**7. Role of the professional**

Advice given in the early years to the parents of children who have a hearing loss has long lasting effects on the children's development and future lives. The professionals who first come into contact with families seeking advice on how best to manage a young child who has a hearing loss bear tremendous responsibility for their futures (Clark, 2007). Their role is complex and challenging. It is different from other professional roles such as teachers or case managers, although it may include some aspects of these roles (Bailey, et.al., 1991; Hoberg-Arehart & Yoshinago-Itano, 1999; Kaiser & Hancock, 2003). Professionals who work with young children with disabilities must know how to partner with families, including working together to address child and family needs. Studies on parent participation indicate

Early Intervention with Children

Who Have a Hearing Loss: Role of the Professional and Parent Participation 127

of joint attention, and how it is created and maintained by both parties, parent's awareness on language facilitative opportunities. These are all critical for planning the intervention sessions. Parents are a valuable source of information about their child and their observations and judgements should be included while planning the intervention (Campbell

It is seen as a professional's responsibility to encourage parents to involve actively in the intervention sessions in a way that is most suitable for the family. The professionals must realize uniqueness of each family to achieve this. It must also be kept in mind that relationships and interaction patterns within a family system are more complex than formerly believed. Family members assume familial roles and functions with proximal and distal features (Campbell & Sawyer 2009). Therefore, the needs, priorities, resources, desires, and wisdom of a child's family should be taken into account. The presence of hearing loss in the child does not mean that the family has to alter what would have been its natural child rearing practice to fit the professional's concept of child rearing. The only time professional alters the way a child is managed is when there is behaviour that is inhibiting the

In recent years interpersonal relationship between parents and the professionals has gained considerable attention as another important aspect of successful intervention process. Research on the subject indicates its role in the development of family centred practices aiming to empower parents in special education (Knight & Woodsworth, 1999; Kratchowill,

Park and Turnbull (2003) created a framework distinguishing interpersonal and structural components of effective partnership. They identified from the literature a series of interpersonal relationship attitudes, skills and beliefs that appear to contribute to effective partnership among families, professionals and agencies. Collaborative partnership characterized by factors such as trust, respect, communication, shared vision and cultural sensitivity were identified as critical for effective partnership. However these are subjective

Bluebanning et al. (2004) emphasized the need for the operational definition of these terms. They argued that the clear operational definition of these terms may help professionals to develop a better understanding of the family perspectives leading to establish good quality early intervention services. Their study focused on parents' and professionals' descriptions of the terminology which are widely used in family centered, collaborative intervention programs. They described six collaborative themes and their behavioural indicators is stressed by parents and professionals. Themes are defined as communication, commitment, equality, skills, trust and respect. Parents and professionals described behaviours related to each of these themes in substantial good agreement except commitment and equality. Parents talked of wanting professionals to "go the extra mile" and to be like one in the family in their involvement with them. Professionals expressed the same sentiments but they also expressed reservations about taking these concepts too far. These reservations centred on the perceived need to "empower" families to take charge of advocating for their child and themselves, and the concern that doing "too much" might foster co-dependency and actually harm the family. The questions of when being "like family" gets in the way of doing one's job and when "empowering" becomes disenfranchising are issues referring to the boundaries between families and professionals. It is argued that the subject needs further research for effective

& Sawyer, 2009; Eriks-Brophy, et.al., 2006; Knopf & Swick, 2008).

development of listening and of spoken language (Clark, 2007).

terms and their meaning can be different from one person to another.

et. al., 2007; Lutherman, 2004; Macy, et. al., 2009).

that intervention efforts are enhanced when families participate in early childhood programs (Bailey et al., 1998; Baguley, 2000; Bluebanning, 2004; Mahoney & Wiggers, 2007; Mahoney, 2009; White, 2006; Wilson, 1998).

