Dr. Ivette Cejas, Psychologist: Parental Stress & Self-Efficacy Support

Stress is a part of every parenting/family journey.  This parenting stress can be compounding when a child is deaf/hard of hearing.  Join me in a conversation with Dr. Ivette Cejas, licensed psychologist, Associate Professor at the University of Miami Ear Institute, and Director of Family Support Services at the University of Miami Children’s Hearing Program. Dr. Cejas is a well-known researcher in the area of pediatric hearing loss. She specializes in psychoeducational evaluations for deaf or hard of hearing children, as well as mental health therapy for this population. She is on the Board of Directors at AG Bell and is a member of the American Cochlear Implant Alliance.  In this podcast, Dr. Cejas shares the top stressors parents are faced with, a tool to help measure parenting stress specific to cochlear implants, and ways to support self-efficacy.  She also discusses the importance of including professionals such as psychologists and social workers to support the whole child.  

To listen to or access transcripts of this episode:  

www.3cdigitalmedianetwork.com/empowear-audiology-podcast

To connect with Dr. Cejas   icejas@med.miami.edu

https://www.linkedin.com/in/ivette-cejas-566783118

https://www.instagram.com/childrenshearingprogram/

For more information about Dr. Carrie Spangler- check out her LinkedIn at https://www.linkedin.com/in/carrie-spangler/

For transcripts of this episode- visit the podcast website at: https://empowearaudiology.buzzsprout.com

Transcript

Announcer: [00:00:00] Welcome to episode 45 of Empower Audiology with Dr. Carrie Spangler.

Carrie: [00:00:15] Welcome to the Empower Audiology podcast, which is part of the three C Digital Media Network. My name is Dr. Carrie Spangler and I am your host. I am a passionate audiologist with a lifelong journey of living, with hearing challenges in this vibrant hearing world. This podcast is for professionals, parents, individuals with hearing challenges and those who want to be inspired. Thank you for listening and I hope you will subscribe, invite others to listen and leave me a positive review. I also wanted to invite all of you to visit and engage in the conversation and the EmpowEAR Audiology Facebook Group. Transcripts for each episode can be found at www3 the number three C Digital Media Network dot com under the EmpowerEAR Audiology Podcast tab. Now let's get started with today's episode. Today I have Dr. Ivette Cejas with me. She is an associate professor at the University of Miami Institute and Director of Family Support Services at the University of Miami Children's Hearing Program. She is a licensed psychologist in the state of Florida and is a well-known researcher in the area of pediatric hearing loss. She specializes in psycho educational evaluations for deaf or hard of hearing children, as well as mental health therapy for this population. She is on the board of directors of AG Bell and is a member of the American Cochlear Implant Alliance. So thank you for Ivette joining me today.

Ivette: [00:02:07] Yes, thank you so much, Carrie, for the special invitation. I'm super excited to be part of the podcast.

Carrie: [00:02:14] Well, I had an opportunity to hear you speak at the recent American Cochlear Implant Alliance conference back in May of 2022. And I was just so intrigued by the different topics of research that you are involved with, including language and academic achievement for children who are deaf and hard of hearing, especially those with cochlear implants and also the societal cost of that severe to profound hearing loss. So I was excited that we were both at the A.G. Bell reopening event in Washington, D.C., and a common colleague, Jordan McNair, said, I need to know you. So I'm glad he connected us.

Ivette: [00:03:02] Yes. I think we all work in a very small circle, so I'm super excited that Jordan introduced me to you and that I can kind of expand a little bit more about the important work that we're doing as part of the Children's Hearing Program at UL, at UT Health , but also just about topics that don't typically get discussed in the deaf and hard of hearing population.

Carrie: [00:03:26] Which is a great segway into my next question, because I always like to ask professionals about their back story and you being a psychologist and getting interested in the deaf and hard of hearing population. I would love if you could share a little bit about that.

