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Put Families In, Coach, for Pediatric Hearing Health

Wolfe, Jace PhD; Smith, Joanna T. MS

doi: 10.1097/01.HJ.0000470896.21812.0d
Tot 10

The motivational tactics of coaches often become interwoven into the fabric of our society. Would you believe that famed University of Notre Dame football coach Knute Rockne uttered the phrase “just win one for the Gipper” almost 90 years ago?

A coach encourages and guides another person to develop competence in a specific role and situation. As pediatric audiologists and speech–language pathologists, we also must be great coaches in order to support families through the diagnosis and treatment of their child's hearing loss.

The 2-year-old patient on your schedule spends more than 4,380 waking hours outside your office a year. In order for the child to progress, clinicians must coach families on their role as teachers during those 4,380 hours.

Many hearing health professionals are also involved in training students. However, most of us received very little education on the specifics of coaching families, professionals, and students.

To address this challenge at Hearts for Hearing, we have been intentional about growing our skills as coaches. Our goal is to understand the principles of adult learning science so that our communication with families improves, as do the listening and spoken language outcomes of the children we serve.

This installment of the Tot 10 focuses on what we have learned about coaching and the impact of different adult learning styles on our work as pediatric audiologists and as listening and spoken language professionals.

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1. Let's talk.

In a coaching partnership, the coach and the adult learner are really both learners with unique skills and goals. (Kinlaw DC. Coaching for Commitment: Interpersonal Strategies for Obtaining Superior Performance from Individuals and Teams. San Francisco, CA: Jossey-Bass; 1999.)

The coach, whether a pediatric audiologist or a speech–language pathologist who is a listening and spoken language specialist, has knowledge and skills related to managing hearing loss and providing auditory access to a growing child's brain.

The family members, who are adult learners, have an intimate knowledge of their child's abilities, challenges, and typical performance. As discussed in our last column, they are the experts on their child ( HJ June 2015 issue, p. 32 http://journals.lww.com/thehearingjournal/Fulltext/2015/06000/How_to_Be_an_Effective_Influencer_for_Good.7.aspx).

Colleagues or students can also be the adult learner, bringing experience and know-how from their own work.

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2. When it comes to learning, adults are different from children.

Children depend on their families and teachers to determine what is important to learn. Adult learners decide for themselves and are motivated to learn when they feel the knowledge is valuable. Children accept information at face value, but adults need to verify material based on their own beliefs.

Children have little or no experience upon which to draw. Adults have a wealth of past experience that influences their viewpoints, and they need to integrate new information into what they already know in order to retain it.

There is a plethora of learning style inventories available today. We used the schema outlined by Bernice McCarthy in the 4MAT System ( Educ Leadership 1990;48[2]:31-37 http://www.ascd.org/ASCD/pdf/journals/ed_lead/el_199010_mccarthy.pdf). She distinguishes four different learning style preferences:

* The analytic learner is all about the facts. Logic and order are paramount. The more detail provided for each rule, the more comfortable the analytic learner will be with the outcomes.

* The dynamic learner is almost the direct opposite of the analytic learner. Details are not important, and creativity is valued. A dynamic learner jumps in and often accomplishes tasks by trial and error.

* The common sense learner is all about the bottom line. This learner likes to gather facts, but only a few, and then tries to use those facts to figure out a hands-on way of doing things.

* The imaginative learner loves to listen, talk with others, and consult with anyone who may have had similar experiences.

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3. Know the style.

In order to be an effective coach, it is important that we know our own learning style as well as the learning styles of the families and colleagues with whom we partner. While we tend to share information based on our own style, more often than not, the parents we coach learn differently, and it is likely that other family members have their own learning styles as well.

One of the quickest informal ways to gain information about an adult's learning style is to pose this scenario (note that the scenario can vary; instead of an oven, you might ask about a piece of lawn equipment or a new computer):

You have just moved into a new house that has an oven with a convection feature. You are ready to use your new oven but have never had a convection feature. How do you learn to use the new oven?

If the adult learner states that she opens the manual and reads it cover to cover before attempting to use the convection oven, there's a high probability that she is an analytic learner. When the adult states that he starts pressing buttons to find out what happens, he's likely a dynamic learner.

A common sense learner might answer that he looks at a few of the bullet points in the manual but then applies what he learned and follows the steps as outlined. If the adult learner shares that she calls her friends to find out how they operate their convection ovens, she is most likely an imaginative learner.

Although this is not a fail-safe measure to determine how an adult learner processes new information, we have found it to be a great conversation starter and a tool to help set the stage for the coaching partnership.

Another option is to ask the adult learner: “How do you learn best? What is the best way for us to communicate so that you are comfortable with the information we will be sharing over the next several months and years?”

Acknowledging that there are different learning styles has proved to be a valuable tool for supporting families.

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4. With the analytic learner, prepare for the “what” questions.

Remember that analytic learners thrive on facts and value expertise highly. They notice when anything is different between appointments or therapy sessions. Analytic learners typically dislike small talk and would be least likely to participate in a parent support group.

When counseling these learners, the use of time lines, checklists, research articles, bibliographies, and quotes from experts is necessary. It is not important that the audiologist or speech–language pathologist have all the answers, but it is important that the professional know where to send the learner for any requested data.

