Rich and I are ETC trained. In the foster and adoption world that means we’ve taken extra classes beyond what is required for state licensure. Specifically, we’ve taken classes that focus on helping children with adverse childhood experiences, or “children from hard places” as the class creators often refer to them. The ETC training provided a window to understand the consequences medical trauma and loss of family brings in Nathaniel’s life.

The last seven years have taken us deep into the world of complex medical and special needs parenting. Meanwhile, our son who is a cowboy has worked seasonal ranch work in New Mexico, a couple years including sub zero winters in Montana, broke and trained colts in Wyoming, and returned to cowboy again New Mexico. We’ve visited him less than a handful of times, typically just one parent at a time, because tracheostomy and cowboy worlds are distanced by more than miles.

Nathaniel and I left his Cincinnati Children’s Hospital check up last May with an interesting recommendation from his ENT: look beyond the pediatric community for information and support. I had arrived with questions about Nathaniel’s options for voicing. They shared of another patient with a laryngotracheal separation who learned to use esphageal speech. They also expressed a great deal of hope that given the right support, Nathaniel had a good chance of voicing.

I spent the last three days in Cleveland, Ohio at a intensive introductory course titled Comprehensive Literacy Instruction for Students with Significant Disabilities and Complex Communication Needs. It was twenty-four hours of lectures focused on teaching conventional literacy instruction.