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Winter 2005 Table of Contents
Versión Español de este artículo (Spanish Version)

Supporting High Quality Interactions with Students Who are Deafblind
Part Two: Research to Practice

By Craig Axelrod, Teacher Trainer, TSBVI, Texas Deafblind Outreach

Abstract: Educators can have more positive, responsive and reciprocal interactions with their students who are deafblind by learning how to modify their own interactive behaviors and adapt the interactive context. High quality interactions contribute to improved educational outcomes for students with deafblindness.

Key Words: programming, deafblindness, Jan van Dijk, research-based, interaction, behavior, communication, educator-oriented intervention, instructional strategies, video analysis

Part One of this article, which first appeared in the Fall 2004 edition of SEE/HEAR, summarizes research-based conclusions about the importance of high quality interactions with students who are deafblind. From that research, and other resources, Kim Conlin, Tish Smith (communication specialists at TSBVI) and I designed a two-day training for TSBVI educational staff. In Part Two, this educator-oriented training process is described. When it was originally published, in the Winter 2005 edition of SEE/HEAR, four trainings had been facilitated, with four participants in each training. At the time of this revision (February, 2008), seven trainings have been facilitated at TSBVI, and regional trainings in two other Texas cities have also been held.

The Interaction Training Process at TSBVI

When determining who will be invited to participate in interaction training, we consider interested staff who are teaching students with deafblindness and understand the basics of good programming, such as structuring a routine and using a calendar system. They have interactive challenges with their students that we want to address. Staff may also be teaching newer students we want to better understand. The students represent a variety of abilities and needs.

Introduction to the training model

The educator-oriented learning goals of interaction training are to:

Several weeks before interaction training, participants are asked to notice and think about the interactions they have with their students, then bring those observations and questions to the first day of training. As the training progresses, and more is understood about the unique characteristics of deafblind children, interactions with deafblind children in general, and with their students in particular, concerns, goals and possible intervention strategies for improving the quality of those interactions become more refined and specific.

On the first morning of training, after introductions and clarification of the learning goals, information is presented about interaction problems and possibilities of students who are deafblind (as described in Part One). To help exemplify these ideas, participants view and discuss the videotaped interactions between a student and three adults. The three interactions are clearly very different, and the student's abilities also seem to differ. An Interaction Data form is introduced as a tool to help graphically represent those differences.

Interaction data

The Interaction Data form codes these components of an interaction:

Interaction Data form

Interaction Data form (75k) MS Word Document


Interaction Data
Student's Name: Date:
Adult's Name: Topic:

Interactive Turns:

A - Student Initiates; B - Student Responds; C - Student Acts Independently / NR; D - Adult Initiates; E - Adult Responds; F - Adult Acts Independently / NR

Interactive Behaviors:

1 - Initiatives; 2 - Confirmation; 3 - Answers; 4 - Turn Taking; 5 - Turn Giving; 6 - Attention; 7 - Regulating Intensity; 8 - Affective Involvement

Connect "related" consecutive turns with arrows

Description Of Turns

             

Interactive Turns

             

Adult's Interactive Behaviors

             

Student's Interactive Behaviors

             

B is 19 years old and has microcephaly secondary to an encephalocele (a congenital protrusion of the brain through a cranial fissure). He's legally blind with a cortical visual impairment, is suspected of having a hearing loss, and has multiple disabilities that include mental retardation and cerebral palsy.

Coded video fragments from B's three interactions are analyzed, to identify and compare components of the interactions that reflect their different characteristics and result in his varying degrees of interactive competence. This activity also familiarizes participants with the Interaction Data form. Later in the training, they will use the form to code and analyze video fragments of their own interactions.


