DISCLAIMER: Raw, unedited transcript from webinar. No guarantees are made for the accuracy of the content.


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>> This is Robbin Bull . I will go ahead and get us kicked off and for people just coming in the room we will give them a little time coming in as we do some housekeeping items. I am with NCDB  and I am going to begin by welcoming everybody. I will go over a few housekeeping items before I handed over to Megan Cote  who will kickoff today's webinar and introducing today's speaker. To begin with, all of our phone lines have been muted to reduce the background noise. I also want to mention that the question and answer session will occur at the end of the presentation. However, you can write your questions in the chat box at any time during the webinar as it will be monitored in anticipation of the question and answer session at the end of the webinar. This webinar will be recorded and archived for future viewing so we want you to be mindful of the questions you post in the chat pod as it will be viewed by folks later. I will start the recording now and Megan when you hear the announcement that is your cue to begin. 
>> Tran -- hello everyone. My name is Megan Cote and I initiative leave at NCDB for early  intervention and family engagement. I am excited to welcome you all to the second webinar in a two part webinar series on communication development for learners with deaf-blindness. Our speaker is Dr. Susan Bashinski . Susan is a and associate Professor and graduate program coordinator at Missouri Western State University. I have the pleasure of knowing and working with Susan for over 20 years and in my opinion there is no one better in the field to teach people about how to enhance receptive communication skills of learners with deaf-blindness. It's her passion and a true gift she is here to share her knowledge with us today. So sit back and enjoy. If you have questions, we encourage you to type them in the chat pod and she will do her best to answer them at the end of the presentation. That will be done during the question-and-answer session. Without further ado, Susan, take it away. 
>> Megan, thank you. You are too kind. The most fun part of Megan's introduction is the fact that Megan and I have known each other and worked together for more than half of her life which is a fun thing to me. You are very kind and I appreciate your generous words. You have been welcomed twice but I want to welcome you again. I'm grateful you joined us and I hope I 3:00 my time or 4:00 or 2:00 or 1:00 wherever you are you feel like you have new strategies in your pocket to help lay a foundation for communication exchange. In the first webinar, we talked generally about what nonsymbolic or prelinguistic communication is all about and we are going to start with a super brief review of a few of those things when we hit the objectives of the session. It's truly a follow-up session in my mind and I hope you will find it to be so. Here we go and I do appreciate you being here. 
>> There are three objectives. Number one, I think you all know this and I believed in my soul but it never hurts to be reminded that when we work with minors who experienced deaf-blindness, it really is more than likely that those learners might need different modes of communication for taking in information, for hearing information, then they need for expressing information. They might take in information by watching manual signs but might expressed by using a picture generating device or vocalization or combination. We don't want to get ourselves trapped into one mode of communication for everything going in and everything going out. Because with deaf-blindness usually doesn't work. The big focuses number two, we will definitely cover how you and your team will be able to develop a set of dictionaries and in the set you need one dictionary that will build the learner's receptive communication and one dictionary that will build  the learner's expressive communication. We will definitely get that far.  The third one is a strategy that time allowing we will cover. We will definitely say something about the criticality of structuring routines, but in my opinion the main thing that routines give us is a way to make sure a learner feels safe enough and secure enough in his or her environment to reach out. You have to be safe and secure before you can ever give a thought to communicating. It is just the way we all work. 
>> This is review of webinar one, if you were with me bear with me but if you weren't there are three are four points that need repeating. There is absolutely not a single learner on this planet who does not communicate. They all do. Every single one of them. They do. The onus is on us as their communication partners. You will hear me use that word a lot today. Partner, partner, partner. If you work with learners who are nonsymbolic and prelinguistic, U.S. their partner hold the responsibility for making the communication happen and be effective. Because these children's -- these children and young adults primarily communicate using idiosyncratic or nonconventional forms which means that you have to be the one who deciphers the code. We had a whole bunch, 14 or 15 communication reminders in the last webinar, and I think two are important to the work we do today. When you are building these dictionaries, I think it is very important for you to bear in mind that the of -- that the learner's's ability of what they can remember or  connect or associate of something in his brain is very likely going to incorporate movement aspects of the experience and tactile aspects of the experience that he is recalling. There may also be visual aspects or hearing aspects and it depends on the sensors oral ability of the learner about the nonsymbolic stage, even kids whose vision and hearing we call typically developing, earliest memories are expressed in movement and tactile aspect. Secondly, I said it again but things I say like 600 times are things I think are really important. The way a learner who is deaf blind experiences communication is going to be different in how she receives information and how she expresses information in the majority of cases it is true. 
