Assessment & Training Trends for SLPS Working with Students who are DHH

Join me in talking with Dr. Kristina Blaiser about the importance of understanding systematic assessments patterns and trends for children who are deaf and hard of hearing and using trends for training and collaboration for SLPs and other related professionals. Dr. Kristina (Kristi) Blaiser is an Associate Professor of Speech-Language Pathology at Idaho State University. She earned her Doctor of Philosophy in Speech-Language Hearing Sciences from the University of Minnesota, Minneapolis, MN. Kristi's professional and research focus is to ensure children who are Deaf/Hard-of-Hearing reach their full potential, specifically through systematic assessment as the foundation for support and training of the adults who interact with them. Dr. Blaiser is the Coordinator for the American Speech-Language Hearing Association’s Special Interest Group, Pediatric Hearing  and Hearing Disorders, the Idaho representative for the national Speech-Language Pathology Advisory Council, and a committee member of Idaho’s Newborn Hearing Screening Advisory Council.

Join Dr. Kristina Blaiser and I in this podcast episode  reviews research about assessment information and the importance of integrating into meaningful goals and objectives for children who are deaf and hard of hearing, through professional development opportunities and resources.  Taking a step back, seeking collaboration, and continuously listening and increasing knowledge are important key discussion points to help children who are deaf and hard of hearing reach their potential.  

You can reach Dr. Kristi Blaiser at kristina.blaiser@isu.edu

Transcript: https://www.3cdigitalmedianetwork.com/empowear-audiology-podcast

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

[00:00:00] Announcer: Welcome to episode 36 of empowEAR Audiology with Dr. Carrie Spangler.
[00:00:16] Carrie: Welcome to the empowEAR Audiology podcast, which is part of the 3C 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 and this vibrant hearing world. This podcast is for professionals, parents, individuals, with your own challenges and those who want to be inspired.
[00:00:45] 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 on the empowEAR Audiology Facebook group. Transcripts for each episode can be found at www dot three, the number three, C digital media network dot com under the empowEAR podcast tab.
[00:01:19] Now let's get started with today's episode. Welcome to the empowEAR Audiology podcast. I am so excited to have a special guest with me today. Her name is Dr. Kristine Blaiser, and I'm going to give you a little bit of information about her before I have her come on the air. Dr. Kristina Blaiser is an associate professor of speech language pathology.
[00:01:43] at Idaho state university, she earned her Doctor of philosophy and speech language, hearing sciences from the university of Minnesota. Dr. Blaiser’s professional and research focus is to ensure children who are deaf and hard of hearing reach their fullest potential specifically through a systematic assessment as the foundation for the support and training of the adults who interact with them
[00:02:11] Dr Blaiser is the coordinator for the ASHA's special interest group, pediatric pediatric hearing and hearing disorders, the Idaho representative, but then national speech, language pathology, advisory council, and a committee member of Idaho's newborn hearing screening advisory accounts. Dr. Blaiser directs the Idaho state university hatch program, which is helping adults talk to children lab on the Meridian campus since 2015 faculty and students graduate and undergraduate from the hatch lab received more than $450,000 of external funding coauthored.
[00:02:51] She has coauthored 12 publications and over 50 presentations at international and national conferences. So that is quite an extensive bio Dr. Blaiser, welcome to the empowEAR Audiology podcast.
[00:03:05] Kristina: Thank you so much for having me. It's an honor to be here with you, Carrie.
[00:03:10] Carrie: I'm really excited for this conversation today.
[00:03:13] And I always like to start my conversation. If I know somebody, how did we actually meet? And I was trying to think about that.
[00:03:21] Kristina: Yes, I, we were talking about maybe it was through an invited speaker, uh, for an ASHA convention, but then also Beth Walker, all good things lead to Beth Walker
[00:03:33] Carrie: good. Thankfully the bedrock that she seemed to pull us into many different things, but yes, and I think this past year has been fun even though, um, we weren't together.
[00:03:46] At ASHA, I was there. You have my trial, but we got to please act together. So that was a fun time to get to know you better. Yeah, that
[00:03:54] Kristina: was so fun. It was great. It was great to hear about our different perspectives on working with kids who are deaf or hard of hearing and how we can work together. The fun experience
[00:04:03] Carrie: it was and all of the technology work that day.
