate the information we’re getting from our other senses. So all of that comes together when we hear, when we. Hear a teacher’s voice. We are processing through all of these different channels. The hearing brain is vast. And the good news is that we really have figured out some good ways to assess what we might call auditory processing in ways that can really inform us about is the hearing brain doing its job? What are the strengths? What are the bottlenecks? And I’ve spent my professional career really looking for ways to best assess the hearing brain. And there are many ways that we can do that. And then you mentioned rhythm. That’s a very important component. But I really. Think that biologically to me, what we have that is the best biological tool right now is something that we call the frequency following response, or FFR. And it is as I’m talking to you now, the neurons in your brain that respond to sound are producing electricity. And we can capture that electricity with scalp electrodes. So if I just deliver a speech sound with an earbud into your ear, it will create electricity that then we can measure. And when we measure that electricity, we can, in fact, figure out how good a job the brain is doing processing the many ingredients that are in sound. Sound is complicated. Just like a visual item has many ingredients, it has a shape, size, texture, color. And sound also consists of pitch. Timing, timbre harmonics phase, loudness, so many ingredients and I think in general and Jacque, I think one of the reasons that hearing is under recognized and overlooked for a number of reasons one is that it’s invisible. Sound is invisible and we are living in an increasingly visually biased world and and yet biologically sound really affects us deeply and how we process sound affects how we learn. So a of all, we can measure sound processing in the brain objectively and so I think if it was my child, I would like to know if the reason he’s having difficulty reading is it because he’s having some difficulty with auditory processing. And one of the beauties of this kind of assessment is that. You know, you you can test a newborn. You can test a three year old. It doesn’t require any kind of understanding of doing a task. The child just sits there. He can watch he can watch a video. As we play these sounds and we measure the brain’s response to sound, certainly in 15 minutes or so, we can get a good idea of whether or not, um, this is is a process that is going well or if there are some difficulties that require further investigation. So that that’s the first thing. The second thing is, you know, what can we do? How do we strengthen what I call the sound mind? We can strengthen the sound mind by playing a musical instrument, and singing counts. Making music really strengthens the sound mind. It strengthens the. Hearing brain and importantly, remember I mentioned ingredients? Well, the particular ingredients that are strengthened by making music is the processing of the harmonics and certain timing elements in sound. So the harmonics is in music. It helps us distinguish if you have two instruments, say a tuba and a piano playing the same note, they sound different because the harmonics are different. The harmonics are also what help us distinguish a D from a B and a T. So the distinction of syllables in speech depends on good process processing, accurate processing, strong processing of the harmonics and sound. So a way then of. Strengthening the hearing brain is through music. And we know that the kids who have reading disorders and have language disorders have diminished processing of the harmonics and of certain timing elements. Timing, sound, it’s all about time. And our auditory system is the hearing expert of the brain. We need to know when things stop and start. We need to know we’re listening to a teacher’s voice. We need to be able to process all that rich timing information in order to make sense of what is being said. And so we see that kids with language disorders have deficit with timing and with harmonics, the very things that are strengthened through making music. Yeah, that’s really interesting. So I definitely want to loop in Representative Blancett here, who is with the Oklahoma House of Representatives, which I think that it was so great to have you join us here, because it’s great to talk through. Okay, here’s how we can improve things. Here’s the issue, right? But how do you actually implement these changes? And so talking with you, Jacque, and the work that you’ve done with Representative Lancet in her office, I think is a really critical part of this story to tell as well of how does that change actually occur? So if you’ve identified the shortcomings in the testing ways to improve it alluding to the things that Nina described, then it’s a matter of how do you actually bring this to fruition? Right, Jacque, maybe you can start with how you linked up with Representative Blancett in her office and then just sort of like. How that side of this works, because I think that’s incredibly interesting and you can kick it over to Melodye at any time. Yeah. Policy change is not something that I learned getting my education as an audiologist by any means. Once you know that there’s a problem, how do you make the change and how do you get people, more importantly, to listen to you? It is a very noisy world out there, and everyone’s trying to grab the mic, but I am actually, ironically, a constituent of Representative Blancett. She actually lives, like, a couple streets over and we happen to have a mutual friend. And I just been really, like, I can’t get anyone to listen to me. No one will listen to me. This I can’t believe. So obvious to me why this is going on and no one’s listening to me then. My our friend Denise was like, I need you to meet Meloyde Blancett. She’s your representative. And so she introduced us. And of course, I chewed poor Melodye’s ears off about auditory. Honestly, it took representative Blancett can tell you, it was not something that overnight she went, oh, yeah, I get it I mean, because it’s it’s it’s very difficult hearing and auditory issues. It’s it’s not as easy