>> What do learners need from us? They need us as their partners to take time to plan how that learner is going to receive information in every single activity throughout the day, we have to take time to plan what a learner will do in every activity, and we have to consider the immediate environmental context. The context and everything that surrounds the learner from the treatment, the materials, social aspects, other children or adults, everything contributes to that learner  this feeling of security. If you go back to the Maslow hierarchy and if kids don't feel safe they won't donate one brain cell to communicate. 
>> As TA providers I think what you guys can do is to provide potential partners with specific strategies they can implement to facilitate a learner's growth . The errors are mine and I apologize. We want to provide them with strategies that will help the learners move or grow in the direction of conventional, which is the way we all communicate -- if I stick my hand out I want something, you don't know exactly what I want but I want something. If I point, I am trying to indicate that I want something particular. Conventional and intentional, doing something on purpose to make something else happen. Those are our goals. Intentional, conventional communication. You might say but this learner is 17 years old and nonsymbolic and it's not too late to start. If you as a partner repeatedly, repeatedly, repeatedly interpret that learner's movement and tactile behaviors over time  in exactly the same way, in other words you are imposing meaning on those same behaviors, you will shape intentionality and conventionality. 
>> Here we go. Strategies. How do you start? The first strategy is just watch. Watch a learner during unstructured time. What does she do? Follow the learner's lead as much as you can. There will be limits and I know this.  I can't take the time today that every time I make a statement I will say there are exceptions and at this kid run -- wants to run in the street you can't let them do that and I get that. To the greatest extent possible if you follow that lead and the learner wants to walk down the hall and you don't know where they are going or want to go, follow them. Follow and see where it takes you. One of the biggest eureka moments of my career and a man -- a young man I talk about lot is a student at a preschool in Kansas City and he was insistent and kept grabbing my hand and wanted to go and we went on a long journey. He took me to a basement parking lot where a van was that they used to take him on community outings. It was the first Intentional Communication anyone on his team could recall. It took us forever to get there. I followed him and we learned a lot about Lance that they.  When you can, take the time and follow the learner. Anything you see that is a potential communication signal, embellish it. Grab it and build on it. Try to extend it. You are going to be dealing with early nonsymbolic learners and doing a lot of guessing. He will be taking data to see if your guesses are on target or if they are wrong. You can look for signals that are potentially communicative and you will run with them. Often especially with learners with deaf-blindness, nonsymbolic skills must be directly taught to them. 
>> How do you do it? This is somewhat repetitive but I think it's important. Involve movement and involve action. Use touch. Interact with things that the learner prefers. Try to get input from family, brothers and sisters, parents and grandparents or previous teachers. What are things this kid or young adult likes? Make those available. Use interactions during playtime with young children. Use routines to make those learners feel safe and secure. And in orange, and orange means Susan thinks this is really important, be responsive. Observed, be present, watch, and be responsive to that kid.
>> How do we do it? The goal is we want to achieve equal partnership. We don't want interactions with our learners with deaf-blindness where we ask all the questions and they respond. We initiate everything and they respond. I bet everyone of you could say yes, I see that a lot. That is not an equal communication partnership. You want it equal. We can't go from having it be totally in balance where we initiate everything to 50/50 automatically but we want to work in that direction to achieve equal partnership. 
>> This is a model that I'm going to take the two or three strategies from that we will visit about today. This is 20 years old now but something that Ellen Segal and I did together at the University of Kansas and it shows you a picture called the tri-focus model. What I like about the picture is it says in order for communication to happen, you've got to be the learner and the partner has to be an equal please and the partner will be highly responsive to the learner within an environmental context that is made to be as meaningful and supportive as possible. 