Ivette: [00:03:45] Yeah. So I always say that kind of fell on my plate. I always knew I wanted to work with children and families. I was definitely always interested in special needs populations and more of pediatric psychology. So I did a lot of work with children with chronic medical conditions, whether diabetes, cystic fibrosis and cancer. And I was kind of just as most people looking for a job in between undergrad and graduate school. And I ended up working as part of a research lab that was doing research on children with cochlear implants. And it was an immediate connection. I had so many questions. I wanted to see how I can help this very unique population of kids. And so I kind of started just doing some research in the area and then realized that there was also a very much clinical need in this population and that a lot of psychologists don't know how to work with deaf and hard of hearing children or adolescents. And so I started to carve out in my graduate training, still doing pediatric psychology, but then working with this very unique population. And my love and passion just continued to grow from there. And I found a very unique niche in my training to be able to provide a little bit more of that clinical need for this group.

Carrie: [00:05:18] That's amazing because I, I agree that we need to have this other perspective when we're working with families and children who do have cochlear implants. Because although the cochlear implants are medically very extraordinary and they're very scientific, scientific, but there's also a lot of other factors that go into working with this population. So to get us started with our listeners. Can you just share a little bit about maybe the landscape of children with cochlear implants and kind of the statistics that you see?

Ivette: [00:06:00] Yeah. So cochlear implants are an amazing technology that, you know, the criteria and candidacy obviously is expanding very, very quickly. But typically, right, we kind of refer children who have a bilateral severe to profound hearing loss, who really aren't benefiting from using hearing aids to kind of do a comprehensive evaluation to see if their cochlear implant, you know, a candidate obviously with the family's choice involved and with the the the that unique partnership between the clinic as well as the family to see if that's the right choice for them. Obviously. Now it's also being recommended for single sided deafness as long as the children are older than five years old. So even in my lifetime and I always say I'm not very old, I've seen drastic changes in one, how they look, how they function, but also just who are candidates. And I think it's just something where, you know, if families have a doubt, if they're interested, I always just recommend that they seek an evaluation, find a pediatric program that is willing to listen to your your concerns, what you want, your goals for the child. And if it's something the family would like to pursue, then it really has amazing benefits and improving the access to their auditory environment. That could really kind of help in terms of the development of listening and spoken language.

Ivette: [00:07:30] But the harder part is that a lot of children that are born with hearing loss are born to hearing parents and to over 95%. Right. I would say I know they say 90%, but really it is higher up there. And this is where it really becomes challenging for parents because it's something very new. They don't know what to expect. Children, you know, are difficult in general. Right. First time parents, I remember the first time I was a parent, I'm like, I really wish I had a manual. I had all of these articles and all of these things that I could do and I read, but there really isn't no true preparation to becoming a parent. So I always say, imagine what that's like when then you have a child that has some other developmental disorder or some other medical condition, right? It brings on a whole other kind of stress into the family. And that's why I think it's so important to have more psychologists, more social workers, more mental health providers that are helping to guide the families in knowing what to do, what are those next steps and how we can help them cope with sometimes the unknown that comes with this hearing loss diagnosis.

Carrie: [00:08:39] Yeah. And like you said, there's really a multitude of factors that goes into the success of, you know, children who have cochlear implants from the age of diagnosis to the age of implantation to the intervention that happens afterward. But I know that you've done and then, like you said, that any kind of co-morbid conditions, too, but you've done a lot from a psychologist perspective and the focus of family and parenting as it relates to children who are deaf and hard of hearing. So can you share a little bit more or take a deeper dive into your research with families and some of those predictors of post implant success?

Ivette : [00:09:27] Yeah. So I always say usually when I'm in conferences, I'm a little bit of the unicorn right in the audience, right? So we always expect that these national cochlear implant conferences or any deaf and hard of hearing conference, we always see, right audiologists, our educators, our speech and language therapists. But then usually I'm kind of the psychologist in the room, or now it's kind of a handful of us. And that's amazing to see that even in my career, I'm seeing to see more people who are interested in learning about the topic. And so one of the things that I've kind of done throughout my career is to really emphasize the whole child and the whole child's development. We're not just talking about hearing, we're not just talking about language, but how all of those things can really affect that parent child relationship or how it could affect a child's social skills. Right. And how they develop in those areas, their emotional functioning, their quality of life. And so I've seen a lot of gaps in those areas. Right? I've seen a lot of gaps where we don't really have validated tools. We don't have really good instruments to help us track these areas.