[00:04:07] Amazing. Right. It
[00:04:09] Kristina: was amazing. It was just like being there,
[00:04:13] Carrie: highlighted on the big screen there. So I always like to ask my guests, if they are in the profession, how did you get to speech pathology? I feel like a lot of people have a story behind.
[00:04:28] Kristina: Well, I started off at Madison and I was going to be a, a business major.
[00:04:34] And I ended up taking a lot of pre-calc classes and, uh, different types of classes and remembered that in high school I had taken a assessment an assessment that said, uh, you know, this would be a great profession. And it was either a florist or a speech-language that. So I remember signing up for my first class, uh, in communication, sciences and disorders.
[00:04:57] And I immediately knew that it was the right field for me. And I think that the idea of. Art and science in terms of helping people communicate with each other just became, it was so exciting. And I took my first aural rehab class in undergrad, and I knew that was it. That was the only thing I ever wanted to do was to work with kids who are deaf or hard of hearing.
[00:05:22] So as I kind of moved on, I really knew I wanted to specialize from a pretty early age, like my junior year in undergrad. And I knew I wanted to find a graduate program that could help me specialize. And so, um, I went, ended up going to the university of Minnesota and, uh, as I was taking my speech language pathology classes, I was realizing I did not.
[00:05:44] Have enough information just from speech language pathology. So I asked if I could take audiology classes. And so they let me start, you know, taking some of those as my electives. And then I realized that I still needed more information to be able to really do it. So I started taking deaf education classes as well.
[00:06:03] And so it's really interesting how my path at the beginning with, so recognizing that I needed to be able to Tap into other experts to be able to get a well-rounded view of, of what, uh, kids with hearing loss need. And so I did that. Back in graduate school. Um, and now I still feel like that's one of the things that I'm still trying to be able to figure out.
[00:06:26] How do we do that better as we are working on in the profession?
[00:06:31] Carrie: Yeah. I think all of us, like you said, the teachers of the deaf and audiologists and speech language pathologists, all look at kids who had deaf and hard of hearing in their unique ways. And we have collaborative ways that we also have our own ways.
[00:06:48] Which kind of brings me to my next question. And it is you have the foresight taking classes as an SLP to see, Hey, I need more knowledge from these different angles. And I know that in your work you've been able to survey some of the background and education and experience of providers working with this population.
[00:07:13] What did you find with that?
[00:07:16] Kristina: Well, the things that I'm finding are that our profession's best practices are really outlining expertise and skill sets of people who are specialized either in listening and spoken language or American sign language, or have these skillsets. But when we look at the training programs that we have at, um, even at the graduate level, We don't have that much overlap or actually any overlap, really.
[00:07:41] And so speech, language pathologists in particular, don't have any audiology classes at the graduate level. And so everything that they are doing when they're working with students who are in school settings or clinical settings, they're basing that information from something they had in undergrad, um, and maybe one class.
[00:08:01] And so. Some of the things that we're seeing is that speech, language pathologists don't have a lot of confidence in working with things like hearing technology. Um, often if they don't have any signing skills, then they don't also have confidence in working with students who are using ASL. And so it leads us to this place.
[00:08:21] Um, that we have these professions and now with the technology, we are so reliant on each other to be able to know how to optimize those, uh, those skills, but we don't really have the tools to be able to communicate them. And so some of the research that I've been doing recently is looking at how do we visualize some of the outcomes that we're getting so that we aren't giving these black and white narratives to audiologists or teacher for the deaf or hard of hearing that we're not saying on the PLS, the child had auditory comprehension skills of some so-and-so and expressive communication skills of so-and-so because that other provider may not have really any idea of what that actually means.
[00:09:07] We've been working on, uh, having some data visualizations through Tableau to be able to kind of show the outcomes and make them very transparent, not only to families, which I think is super important, but also to the providers, um, who, who are interpreting those so that they can see, well, maybe they're.
[00:09:26] Uh, language or their vocabulary isn't quite as developed as they want, but maybe their auditory skills aren't as developed as they need them to be either. And so we can start looking at the child as a whole, in terms of communication, as opposed to just our individual assessments that we get from our profession.