Interaction Data
Student's Name: B Date: 5/02
Adult's Name: Teacher Topic: Physical Therapy - Therapy Ball

Interactive Turns:

A - Student Initiates; B - Student Responds; C - Student Acts Independently / NR; D - Adult Initiates; E - Adult Responds; F- Adult Acts Independently / NR

Interactive Behaviors:

1 - Initiatives; 2 - Confirmation; 3 - Answers; 4 - Turn Taking; 5 - Turn Giving; 6 - Attention; 7 - Regulating Intensity; 8 - Affective Involvement

Connect "related" consecutive turns with arrows

Description of Turns Teacher unbuckles seatbelt   Teacher takes towel   Teacher says "Let's get out of the chair," etc.   Teacher stretches B's arm   Teacher says "There you go."   Teacher stretches B's fingers   Teacher picks up B to reposition

Interactive Turns

F

 

F

 

D

 
F
 
D
 
F
 
F

Adult's interactive Behaviors

------

 

-------

 
1
 
------
 

2

 
------
 
------

Student's interactive Behaviors

                         

B and the teacher - stretching on the therapy ball: The teacher talks to B twice in this fragment, but acts independently during the other turns. He prepares to move B, positions him on the therapy ball and stretches parts of his body with no interactive behaviors, no expectation for B to take a turn and no connected turns.


Interaction Data
Student's Name: B Date: 5/02
Adult's Name: Aide Topic: Eating

Interactive Turns:

A - Student Initiates; B - Student Responds; C - Student Acts Independently / NR; D - Adult Initiates; E - Adult Responds; F- Adult Acts Independently / NR

Interactive Behaviors:

1 - Initiatives; 2 - Confirmation; 3 - Answers; 4 - Turn Taking; 5 - Turn Giving; 6 - Attention; 7 - Regulating Intensity; 8 - Affective Involvement

Connect "related" consecutive turns with arrows

Description Of Turns Aide waits, then offers spoon   B takes a bite   Aide wipes B's mouth   B chews and swallows   Aide offers spoon   B refuses bite   Aide puts down spoon and gets milk cup

Interactive Turns

D
related to next cell to the right
B
 
F
 
C
 
D
related to next cell to the right
B
related to next cell to the right
E

Adult's Interactive Behaviors

1, 4, 6, 7
     
------
     
1, 4, 6, 7
 
 
2, 4, 6

Student's Interactive Behaviors

   
3, 4, 6
     
-------
     
3, 4, 6
   

B and the teacher aide - eating lunch: The aide is attentive to B, and waits until he's ready before offering a bite of food. B responds once by accepting the spoon (answering "Yes") and once by rejecting it (answering "No"). When he refuses the food, she confirms his response by putting down the spoon and getting the milk cup. Turns in both of these sequences are connected. She acts independently by wiping his mouth. There is no observed enjoyment (affective involvement) of the interaction.


Interaction Data
Student's Name: B Date: 5/02
Adult's Name: Visitor Topic: Conversation

Interactive Turns:

A - Student Initiates; B - Student Responds; C - Student Acts Independently / NR; D - Adult Initiates; E - Adult Responds; F- Adult Acts Independently / NR

Interactive Behaviors:

1 - Initiatives; 2 - Confirmation; 3 - Answers; 4 - Turn Taking; 5 - Turn Giving; 6 - Attention; 7 - Regulating Intensity; 8 - Affective Involvement

Connect "related" consecutive turns with arrows

Description Of Turns B vocalizes   Visitor says "What?"   B extends finger in lap   Visitor says "There goes that finger to the nose."   Visitor extends and lifts finger to nose, says "Hey…"   B lifts finger to nose   Visitor lifts finger to nose and says "Hey…"

Interactive Turns

A
related to next cell to the right
E
related to next cell to the right
B
related to next cell to the right
E
related to next cell to the right
E
related to next cell to the right
B
related to next cell to the right
E

Adult's Interactive Behaviors

 
2, 5, 6
 
 
2, 4, 6, 8
 
1, 2, 4, 6, 8
 
 
2, 4, 6, 8

Student's Interactive Behaviors

1, 4, 6
     
1, 4, 6
         
4, 6, 8
   

B and a visitor - having a conversation: B initiates the interaction by vocalizing. The visitor responds by asking "What," which confirms B's initiative and gives him a turn. B introduces a new initiative by extending the index finger of a hand in his lap (preparing to touch it to his nose). The visitor takes a turn, and confirms B's initiative, by saying "There goes that finger to the nose." He also shows affective involvement with facial expressions and tone of voice. The visitor then expands on B's initiative by extending his own index finger, positioning it under B's other hand, raising B's hand and saying "Hey" each time he (the visitor) touches it to his own nose. His affective involvement continues. B responds by lifting his finger, touching it to his nose, and smiling. The visitor takes a turn, and confirms B's actions, by laughing, saying "Hey" and touching his own nose again. B and the visitor are attentive and responsive to each other throughout the interaction. All turns are connected.