Ivette: [00:10:39] We're great tracking speech and language skills. We're great about looking at auditory development post implementation, but sometimes those things do not connect, right? Our best performers sometimes are still struggling socially. Our best performers sometimes are still struggling academically. And so I in my career have wanted to look at those things and find out what can we do? Why is there still so much variability in performance when we look at this population of cochlear implant recipients, is there something right that can lead us to do something differently in terms of intervention? And so those are some of the questions that I started to ask and started to uncover because I know as a group that they do well. Right. But still, there's still a subset of these kids that are not even though they're being implanted earlier, even though they're receiving all the interventions that we think could benefit them. And so I wanted to kind of start to ask, answer some of those questions to see what we could be doing in both the clinical side, but also the educator side into improving those outcomes for those children.

Carrie: [00:11:47] And what have you found? I know that you. One of the big things that you've looked at is parenting stress. And you kind of alluded to that earlier. As a parent, even as a first time parent, we don't have a manual. We we don't really know what we're getting into until you actually have a child of your own and then you add, you know, another unknown on top of it. So what have you found in your research with parenting, stress and children who are deaf and hard of hearing?

Speaker3: [00:12:22] Yeah. So I always, you know, parenting, stress, like I said, even somebody with a lot of training or. I thought I had a lot of training. Right? Developmental training. I knew exactly what to do. When I had my first baby. I probably looked like a deer with the headlights. I was unsure. I was afraid. You're nervous, you're happy. You have all of these emotions. And I always tell parents you're not alone in that. Right. And, you know, the literature really has found that if we look at general parenting stress, our parents of children with hearing loss are no different. So general stressors, we are all stressed as parents. It is what it is. Right? But the unique part that we've started to find in my research is that there is higher reports of condition or what we say, context, specific stressors related to hearing loss that we do not obviously see in a hearing population. And so what we found is that those are more predictive or more related to a parent self efficacy, which is parent, which is basically how confident you feel in your skill set. Parent Right. So we see that that parenting stress is related to parental self efficacy, but all of that, more importantly, is related to child a child's communication or a child's language development. And so that's where right that started to catch my attention where okay, these parents, right. If they're more stressed, they're less confident in their skills. And if they're less confident in their skills, they're less involved. And if they're less involved, we know that that has a direct effect on a child's development. And that's why we really need to be doing better about helping parents when they start to feel right, scared when they start to feel that they're not equipped with the right skills or when they're really feeling high levels of stress.

Ivette: [00:14:13] So that way we can do something to help in terms of that that their child's overall development. So one of the studies that we recently published in the Journal of Otology and Neuropsychology was part of the childhood development after cochlear implantation study. The CDCI study is some people call or maybe the CDCI study and that actually that study is kind of like a hallmark of my career. I started to work on that study when I was still an undergrad before I had graduated, and that study is the one who sparked my interest to go into this career. And I've been able to work on that project through right undergrad, through graduate school, and then as an actual investigator on the project. And we followed 188 children with cochlear implants from before they received their implant all the way to several years after. And that's the study that we found that parents who reported higher levels of stress reported lower perceptions of self efficacy and involvement. And this was after kind of controlling for things like age at activation, parent education, all of these variables that we know could affect outcomes. So in itself, after controlling for other key variables that we know still parental self efficacy and parenting stress were still affecting child's spoken language development, which as a psychologist and as someone who's working as part of an implant team, I started to realize, okay, we should really start to be assessing this in our clinical sample. That way, when we start to see that these things are on the rise, we can kind of help families before it becomes to a clinical level that we know could really affect the child's outcomes.

Carrie: [00:16:00] Wow to get 188 families is amazing to you to be able to follow because that's a pretty large population when you think about how small the population really is for, you know, children with cochlear implants. But you mentioned the self efficacy and measuring that for parents. Is there a and have you worked on a tool to help clinicians and researchers to look at that with families?

