Tricks to Help Speech Lessons Carryover into Daily Life

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How can our clients better incorporate new skills into their speech in their daily lives? It seems that they are often limited by their social interactions with caregivers, parents or spouses, so that they can’t practice or complete speech homework between sessions.

Some of my adult clients will avoid practice sessions with their spouses altogether. How can we encourage use of newly acquired skills between visits? Wouldn’t the duration of therapy be reduced and functional communication improved? Research has supported more intensive therapy approaches to promote a more efficient, complete healing process. Because time and funding often limits therapy frequency, we send patients home with work for practice. Follow-through with homework generally rests on the motivation of the client or the client’s family. We need to find ways to make the therapy process efficient and functional.

In Pam Marshalla’s 2010 book “Carryover Techniques (in Articulation and Phonological Therapy),” she defines the term carryover are referring to “a client’s ability to take an individual speech skill learned in the therapy room and to apply it broadly in all speaking situations.”

Getting our students and clients to use their articulation and communication skills outside the therapy environment requires that we begin the process of carryover as soon as the skill is demonstrated in a variety of environments. For children, it might mean saying a fluent word or phrase during a game to get to the next square, or using the correct production of /r/ and /l/ during a short conversation about sports. For adults, the rules of learning after a stroke or traumatic brain injury still may require learning a new skill, like writing the first letter for phonemic placement or using cognitive-semantic linking to ask for coffee.

We need to get more creative to promote carryover across all our clients because of additional sensory, physical, psychological or cognitive difficulties that may impede the process. Charles Van Riper in 1947 wrote that while we cannot rush carryover, we must facilitate its progress.

Pam Marshalla listed some functional ways to promote carryover in children and adolescents, including use of:

  • Fill-in sentences or fill-in stories to stimulate spontaneity.
  • Idioms to stimulate spontaneity.
  • Negative practice to help break the incorrect speech habit.
  • Nonsense syllables and words to strengthen the carryover process.
  • Over practice to cause a hyper-awareness of the goals of therapy.
  • Rapid-fire questions and answers to promote naturalness.
  • Reading aloud as a step between word productions and conversational speech.
  • Rhyming to capture a client’s attention and encourage practice outside of therapy.
  • Riddles because they cause a client to combine practice material with creative thinking.
  • Shortening productions to encourage naturalness.
  • Singing to help children remember their speech work and to encourages effortless practice.
  • Spelling out errors to help the client think about what she is saying and how she is saying it.
  • Story-telling and re-telling to cause stimulate spontaneity and to cause a breakthrough in carryover.
  • Tongue twisters to teach children how to control their articulation.

More on promoting carryover in speech-language treatment can be found on Pam Marshalla’s website.

Many of these techniques are useful for adults as well as children. Here are some additional carryover ideas for adults:

  • Create a script to practice at a favorite restaurant.
  • Use the carryover phrases and substitute other items at a counter deli or a department store.
  • Make a to-do list (or grocery list) each day. Practice writing and reading.
  • Talk about the programs you will watch.
  • Use carryover phrases for conversation, such as, “Hi. How are______?” “What is____?”  “I’m _____.” “Who is____?”
  • Use a calendar and an 8 by 10 dry-erase board to practice drawing,writing and gesturing.
  • Use your smart pad, apps, whiteboard, AAC, text-to-speech, and speech-to-text to send emails and do alphabet board, speech tutor and naming practice.
  • Play your favorite brain games daily. They will help you with focus, learning, word-finding and memory.

If you encourage your clients to engage in games and functional activities daily, the overall quality of your clients’ understanding and speech production will improve because you are encouraging the growth of new neural connections. Your clients are naturally acquiring and using the new skills in their daily lives because they are using them. Becoming more functional can be the most motivating effect of carryover.

 

Betsy C. Schreiber, MMS, CCC-SLP, is a clinical supervisor at Ladge Speech and Hearing Clinic at LIU/Post on Long Island, and a partner at Hope 4 Speech Associates, P.C. She is an affiliate of ASHA Special Interest Groups 2, Neurophysiology and Neurogenic Speech and Language Disorders, and 18, Telepractice.

 

Practice Portal: Making Its Way to You …

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If you’ve been a member of ASHA or NSSLHA for any length of time you probably know about the ASHA website and the resources offered for SLPs and audiologists. ASHA is currently focusing efforts on a new resource, known as the Practice Portal.  The Portal is designed to support your professional practice by offering guidance on professional and clinical topics, evidence maps, client/patient handouts, as well as templates and tools. As with any project, the work takes time. So far, development is complete on  five topics including aphasia, superior canal dehiscence, audiology assistants ,speech language pathology assistants, and caseload/workload.

Several more topics are on the horizon and more will be published later this month. Those include pediatric dysphagia, social communication and permanent childhood hearing loss. ASHA currently has dedicated staff members who work daily to move this project forward. We also gather input from our members from the relevant area of practice to assist with writing and reviewing the content at three separate stages of subject matter expert review. We are very grateful for the member volunteers who have graciously offered their time, skill and expertise to ensure the content is of the highest quality.

Each Portal page follows a similar framework depending upon the type of topic. The clinical topics begin with an overview, and include incidence and prevalence, signs and symptoms, causes, roles and responsibilities, assessment, treatment, resources and references.  Professional issue topics include an overview, information on key issues, resources and references. This framework makes each page easily navigable and user friendly.  Every portal page includes links to technical assistance, relevant Special Interest Group(s), products, events and related resources. All of ASHA’s clinical resources on the topic are included in one place.

The site is currently in “beta” or “trial” mode. During this time we invite you to review the site content and offer feedback. ASHA staff members will read and consider all feedback offered.