>> Typically people who are familiar with a learner are able to facilitate more communication as well as more effective communication with a learner with DB and you know that and it's true for everyone of us, isn't it? If we are interacting with familiar people, we are less anxious or nervous and not stressed like who is she and what does she want and what will she do to me and will she hurt me? And those kids are more comfortable saying stop, I need a break, I'm tired. I think we get caught up in a role of teaching and we forget sometimes how very demanding trying to use what vision you have left or trying to use whatever hearing you have left is. We forget about the stamina of the kids and we need to bring them into that. 
>> These are the keywords I would say for an effective partner for a learner who was nonsymbolic needs to demonstrate. You have to be positive. You have to always expect that whatever the learner is doing, or is not doing is communicating with you. Expect communication and then you will start to see things through a filter of communication. What could that mean communicatively? When he isn't doing anything when I try to get him to move, what could he be telling me? Expect communication and you start to see it. You want to be responsive even to the most subtle cues and you want to be attuned and plugged into the kiddo and join him in his world. 
>> In the model, the tri-focus model, we built in five mean strategies on your screen. We will definitely talk about the first two, enhancing partner sensitivity and we will build one dictionary around that skill today. The second one, augmenting input, we will build a second dictionary around that skill today. And we will cross our fingers and if I don't talk too much we will get to something about structuring routines as well. 
>> Here we go. Enhancing sensitivity. This is the way you are going to build the learner  office expressive can -- the learner's  expressive communication. Here is where we get in trouble with devices being banned and people say they don't work is because those programs only target expressive skills. We will target expressive skills right now with enhancing sensitivity and then we come full circle and will build receptive skills. You have to build them both. Simultaneously, concurrently, or you are building a foundation for genuine communication. You might be teaching splinter skills or root behavior but you are teaching communication. So when we say we will build this dictionary to enhance sensitivity, the strategies are all associated with what a partner has to do. Not what the kiddo has to do, what you was the communication partner have to do. The purpose is you will be aware and receptive to whatever subtle cues  that learner sends your way. So how might he do that? He might shift his attention. If you are talking to somebody and while you are talking to them they do this, they are communicating with you by saying shut up. I don't want to talk to you anymore. The kid turns away. In the literature people talk about visual shift. I don't talk just about visual shift because some kids with severe vision loss, vision shift is a moot point. There is a tension shift and tactile and movement. If they had their hand on you wanting something or reaching for something or exploring something and then they shift and drop it, or they start exploring something else, that is a shift of attention. If the learner is reluctant to initiate, that could have a meaning. Watch for reluctance. Please don't look at reluctance through a behavior filters saying challenging behavior and I need to stop that. He won't follow directions or he won't listen. Don't do that. That's looking through a behavior filter. Takedown the behavior filter and put up a communication filter and looked through that filter and say what could he be telling me? Maybe he is tired or his foot hurts. Maybe he is thirsty. What could it mean? Be persistent. Anyone who is raise the child or been around a little child when they pull on you and keep pulling and pulling on you and don't stop, folks, they are telling you something!  Kids with deaf-blindness do this. They persist in self-stimulatory behaviors. They persistent things that at first blush to us might look like random acts for self-stimulation or just because the kid is poured or has nothing to do. Sometimes those things might be true. But sometimes a persistent behavior means I need help with this. I want you to come do this with me. I don't understand what the heck this thing is for. Think through that communication filter and not through the behavior filter and you will wind up in a different place. Kids will change the form or quality of their behavior. Those among you who might be speech pathologists or those you work with call it recasting. They recast a signal. In other words, if they grab and grab and grab and that doesn't work, then they start hitting. And they start screaming or falling on the ground. The change what the behavior looks like because they are bracingly tell -- they are basically telling us come on stupid, I'm trying to tell you something!  When kids terminate a behavior, that tells us maybe I gave him what he wanted. Maybe that works. And the last one is more common of kids when you try to get them to do something and they scream and yell and pinch or fall to the ground, that display of dissatisfaction, don't look behavior but look communication. What could he be telling me? Even if you cannot honor what the communication is. When he falls to the ground when it's time to go to the bus to go home, you can't honor that. He has to get on the bus and he has to go home. But you can still recognize the communication. You say I get it and I hear you. You don't want to go on the bus. But we have to go. Honor the communication regardless. 
