Self-advocacy as a practice of empowering adolescents with hearing impairment: a pilot study

Silva, Rebeca Liaschi Floro; Carneiro, Larissa de Almeida; Nery, Daniele Batista; Duarte, Luciana Alves; Moret, Adriane Lima Mortari; Salimon, Amanda; Angelo, Thais Corina Said de; Medina, Camila; Albano, Danielle Mecheseregian; Abramides, Dagma Venturini Marques; Lopes, Natália Barreto Frederigue; Jacob, Regina Tangerino de Souza

Rebeca Liaschi Floro Silva

Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP – Bauru (SP), Brasil.

http://orcid.org/0000-0002-3173-3309

Larissa de Almeida Carneiro

Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP – Bauru (SP), Brasil.

http://orcid.org/0000-0001-5254-4542

Daniele Batista Nery

Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP – Bauru (SP), Brasil.

http://orcid.org/0000-0003-0375-8653

Luciana Alves Duarte

Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP – Bauru (SP), Brasil.

http://orcid.org/0000-0002-6934-9564

Adriane Lima Mortari Moret

Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP – Bauru (SP), Brasil.

http://orcid.org/0000-0002-1776-9209

Amanda Salimon

Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP – Bauru (SP), Brasil.

http://orcid.org/0000-0002-7224-8385

Thais Corina Said de Angelo

Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP – Bauru (SP), Brasil.

http://orcid.org/0000-0002-3268-8490

Camila Medina

Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP – Bauru (SP), Brasil.

http://orcid.org/0000-0002-9802-9965

Danielle Mecheseregian Albano

Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP – Bauru (SP), Brasil.

http://orcid.org/0000-0003-4401-8547

Dagma Venturini Marques Abramides

Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP – Bauru (SP), Brasil.

http://orcid.org/0000-0002-2447-3860

Natália Barreto Frederigue Lopes

Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP – Bauru (SP), Brasil.

http://orcid.org/0000-0001-6738-3278

Regina Tangerino de Souza Jacob

Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP – Bauru (SP), Brasil.

http://orcid.org/0000-0002-6375-1384

Conflict of interests:

No.

Authors’ contribution:

RLFS, DBN, LAD, DMA and DVMA participated in the design of the project, data collection and analysis, and writing of the manuscript; ALMM participated in the data analysis and writing of the manuscript; AS participated in the writing/reviewing of the project and the manuscript; TCSA, LAC, CM and NBFL participated in the data analysis and writing of the manuscript; RTSJ participated in the elaboration of the project, data analysis, writing of the manuscript and guidance in all stages of the work.

Corresponding author:
Regina Tangerino de Souza Jacob. E-mail: reginatangerino@usp.br

Participants	Age (years)	Gender	Socioeconomic level	Degree of hearing loss	Assistive device	Device usage time (months)	Use of FM System	School performance
1	16	M	Lower lower	Profound bilateral	Bilateral CI	RE: 60	Yes	Inferior
1	16	M	Lower lower	Profound bilateral	Bilateral CI	LE: 156	Yes	Inferior
2	16	M	Upper lower	Mild bilateral	Bilateral HA	RE/LE: 156	Yes	Inferior
3	17	F	Lower lower	Profound bilateral	Bilateral CI	RE: 72	No	Inferior
3	17	F	Lower lower	Profound bilateral	Bilateral CI	LE: 168	No	Inferior
4	12	F	Lower lower	Profound bilateral	Bilateral CI	RE: 125	Yes	Inferior
4	12	F	Lower lower	Profound bilateral	Bilateral CI	LE: 96	Yes	Inferior

Participants	Verbal IQ		Performance IQ		Total IQ
Participants	Score	Classification	Score	Classification	Score	Classification
1	71	Borderline	97	Average	81	Low average
2	75	Borderline	104	Average	88	Low average
3	59	Intellectual Disability	90	Average	71	Borderline
4	81	Low average	97	Average	87	Low average

Participants	Total score			Classification
Participants	Frequency	Classification	Difficulty	Classification
1	3	Below average	85	High Cost of Response
2	35	Low average	1	Low Cost of Response
3	35	Low average	85	High Cost of Response
4	10	Below average	60	Medium Cost of Response