Analytic learners often inquire about what is happening during the session and the purpose of each test. It is a wise counseling suggestion to ask these learners to email questions before scheduled appointments.

It is also crucial to remember that although an analytic learner may research which hearing aid or cochlear implant is best for his child, he is usually not questioning the judgment of the professional but instead processing the information in the way that is most comfortable for his learning style.

The analytic learner often takes notes during the session, keeps copies of all audiograms, and has a notebook detailing every aspect of the child's listening journey. A step-by-step guide will reduce the anxiety of an analytic father when it's time to practice putting in his child's hearing aids.

These learners fear making mistakes and often need to be encouraged to “let go of the notebook” and enjoy their child.

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5. Prepare for “what if” or “what can this become” questions from the dynamic learner.

Dynamic learners enjoy acquiring new information and often are enthusiastic. They are not afraid to make a mistake and learn through experimentation, and they need variety and flexibility.

A dynamic learner may seem to take over a therapy session without knowing the goals. In the booth with the child, this type of learner may become so engrossed in the conditioning task that it is hard to determine who is the patient.

It is crucial that the professional give dynamic learners opportunities to jump in while also providing them with a plan. These learners might not see the need to bring their notebook to every session, and the details of their child's hearing aids might escape them, even though they quickly learned how to keep them on the child. Dynamic learners often come up with new ways of doing things or teaching a concept to their sons or daughters.

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6. With the common sense learner, get ready for “how” questions.

Common sense learners like to solve problems and are practical in seeking solutions. Although these learners might ask how the hearing aid works, they may resent being told the answer because they would prefer to figure it out on their own.

Recently, a common sense parent said in a therapy session, “Forget all the fancy jargon; just tell me the three things I'm supposed to work on this week.” Another noted, “I know the audiologist said he needs to have his hearing aids on during all waking hours, but exactly how many hours a day is he supposed to have them on?”

Bullet points are a very effective tool for sharing new information with these learners, but there must always be a hands-on component in order for them to grasp new ideas.

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7. When it comes to imaginative learners, prepare for “why” questions.

Imaginative learners seek meaning. They like to participate in small-group discussions; these learners enjoy sharing their ideas for teaching certain skills and are willing to get suggestions from others.

This type of learner is not likely to take pleasure in therapy activities unless there is an opportunity to talk about the process. Imaginative learners need to feel they are being heard.

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8. While every coaching opportunity is unique, success depends on particular qualities and skills that can be learned.

Coaching requires a specialized set of learned skills. In Coaching Families and Colleagues in Early Childhood, Barbara E. Hanft and coauthors outline the five key qualities of an effective COACH (Hanft BE, Rush DD, Shelden ML. Baltimore, MD: Brookes Publishing; 2004):

* A competent coach knows how to promote self-discovery by the parent or caregiver, and fosters independence.

* An objective coach focuses on parents’ perspectives, interests, and intent, supporting family members.

* An adaptable coach is able to switch from a preplanned activity to one that better meets the family's immediate needs.

* A caring coach creates a safe environment in which the adult learner can make mistakes without judgment.

* An honest coach provides constructive feedback to support family members in their growth as the primary language facilitator for their child, building trust and respect.

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9. Every appointment presents an opportunity for coaching that includes observation and action.

Whether a programming visit for a 12-month-old's cochlear implant or an auditory–verbal appointment with a 3-year-old, each session is most effective if there is a plan in place with defined goals. As James Flaherty aptly noted in Coaching: Evoking Excellence in Others, “If the purpose of coaching is to change behavior, then the coach's mission is to find what affects behavior in a way that will bring about the desired changes” (Boston, MA: Butterworth–Heinemann; 1999).

Pediatric audiologists and speech–language pathologists should state the goal of every session before beginning the activity. If the goal is to introduce a specific auditory–verbal strategy, the professional should demonstrate the approach and then turn the activity over to the parent, carefully observing as the process unfolds.

During coaching conversations, take note of the learner's nonverbal communication, including eye contact, vocal inflections, and body posture, as well as verbal responses, such as the ability to explain or demonstrate an activity or strategy.

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10. Effective coaching must always include time for summarizing and reflecting.

As professionals in hearing health, we serve many families a week. For us, the terminology and strategies are routine, and the words roll off our tongues with ease. That is not the case for the adult learners we coach.

Effective coaches recognize a family's need for time to process and reflect on what they are learning. At the end of every coaching opportunity (appointment), it is important to summarize the goals of the session.

For example, the audiologist might say, “Today we discovered that Molly is more consistently demonstrating a conditioned response.”

Or, the listening and spoken language specialist might share, “In today's session, we observed that when we paused and waited, Ryan responded with a one-word request.”

Additionally, it is important that the coach seek feedback on the effectiveness of the coaching relationship during the reflection phase. Questions such as, “What do you need more of from me?” and, “What do you need less of from me?” are excellent ways to gain the necessary information for improving the coaching relationship.

Although this approach might be uncomfortable for some, and it's certainly hard to ask these questions in a busy clinic, the value far outweighs the time it takes to obtain the feedback.

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EMPOWERING FAMILIES

An increased understanding of adult learning styles and a dedication to coaching positively affects the hearing health professional as well as those we serve. Let's strive to channel our inner Knute Rockne so that we become better clinicians, and our families are empowered and inspired to achieve the best results.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.