>> So you build a dictionary. This is a blank form. This is what I think it looks like. I have been messing with this form and changing it for 20 something years. I will tell you that the PowerPoint as well as the recording will be uploaded separately on the NCDB site so you can print this if you like it.  What you will do is use these headings. We will talk about the learner Lance, and each time Lance  does something that is a learner behavior in these other four columns of the partner behavior. The partner will interpreted to mean X. The partner will do Y. The partner will say Z. And in the far column on the right, folks in Georgia, the Georgia or center assistance project have been using this and they said Susan, would you be upset if we added this column to your dictionary and I said no. I think it's good and I like it. I think this last column about how the partner will shape the behavior to more conventional form is good. I think it can be listed separately as it is here or it can be embedded in the middle column and what the partner will do. Let's take a look at an example quickly. It's the same form in the same five headers. We will say we have this gal Jennifer. I'm sorry -- the little girl is Susan and Jennifer's the teacher. When Jennifer gets up from her seat, Susan the learner follows her around the room with her eyes. I watch her. It could be interpreted to mean what? It could be interpreted to mean where are you going? It could be interpreted to mean I hope you are coming over here to talk to me. It could be interpreted to mean I'm scared. What will she do to me now? It will be based on previous experiences. If Jennifer has changed Susan's diaper and she is rough when she changes it, if she starts walking toward Susan, Susan will have the memory of that movement and rough touch and she will feel agitation or fear. It could mean anything. But if you watch this Susan always following Jennifer with her eyes, you will choose what in your best professional guests with the input of your team members, their best professional guesses, what the heck it means. Here is what the partner will do. The partner will approach Susan from the front and from the right and touch her hand. The person is going to approach Susan and touch her knee. But whatever the partner is going to do, you say what difference does it make X I suggest to you very strongly that every partner has to do the same thing. Every partner has to interpret things with the same meaning and do the same thing and say the same thing. So let's go back to when Jennifer gets up from her seat Susan follows her around the room with her eyes. It's interpreted to mean I hope you're coming over here to talk to me!  The partner will approach Susan from the front and say let's play. Or approach Susan from the front in the do column and bring one of Susan's preferred toys and in the say column she will say let's play. You are going to write a script in the say column. Kids who are nonsymbolic do not understand the meaning of most verbal words. They understand tone of voice and they understand touch. It will mean I hope you are coming to play with me and the partner will approach from the front and bring a toy and touch Susan's hand. And say let's play!  And that will be in an enthusiastic tone. How the partner might shape a more conventional form of that behavior is to prompt Susan to get her to extend her arm. She might prompt her handing her hand to turn it over so the partner can put the object in her hand. Always trying for the next step, the next depth, the next step. I hope that makes sense. I think given the time we will move on. I had another example about Christopher kicking his feet when his wheelchair tray is removed. You can play with that one and try to see what you think it white mean and what partners can do and say and so on. If Robbin wants me to  if there is time to fill it out and posted on the NCDB website, I can do that. 
>>  The next two slides I won't read to you but I want to tell you what they consist of. You can get them off the PowerPoint if you are interested. This slide and the subsequent side list -- subsequent slide list seven steps of what you can do sequentially, linearly, follow them in order if you want to build a dictionary to try to increase a learner's expressive communication. You observe, generate a list of potential signals, look for patterns , so on and so forth. There are steps four, five, six, and seven which consist of you determine what you put in the two and say and scaffold column. Seven is most important. Make sure every single partner who will work with that learner during the day will respond according to the dictionary. Whenever Susan does those things in the first column, every partner has to do and say and interpret it exactly the same if you are going to build communication. If you can get families on board too, all the better. It's a wonderful thing. 
>> How would I sum up enhancing sensitivity? This is one of my two or three favorite mantras. Just accept the learner's message. Throw down your behavior filter and put up your communication filter and accepted the message.  And listen but listen with your eyes to what you observe. Listen with your hands to what you feel and the learner's tone in overt behaviors and listen with your heart.  Don't just listen with your ears because it's not good enough. 