MEETING	OBJECTIVES	PROCEDURES
1^st	· To integrate the participants	Rapport.
	· To establish rules	Presentation dynamics.
	· To evaluate the participants (pre-intervention)	Application of the Self-advocacy Checklist “I can” and the CPQ.
2^nd	· To promote bodily awareness	Dynamics to exercise body expression.
	· To know and understand the concepts of self-advocacy and citizenship	Themes: Self-advocacy and citizenship.
	· To develop strategies to deal with learning and communication difficulties	High school, Higher education and employability
	· To know the Brazilian Laws regarding the inclusion of people with disabilities and how to use them to obtain accommodations
3^rd	· To identify individual qualities	Dynamic: “Valuing your qualities.”
	· To understand hearing loss	Themes: Understanding hearing loss
	· To identify and describe the benefits and limitations of the use of hearing aids (HA) and cochlear implants (CI)	The use of electronic devices applied to deafness (benefits and limitations).
	· To identify and describe the benefits and limitations of using assistive technologies	The use of assistive technologies.
4^th	· To use recreational elements to reinforce and apply concepts learned in previous meetings	Dynamics using the following games from the website “Rule the School”: “Rule at the school,” a self-advocacy board game; “FM Tic Tac Toe Bingo Featuring Phonak's Inspiro” and “Hearing Aid Tic Tac Toe Bingo,” which aim to teach vocabulary and functions of hearing devices; and “Helping Hands,” which aim to teach how to request essential accommodations independently.
4^th	. To practice self-advocacy through problem-situation games
5^th	· To internalize the concepts learned in previous meetings	Closing dynamics with games used in the 4th meeting.
5^th	· To evaluate participants (post-intervention)	Second application of the Self-advocacy Checklist “I can” and the CPQ.

Meeting	The topic addressed/Proposed activity	Result
1^st	Rapport	P3 interacted in the rapport situation and had difficulty expressing herself in other group situations, requiring the researcher's intervention to encourage her participation, which consisted of only short comments.
2^nd	Self-advocacy	In the second meeting of the program, after performing the true or false activity about the theme, the researcher stated that “Self-advocacy is telling people what I need.” “Self-advocacy is telling people what I need.” All participants responded that the statement was false.
		Some participants pointed out that:
		P4: “Self-advocacy is taking care of yourself.”
		P2: “It is to tell people about my rights.”
3^rd	Hearing functioning and types of hearing loss	The dialogues demonstrated that the participants had limited knowledge about how hearing works and the types of hearing loss. The researcher presented a diagram to show how hearing works and images to exemplify the types and degrees of hearing loss. After this explanation, the level of knowledge was resumed through questions:
		T: “When there is a problem with the sound conduction, what is the type of hearing loss?”
		P1: “Conductive.”
		T: “And when the loss affects the cochlea?”
		P1: “Sensorineural is the hearing loss in the cochlea.”
	Use of hearing aids and assistive technology	The participants were able to describe the functions of each assistive device and list some of their components.
		T: “What is the battery for?”
		P2: “The battery is used to power the device.”
		P2 explained how the parts of his hearing aid worked, especially the volume controls. P1 explained the functioning of his CI and emphasized that the CI helps him to understand speech.
		P4 explained his CI's connectivity with TV and cell phone when he wants to listen to music.
		Some hypothetical situations were raised regarding the use of hearing devices. Participants were encouraged to answer what they would do in those situations. If a situation had already happened to them, they were encouraged to answer what they had done.
		T: “What would you do if a new teacher, who did not know that you use the FM System, arrived in the classroom?”
		P1: “I would hand the FM microphone to him and explain how it works.”
		P1: “Once, the teacher forgot the microphone on while calling out another student. It was not cool, but the teacher apologized.”
		P2: “I would warn the teacher and explain.”
4^th	Access to health professionals and each of their functions on the health service	After the discussion was held in the meeting, the participants could describe each health professionals' function.
5^th	Reapplication of “Rule at the School” games translated into Brazilian Portuguese, also used in the 4th meeting	The adolescents were very excited and participative. From their answers to the games' questions, we noticed that the activity contributed to the internalization of the contents worked in the previous meetings, especially because, when there were doubts, the participants retrieved the contents and discussed them with the group.

[1] Conflict of interests:

No.

Brasil

Brasil

Self-advocacy as a practice of empowering adolescents with hearing impairment: a pilot study

ABSTRACT

Purpose

Methods

Results

Conclusion