[00:09:47] Carrie: Yeah, which kind of brings me to some of your, uh, research, focus on assessment of children who are deaf and hard of hearing. And you kind of touched on it a little bit, but you also are looking at identifying patterns and trends and using that information from assessment for training and collaboration.
[00:10:08] So what have you found with your research in this area?
[00:10:12] Kristina: Yeah, it's been, it's been really interesting. And so what we've done is we've taken assessment protocols and we've been at been able to get permission from the publishers to be able to put them online. And so we have the families take the assessments online at home, and so we can create this cool visualization visualize report for the individual family.
[00:10:34] But then we also have the ability to look at it across all of the families in Idaho to see where are sort of the trends or the patterns that we're seeing in specific, um, assessments or, um, even in different regions, really. So we can look at how those, uh, those outcomes are even related to sort of the 1, 3, 6 milestones that we're looking at from, um, identification and enrollment in early intervention.
[00:11:01] And some of the things that we're seeing is really just this lack of, um, The of high expectations are understanding how to take auditory skills and turn them into language. I think that sometimes when people don't have a lot of experience working with kids who are deaf or hard of hearing or are using listening and spoken language, that they will focus on skills like.
[00:11:28] Identification of a sound or detection of a sound or identification of a certain object or localization that then when it turns into how does that auditory information translate into communication? Sometimes that they will switch into either a manual mode of communication or it will, it's not really sure about a lot of providers may not be sure about how to translate that into spoken communication or, um, getting a child to be able to do.
[00:11:54] generalize too. And that when we're working in early intervention, that can be a really natural thing to do with families. And it's just a matter of having that expectation that that can happen. So some of the things that we're seeing is just not really topping out in some of the skills that could be.
[00:12:14] So in terms of auditory skills, that may be again, just a detection or identification or localization, uh, in. The, um, vocabulary. We might see. One of the things I see a lot is that we're having kids who are really using a lot of requests for help or, um, signing for more asking for more. But we're seeing as that complex language or the increased variety of vocabulary is really not there.
[00:12:43] And so how do we take these different pieces? And really integrate them in together so that we can say, well, yeah, that the child can detect this, or the child can identify this, but how do we make that into it vocabulary goal? Or how do we turn that into a combination goal or start incorporating in morphology or syntax or, um, The other thing we've been using is that language use inventory, uh, by Daniella O'Neill.
[00:13:14] And we've been really seeing some pretty amazing trends from our younger kids, um, who are deaf or hard of hearing that near some of the trends in pragmatics that we saw for older kids, um, some of the previous research. And so we've been starting this conversation about how do we take these trends and then turn it into.
[00:13:36] Professional development, uh, because everyone has these great intentions of working with children and families, but not all of us have the same background. And so we've been really looking at how do you, how do we take the trends and the strengths and build on those strengths across the state or better also, how do we look at, wow, this is a skill that we could all work on.
[00:13:58] And so we've been working on doing things like lunch and learns or, uh, professional development opportunities. Um, We have a lot of awesome graduate students right now who are really interested in working with children who are deaf or hard of hearing. And we're trying to incorporate, uh, their skills because they're so good at technology and so good at creating resources.
[00:14:18] So we're trying to help them kind of seize this opportunity, um, and work as we'd look at that for professional development.
[00:14:28] Carrie: So what you're doing is you're identifying assessment trends. Through like family surveys and assessment tools. And you're looking at those different trends and the areas that are lacking, you guys are trying to put together more on-line professional development or resources that are accessible for individuals within your state, or is it a national trend or what, what do you see?
[00:15:00] Kristina: Yeah, well, we're starting it within the state. Um, and then we've been started incorporating, inviting some other states to participate and, um, get involved because the trend that we're seeing here is not just unique to, uh, to Idaho. I think that we see a lot of providers, um, just even through SIG 9 or some of the other activities that I'm involved with that.
[00:15:25] That providers again, have this great intent to be able to serve kids, but they're not always sure exactly what that means or how to translate that into intervention or translate actually our assessment data into intervention plans. And so, uh, we're trying to think of both synchronous and asynchronous opportunities for training, but the other thing that we're really seeing is.
[00:15:49] If you ask five people who specialize in working with children who are deaf or hard of hearing, they could know resources to go to off the top of their head. Right. They would be able to find those. But when we have providers who are less experienced, it's sometimes hard for them to navigate or find. The resources that are specific to the child that they're serving.