>> Shifting gears now, the numbering threw me off and I apologize but now we will talk about the other half of the loop. Enhancing sensitivity builds an expressive communication signal dictionary. It builds the learner's expressive skills . But you have an equal partnership so you have to build the other half of the loop which is building the receptive abilities of that learner. Receptive abilities how well the learner understands, comprehends what you and other partners and the messages you are sending to the learner. This is where so many programs fall apart in my opinion and experience. When we say we are going to augment input to that learner, we are going to enhance meaning and facilitate that learner's retention by doing more  than simply talking to her. We are going to do more than simply signing manually to her. All communication should be multi-modal. What does that mean? Mike -- multi-modal and my favorite word and Megan Cote should be laughing now, multi-modal  you use objects and things or hold them up and point to them or touch them and use gestures and signs and facial expression and body movement or words and all these different forms. Not necessarily all at the same time. You use them all. That is what we need to build communication with learners were nonsymbolic. It's how we communicate. You already figured that out even if today is the first day you have seen me. I can't teach with only my mouth. My hands are flying all over the place and I am picking up stuff and shuffling papers. My students say, Susan can you teach with your hands in your pockets? I tried and I can't do it. We communicate multi-modal and need to build multi-modal systems for learners who are nonsymbolic. We will talk about two major types of cues. We will first talk about  touch cues. Remember we said touch is critical and that's what kids on this level understand. They understand touch and we will talk about objects. We will talk about objects and touch. Touch first. 
>> What is a touch cue? This is taken from the work of others and it consists of tactile contact, but here is where it's important, made in a consistent manner, directly on the learner's body .  Made in a consistent manner on the learner's body to communicate a message with him. 
>> Why? Why do we use them? The purpose is for you as a partner to communicate your intention to the learner. It's a way that we can hopefully reduce kids being startled, being scared, not feeling secure, because when they feel those things that's when we see the bursts of challenging behavior. On a more positive side, if kids are not startled or afraid or caught off guard, it helps that learner anticipate what will happen next. I don't know about all of you guys, but have you ever seen someone come up behind the kid who uses a wheelchair and all of a sudden take the chair and start moving. I want to scream don't do that!  It's like this fairy comes down from the heavens and I'm sitting in a chair and someone races me away. You would scare me to death if you did that to me. Think of yourself when someone comes up behind you and you don't know they are there. You are startled. We owe the learner the respective saying I am here and I am going to move your chair now. You can do it with a touch cue. A touch cue is intended to support the learner's understanding or comprehension  of what is going to happen. What are some guidelines? There are many. If the learner has severe neurological disability, you need to be aware of that. You definitely need to have conversation with the learner's  OT or PT or anyone knows from the profile in terms of motor skill, motor sensitivity, sensory sensitivity, more than you do. You need to solicit input from the family. And this is when the professional team is so important. You do not want to deliver a touch cue on the part of a learners body where they have no sensation. You might be saying, yes's -- yes, Susan. I have seen it done. The purpose of a touch cue is for the learner to feel it to anticipate. If you touch a child with no sensation below the waist and touch him on his knee it doesn't do any good when he cannot feel it. A second consideration is if kids are super tactilely defensive particularly on their hands or with a superlight touch, don't do that. Use deep pressure or deep touch. Touch them and less sensitive areas. PTs and OTs are great resources for this. When you are thinking about what kinds of touch cues to use, you need to think about the preference of the learner in terms of what kind of touch like I just alluded to. Willoughby light and feathery or will it be firm? Or in between? And where will you put it? What will be the place in which you will touch? Would you touch on the shoulder, the elbow, the hand, the cheek? One of the most brilliant set of touch cues I saw for greetings with a young woman who was deaf-blind and wish I could claim it as my own but I can't, people came up with greetings. Grandma, mom and dad were the three key adults in the home life of the young girl. The way they handled it was grandma kissed her on the nose to say it's grandma. That's the touch cue for grandma to say hello. Her dad kissed her on the cheek. It's a kiss but when the kiss is here it is daddy. And her mama kissed her on the top of her head. Grandma, daddy, and mama. Same Q but different place and gave every person a separate identity. I love it. Number two is important. Never use force to make a learner accepted touch cues or engage in touch conversations. Never force that. Last consideration is that it's important that touch cues be easy for the learner, not for you, but for the learner to differentiate from routine physical contact. How kids bump into other kids or the way you touch kids when you are trying to put them in a position in their chair or something. They have to be separate from the routine kind of touch. 