as putting on your glasses and all of a sudden seeing all the leaves on the trees. It doesn’t work like that. So, representative Blancett, I’ll let you kind of take it from there on because I did chew on your ears quite a bit. Thank you, Jackie. I think first of all, for me, this is certainly not anything that’s been on my radar. Screen, but I always try to listen to my constituents and my constituents concerns. And Jackie, being a constituent and a close friend of a friend of mine, I wanted to better understand what her professional frustrations were and what was driving that and what I could do to help. So I needed to do a better job of digging in once the issue was brought to my attention, which I did, and I became really more understanding about what was going on and what some of the problems were. But at the same time, I also then was what Jackie was coming up against. And that was, one, a lack of understanding within the educational community, and two. Um, the well, as I was mentioning before we started recording, you know, there there is a fatigue in public education today because they’re getting bombarded in terms of funding, in terms of additional unfunded mandates from state legislators. And you look at even at the district level, you’ve got school board really some serious school board challenges that are going on right now. Public education is at the forefront of a lot of political discourse, and so you’ve got, consequently, a lot of fatigue by professionals in the public education system. However, we also know this is where I think the most important thing for me really came into focus, and that. Was I come to this policy position not because I ever wanted to be in public office, because that was absolutely, categorically not the case. I hate politicians and I hate politics, but just the truth. But I come from a private sector background. I also did a small stint as a leadership in a leadership position at the Oklahoma Department of Commerce, trying to recruit businesses to relocate to Oklahoma and to help Oklahoma businesses grow. Well, the key thing in our ability to do that is workforce. And guess what is the workforce pipe line? Our education system. And if we don’t have a very strong, robust education system, we cannot grow jobs. We cannot be Economically successful. Education is the silver bullet that can enable our state to be economically successful so that our folks can get good paying jobs and do so without public assistance. And so you have to look at this as an ecosystem. So with regard to being able to best equip our those to be successful, well, yeah, they have to hear. And so when Jacque was educating me about what some of the challenges were, that, one, we weren’t doing any testing whatsoever, two, that there was really a lack of understanding about the need to test. Three, and if there even was to testing, it really was not being done in a way that would enable successful diagnoses that could. Cause kids to be able to be successful in school. And so I really started becoming just more concerned on the level of Jacque’s. Concern about this is an unmet serious problem. So in the government process, the first thing I jumped to was, well, what can we do to mandate testing? Well, you don’t just jump in with both feet, particularly in a political environment. You got to build consensus. You have to make people wear the problem. They have to understand what the issue is, because I’ve got people pulling on me all day long, and you should see the literature stacks on my desk after even. Of in legislative session by the stream of people that come into your office wanting you to take their cause on as your number one challenge. And so we had to really kind of sit down and devise a longer term strategy to do that. And we started with let’s start educating some people that are key decision makers within the legislative process, because I can’t just walk in as a legislator and say, I want this to be done. I’ve got to have a group of people that, one, understand the problem, and two, believe that it’s priority in order for them to put resources against it, whatever those resources are. Right? And so right now, we’re in the consensus building phase. We. We couldn’t just jump in and just start mandating testing all at once, because the question comes up, do you have the people that are educated enough in the testing process to be able to do it? Do you have the equipment? Is it Calibrated? Who’s going to pay for it? How do we get the local school districts on board, et cetera, et cetera, et cetera. So we had to start a at step one, and that is with educating policymakers about the issue and why it’s important. And that’s really where we are at right now. And we started with an interim study, a legislative interim study that Jacque presented at and Dr. Kraus presented at, and we presented to the Education the Common Education Committee of the Legislature, and they walked away with a much better understanding of the issue. Do. So that was step one. Well, for Christmas for Christmas, they all got the book from that was written by Dr. Kraus of Sound Mind, with a thank you card for me for listening. But even before that, I believe the conversations that happened immediately after interim study was very encouraging because, like Representative Blancett, it was not on their radar at all. Right, now, this next step that we took, and that was really kind of step one, was to establish a body of knowledge and a framework that could be shared. So we presented to the Common Education Committee of the House of Representatives. So then we were able to take that presentation, and then I was able to set. Up a working group meeting with the state Department of Education. And the other critical element of this is our state Department of Health, because it’s not just the Education Department that really has the decision making capability to just say, oh, we’re going to test all the students it asks to be done in conjunction with another state agency, the Department of Health. So we had a working group meeting to then educate them about the issue and the challenge. And so that was really kind of