[00:16:10] And so my vision in the future, which hasn't come to fruition yet, but is to have assessment outcomes with QR codes that bring them to specific resources or things that they need specific to that child. So if we want to increase like lexical diversity, Where the type of vocabulary a child might have, we would have a QR code that would bring them to a list of existing resources.
[00:16:36] That would say here's a good way to, to practice, um, increase, use to verbs or adjectives, uh, and so that it would be very specific to help families with their child's specific needs and providers to be able to look at and find the resources they need for that specific. That's my dream.
[00:16:59] Carrie: That sounds like a great dream.
[00:17:02] I was just, this is just a question that popped into my head. Have you found that SLPs who may not have a background in working with children who are deaf and hard of hearing do a similar like assessment battery as they would with typical, um, or developing or typical hearing children. And has that been good or not so good?
[00:17:30] Uh, oh, what pieces are missing by doing it that way?
[00:17:34] Kristina: No, that's a great question. And some of the things we've been talking about so far, I've been more early intervention based, but as we kind of move into that school age, We have a lot of speech, language pathologists who are giving batteries of assessments for kids who are deaf or hard of hearing.
[00:17:51] And. The trick is, they're not really always sure about how to interpret those because the assessments aren't based or normed on children who are deaf or hard of hearing. So a lot of times they'll give us more developmental outcomes as opposed to like acoustic outcomes or look at trends. Um, or errors that may be more specific to a child who's deaf or hard of hearing.
[00:18:12] So a child could potentially be on the borderline of like an 84 and 85, um, sort of qualifying by a standard score. But when you look at the specific errors that a child might have, they might be missing things like plural S or. Third person singular possessive S and so when the speech language pathologist looks just only at the score that doesn't really look at the specific errors that the child might have, they missed that those cracks in that child's foundation that can lead to later literacy challenges or writing challenges, or even spoken communication challenges.
[00:18:50] And so I think one of the things that. I really like and recommend is that, um, speech, language pathologists use language samples to supplement their standardized assessments because that sometimes can give us a lot better picture of what that child is able to produce and as well as how well they do with narratives and how, how does the content and form, uh, really shape up when the, when the cognitive task is a little bit more challenging?
[00:19:20] Carrie: Yeah, no, that's great information there. And I know, um, once they have that more diagnostic information, how do you suggest, um, that the SLP work inter professionally to provide in a venture to enhance that communication and language and access for our deaf and hard of hearing students?
[00:19:47] Kristina: That's a good question.
[00:19:48] I think that
[00:19:49] Carrie: the,
[00:19:51] Kristina: a key part is really understanding that we have to be interprofessional when we're working with a child who's deaf or hard of hearing that we, to be able to, for a very sort of low level example, be able to target a phoneme that a child is not able to hear is, is very challenging when, and to, I think the other thing.
[00:20:16] Thing is really important for our field is that if a lot of speech language pathologists haven't had a graduate level audiology class, or they haven't had any of that content since undergrad, they may not always realize what the hearing technology can do right now. And, and so it may be like, well, we were going to work only on visual phonemes because the child can't hear this, or we're not going to be able to do this, but this is pretty good for when a child with a hearing loss can do or what a child with a cochlear implant can do.
[00:20:45] And I think that that's really kind of old school expectations. And so. Really somehow we need to be able to get that speech language pathologist to connect with an audiologist, whether it's an educational audiologist or a clinical audiologist to really kind of recharge their thinking of what that technology can do.
[00:21:07] Um, and then I think we need tools to be able to communicate effectively so that a speech language pathologist isn't kind of just thrusting a standards, you know, a standardized assessment into an audiologist's face. What can we do here, but being able to look specifically at what are some of that error patterns that might exist so that, that collaboration can really take place to start thinking about, well, is it about auditory access is about consistent access or are there things in quiet or are there things in noise that we should be working on?
[00:21:42] Um, but it's really just integral that we are talking to each other. I've been so fortunate to work as a speech language pathologist in an actual audiology office when I was at, um, in Minnesota. And so it became so clear to me how quickly we could change outcomes. When we talked to our audiologists really frequently and say, Hey, I think we might need a little bit of a modification here.