>> Here are examples. You have kids in a supine position for a diaper change, you will tap the bottom of the child which means I'm going to lift your hips up now. Or when a child is sitting in his chair, you will gently pull up on the upper arms of the child and go up, up, which means get ready to stand up now because here we go to move your body. And so on and so forth. I don't think we should ever act on a learners body without queuing him or her in some way because it's not respectful. 
>> Project SALUTE , check this link it is still there. Project SALUTE  has some fabulous information sheets about how to use touch cues and build them into the routine of kids. Check them out. The information sheets are great for routines and for families and I love the work and encourage you to check it out if you aren't familiar with it already. 
>> Let's shift gears. We were talking about touch cues and how these involve the tactile aspect to recall tactile experiences and build on the tactile memory of the child. Now we will talk about object cue's and run through the same kind of information. Object cue's potentially involved movement. It could be a hand movement to manipulate an object or full-body movement if the object is a standard different kind of object with object use broadly. What is an object cue? It's an object or a part of an object that is used to refer to a person, a place, or anything. It's not rocket science but it's so important. Person, place or thing. 
>> Why do we use them? The purpose of an object cue is to provide a concrete way for you as a partner to support communicative interaction with a learner. If you are supporting that kind of interaction, if you are supporting that conversation, you are growing that learner's communication skills. Remember what we said earlier.  By just partners repeatedly saying and doing and responding in exactly the same way as each other, you will build that learner's  nonsymbolic communication skills and shape conventionality and shape intentionality and that is what we have to do. 
>> Here are some guidelines. Does a learner have sufficient motor ability to actively explore or manipulate the object by himself? Does a learner have sufficient sensory ability to process the features of the object? With a child who is totally blind and does not have light or dark perception, you won't use flashing lights and spinning balls and sparkly things because guess what, she can't see that. I don't mean to insult anyone with that, but sometimes we just go because we don't stop and step back and take time to think. It worked with Austin so maybe it will work with Lance. Maybe not.  And this is a time when orange comes up again because Susan thinks it's important. With learners who have very significant vision loss or learners who are blind, don't use miniatures. They are not appropriate. The only reason that a little metal school bus this big has meaning to us is because it is yellow and has the shape of the big giant school bus out on the road that we can see. Miniatures for kids who have basically non-functional vision, they don't work. Don't use them. Find tactile features and auditory features or olfactory features, but don't use miniatures. 
>> Here are some more guidelines. Never force the learner to accept an object cue. Never force a learner to engage in exploring an object where you put the kids hands all over it and make them. Don't do that. That's an issue of respect so don't do that. You want to demonstrate how the learner can explore the object. You want to demonstrate that. It's like tactile modeling. Just like we model behavior. You can guide the learner with your hand on their hand to feel the surface of an object for the indentations on an object. We model tactile exploration and we can and should model tactile exploration the same way we model other things. And especially when you start with the new object, offer it gently. You don't know, when you think something is going to feel one way and you reach out and grab it and then you are shocked because it's spooky and creepy and you don't like it? You don't know how kids will react to the way the object feels. 
>> So you can use whole objects or parts of objects. You could use a whole backpack or bag to mean get your things to go home. Or you could just use the strap of a backpack which would be a part to say get your things to go home. You could use bubblewrap to mean take a break. You might say where did that come from? I guess it comes from the fact that I think popping bubblewrap is really fun!  So that's something I get a charge out of so it could mean a break. With some kids that might be horrible and startled them it and the sounds might scare them but it's a potential idea. Parts of objects. Use the very top of a plastic bottle. If you have a bottle of water, cut the top of of it. It could mean lunch, go to the table. You could use a whole object like a spoon or fork. You could use a partial zipper to mean time to get dressed. Whole objects and parts of objects it doesn't really matter. 
>> Here are some examples. I tried to give you two different examples of something that means glass or get a drink. You could use essentially the whole object, and the back of it is cut off but it feels like a cup on the top and it's open at the top and the biggest part of the cup. Or you could use the top looking down and just cut off the rim to mean glass. The kind of cue you choose is dependent on how that learner  first experiences that. With a learner who is blind and you are trying to teach them to insert their fingers over the rim of a cup, to start to feel when it is full, you might use the green ring to represent a glass. Whereas with other kids you might use a yellow full glass and so on and so forth. 