step two. We’ve still got the working group in place right now. Our next step, and we’re still working on this our next step is to get a sample size from a representative number of. Districts so that we can go in and do auditory pathway testing at these representative school districts so we can take that data and go back then to these policymakers both in the legislature and within these state agencies and say, here’s what the research is telling us. And so that’s really where we’re at the place right now. So once we get data and we get facts, we know that we’ll find it. But once we’re able to get that data, we can put it into a compelling analysis format and then really hopefully get some movement on the issue. And I also have a second track that I’m pursuing, but I don’t want to occupy the entirety of the conversation here. No. Well, thank you. I think that was incredibly. Informative of how this actually works, because that, to me, is like where the rubber meets the road is Jacque can talk me to I’m blue in the face about why this is such an important problem, but how do you actually implement real policy change? And so to hear that makes a ton of sense to me. And I want to then transition this either to Jacque or to Nina that what does your suspicion tell you in terms of how pervasive are these auditory pathway disorders that aren’t being caught? Essentially, how much potential is here? If we have an updated methodology of how we’re testing school age children? And I’m sure that’s only just one example of the type of people that can have better testing, if you will. Yeah, I would say that the prevalence is very high and we’re not capturing. A lot of these kids. If you look at the incidence of reading disorders, you’re talking about 8% to 10%. Again, it depends on the constituency. It depends on the neighborhoods. But the numbers are percentages are much greater in neighborhoods of higher need. But but kids have language disorders and attention disorders which, as Jacque mentioned, are often just masquerading as auditory processing disorders. So I think that to the extent that we have difficulty, we have a large population of school age children, children who are not doing well in language themed subjects and in communication. Abilities who are having difficulty in the classroom. I think that we’re really looking at the majority of these kids actually having a fixable problem, actually having something that is just under recognized. And it was funny, it we’re all kind of talking about how we recognized and had our own moments of, AHA, I wrote my book because I wanted this very unrecognized problem of hearing disorders to be better recognized, and when I sent the book off to MIT Press, I thought. Why did I even write this book? This is all so obvious. The number one comment that I have been getting from people from all walks of life is I had no idea. So I do think that a step and it’s just one person at a time. A step is education and totally agree knowledge. So we need people to just become aware. And so a little thing that I did is I’ve written this book. It’s conversationally written for anyone. And we have a website. It’s called Brain Vaults. You can find it easily. And I encourage people to look well, actually a couple of things to look on the home page. And there is a little icon of a bus a tour bus. So take that. Two minute tour and it will help you find what you’re looking for, because there’s a lot on the website. But again, this is our way of imparting information. And the other thing that I want you to get from, if you just look at the homepage of our website, you will see that we study many things. We study education, we study music, we study bilingualism, we study head injury, we study hearing loss, language disorders, autism. You might dyslexia, you might wonder, what are they doing at brain vaults? But in fact, it’s all under this mighty umbrella of sound and the brain. So sound in the brain really touches almost everything we really care about. So for me, it’s. You know, how can I help bringing the biology to bear? Because the other thing that the reaction I got from my editor at MIT Press was he was surprised that 25% of the book is references. So even though I’m speaking conversationally, I’m really speaking to my 30 years of knowledge of the biology, of how we hear and trying to bring that to bear. And we’ve learned a lot. Jacque, you say audiology hasn’t changed in 50 years. Well, certainly our knowledge of the hearing brain has changed massively and we have a lot to draw from. So I to try to help that I’m kind of on this crusade to help. Help us all really appreciate what an important force sound is in our lives because it is so under recognized and educationally. Also, this is a bit of a side point, but we live in a noisy world, but people don’t think about how important it is, um, you know, not to have the the school windows right by a very busy street, if that’s possible, to spend more money on getting a quieter heating system or whatever devices we bring into the classroom. We know what it’s like when the refrigerator shuts off or there’s a truck outside and we didn’t even know it was out there. But then the guy cuts off his ignition and. Ah. You know, so we’re all in this constant state of stress because sound is our alarm sense, and sound also because it alarms us every time we get a notification of one kind or another, someone is unlocking their car outside, we lose focus. Focus is really important for learning. So what are people telling us? Kids are saying, I’m stressed. Kids are saying, I’m having difficulty focusing. We all are. And sound is at the root of this. So it’s my hope that there will be legislature and that really, in terms of public policy there will be public policy to mitigate some of the deleterious effects of noise and important. How to really recognize the auditory processing problems that many, many children have that get in the way of their learning. And Nina, I’d like to take even like everything you said is spot on. But in addition to what you’re saying, we are not only missing those kids, we’re also missing all of the kids. We have screenings