Ivette: [00:16:27] Yeah. So actually the tool that I use to look at parental self efficacy and involvement was called the SPISE, and it's the scale of parental involvement and self efficacy by one of my colleagues, Jean Desjardin. And she developed that tool, which I have found very useful. And, and it has some information just to kind of even guide intervention. So you can kind of see where parents are feeling that they need a little bit more support. And so for my you know, for the audience, right, if you're an educator, if you're a speech and language pathologist or an LSL specialist, they really find this helpful because it's not just identifying areas, but it's giving you targets for what you could do. And even for my parents, my families, that they don't realize the areas are struggling. But then you have a measure to say, let's kind of use this to monitor what areas maybe you need a little bit more help with. So I tend to use the SPISE for self efficacy and involvement. And then in the study I was referring to, I used the family stress scale for parenting stress, but that scale was actually developed many years ago before I was even in the field.

Ivette: [00:17:35] And so I found that even though it was helpful because of the population that we're serving, I actually developed a specific parenting stress measure for cochlear implants for parents of cochlear implant users. And so that's one that I did recently develop and validate, and that was published in the Journal of Pediatric Psychology. And that's because I really started to see again with the research that it's not just general stress, it's stress related to cochlear implants specifically that was really being a stronger predictor. So I wanted to develop something using the current day practices, right, to make sure that I was using something that was applicable for the entire cochlear implant population and parents. So we recently did involve develop that and validate that. And that's a free screening tool that anyone is available open to, to, to using. And we're in the process of actually translating it in Spanish and validating it that way. We can also use it with our Spanish speaking population.

Carrie: [00:18:39] That is great. Well, at the end, in the show notes, we're definitely put a link so people can access that tool as well. When you were developing that tool specific for stresses for parenting, for kids with cochlear implants, what were some of the main stressors that stood out in this for this parental, you know, population?

Ivette [00:19:03] Yeah. So, you know, it's not surprising even when we see it. And what was more surprising to me is that the top stressors don't change much from early childhood to school age. I expected that there was going to be a bigger shift or difference. But, you know, the as in early childhood, the main stressors were being a language teacher for your child's educational concerns and safety. Those were the key ones. In addition to financial stressors, which actually is a common stressor across any parent, whether you have hearing loss, a child with hearing loss or not. But those were the main stressors when you go to the school age population, some of those change in the top five in terms of where they are from number one to number three. But the added ones are more of, you know, your child spending time away from home, being with peers. And so that starts to kind of creep in a little bit as parents become more concerned as the child goes away from the household. But being a little bit more independent and then not knowing if their child's ready to advocate for themselves or if the child's ready to to kind of manage their, let's say, their devices independently or if their child is going to lose the device. That became one of the top stressors later on of the device breaking and or their child losing the losing the implant.

Carrie: [00:20:30] Yeah. I could see how many of those starters would be at the for a lot of our families, too. So from your perspective, too, you talked about, you know, families that have higher self-efficacy skills that kind of translates in the child having better own advocacy skills as well as maybe language skills and social skills and things like that. Have you found some good tips or tools to help increase self-efficacy to skills, or is that kind of individual?

Ivette [00:21:10] Yeah. I mean, in general, the biggest thing I always say is, you know, we're very hard on ourselves as parents. It is what it is, right? It's the hardest it's the most rewarding job you have. But it is among the hardest job. Right, that you have. And so I always tell the parents that I'm working with, stop comparing yourself to others. Stop comparing yourself to the family that maybe you wait, that you you met in the waiting room. Right. We got to take all of our positives and realize that we're all unique. Our children are unique, but we're also as parents, we have different styles. And that is what works for one family is not another. So that's probably the number one recommendation I give. And also, you know, the importance the importance of positive self-talk. Right? We always remember every mistake we made, maybe something we shouldn't have done, but we fail to realize all the amazing things that we do right for our children and all of the wonderful things that they are doing, too. So when we can use positive self-talk and give ourselves a pat in the back, that is really important to developing your self esteem, which is going to affect your self efficacy. When we talk about that confidence and that confidence of, of, of the skills that you have as a parent, I also always said make sure you're setting realistic and attainable goals. Right? The same thing you say. Let's say you're a speech language pathologist or you're an educational specialist. Right. We got to set attainable goals for our children right in the IEP process, but we don't really do that to ourselves as a parent.