[00:22:09] And then when we worked together, Kids would walk out of the audiologist office like sh/s… oh, wow. I hear that now. Well, I never knew that was missing. And so, um, so I, not everyone has that optimized work environment, but that as a profession is something I think we really need to figure out is what are the tools that we have to share this information without reinventing the wheel for either profession.
[00:22:37] Um, so that it's easy. That, um, that consistent.
[00:22:42] Carrie: Yeah. You bring up a good point about the knowledge from both ends, because like you said, if a child is not producing any high frequency, phonemes is that a programming, you know, issue that they're experiencing. And by having that knowledge from a speech language pathologist standpoint, it's not just, they can't make the sound, but are they not hearing it?
[00:23:10] And to have that collaboration with the audiologist is, is important as well. So it goes both ways for sure.
[00:23:20] Kristina: Yeah, it's real. I think it, and I, there's not a lot of existing tools out there to make it super easy for, uh, for some of the communication and, and that's in places where people. You know, have a lot of clinical audiologists or educational audiologists.
[00:23:36] And there are a lot of shortages of providers, um, across the country. And so how do we, how do we do that when someone went in a pediatric audiology setting, but why do we do that when we don't have someone who even has a lot of experience with peds.
[00:23:55] Carrie: Right. And I just think of my experience in the school was, and there's definitely.
[00:24:01] Hearing loss are lower incident. Um, yeah, so, um, at most schools, speech pathologist may not have a student who is deaf or hard of hearing on the case mode for multiple years. And then all of a sudden they get someone and they haven't had somebody for 10 years. So the, like you said, the expectations have to be different, um, based on advancements with newborn hearing screening and.
[00:24:28] Yeah, early identification and technology when our kids are using technology as a form of communication.
[00:24:37] Kristina: Right. That's so that's so important. And that's where I feel like resources have to be catered to some of the assessments that we have so that we can better align sort of assessment, uh, interpretation to, to actual intervention.
[00:24:56] Carrie: Right. And fit it when it is school-wide with just common core curriculum and educational curriculum. How do you patch that in together as well? Absolutely. Well, your research has showed that there's definitely a, a gap with assessment and, um, how we integrate, um, interventions and just knowledge as well.
[00:25:24] So for those of who are listening today, who may be out there, and whether the speech language pathologist, the teacher of the deaf, even audiologist, um, um, parents, why would. What advice would you give? As finally, I was sharpening their knowledge and skills when they may have a student that is new on their caseload, or even current on a caseload.
[00:25:51] Kristina: I think being humble is an important piece. And recognizing that you don't come to the table with everything and that's okay. Um, you come to the table with a lot and. And that we have so much to learn from each other. I know that sounds a little bit cheesy potentially, but that watching, you know, cochlear implant mapping or watching a hearing aid fitting as a speech language pathologist, spending the time to be able to see how that actually looks and works is amazing.
[00:26:24] Right. And so, so many SLPs never had that experience, but if you can, and it, it makes sense. And just, it doesn't. I mean, it takes a lot of time to become a specialist in this, but to open your mind a little bit, to be able to say like, wow, I see, you know, cochlear implant programming is, is amazing. And seeing how that, how that hearing technology works in getting that idea is I think a huge piece of, um, of getting started.
[00:26:56] I think. Creating, there are a ton of amazing resources out there. Uh, and so maybe it's even going to something like, you know, our presentation at ASHA where it, it challenges you a little bit to be able to think outside of the box or to give you a little bit more information, thinking about. How do I get that refresh on what's really out there and what that expectation is, uh, connecting with.
[00:27:27] I think the family, the teacher for the deaf or hard of hearing, the audiologist, um, the speech language pathologist. Having a good relationship and figuring out what's the best way to communicate. Um, we, when I used to direct a school, we had a day where we had audiologists on the phone and speech language pathologist on the phone, and we would have just one room set up for conference calls and different people would go in and out, uh, for their child that was on their specific caseload.
[00:27:55] So, but we had it sort of set up so that this was the day, the second Tuesday of the month. We are still really good about privacy, that we could have the peep, right. People in the room at the time. And, um, and it was carved out and it worked really well. It took time and trust and, uh, and sort of creative problem solving.