General Profile

Prior to training, participants develop General Profiles of their students, by compiling information about them that may impact the quality of their interactions. This includes:
  1. Medical/Sensory Information:
  2. A "Communication Assessment [based on the communication model developed at TSBVI for nonsymbolic and early symbolic students with visual and multiple impairments, including deafblindness]:

    The Communication Assessment often includes a description of the student's calendar system, which, among its many benefits, plays "an important role in supporting and expanding students' communication." (Blaha, 2001, p. 10).

  3. Present Levels of Educational Performance, especially in the areas of:
  4. Instructional Modifications: Examples include fine task analysis of activities, highly structured routines and learning environment, special materials to structure activities, extended time for processing, increased response time, concrete symbols, tactile symbols and special communication systems.
  5. Appetites/Aversions (Likes/Dislikes): "One sheet is completed for each student. Over a period of time, through observation and listening to stories from others, a list is developed of things the student likes and doesn't like. We all enjoy things that we are good at and that we understand. A student's 'Likes' will be areas of strength and indicate sensory channels that are working. 'Dislikes' will be areas of weakness and indicate sensory channels that may not be working efficiently. The information gathered on this form will suggest underlying themes that can be used for modifications, teaching strategies, topics of communication, and activities. (van Dijk, 1985)." (Blaha, 1996, p. 20).

After the video fragments of B's three interactions are analyzed, participants review their students' General Profiles and summarize them to the group.

Video analysis

Within a few weeks of training, a baseline videotape is made of each participant/student pair engaged in an interaction. (Participants are taped interacting with the same students on the second day of training.) When determining what to videotape, participants are asked to consider these criteria:

After the General Profile summaries are shared, each baseline video is reviewed in its entirety, to provide an overall sense of the activity, and to identify general participant and student interactive strengths and challenges. A brief fragment from each video highlighting these qualities is selected for coding and analysis. The fragment is coded on the Interaction Data form, then analyzed to identify aspects of the interaction that are successful and those that may be contributing to interactive problems. Based on this analysis, participants discuss ways their interactions might be improved, by changing their own interactive behaviors, and by adapting the interactive context. Changes in student behavior that might indicate improved interactions are also identified. For example:

On the second day of training, participants are videotaped with their students, as they incorporate new intervention strategies into the same activities that were taped for the baseline. Videos of these interactions are then reviewed, representative fragments are coded and analyzed, and strategies are further refined for future implementation.

At the end of the second day, to conclude interaction training, participants discuss what they've learned. They also describe how they will apply the principles of interaction training, in other situations with the same students and with their other students.

What we learned: 4 case studies

Matt and J

J is 13 years old and deafblind due to prematurity. He is totally blind and has a severe to profound hearing loss, bilaterally (moderate when amplified).

J expresses interest and affection for his primary caregivers by smiling, laughing or hugging. He initiates familiar interaction routines when an adult is nearby. He maintains preferred, turn taking interactions for a long time. In stressful situations, these people can calm him with deep pressure hugs, redirection to a preferred activity, or by reviewing his schedule and giving him more time to process information.

J knows 125 receptive signs, and uses more than 60 expressive signs to request activities, interactions, assistance, and information about the day. These signs are often inexact, but recognized by familiar people. He'll place his hands in the adult's hands, sign "now" to ask about what's happening next, and sign "then" to ask about the day's sequence of activities. He is beginning to comment about past and future events. J recognizes at least 50 tactile symbols that represent activities on his calendar, identify possessions and activity areas, etc. He also uses them to choose between people, food and leisure activities.

J has a daily calendar, with an expansion strip that gives additional information about the "who," "what" and "where" of each activity, and a weekly calendar with a highlighted activity scheduled on each day. It's important to review J's daily schedule with him throughout the day, especially in the morning. J anticipates and completes "next steps" in familiar routines.

J's favorite topics are movement, food, sounds or music, and activities that incorporate these interests. He enjoys knowing what his peers are doing, attends to their actions if they're close and, with support, will pass them materials in structured routines.

J may express frustration about changes in the schedule by refusing conversation, banging his head or crying. He often calms after multiple reviews of the new schedule, along with additional support and reduced demands.