Ivette [00:22:47] So we say, make sure you're picking a goal that you feel like you can reach, right? We don't want to set a goal that then you're not going to reach because life happens and that's okay. You want to pick simple, attainable goals and that is really huge. Also, make sure you're looking at the bigger picture. You know, we kind of sometimes are so, so specific and we're thinking way too much, too much in the future, and that's okay. And we want to look at bigger picture in terms of growth. So I always recommend that and let's reframe the obstacles, right? Life has obstacles, life has speed bumps, and that's okay. But we need to reframe them because even when they do happen, you're going to learn from it and that might help you accomplish another goal in the future. So I would say those are probably the main general kind of goals or tips that I have when you're kind of a parent that's struggling in terms of believing in yourself. And the number one thing is believe in yourself because I know you can do it and every day is not perfect, but that's what we learn. And make sure, of course, that you're finding attending some social activities, some groups finding opportunities for you to share stories with other parents that are experiencing the same things. I would say that's really, really important, not just for self efficacy, but just helping overall mental health and increasing your positive mental health.

Carrie: [00:24:13] They're all great tips for all of us, but especially, you know, having that believing in yourself and being able to connect with others. Have you seen and I'm just going to ask this and I don't know, but have you seen any correlation between parents who have higher self-efficacy skills and themselves and their children then like later on as they get into school age? Did you see a positive shift that way? Because I know kids who are one and only in a school or a district because they might be the only child with a cochlear implant or hearing challenges. They can sometimes have lower self esteem or motivation. Do you see any correlation between the parenting part and the child part?

Ivette : [00:25:05] Yeah, absolutely. And this is more just thinking about the general psychology literature. Is that how we behave, how we function as a parent directly affects our kids. Right. So this is why it's important. And I always say if you are struggling as a parent, don't be afraid to ask for help. Right. Ask one of your providers, ask your your your PCP, your physician for help, because parents who are more anxious have children who have experienced more anxiety. So the same thing when we think about the positive skills. If you're a confident parent and you kind of are not one that's afraid to try new things, guess what? Your kid is going to do the same thing. They're not going to be afraid of trying things. And that's a very important skill for our kids with hearing loss of we have to teach them that we all make mistakes and everything is not going to come out of our words perfectly or we might not maybe make the best choices. And so sharing those same opportunities with your kids is really, really important, as well as just using a lot of emotional vocabulary, right? We don't do that. But that's something I'm very, I think, conscious of, even with my own children, of if they notice that I'm not in a good mood, I'm like, Yeah, it's talking about those things of why Mommy felt this way, or maybe why Mommy reacted in a certain way. And also just to share with them that it's okay to try things and it's okay if you you make a mistake. And all of those things I do think are really important, especially for our population, because it is a little bit more harder for them. And I think that the more that parents can share with them their confidence and their self esteem, then the higher the chance that the kids will also have those skills as they're growing up.

Carrie: [00:26:59] Yeah, that makes a lot of sense because I could, like you said, have a harder time with that and that incidental learning is harder, which all of that kind of translates into the pragmatics and emotional development. So to be able to teach our kids some of that vocabulary and talking them through those moments, they they learn to develop those skills as well. So I know you're pretty unique down in Miami. And you said that usually at conferences you'll be the only psychologist there, one of the only few. And how how do you expand you everywhere? What advice do you give to different centers?