in place at birth. Those screenings will miss children with mild hearing loss, children with the cookie bite hearing loss. We know that children from the time they’re born and they start school for a lot of reasons genetics, anatomic, whatever develop hearing loss. We have a golden opportunity to not only find, to catch, and to red flag these kids. Hey, these kids may be risk for reading. We could also find the kids that we missed. in the beginning because those screening, those screeners are not designed to pick up a mild hearing loss. They’re set at 35 dB. So we can say there’s one to two children born with hearing loss per thousand, but I would argue there’s more because we’re missing them. So not only are we looking at what I consider to be a huge problem if it happened to me, and I’m an audiologist you don’t know what you don’t know. And I, fortunately didn’t discover and really get interested until I thought my equipment was broken and it happened to be. My son’s auditory pathway was broken. Um, but we have the opportunity to change the trajectory of so many children’s lives. It has to. Policy. It has to be because what I’m seeing, even the children that have to have screenings done because they’re on an IEP, they’re getting screened from on equipment that hasn’t been calibrated six, seven, eight years. It’s not even a valid test. So we’ve got to put focus, just as we do with eyesight. You got to have your eyes to read, but reading is more of an auditory skill. You need your ears, too. So I think the numbers are going to be astronomical. Myself, I want to mention just one little thing about because people don’t think that reading involves our hearing, right? In the same way as we learn to speak first, and then we learn to write, and we need to be able to. Have this sensitivity to sound and to make sound to meaning connections in our lives in order then to make the sound to meaning connection between a sound and a symbol on a page. So, in fact, Jackie, is a very good point that people think, oh, well, reading involves your vision. Well, it involves your hearing brain, which also involves your vision. And the hearing system is often overlooked for language disorders. The thing that’s going through my head throughout this conversation is that to your point, Nina, that you said earlier, a giant critical step here is education. And I look at rep Blancett as being the epitome of this, where I think that as you sort of illustrate the problem beyond just what maybe the status quo. Perception is that it’s just simply a hearing test, turning up the dials kind of thing. And as you understand that this is something so much bigger, in a way, you have to sell it and you have to paint the picture of why this is so important. I loved what Melody said, where if you think about it from her perspective of why this is so critical and all of the things that she’s considering about the future workforce and how important this is from a policy, standpoint, and from a political standpoint, I think that’s just critical for the hearing healthcare industry to really understand, which is this is maybe like you said, nina, why did I write this book? This is common knowledge. I mean, it really isn’t. And I think that’s a giant part of the mission here is to figure out how do we as an industry really help to frame this as being something that’s so much more important. Because, to your point. It impacts reading scores. It impacts these things that on the surface aren’t super obvious. And I think that, as you can tell that story, that’s how you can catch the policymakers attention to make changes at the policy level. So I just found this to be Jacque and Nina. You did a really good job of kind of like, painting the picture here. And that’s what’s going through my head, is it seems that the thing that’s really sorely lacking is that there doesn’t seem to be widespread awareness of the depth of the problem, because I think many people do look at it at that very surface level. You get your eyes tested, you get your hearing tested. Not fully taking into account the brain auditory relationship here, that is really what could be being. Tested on is that auditory pathway brain connection as well. So that’s my third person or third party perspective. Here is how I see this as one of the roots of the problem. Let me jump in here, too, Dave. I’m going to give an example of another issue that I think I as a policymaker have recently been educated on and we all have been hearing, at least on the policy side, the impacts of ACEs or adverse childhood experiences. In Oklahoma, we have a significant school population of children with high Ace scores and have been educated on the critical importance of the impact of high Ace scores in a child’s ability to learn. And thrive growing up. And so this reminds me this issue of auditory Pathway disorders reminds me a lot of the education process that has gone on in the policy and education community about the significant negative impacts of adverse childhood experiences. And what we need to do is really very similar to what has been done with regard to educating people on the impact of adverse childhood experiences or aces on a child’s ability to thrive and be successful in a school environment. I’m so glad you said that, because also, I mean, you know, the perspective that I’m advocating for is a holistic one, right? So that the heat. Brain really does involve so much of the experiences that we have for better and for worse. And one of the areas is memory. And memory is tremendously important for learning. And I think that people often fail to realize how tightly our hearing and memory are linked. And so developing good auditory skills or not having them has a direct influence on one’s ability to learn and to remember. We know that even at the end of life when someone has has dementia, they will still remember the songs of their childhood because that’s just from an evolutionary standpoint. Sound. Organisms had to remember that sound. Is that a sound that is associated with danger or can I mate with it? From an evolutionary perspective, sound and memory are really, really late. So it’s