Matt's goal was for J to communicate more spontaneously during his daily calendar discussions. The coded baseline video fragment indicated that Matt had nice interactive behaviors, such as confirmation, turn giving, attention and affective involvement, but he initiated most turn sequences and J primarily responded (D to B). Matt decided to be more responsive to J's initiations (A to E) and initiatives. It was thought that J might initiate more if he was encouraged to get his tactile symbols from the storage bag in the order they interested him, rather than prompted to get them from the slantboard behind his calendar in the order they occurred. After a conversation about each activity, he'd put its symbol on the slantboard. When all of the activities had been discussed, the symbols would be brought from the slantboard and scheduled left to right on J's daily calendar.

These are the strategies Matt introduced in the second taping:

When Matt first implemented these strategies, the new expectations seemed to confuse J a little, but he did initiate more, especially when Matt gave him turns by waiting, signing "Now" or showing him the bag of calendar symbols. J also had more initiatives on topics, and Matt was more responsive to those initiatives. J wasn't always sure what to do with the symbols he selected. The strategy of putting them on the slantboard before they were scheduled on his calendar was confusing, and needed to be further modified. Nevertheless, J continued to initiate and make initiatives on topics that interested him, sometimes with Matt's hands!

After the training, Matt replaced the slantboard with a carpeted tray that is positioned on his lap, between him and Jarvis (adapting the interactive context). He also changed the "Now" sign to an open handed "What?" gesture (turn giving), as encouragement for J to add something new to the current topic (initiative). Using a third person to model initiations and initiatives was awkward, and discontinued.

These new strategies have resulted in even more initiations and initiatives from J. Now he shakes all of his daily symbols onto the tray, and hands Matt symbols in the order they interest him. Matt responds by identifying, labeling and commenting about each activity, and helping J schedule the symbols on his daily calendar. He also gives J turns to make new initiatives on a topic. When all of the symbols have been discussed and scheduled, Matt and J preview the entire calendar sequence.

Laura and L

L is 21 years old and has CHARGE Syndrome. He recently lost all of his vision, and has a profound bilateral hearing loss. L also has a history of perseverative, aggressive, destructive and mildly self-injurious behaviors, which are being treated with medication.

L enjoys interactions, forms bonds with adults and peers, and asks about them when they're not present. He expresses affection toward preferred people and encourages them to communicate with him. Before becoming totally blind, L initiated interactions by sight. He's now learning to get people's attention by tapping their arms or raising his hand, but interactions are usually initiated by others.

L has many topics of conversation, and an expressive vocabulary of approximately 200 signs, which he typically combines in 2-3 word phrases. He initiates conversation, in structured and unstructured situations, to request objects, activities, assistance and people, and to make comments. L also requests information about things that have happened in the past and will (or might) occur in the future.

L participates well in structured routines, has preferences and makes clear choices. L has a daily calendar with the sequence of his daily activities and a monthly calendar for scheduling important events, such as which weekends he's going home or staying on the dorm, when he's going grocery shopping or to a restaurant, etc. Before losing his vision, L used standardized pictures, drawings, photos and some sight words with his calendar, for cooking recipes and other sequences, to label storage areas, etc. Calendar activities are now represented by object symbols and some alternate objects. Tactile symbols are gradually being introduced at the calendar and in a few other situations.

L is able to move about in his classroom without assistance, and has learned to travel many familiar routes independently. He's learning an organizational system for his calendar symbols and other symbols.

Laura's goal was to have a more "connected" interaction with L during his footbath routine, which she knew he enjoyed. In the past, L had often introduced conversational topics unrelated to the activity at hand. After losing his vision, he was constantly asking questions about current and former classmates (what they would be doing in 100 days, whether they were flying home that weekend or riding the bus, etc.). This also occurred during his footbath.

The baseline videotape reflected a chaotic conversation, with Laura and L both initiating on different topics. (Laura communicated about the footbath while L asked about other students.) Only two or three turns were taken on the same topic. One person would initiate, the other would respond then initiate about something else (D to B to A to E to D to B to A to E, etc.).

Laura wanted to increase the number of L's initiations around mutually interesting and less repetitive topics. She also wanted them both to have more turns (initiatives, turn taking, turn giving) around those topics. This would be represented on the coding with more turns connected by arrows, indicating that Laura and L were taking multiple turns on the same topic.

