Christy Marzzacco Interview; Part 2
On Friday, I posted the first half of my interview with Christy Marzzacco. She is a therapist dually certified as a teacher of the deaf (CED—Certified Teacher of the Deaf) and a speech language pathologist (CCC-SLP). She also has a special certification as a Listening and Spoken Language Specialist (LSLS) Certified Auditory-Verbal Therapist (Cert. AVT).
Our conversation on Friday highlighted her educational background and professional credentials, as well as the incredible work she does with children diagnosed with a hearing loss in her county, across five school districts. Today, we continue the discussion and Christy will share with us the importance of therapist collaboration when working with children with hearing loss. She will also share a more personal side as she describes the challenges and triumphs of her field.
Stephanie: Christy, tell us what you feel SLPs, as well as other disciplines, can learn from you to improve their therapy with children with a diagnosed hearing loss?
Christy: When working with children with hearing loss, it is extremely important to be aware of the acoustic environment. Hearing aids and cochlear implant are not perfect technologies and although they have the capabilities of giving children access to speech, they can also give them access to the blowing air in a heating or cooling vent, a jingling bracelet on the table, or the hum of a dishwasher. By taking little steps, to ensure that there aren't any auditory distractions, it can help a child focus during any kind of therapy.
For a child with hearing loss, using their equipment properly is a must. I feel that a child needs to have auditory access at all times, just like their hearing peers do. That means that hearing aids need to be checked prior to all therapies and FM systems should be used. This is especially important in early intervention when a child is too young to alert the adults when they are not hearing optimally. In early intervention, families and caregivers should be checking the equipment daily but it can never hurt to double check and be sure that the child can hear. You never know when a battery will die or wax from a child's ear will block the tube leading to the hearing aid and alter the signal.
Stephanie: Tell us why collaboration is so important for children with hearing loss and please feel free to discuss whatever information you think is most beneficial for our readers.
Christy: For children with hearing loss, collaborating with other specialists is extremely important. First, and foremost, is collaboration with the clinical and educational audiologists. I am fortunate to work in an area where there are wonderful hospitals for children that provide optimal clinical audiological care. The clinical audiologist is sometimes the first professional that a family sees providing them with detailed information about their child's hearing loss. For a family choosing oral communication for their child, is imperative that their little ones have access to spoken language utilizing appropriate technology. In early intervention, I can help families and audiologists make decisions about technology based upon my experiences with the child and the needs of the family.
Forming good relationships with the audiologists is essential. I can help make the audiologists job a little easier by making sure the child is able to play conditioned response games, or understands how to turn in response to a sound (Visual reinforcement audiometry) and receive reinforcement. These are games that can be practiced in the home during therapy. Better testing leads to more accurate audiograms which then leads to amplification that specifically meets the needs of the child. Children using cochlear implants need to have their speech processors "mapped" and results of my therapy sessions can help the clinical audiologist know where a child is responding to sounds. As those of us working with small children know, it can be challenging to get a child to perform on command. However, this is exactly what a child must do in the audiological booth. Sometimes, children enter the booth and just cry! I have actually gone with families to the audiology centers when their child is extremely difficult to test. In order for a child to learn how to listen and talk, he/she needs to have optimal amplification and this can only be done when we know exactly what they are hearing at each frequency.
I've also had hearing aid representatives and audiologists visit my preschool program so that they truly understand how the equipment that they are recommending works in the "real world". Sometimes, the fanciest hearing aids aren't what is best for a young child who can't really tell you when the aid is working or not. I've found that professionals in this field really do care about the children and want to do what is best in helping the child access sounds and meet their auditory potential.
Collaborating with other therapists is also important for a child with hearing loss. All caregivers and therapists need to understand the impact that hearing loss has on speech and language development. They also need to understand the importance of using audiological equipment. It certainly doesn't make any sense for an occupational therapist to instruct a child on grasping objects or how to take a sensory break if the child can't hear the instructions. I need to work with the families so that they understand the importance of wearing and using amplification and/or cochlear implants and then support them as they work with other professionals.
Stephanie: I couldn't agree with you more. Even in my limited experience with children who need ear tubes and may have been suffering with fluid and temporary hearing loss of some kind, I see the tremendous affect it has on their speech and language development. I think both parents and professionals sometimes underestimate the connection between hearing and speech.
This leads me to my next question....tell us about the most challenging parts of your job.
Christy: The most challenging part of my job is dealing with all of the audiological equipment. Families often leave the clinical audiologist or hearing aid dispenser with equipment that they don't really understand how it works. The parents are often trying to entertain/contain their children and trying to listen to the audiologist at the same time. Any parent of an 18 month old will tell you that trying to listen to important information and keep your child from tearing apart an office at the same time is challenging and frustrating. That is where I and the educational audiologists can really help. We can take the time to really explain how equipment works, how to troubleshoot it and how to care for it in the comfort of a parents' home when their child is safely occupied. Where I work at the DCIU, families can come into the audiology booth with or without their child to help them gain an understanding of what their child is hearing and how all of the equipment works. We have to remember too that families are dealing with the emotional aspects of finding out that their child has a hearing loss and we as professionals need to be sensitive to that as well.
Stephanie: That makes a lot of sense. I think we've even seen some of that with the family we have worked with together. To end our interview, please share some of your favorite aspects of your job.
Christy: I love my job! It is extremely gratifying to watch a child make progress in their speech and language skills by utilizing audiological equipment. The field of educating children with hearing loss is ever changing and evolving. From the time I entered the field, 13 years ago, to the present, I have witnessed such tremendous growth and knowledge in the way that children are educated. Families of profoundly deaf children, now have choices that weren't available to them years ago. Families can choose to have a cochlear implant for their child and give them access to auditory information. Some families embrace Deaf Culture. Whatever, they as a family choose, it is their choice. I feel privileged to be able to work in this field and can't wait to see where the future takes us.
For additional questions or to make a comment, readers may do so on this site in the comment section or by contacting Christy Marzzacco directly at her email address: cmarzzacco@dciu.org
Note: This post marks the beginning of Stephanie's summer schedule. "Early Intervention Speech Therapy" will be updated once a week—every Tuesday—through the summer months. The twice-weekly post schedule will resume in September.