If a family centred and participation-based philosophy is adopted, roles of parents and professionals become different from traditional practice on the basis of four primary features: (a) activity leader, (b) use of natural materials, (c) role of the parent, and (d) role of the provider. (Brown & Nott, 2005; Campbell & Sawyer, 2009; Dunst, 2002) In traditional practice, the professional is generally the activity leader, materials that are not likely to be natural to the home setting are used in intervention, the parent most frequently plays a passive role such as an observer, and the professional is the primary person interacting with the child. This type of intervention approach has been identified by a number of labels including one-on-one intervention or direct intervention (Dunst, 2002). In a participationbased approach, the focus is on promoting a child's participation within typical family activities and routines. The activity leader is the parent or child, materials natural to the activity or routine are used, the parent actively interacts with the child, and the professional plays a role of facilitator (Campbell & Sawyer, 2009; Childress, 2004; Dunst, 2002; Macy, et. al., 2009; Mahoney, 2009;) suggesting appropriate techniques and strategies to facilitate language development and sometimes interacting with the child to model the parents at certain techniques (Clark, 2007; Estabrooks, 2006).

In order to work effectively in the field, the professional must be fluent in specific intervention they will teach parents (Kaiser & Hancock, 2003). Fluency requires mastery of specific intervention procedures, understanding of the conceptual basis of the intervention and its main assumptions. The conceptual knowledge is required in order to explain the rational behind the each aspect of the procedure to parents, to place the intervention in the framework of the child's developmental characteristics, to relate the parents' behavior to the goals of the intervention and the family's goals for the child and themselves and to answer parents' questions (Brown & Nott, 2005; Estabrooks, 2006; Hogan, 2008).That is consistent with the findings indicating technical knowledge and skills of the service providers, parent education and diagnostic evaluations/ assessment of the child as the most beneficial aspects of early intervention experiences among the other properties as well (Foran & Sweeney, 2010).

The ability to present the intervention in a way that is understood by the parents is another aspect which is crucially important (Kaiser & Hancock, 2003). The professional must be able to instruct parents on interacting in a language enabling way with their child and to troubleshoot with parents in their use of it in order to provide specific feedback, guidance and coaching toward effective implementation (Brown & Nott, 2005; Estabrooks, 2006; Kaiser & Hester, 1995; Kaiser & Hancock, 2003). This can be achieved by observing parents while they are interacting with their baby during play or daily activities. Depending on these observations, the needs of a specific parent child relationship at a specific language learning stage can be decided (Brown & Nott, 2005; Clark, 2007; Estabrooks, 2006). From the start parents must understand that the professional's task is to observe and to offer advice on the type of interaction that the professional sees them enjoy with the child. Initially some parents are resistant to this approach because they want to the child to receive therapy from the professional (Clark, 2007).

Observing parent child-interaction either in daily activities or at play the professional gathers information on contingent responsiveness between the parent and the child, amount

that intervention efforts are enhanced when families participate in early childhood programs (Bailey et al., 1998; Baguley, 2000; Bluebanning, 2004; Mahoney & Wiggers, 2007;

If a family centred and participation-based philosophy is adopted, roles of parents and professionals become different from traditional practice on the basis of four primary features: (a) activity leader, (b) use of natural materials, (c) role of the parent, and (d) role of the provider. (Brown & Nott, 2005; Campbell & Sawyer, 2009; Dunst, 2002) In traditional practice, the professional is generally the activity leader, materials that are not likely to be natural to the home setting are used in intervention, the parent most frequently plays a passive role such as an observer, and the professional is the primary person interacting with the child. This type of intervention approach has been identified by a number of labels including one-on-one intervention or direct intervention (Dunst, 2002). In a participationbased approach, the focus is on promoting a child's participation within typical family activities and routines. The activity leader is the parent or child, materials natural to the activity or routine are used, the parent actively interacts with the child, and the professional plays a role of facilitator (Campbell & Sawyer, 2009; Childress, 2004; Dunst, 2002; Macy, et. al., 2009; Mahoney, 2009;) suggesting appropriate techniques and strategies to facilitate language development and sometimes interacting with the child to model the parents at