Laura's strategies were to:

L smiled and enjoyed himself (affective involvement) during the second videotaped interaction. He and Laura took several turns around the same topic (more arrows!), and she was more responsive (confirmation, attention, affective involvement) to his initiations and initiatives.

Introducing novelty to a topic helps L pay attention to it. Setting up the environment to give tactile procedural information, such as storing materials in consistent places and labeling storage areas (adapting the interactive context), reduces the need to tell him what to do, where to go, etc. He and Laura can then put more emphasis (attention) on mutual enjoyment (affective involvement) of the interaction. Laura will also begin using objects and parts of objects to support L's expanded conversation about other interesting topics (parties, changes in the schedule, etc.), introduce more tactile symbols in the environment, and add tactile symbols of people to his daily calendar.

Hank and S

S was born prematurely and is 9 years old. He has light perception in one eye and a moderate to severe hearing loss. He drinks Pediasure from a bottle and does not eat solid foods.

S will initiate interactions when a partner is near, but most interactions are initiated by others. He recognizes familiar people and initiates interaction games specific to each of them. He encourages (requests) interactions with others by smiling, laughing, signaling, repeating their words, taking and giving turns, saying "Thank you," and giving hugs. He can maintain interactions for up to 10 minutes on topics that incorporate music or movement, and will interact around topics with other sensory aspects (such as inflating and deflating balloons to feel the air, and imitating the sounds they make) for shorter periods of time. Some topics (for example, food and oral stimulation) appear to trigger strong negative reactions that disrupt interaction. He discourages (rejects) these interactions by gently pushing away people or objects. S is drawn to the sensory experience of touching Hank's hair with his palms and face. If those behaviors last longer than 5 seconds, they seem to cause sensory overload, which results in S hitting Hank and biting himself on the arm.

When S does not feel in control, he tries to end an interaction by saying "Finished," or turning away from the activity. He is often less focused and more nervous in new environments or with novel materials. Information is taught within routines, which increases S's sense of security and ability to focus. Novelty is infused into familiar routines to broaden his understanding of concepts and vocabulary. A divided choice board is used to present options within routines.

S understands numerous phrases spoken consistently in his routines and a few signs produced without speech. He can process signs and speech simultaneously. S expressively signals with his body and voice, hand guides adults, gives them objects, and is beginning to request leisure activities with tactile symbols during structured choice times. These symbols are stored in an accessible place so he'll be able to initiate requests. He uses mitigated echolalia (repeating phrases previously heard in appropriate contexts for communicative purpose), and often repeats an adult's spoken words immediately after hearing them.

S's morning or afternoon activities are represented by tactile symbols in a 5-compartment calendar box. Expansion strips are used to pair two tactile symbols in each compartment, introducing the concept that familiar words can be combined in novel ways. Touch prompts remind him to scan left to right. Materials in S's routines are also sequenced in a calendar box, to provide additional structure and give him practice scanning left to right.

Hank was comfortable following S's lead during preferred interactions, such as playing with a balloon. He chose to analyze S's grooming routine because he wanted experience implementing intervention strategies during more outcome-oriented routines. Hank's goals were to feel calm during his interactions with S, be less directing, and follow S's lead more often.

After reviewing the baseline videotape, Hank identified these strategies:

During the second interaction, Hank felt calmer, the pace was slower, and the routine was more conversational. He commented and paused more, S had more initiatives, and he was more responsive to those initiatives. Simple, familiar labels spoken in a rhythmic manner ("jaw, jaw, jaw," "chin, chin, chin," "lip, lip, lip") helped S stay organized, focused (attention) and calm (regulation of intensity of the interaction). Hank's sound effects and funny voices also kept S engaged (affective involvement). When Hank modeled toothbrushing, he was able to redirect S from his hair to his face before S became overstimulated (regulation of intensity of the interaction). While deep pressure to S's arms seemed to help calm and organize him, he showed signs of being overwhelmed by the lotion. Hank got a lot of information about how S was feeling by watching his hands (attention). This helped him fine tune his responses.