Ivette: [00:27:46] Yeah. So that is probably one of the most common questions I asked, like, how can we clone you? Or can we take you? Can we take you with us? You know, and I'm super proud of of of what I kind of have been able to accomplish in a short amount of time and in being the field. And I've been, you know, as a faculty member with the University of Miami going on 12 years. But, you know, my interest, right, of of noticing that there actually was an auditory oral preschool across the medical campus that no psychologist was going into. I wanted to walk through that door and I was bold enough to walk in and say, hey, I'm a psychologist, can I help out? And it really started from there. So I always say, if you have a trainee that's interested, take them, take them into your clinic. And that's actually what I'm doing is I've been very lucky that as a faculty member I do have access to psychology trainees and so I have practicum students. I now accept also pediatric psychology interns into our department in our program so I can train them in hearing loss and all of the things that actually we don't get specific training as a psychologist, but then they have the right tools in their toolbox. So if they interact with that population and wherever they they end up, then they'll know what to do. Right. I say, I always tell them, you might not know everything you need to do, but at least if you know the right first steps or who to reach out to, then you're in a better place. And to. One of the things that I've done, too, is, is making more connections with my community and community psychologists, because I can't see everybody myself.

Ivette: [00:29:36] But, you know, I've started to kind of reduce some of that stigma of what it is to provide mental health services for this population. And so what I do is as much as I can go out and present at different conferences, whether it's cochlear implants or educator conferences that are very rewarding. And I've been able I recently came back from one in Indianapolis. I did one in Indiana, all of those. Right, to kind of also help educators and people that are more likely going to interact with this population, making sure they feel comfortable in assessing and getting these kids to the right place. So if you're interested, I'm always willing to kind of have those conversations. How do you start it off? Like I started myself, but now there's myself and I was able to hire another psychologist on the team. So now there's two. Plus, I was able to start off with a part time social worker, and now I showed the benefit to our chairman and to our department. And so now I have a full time social worker. So same thing with our educational specialist. And so sometimes we start small and you got to capture data and show the benefits and how you're helping those families. So that way you can expand your program. So it's not easy at first, but it's really rewarding. And if you track your data and track the benefits in terms of the outcomes of the families and children you serve, I promise you're going to able to to expand them, to be able to really offer this comprehensive and multidisciplinary team to all the families you serve, whether you're in clinical practice or whether you're in a school setting.

Carrie: [00:31:21] That's great. Yes, I, I know that I work with a lot of school psychologists and they always comment that this was definitely not an area that they received a lot of training and a background in. And when they do have a student who is deaf or hard of hearing, they don't always know what tools to utilize to assess and help make a plan.

Ivette: [00:31:49] Yes. So if any administrators are out there, you know, from the educational system, I am willing to do trainings for your school psychologist. I always find that it is a very difficult area and sometimes I'm surprised when I review reports and maybe I don't agree, but I can't blame my school psychologist because like I said, even as a clinical psychologist, I did not get any specific training. So we need to be offering school psychologists, educators the training so they can really use the right tools and assessments to be monitoring progress in this population.

Carrie: [00:32:27] And do you have certain tools that you point or resources that you typically point to school psychologist or the clinical psychologist to if they are going to be working with this population?

Ivette: [00:32:42] Yeah. So I mean, definitely when we're talking about, you know, the psycho educational evaluations to kind of see how our children are functioning, you know, depending on the child, how they're doing, you know, we might want to do non verbal IQ measures like a LITER, right? But then that's not always appropriate because our kids are expected to function in a mainstream setting. And so that's not sometimes very useful in saying how our kids are going to do. So then I will do more of your traditional WISC assessment. And so sometimes you need to know how to interpret both of those to kind of know what kind of goals for that child for academic performance. My you know, my preference is still using the Wechsler the WYAT in looking at how those kids are doing. And then depending on that, I do use a range of self report or parent and teacher report forms that are really helpful. And my, my, my approach is that I shouldn't be comparing them to a deaf and hard of hearing population. I should be comparing them to hearing children because that is the expectation of a large population of our children. Like you mentioned earlier, they're in the mainstream class. And so we need to make sure that we can get them functioning like that. And if they're not, what are those additional maybe positive behavioral supports that we can incorporate in into schools that's going to help them? So I like to use the BASC. I like to sometimes add and look at executive functioning since that is one of our areas that our kids struggle in terms of their working memory, their processing speed. But what I'm finding is that these things are not being assessed in a in a in a way that we know how to identify it early and we end up being a little bit more reactive. And so we're waiting to our kids struggle before we intervene when really we should be tapping this a lot earlier. So that way they're not at the point where then they're struggling or doing poorly academically before we intervene.