In order to work effectively in the field, the professional must be fluent in specific intervention they will teach parents (Kaiser & Hancock, 2003). Fluency requires mastery of specific intervention procedures, understanding of the conceptual basis of the intervention and its main assumptions. The conceptual knowledge is required in order to explain the rational behind the each aspect of the procedure to parents, to place the intervention in the framework of the child's developmental characteristics, to relate the parents' behavior to the goals of the intervention and the family's goals for the child and themselves and to answer parents' questions (Brown & Nott, 2005; Estabrooks, 2006; Hogan, 2008).That is consistent with the findings indicating technical knowledge and skills of the service providers, parent education and diagnostic evaluations/ assessment of the child as the most beneficial aspects of early intervention experiences among the other properties as well (Foran & Sweeney, 2010). The ability to present the intervention in a way that is understood by the parents is another aspect which is crucially important (Kaiser & Hancock, 2003). The professional must be able to instruct parents on interacting in a language enabling way with their child and to troubleshoot with parents in their use of it in order to provide specific feedback, guidance and coaching toward effective implementation (Brown & Nott, 2005; Estabrooks, 2006; Kaiser & Hester, 1995; Kaiser & Hancock, 2003). This can be achieved by observing parents while they are interacting with their baby during play or daily activities. Depending on these observations, the needs of a specific parent child relationship at a specific language learning stage can be decided (Brown & Nott, 2005; Clark, 2007; Estabrooks, 2006). From the start parents must understand that the professional's task is to observe and to offer advice on the type of interaction that the professional sees them enjoy with the child. Initially some parents are resistant to this approach because they want to the child to receive therapy from

Observing parent child-interaction either in daily activities or at play the professional gathers information on contingent responsiveness between the parent and the child, amount

Mahoney, 2009; White, 2006; Wilson, 1998).

certain techniques (Clark, 2007; Estabrooks, 2006).

the professional (Clark, 2007).

of joint attention, and how it is created and maintained by both parties, parent's awareness on language facilitative opportunities. These are all critical for planning the intervention sessions. Parents are a valuable source of information about their child and their observations and judgements should be included while planning the intervention (Campbell & Sawyer, 2009; Eriks-Brophy, et.al., 2006; Knopf & Swick, 2008).

It is seen as a professional's responsibility to encourage parents to involve actively in the intervention sessions in a way that is most suitable for the family. The professionals must realize uniqueness of each family to achieve this. It must also be kept in mind that relationships and interaction patterns within a family system are more complex than formerly believed. Family members assume familial roles and functions with proximal and distal features (Campbell & Sawyer 2009). Therefore, the needs, priorities, resources, desires, and wisdom of a child's family should be taken into account. The presence of hearing loss in the child does not mean that the family has to alter what would have been its natural child rearing practice to fit the professional's concept of child rearing. The only time professional alters the way a child is managed is when there is behaviour that is inhibiting the development of listening and of spoken language (Clark, 2007).

In recent years interpersonal relationship between parents and the professionals has gained considerable attention as another important aspect of successful intervention process. Research on the subject indicates its role in the development of family centred practices aiming to empower parents in special education (Knight & Woodsworth, 1999; Kratchowill, et. al., 2007; Lutherman, 2004; Macy, et. al., 2009).

Park and Turnbull (2003) created a framework distinguishing interpersonal and structural components of effective partnership. They identified from the literature a series of interpersonal relationship attitudes, skills and beliefs that appear to contribute to effective partnership among families, professionals and agencies. Collaborative partnership characterized by factors such as trust, respect, communication, shared vision and cultural sensitivity were identified as critical for effective partnership. However these are subjective terms and their meaning can be different from one person to another.

Bluebanning et al. (2004) emphasized the need for the operational definition of these terms. They argued that the clear operational definition of these terms may help professionals to develop a better understanding of the family perspectives leading to establish good quality early intervention services. Their study focused on parents' and professionals' descriptions of the terminology which are widely used in family centered, collaborative intervention programs. They described six collaborative themes and their behavioural indicators is stressed by parents and professionals. Themes are defined as communication, commitment, equality, skills, trust and respect. Parents and professionals described behaviours related to each of these themes in substantial good agreement except commitment and equality. Parents talked of wanting professionals to "go the extra mile" and to be like one in the family in their involvement with them. Professionals expressed the same sentiments but they also expressed reservations about taking these concepts too far. These reservations centred on the perceived need to "empower" families to take charge of advocating for their child and themselves, and the concern that doing "too much" might foster co-dependency and actually harm the family. The questions of when being "like family" gets in the way of doing one's job and when "empowering" becomes disenfranchising are issues referring to the boundaries between families and professionals. It is argued that the subject needs further research for effective

Early Intervention with Children

283-296.