Hank will keep interactive turns short in situations where S might become overstimulated, and be sensitive to what his hands are "saying" during interactions (attention, regulation of intensity of the interaction). He'll incorporate rhythmic, turn taking vocal games into interactions, to help S stay engaged, focused, organized and calm (attention, regulation of intensity of the interaction, affective involvement). He will continue to give S deep pressure, but no longer use lotion, and ask the OT for additional calming and focusing strategies. Hank will also continue inviting S to introduce initiatives, by commenting then pausing.

Sara and N

N is 9 years old. She had a corpus callosotomy (surgical severing of the corpus callosum, the large fiber bundle that connects the two sides of the brain) at 4 years of age, to control seizure activity that began at 4 months. She has a cortical visual impairment and a suspected mild to moderate hearing loss. Without amplification (which she does not tolerate wearing), "She will at least be able to detect speech at a normal conversational level."

N bonds quickly with her primary caregivers. These relationships are reinforced through resonance-level turn taking interaction routines, in which frequent pauses allow her to signal for continuation of the interaction. N is affectionate with familiar people, seeks them out and allows them to calm her when she becomes upset. Vibration, deep pressure touch and vestibular stimulation help calm N and enable her to attend. N will explore unfamiliar experiences with the people she trusts. Unexpected touching and guiding through movement may overstimulate her.

N receptively understands some object symbols, natural gestures and points. She will move toward, touch, or physically guide people to desired objects, actions and locations. An object symbol placed in a single compartment calendar basket helps N anticipate the "next" activity in her day. She demonstrates recognition of those symbols by performing appropriate actions on the objects or moving toward the correct activity areas. The symbol is placed in a "finished" basket to conclude the activity. N shows a general awareness of the time of day by, for example, going to the breakfast table after arriving at school in the morning, and getting her jacket in the afternoon as she anticipates going home. She recognizes her classroom, calendar area, seat at the table and possessions.

A 3-step sequence box is used in some routines, such as breakfast, to help N anticipate the sequences of steps and to establish clear beginnings and endings. With other routines (for example, hygiene) she chooses the order of steps in the sequence. In general, N is more willing to participate in activities that have become familiar, when high demand activities are followed by those with low demand, and if she is allowed to observe and join in without being forced, then retreat and process the input. She is less distracted in learning environments where visual and auditory clutter is reduced.

Sara's goals were to increase the length, and improve the quality, of her interactions with N during functional routines. She selected a hygiene routine to analyze.

After studying the baseline video, Sara decided to:

During the second interaction, Sara was more responsive to N's topics (confirmation, positive answers, turn taking, turn giving, attention, affective involvement), and less focused on completing the routine. When N needed to take a break and process information, Sara let her do this. By allowing these pauses, and providing calming proprioceptive and vestibular input at other times, Sara helped N manage her own biobehavioral state (attention, regulating the intensity of the interaction). The interaction lasted longer, and N stayed in the activity area. There were also more arrows between turns, indicating longer periods of connectedness within the activity, and the turns were often on N's topics (C to E to B to E, etc., or A to E to B to E, etc.). When N signaled a request (initiatives, turn taking), Sara responded (turn taking, positive answers), then gave N another turn (turn giving). During toothbrushing, N let Sara touch the toothbrush (turn giving), which she usually doesn't allow, and was attentive (attention) to Sara's imitation (confirmation, positive answers) of her actions. N and Sara both enjoyed this interaction (affective involvement).

The most effective way to support an interaction on N's topic is to pause (turn giving), observe (attention) her independent or interactive behavior, imitate that action (confirmation, positive answers, turn taking), then pause again (turn giving) so she can take another turn. This verifies to N that her initiative has been acknowledged and approved.

Since the training, N has begun initiating and maintaining interactions from further away (indicating that she seems to be moving into a coactive phase of interaction), and attending for longer periods of time, sometimes for as many as 10 turns. The hygiene routine now goes on for quite a while, and sometimes must end before N is ready, so she can participate in other scheduled activities. When N is allowed to initiate interactions on topics of her choice, even within functional routines, and the adult responds positively to those topics, she more willingly participates on the adult's topics at other times.