Carrie [00:34:48] Yeah, that's a great point because I feel like a lot of our kids who are deaf and hard of hearing, especially if they've had the early intervention, the receptive and expressive skills look really good, but they have that swiss cheese of having different, you know, executive functioning skills that are lacking and things like that that maybe we're not taking a deeper dive into. And that is why they might not be progressing at the rate that we that they might be able to at the potential that they might be able to.

Ivette : [00:35:20] Absolutely. You know, I think sometimes. Right. We are not setting high enough standards for our kids. And they they should be performing. They can do it. And so I think the field has definitely moved from so much of the focus of the auditory piece and the language piece, which we've done a lot better about. But now we really need to be focusing on more of these functional outcomes, like I say, and looking at academically and their transition to being independent adults and all of these things that are really, really important. And the earlier we start to have those conversations and helping our children, the better that they're going to do in the long run.

Carrie: [00:36:01] Yes. That's that's all good information. So from a psychologist lens. Do you have like five main takeaways that you would like to share with our listeners today if they. I don't know. I just feel like this need to be such a part of every cochlear implant team and community like the whole child, like you said, educationally, community, parenting, you know, home as well as the cochlear implant team. So I was I thought I would ask you if you have some takeaways that might be helpful for our listeners.

Ivette [00:36:37] Yeah, well, that's a that's a tough one. But let's see. So I'm going to give a I'll try it out. But I think my biggest one is, if you are, let's say, as part of a team, a clinical team or an educator team at school, don't let the administrators tell you you can't have access to all of these professionals. There is a way. Maybe it is not a full time person, right? Maybe it is working with another department or another division. But I would say do not give up in terms of getting these qualified professionals and these multidisciplinary professionals. Right. We all need to make sure that if your child if you're you're working with a with a family has hearing loss or if you're a parent of a child with hearing loss, that you have access to all of these professionals and providers if you need it. It doesn't mean you always need to have the psychologist, but or a social worker or educator. But there might be stages and times that you need them and you should be able to have access, so don't give up on it. And so if you're an educator, don't be afraid to ask your administrator for them. And if you're a parent and need access, don't be afraid to talk to your provider, your team.

Ivette: [00:37:53] Right. You're hearing loss team and say, I need help with these areas. Who can you get me in touch with in the in the field? And so I think that would be my biggest one of we need to be asking for more and it is possible don't be afraid to ask for things because if you don't ask for it, it's never going to happen. And I was surprised. I'm going to say I was surprised of how quickly I was able to get these people. Once you show the true benefit, get those patient anecdotal right quotes of how helpful those team members are. So that way you have that for the future to make a case for maybe having somebody more full time. For my educators out there, you know, my school psychologist is if you don't feel comfortable or feel like you don't have the training is to ask for that. There are people out there, there are more than me right out there and that we could do some of these trainings, even though we might be in a different state. We can now use what we've all learned due to COVID. That's the positive part of COVID, is that we've all done very well about doing Zoom trainings. And so now you have more access right into people around the nation, around the world that maybe could provide some of this training.

Ivette: [00:39:08] So we're doing a better job about monitoring these kids. And for my families out there is to realize you're not alone, realize how amazing you are. You are a champion for your children. And we've got to believe more in ourselves and know that you're there and you're doing the best that you can. And if you need help, don't be afraid to ask for it. There is somebody there who's gone through your experience. You're not alone in this journey and speak up because I am sure that you're amazing audiologists. You're amazing hearing health providers. The team that you're working with could put you in contact with someone that will help guide you if you need that support. And there's a lot of organizations out there, right? There's a lot of Hands and Voices. There's AG Bell, there's the American Cochlear Implant Alliance, where if you can't find a provider in your area because it could happen, then we could still link you up with one of these amazing organizations that have parent groups and different resources that you could have to your disposal to help navigate what you're going through, because there's a lot of really, really nice resources out there.