[00:28:18] But I think that was doom now. And some of the other ways we have for communicating it can happen. It can happen. Uh, it's just a matter of putting the intent behind it.
[00:28:31] Carrie: And is that our great. Suggestions as far as collaboration and using technology and putting yourself out there and being humble about who you are and, and asking, right.
[00:28:43] Asking questions and developing those relationships. Do you have any favorite resources or are the resources that you were talking about as far as, um, some of the professional development that you went to develop, uh, any of those available yet, or? Well,
[00:29:01] Kristina: Yeah, we're getting there. Um, so I mean, I think Hearing Rirst is a great resource that is out there and Hear to Learn is another great one.
[00:29:12] Um, there is another really good one at, uh, Boys Town and I'm forgetting that website at the top of my head. Uh, but, but I think that there, I mean, there's great resources out there. A lot of the. Um, hearing technology companies have resources. It's, it's not that they're not out there sometimes it's just hard to navigate.
[00:29:35] What resource do you need for the specific child or specific case that you're working on? Um, I think that. I, this is a bias, but I think SIG 9 is a great resource. There's a great learning community that a lot of those different resources also have learning communities. Um, so being able to just join one of those and have that, that interprofessional collaboration, I think if you can be an interprofessional, um, community, I think EAA has a learning community as well.
[00:30:07] Um, I think that those things really help you to be able to see outside of just. Your specific area of expertise. Yeah.
[00:30:18] Carrie: And I think there's even some Facebook groups for sure. Professionals out there who, you know, can ask questions and, uh, lots of people chime in on different resources that they use to.
[00:30:29] But I agree with you. I think sometimes it's just hard to match Assessment data with what to do next. People can get overwhelmed. And if you're already busy with a huge case load, your idea of being able to have this is the assessment area, and this is a QR code that will take you to different interventions or tools that would be helpful would be a great way for.
[00:30:58] Early interventionist and school-age speech pathologist. It really just pick up and go, um, along with being humble and collaborating with the right people who are on their team too. Is there anything I didn't ask you that you were like, I wish I could talk about today?
[00:31:21] Kristina: Oh gosh. Um, you know, I think that the one thing that I'm kind of.
[00:31:28] Recognizing is that it takes all of us to be humble to do this. And I know that I've used that word twice now in a short amount of time, but just thinking about there's things that we know, and then there's things that we don't know. And, um, and that we, we are so much better when we try to just listen to the other person's perspective.
[00:31:53] Um, and. And I think that this field is so full of philosophies and, uh, backgrounds. And in that, if we can, if we can try to listen to each other, I think that may, that may help us because I think it's really important that we just try to optimize Outcomes for kids who are deaf or hard of hearing. And it's, we cannot do it by ourselves.
[00:32:23] I mean, we just, we cannot do it. We don't have a scope of practice. That's big enough to be able to do it all on our own. Uh, so I think that it's really a, it's an exciting thing when it works really well. And I think we have all the capability to be able to do it, uh, to, to a really, you know, pretty significant extent.
[00:32:45] It's just a matter of. Learning from each other. Like I learned from you, Carrie. I think you're awesome.
[00:32:54] Carrie: I learn from you too. I have to say that when we did our presentation together, Asher, I learned so much from you and thinking about it from a different lens, but it really solidified again, the importance of our two professions, really working closely together because.
[00:33:13] Like you said communication is important for both listening and it's a two way street. And by having our professions work very collaboratively together, this is, it benefits the whole child. Absolutely. Well, if other people are listening today and they were like, I have to get more information from Dr.
[00:33:40] Blaiser. I know she's working on some great information and resources and research. How can they get a hold of you?
[00:33:48] Kristina: Well, probably just my email. Uh, I'm not always the fastest at email, but I always get back eventually. Uh, uh, it's Kristina, kristina.blaiser@isu.edu
[00:34:08] Carrie: Perfect. And I can put that in the show notes as well. So people want to get a hold of you. They can reach you that way. I just want to say thank you for being a part of the empowEAR audiology podcast. I loved having you on today. I love having the lens of a sweep language pathologist who are working with children who are deaf and hard of hearing as part of the podcast.
[00:34:30] So thank you again for being a wonderful guest.
[00:34:34] Kristina: Thanks Carrie. Thanks for having me.
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