Date of Graduation


Document Type


Degree Name

Master of Science in Communication Disorders (MS)

Degree Level



Rehabilitation, Human Resources and Communication Disorders


Rachel Glade

Committee Member

Tracy Pate

Second Committee Member

Elizabeth Rosenzweig

Third Committee Member

Christine Holyfield


Auditory skills hierarchy, Auditory Verbal Therapy, Hearing loss, Parent engagement, Speech-Language Pathology, Telepractice


Parent engagement is a key component during early language development for all children, but particularly for a child with hearing loss. Through the application of technology-based models of service delivery such as telehealth, researchers have found an increase in parent-child engagement during auditory-verbal therapy (AVT) sessions due to the physical absence of the provider and parents becoming the primary language facilitators. However, current measures of parent-child interactions do not have a coding system to monitor facilitation of auditory skills. This present study will discuss the development of the Caregiver-Child Auditory Skills Tracking (CAST) Scale to track progress of caregiver implementation of the auditory skill hierarchy. Initial development included using the CAST scale for a pilot case study of parent interaction during 2 sessions (6 months) of auditory-based sessions via international telehealth. The participants were Spanish-speaking parents of a 2-year-old child with bilateral cochlear implants who reside in Mexico and received intervention from an Arkansas-based clinician. Parent interactions were qualitatively coded by graduate student clinicians using the CAST scale to rate implementation of auditory skill hierarchy stages. Data was coded twice (approximately 4 weeks apart) for both sessions on the auditory skills strategies data sheet developed by the researchers. The statistical analysis performed on the data collection was a repeated measures ANOVA. The results of the analysis found that there is a significant effect of time on both session conditions (rating one and rating two). Specifically, the rater’s auditory skills training had a statistically significant effect on auditory skills strategies data. Additionally, telehealth was observed to increase parent engagement in both sessions. These findings provide a guideline towards continued progression of the CAST scale and adds to research that supports telehealth as a viable option of speech-language pathology service delivery.