Enduring effects

In a recent study, Dr. Marleen Janssen and her colleagues found "…that it is possible to improve the interactive competence of deafblind children by teaching their educators to respond more adequately to the children's signals and to adapt the interactional context." (Janssen, Riksen-Walraven & van Dijk, 2004, p. 88). They also concluded that "…the positive effects of the intervention were retained for two children and diminished but nevertheless remained well above the baseline level for two other children." (Janssen, et al., 2004, p. 89). In addition, these positive effects endured even after staff changes were made following the intervention. This was attributed to training provided by previous staff to new staff, and consisted of "…two components: a) the new staff member observes an educator working with a child and is given information by the educator; b) the new staff member is later coached by the educator while working with a child. While not instructed to do so, the current staff apparently transferred the principles of the intervention to the new staff members via either explicit teaching or having the new staff observe their improved interactions with the deafblind children." (Janssen, et al., 2004, p. 89-90).

At TSBVI, continuity in the implementation of student-specific intervention strategies is maintained with videotapes and written summaries from interaction training, ARD documentation that incorporates information learned during the training (communication assessment recommendations, IEP objectives, instructional modifications, etc.), end-of-the-year videotapes, instructional support staff who provide services to the same students for multiple years (especially communication and behavior specialists), and previous classroom staff, who may be teaching other students on campus but are available to assist new team members. Continuity is also provided by past interaction training participants, who have generalized their understanding and application of interaction principles and intervention strategies.

Participant feedback

"These intensive trainings are extremely useful. Observing and analyzing oneself on video is so important. It always amazes me to see things that I'm not even aware of doing, or not doing. It is also useful to get feedback from a variety of people. Everyone has an opinion about how to make an activity better."

"I was shown how to effectively communicate with my student, as well as how to increase his participation during activities. I liked being able to discuss my student with the other participants, share instructional challenges and frustrations, and brainstorm together. Through our discussions, and the information that was provided, new solutions and strategies were discovered."

"I'll carry away valuable information that will help enhance the quality of my interactions with my students. Being aware of your own interactions, consciously thinking about them, can help improve them."

"I will be more aware of possible initiations by my students, and remember the importance of having both physical and emotional presence during activities. The coding helped me break down interactions, and showed how even a student's most seemingly insignificant gesture may be an attempt at communication."

"I received a lot of helpful information about what a good interaction should look like and feel like; giving and taking turns, etc. I will introduce more novel routines, and label the environment so I can be there to comment, instead of always being the one to provide information. The before and after videos with my student showed me that positive interaction is possible, and that we can both enjoy the activity."

"I will be more aware of my interactions with my students, and mindful about allowing maximum opportunities for student initiation. I really appreciated and valued the opportunity to evaluate my performance, to set goals and to see them being achieved. It helped respark my enthusiasm to try new ideas and see how they benefit my students. It also encouraged me to focus on the positive aspects of my teaching. Sometimes it's easy to see only the negative."

Conclusion

We hope this information has motivated you to take a closer look at your own interactions. Learn more about the unique characteristics that impact your deafblind student's ability to interact. Analyze your interactions. Recognize and celebrate the qualities that are successful, and identify specific ways to improve the interactions, by changing your interactive behaviors and by adapting the interactive context. Remember, you make the difference.

Further Information

This two-part article describes an educator-oriented training process developed at TSBVI, based on current research about supporting high quality interactions between educators and their students with deafblindness. A written format, however, has its limitations. As Dr. van Dijk suggested, "Let the videoclips do the talking." With his suggestion in mind, an interactive DVD is in production, and will soon be available through TSBVI's Curriculum/Publications Department. The DVD will introduce users to the interaction training process and include:

Students in the video examples represent a range of ages, etiologies, degrees of vision and hearing loss, additional disabilities, and educational strengths and needs.

References

Blaha, R. (2001). Calendars for students with multiple impairments including deafblindness. Austin: Texas School for the Blind and Visually Impaired.

Blaha, R. (1996). Thoughts on the Assessment of the Student with the Most Profound Disabilities. SEE/HEAR Newsletter, Fall 1996, Vol. 1, (#4), 13-21.

Hagood, L. (1997). Communication: A guide for teaching students with visual and multiple impairments. Austin: Texas School for the Blind and Visually Impaired.

Janssen, M.J., Riksen-Walraven, J.M., & van Dijk, J.P.M. (2004). Enhancing the interactive competence of deafblind children: Do intervention effects endure? Journal of Developmental and Physical Disabilities, 16, 73-94.


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