>> This is critically important. You will mount the objects used in the supports for object cue's because if you just have the full object without them being mounted, you see how these are mounted on cards? If you don't mount them, the learner will not be able to distinguish when an object is the actual object or when the object is the representation of the object. Its a cue that stands for this other thing and that's what we are trying to build. This one thing stands for this other thing. That is symbolic ability. 
>>  Again Project SALUTE has information sheets on building  object cue's and they are fabulous so check them out. 
>> Here is the form I suggest you consider for a dictionary. You are going to list -- the augmented input dictionary will build the learner's receptive communications  skills and understanding and comprehension. So you will provide a touch or object cue and I will always wear this one watch, and when I go it will be my personal identifier. So every time I approach Lance I will go up to him and gently lift his hand and put it on here to say that it's Susan.  This is Lance is  hand and I will put it on the object and say, it's Susan!  That's the meaning. Hand on hand take his hand to the watch so he can explore it. What I expect him to do, if he has some vision I expect him to look up at me. And this is a true example, in this case after I say it's Susan, we taught him how to greet and what he eventually learned to do was put his hand up in the air so we could do a high five and say hello. There are a couple other examples here. You could tap on Susan's ankle two times. You can do it two times because sometimes you pump it accidentally wants, so you tap it purposefully two times to mean I'm going to take off your shoes now. And the partner will start and take off Susan's right shoe. And then repeat and tap the ankle on the left two times to take off her left shoe. And what is expected from the learner is expect her to relax her tone or try to lift her foot. Even if she only lifts her foot two inches, to say I got your message and I get it. You are going to take off my shoe so I will help by lifting my foot, whatever it is that you as a team think the student could do for you. You could put a handlebar grip on Christopher's tray to mean it's time for exercise to ride your tricycle down to speech therapy. So the partner will wait before she helps Christopher stand up and count to 10 to see if Christopher either picks up the handlebar grip or extends his hand to reach for it so the partner can put the grip into his hand. That will flavor what you put in the do column depending how much motor ability the learner has. So these things about what it will mean and do and what is expected from the learner have to be internally consistent. 
>> The next two slides have the exact analogous feature to what I did with the other dictionary. There are seven steps how you build an input dictionary to increase comprehension. Number ones through three will not only be in the recording but on the PowerPoint on the website. I suggest you start by getting object cue's to identify key people who interact with that learner every day like my watch was for Lance. 
>> You can read these seven and in the interest of time, they will be in the recording and PowerPoint. 
>> As a summary, augmenting input,  you are supporting the learner's comprehension. Basically I urge you all  to talk with more than your mouth. Talk with your hands and your touch and with objects. Maybe it should say communicate with more than your mouth or your hands or with more than words. Communicate with multiple forms of communication. 
>> I think we have just a few more minutes before we have to have this open for questions so I will hit highlights of routines. I hope you have 10 minutes for this and we have about five. So we call it close and that's good enough. 
>> In honor of Van [ NULL ] who just passed away  I thought it was fitting to use the phrase which I think when we partner with those who experience deaf-blindness we are inviting that adult or child out of their body and join us in the world. We are inviting that learner out of the body to build connections with us. To build communicative interactions with us. This is in the external world.
>> How do we define a routine? It's a series of activities that are organized into a predictable format. There is that word again. Safety, security. Kids feel safe and secure when they can predict what the heck will happen to them and what the heck will be done to their body. Kids need to be able to learn how to anticipate. That's what calendar boxes and shelves are about. Kids anticipating. And being able to anticipate, you are helping the learner organize her world. Every routine and this is from the work of Mary Beth Doyle needs to have four parts. How does the learner know it will be starting? What is the initiation? Use a touch cue or object cue. Prepare. What does the learner need to do to be ready? They need to give you the behavior that you put on the augmented input dictionary. Okay I am ready, I will relax the tone in my leg and lifted up so you can put on my shoe. And then perform the core. Think about how the kid can partially participate. And then termination. How will the learner know when the routine is over? Don't just do that thing and disappear. You have to finish and end it and do something that says we are done now. Especially for kids without vision or hearing. You can't just disappear from their immediate availability. You have to and things. -- You have to end things. You have things you integrate like communication skills, choice making, social skills, and your therapist would love optimal positioning. It all begins with 90 degrees at the hips. I talked to enough PTs and OTs through the years and it all starts with the position of the hips. The kids have to be secure physically to learn anything let alone communication.