Carrie : [00:40:28] But there are there are great tips for both families, education specialist and then clinical providers as well. Is there anything that I didn't ask you that you were like, I really want to share about this with my research or my clinical experience?

Ivette : [00:40:49] You know, I think you I mean, I think you pretty much covered it. I probably can just stay here talking to you for like hours. But I think the main thing is, you know, we have to stop using mental health and as a stigma. Right. There's a lot of that in out there. There's a lot of stress. Right. That that just is part of living in our community, living our society. And luckily, we have a lot more resources out there. So I think everybody if there's one thing I want to get out there is that, again, like I've said, you're not alone. There's a lot of people experiencing it and there's ups and downs, right? That happens. And we want to make sure that we're talking more about these areas. So that way parents know what to do, providers know what to do. And I'm just happy that that my research. Right. Has started to just open up some of those conversations. And so I love to hear, you know, when I go to these conferences, it's I'm not the only one talking about these things anymore. And that's great to me. That's that's really important to see or to just see the the interest about these areas. And the more we talk about it, the better we're going to be able to do to be able to identify who really needs help in terms of these areas. And also then that's going to lead to more effective interventions that are available out there. So I really, really appreciate, Carrie, you inviting me to kind of talk about these things. And I'm happy to to provide more for listeners if they're if they're interested in reading a little bit more about my work.

Carrie: [00:42:30] And if they are interested, how do they get ahold of you?

Ivette: [00:42:34] Yeah. So let's see. So probably the best way is, I guess my email address and I promise to try and respond as quickly as I can. But if you're interested in any of the articles or chapters that I've written on some of these topics, I'm more than happy to share. So my email addresses, I say this and I'll spell that out. That is I as in ice cream C as in cat E as an elephant J As in Jack A as an apple and S as in Sam at med which is m e d dot Miami dot edu. So you can feel free to reach out there. I also, you know, do a lot with from my academic side on Twitter. So I do have Twitter. I think it's Ivette Cejas pretty easy just my name out there and so feel free to kind of reach out. We also have an Instagram page for our children's hearing program that we actually post different topics about these things and mental health tips and LSL tips so that Instagram account for our U. Health Children's Hearing program is @ children's hearing program.

Ivette: [00:43:49] So very simple. And so you can reach out in any of those ways if you have a question or you're interested in any of our resources. And then, of course, I know the listeners are from everywhere, but if you're interested in reaching out to our actual UHealth children's hearing program for an appointment or anything along those lines, we actually are very fortunate that we have a nice organization that we could we have a hearing aid loaner bank. So if you can't afford hearing aids, we have a cochlear implant loaner bank. If you cannot afford your repairs through our children's hearing program and we actually help to sometimes do pro bono cochlear implant surgeries if you cannot afford it and you don't have insurance through our children's hearing programs. So if you're interested in an appointment to kind of see if you're a candidate and not sure if you can afford it, don't be afraid to call us. It is at 305-243-1110. And we will make sure that we can get you resources so that you can get the hearing care that you need.

Carrie: [00:45:00] Wow. That is amazing. Thank you for sharing all of that. And I will make sure that I link some of your contact information in the show notes so people can also just click on that and be able to reach out to you as well. But I want to say thank you. And that, again, for being part of the EmpowEAR Audiology podcast. Your perspective as a psychologist is so important for the whole child and for the whole team and and family. And it's such an important part of probably one of the most important parts of that cochlear implant process is how do we emotionally deal with some of the stressors that really do come up along the way with our families. And then again, that translates to our kids and we want to have successful kids as well. So thank you again for sharing all of your research and your knowledge and your updated of the different surveys that you have for stressors that people can utilize those in their own practice and hopefully build some very effective self efficacy skills and help families that way as well. So again, thank you for being a part of it today and I appreciate you coming on.

Ivette: [00:46:19] Thank you so much, Carrie.

 [00:46:21] This has been a production of the Three C Digital Media Network.