New York

and Development, 22(1), 65-85.

http://online.sagepub.com

www.mass.gov/dph/earlyintervention

*Special Education,* Vol. 36, No. 3., pp. 139-147

Inclusion. *The Volta Review,* Vol. 106, No. 1, pp. 53-88

*Children,* Vol. 19, No. 3, pp. 179-189

Washington, DC

Who Have a Hearing Loss: Role of the Professional and Parent Participation 129

Bluebanning, M., Summers, J. A., Frankland, H. C. Nelson, L. L. & Beegle, G. (2004)

Brown, A. S. & Arehart, K. H. (2000) Universal Newborn Hearing Screening: Impact on Early Intervention Services. *The Volta Review,* Vol. 100, No. 5, pp. 85-117 Brown, P.M. & Nott, P. (2005). Family-Centred Practice in Early Intervention for Oral

Available from http://site.ebrary.com/lib/anadolu/Doc?id=10091866 Bornstein, M.H. & Tamis-LeMonda, C.S.(1997) Maternal responsiveness and infant mental

Bornstein, M.H., Tamis-LeMonda, C.S. & Haynes, O.M. (1999) First words in the second

Bruner, J. (1983) *Child's Talk: Learning to Use Language*. W. W. Norton, ISBN 0-393-95345-9,

Bruner, J. (1990). *Acts of Meaning.* Harvard University Press, ISBN 0674-00361-6, Cambridge Campbell, P. H. & Sawyer, L. B. (2009). Changing Early Intervention Providers' Home

Clark, M (2007). *A Practical Guide to Quality Interaction With Children Who Have a Hearing Loss,* Plural Publishing, ISBN 1-597556-112-6, San Diego, Oxford, Brisbane Childress, D.C. (2004). Special Instructions in Natural Environments: Best Practices in Early

Cole, E.B. & Flexer, C. (2007). *Children With Hearing Loss: Developing Listening and Talking Bith to Six,* ISBN 978-1-59756-158-7, Plural Publishing, San Diego, Oxford, Brisbane. Department of Public Health Interagency Coordinating Council (2009). Partnering for the

DesJardin, J. L., Eisenberg, L. S., & Hodapp, R. M. (2006) Sound beginnings: Supporting

Dunst, C. J. (2002). Family Centred Practices: Birth Through High School. *The Journal of* 

Eriks-Brophy, A., Durieux-Smith, A., Olds, J., Fitzpatrick, E., Duquette, C., & Whittingham,

Estabrooks, W. (2006). *Auditory Verbal: Therapy and Practice.* AG Bell, ISBN 978-0-88200-223-1,

Foran, S., & Sweeney, J. (2010) Accessing Specialist Early Intervention Services for Pre-

*Childhood Special Education,* Vol.28, No. 4*,* pp*.* 219-234*,* Available at:

Intervention. *Infants and Young Children,* Vol. 17, No. 2, pp. 162-170

Collaboration. *Exceptional Children,* Vol. 70, No. 2, pp. 167-184

Dimensions of Family and Professional Partnerships: Constructive Guidelines for

Language Development: Philosophy, Methods and Results. In: *Spoken Language Development of Deaf or Hard of Hearing Children*, 136-165, P. E. Spencer (Ed),

abilities: specific predictive relations. Infant Behaviour and Development, 20 (3),

year: continuity, stability and models of concurrent and predictive correspondance in vocabulary and verbal responsiveness across age and context. Infant Behaviour

Visiting Skills Through Participation in Professional Development. *Topics in Early* 

Success of Children With Hearing Loss Task Force Report. Available from

Families of Young Deaf Children With Cochlear Implants. *Infants & Young* 

J. A. (2006) Facilitators and Barriers to the Inclusion of Orally Educated Children and Youth with Hearing Loss in Schools: Promoting Partnerships to Support

School Children: A Lack of Co-ordination in the Delivery of Early Intervention to Children with an Intellectual Disability in Ireland Led to Examine the Lived Experiences of Families Accessing Services. *Learnng Disability Practice,* Vol.13 No.2

guidelines on creating appropriate boundaries between families and professionals that preserve warm and committed relationships without disempowering families.