a vast issue that really acts our health and our ability to learn from early on throughout our lives. Yes. And I will add that with regard to the education process that we as policymakers have gone through in our understanding of adverse childhood experiences, you can follow the steps that were taken to educate policymakers and then to take action on that. And one you’ve got. Research. And so what we’re trying to do on auditory pathway disorders is, as I mentioned earlier, is to get research in place. And we’re working on trying to get a research partner right now so that we can go into a select number of schools and get some data that shows us the degree of the problem and what we’re dealing with. Once we get the data, we can use that for variety of things. Parallel to this process is a step that I’m taking right now. I just passed off the House floor last week. It’s now lobbed over to the Senate side legislation. It’s House bill 2827, and it is a grant program that I’m advocating putting state dollars. I’m hoping for about $10 million. We’ll see if I’m able to get that about $10 million into a grant program. That program. Would fund school nurses, it would fund counselors of a variety of types of counselors, and it would also fund mental health professionals to be out, third party mental health professionals to be hired. But what we’re also looking at, adding in terms of an amendment to the bill on the Senate side, is educational, include educational audiologists. And one of the things and in our conversations that we have learned is one, there is a critical shortage of school nurses in schools. And guess who used to do the hearing testing? School nurses. Well, we don’t have school nurses anymore. They’ve almost been completely removed from the school environment. And we certainly do not have educational audiology. I think we’ve got one. Jacque at the state level, isn’t that correct? So we have one audiologist for the entire state. And so we’ve got to get the money at least in a grant program that can show proof of concept. So that’s step two. In addition to the research, then we’ve got a grant program. And on top of that, what we’re going to do is use that money that gets put into this grant program so we can go back to the federal government and get matching Medicaid dollars, because Medicaid dollars at the federal level will pay for school nurses. They will pay for educational audiologists if we can prove that there’s a significant health challenge that we’re trying to deal with. And then three, the next step that we’ve got to take is we’ve got to get in front of other key opinion leaders, nonprofits that are out there. That are focused on early childhood education. They’re going to care about this issue once they have a better understanding about what it is. And then two, we need to get in front of possible funders, large scale funders that can support dollars donated for training and for professionals. So we’ve got a lot of steps in front of us, but we’ve outlined a plan and that really kind of focuses on what everyone out there can do to help move this issue forward in their own state. That is fantastic. I am so proud that Representative Blancett is my representative. I’m jealous. Right. It’s a across the country, we need people acholders who can follow her lead. Because I’ll be real honest. I’m just going along. I do what she tells me. What do you need? What do you want? So, yeah, it’s been pretty amazing, actually, to have her charge ahead. Well, I think it’s great to hear what a course of action might look like. This could potentially be a blueprint. I think you’ve really outlined some of the major challenges associated with this from the school nurse shortages. Public schools just in general are obviously they’re very resource strapped right now. And then you factor in there’s one educational audiologist for the entire state of Oklahoma. These are challenges, so I think it’s a matter of figuring out how to work through that. But you seem to at least be moving the ball forward, which is really encouraging to hear, because I think we need validation that there is merit to what you’re saying, which I think Jacque and nina Feel very strongly about this. This is Nina’s life work. There’s obviously a lot to this whole idea, but to see some real data I think will be really validating to this whole idea of and, Dave, it has been nothing short of herding cats. Right, Melody? Yes, and but, you know but that’s policy. I’m telling you, that’s my work every day. I know. So glad it’s you. Every day hurt someone, I think. Well, there are times when you want to, but then there’s thank heavens, the weekends. Amen. Amen. Well, on that note, I just want to say thank you to you three. I know that it’s hard to find a time for all of us to get together and do something like this, but this has been incredibly enlightening for me to hear. Sort of Your own words, Jacque, of what you think. The issue at hand here is having Nina here to really walk through the science behind how we can improve this. And then, of course, having Representative Blancett to outline how a policy change like this actually comes to be, because that, for me, is really important to hear. And I hope there are other people from around the country that want to join forces here and see this thing become something that there is real momentum behind. So that’s all I got. Any closing thoughts from any of you? Well, our kids are worth it at the end of the day. And I will reiterate that if we aren’t successful in tackling this problem, we’re not not going to have the kind of successful workforce that we all want and need in order for our citizens to be best. Prepared to be successful on their own. And this seems to me to be a relatively easily identifiable fix in the toolbox of how we address what our kids need. And I would like to say in the words of someone who I love very much and was a very influential mentor in my life, dr. Chuck Berlin, who would always say we need more literate taxpayers. Well said. Well, thank you three so much for coming on today. Thanks for everybody who tuned in here to the end. And we will chat with you next time