>> You have process steps and the next two slides cover those. Can you tell Susan is a linear thinker? Yes I am. I have seven steps of how you can build a structured routine. I encourage you to only do one at a time. Don't try to write routines for the entire day at one time. You can't do it. Just choose one and after you have that one routine going, then add a second one. Number five is very important. Find a way for that learner to actively engage and participate at least partially. That is an old principal in the field of severe disability. Partial participation. I think we lost sight of that and it's important. And don't forget time delay. Some kids need 20 seconds or 25 seconds. Lance that I mentioned , his average response latency was 25 seconds. No Joe. Don't rush them. They need time. 
>> Someone asked me last time and after this I will stop. If you can in a routine build in data collection. This is how I would suggest this and the slide is in for the person who asked me that and I apologize for not remembering who it was. This is how you would have a touch or object cue and how you pair it with a verbal cue, what your time delay is and you can have your data right there. 
>> So what do routines do? They create predictability. I hope if nothing else today, this is what you take away from our time together. First you take gratitude for listening to me because I think this is important. But listen with your eyes and your hands and your heart and talk with more than your mouth.
>> And there is my contact information and we have 4 1/2 minutes so Robbin I was supposed to give you five and I gave you 4 1/2 so I hope it's good enough . 
>> Susan, this is Megan speaking, and thank you so much. We have a few minutes where folks have burning questions they can put them in the chat pod and if we can't get to all of them, what we can do is cut and paste them in a document and I can put them in a forum on the NCDB website  so we can get answers to everybody and also I know Susan is open to you emailing her directly with any questions that you may have. If you do you can email her directly as well. So Kim's said excellent webinar, best one yet. And Sherri said excellent , Susan. Thanks so much. Sheila is saying she loved it and she would love your PowerPoint. I want to make everyone aware of the fact that we will be archiving the recording of the webinar on the NCDB website under the  events and training tab. The library page Robbin put up in the chat pod in the lower right-hand corner.  The other thing I would like to tell you is the first webinar is already archived and put there. We encourage you to share these with anyone who feels benefit from the information. It could be teachers, service providers, parents, whomever you want to share it with. Anyone in your network is welcome to use it. The more we share the knowledge, the better the interventions are that happen for the kids. So I see a lot of praise for you, Susan, and we could stay here for 20 more minutes and watch everyone say thank you. I want to thank all of you for participating in the webinar today. And I want to thank Susan for sharing your time and expertise. She has given everyone lots of helpful information to ponder, use, and share and the archive will be on the NCDB website.  We encourage you to use them. For those of you who have additional questions, please feel free to email Susan. This is such a big and important topic and a whole semester long class that Susan usually teaches that we asked her to cram into 60 minutes or less. So and hours just enough to get your head racing and spending. So you can leave and take this information and use it you will have additional questions. We hope you have a wonderful rest of your week. I want to thank you all again for joining us today. And again, big thanks go to Susan for her time. And Susan, what were you going to say? 
>> I was going to say Sheila James said hello, I need to get your PowerPoint. Could you remind me by emailing me. I need you to initiate the email so I can send it. 
>> This is Robbin Bull and Sheila I will put my email in the chat box and if you email me I will forward  the accessible version to you. 
>> That's perfect. Thank you, Robbin. 
>> I want to thank you all again and Robbin, thank you for converting what I sent you two an accessible version.  Thank you. 
>> Thanks everybody. 
>> Thank you to Susan and everyone for coming today. A great presentation and we really appreciate it, Susan. 
>> You bet. Thanks for the opportunity. 
>> Everyone have a great rest of your day. 
>> Let's make it be spring wherever we are!  I'm tired of being cold! 
>> All right and thanks again everyone. 
>> Goodbye. 
>> [ Event concluded ]