If you’re a school-based SLP, check out the SLPA and the Caseload/Workload Portal pages. The SLPA page features a newly developed Scope of Practice for SLPAs along with supplemental content that is designed to inform and enhance your daily practice as you supervise SLPAs.
The Caseload/Workload page features guidance on conducting a workload analysis, School Survey data and approaches used to manage workload. ASHA applauds the member experts who assisted with these pages.

When available, clinical topics also include evidence maps that are intended to provide you with tools and guidance for evidence-based decision making. These maps highlight the three components of evidence-based practice (EBP):

  • external scientific evidence,
  • clinical expertise/expert opinion
  • client/patient/caregiver perspectives

Learn more about the evidence maps

 

Join us as we develop new pages!  You can nominate yourself and others  as a subject matter expert (SME) to review pages and provide feedback.  Just send us a message indicating your clinical or professional area of interest.  We look forward to hearing from you!

Lisa Rai Mabry-Price is the associate director of school services for ASHA. She can be reached at lmabry-price@asha.org.

On the Brink of Kindergarten: Placement of Bilingual Students

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As a preschool-based speech-language pathologist in New York City, I get a number of bilingual children on my caseload every year. Many of them are sequential bilingual learners, with English being their second language (L2). It is also not uncommon for these sequential bilinguals to first begin to acquire their L2 here at the preschool. Speech-language and overall cognitive functioning of these children varies greatly, often a function of how much exposure to English they had to prior to preschool. During the Turning Five meetings, these students’ overall speech-language progress becomes especially salient.

At these meetings, I find that for some of our bilingual students, particularly the sequential bilinguals, the kindergarten setting recommended by the evaluation team tends to be smaller (for example, a classroom size of 12). This type of educational environment is often recommended for children with severe delays and disorders such as autism spectrum disorders, learning disability and childhood apraxia of speech.

During one of these meetings, a graduating student I will call Andy was described as extremely slow to progress and retain information. All team members agreed he requires a lot of support to comprehend basic in-context commands in therapy sessions and the classroom, and presents with minimal use of words. However, we also know that he is from a home where the primary language is not English. In addition, the student only joined the program at the age of 4, not at 3, which would probably have made a big difference. The speech-language evaluation in the child’s file indicates a severe delay in English (I bet I would be severely delayed in a language to which I had minimal or no exposure) but no mention of the skills present in L1. Communication with the family has been limited due to a language barrier.

There are many bilingual children in the New York City school system that follow Andy’s path. Hence, it should always be alarming to us, the educators, when a bilingual student in whom L1 is not English but there are no known global delays transitions into a kindergarten setting of 12. Additionally, a kindergarten special education classroom includes students with a variety of diagnoses and behaviors, with the more severely impaired students not providing a model for appropriate social skills and verbal communication.

So why do these students continue to get placed into smaller, more restrictive educational settings? Most obviously because of concern that they will not be able to function in a larger setting. But what could we be doing instead? Each child’s case would need to be studied individually. Specifically, we would need to review all the relevant cultural and linguistic background information starting at birth, such as the amount of L1 and L2 exposure in and out of home, history of speech- language delays, and the level of education in the family, to name a few. Other variables to consider are: 1) the amount of time that the bilingual student has spent in an all-English formal academic setting, 2) the presence of “problem” behaviors that significantly maintain the overall delays and reduce time the student is actually learning, and 3) the lack of sufficient, if any, L1 support (Spanish/ Bengali/Arabic) received in the school setting, including from an assigned SLP.

The latter one is of particular interest to me, as I am a bilingually certified English/Russian speech-language pathologist. However, I have little practical language skill to offer to my Arabic-, Spanish-, Bengali- or Albanian-speaking students. In such cases we, for the lack of a better word, “exercise,” our nonverbal communication skills and teach English as a second language.

Sure, an ongoing collaboration and a close relationship with the child’s family can potentially shed light on the speech-language and cognitive skills of the student. However, my experience has been that, due to communication barriers, the family yields little information that can guide me. Therefore, in most cases, I cannot reliably pinpoint speech-language deficits present in languages other than English or Russian.

This is an ongoing issue of inappropriate services to and settings for our bilingual special education students. Research is full of examples of typically developing bilingual students taking longer to learn and acquire L2 skills. This is even more consequential for children with special needs, whose speech- language and/or cognition is already delayed. Subtractive bilingualism is the term Fred Genesee and colleagues use in their book “Dual Language Development and Disorders” (2004) to describe this language-learning dilemma and the danger of “switching” our culturally diverse students to English only. According to the literature, the problem with monolingual (English-only) placements is that many of our already delayed bilingual children can’t “catch up” to their monolingual peers. Therefore, the all-English classroom setting of 12 carries a rather pessimistic long-term implication for overall academic success.

But what if every bilingual child with special needs received enough L1 support? Would that change the outcome? What if we had enough bilingual certified SLPs representing a variety of cultures and languages to help our culturally diverse students? Would the bilingual children still be placed into restrictive settings with no L1 support and with communicative interactions that offer few appropriate models? I believe that if these students received speech-language services in both the L1 and L2, they would make significantly more progress and at a much higher rate.

It would certainly further expedite their progress and make the instruction more holistic and ethical. Of course, today, more than ever, we have major problems with budget cuts that affect the number and the size of special education classrooms available to us, as well as the amount and the type of services we can offer. In fact, in recent years it has become much more difficult to qualify a child for related services even in the presence of notable deficits. Greater still is the cost of not delivering appropriate and culturally/linguistically ethical services to our bilingual children. We might be in far greater need of special education services years down the line when trying to remediate difficulties that were further compromised due to lack of appropriate language support. Just something to think about!

Natalie Romanchukevich, MS, CCC-SLP, is a bilingual Russian speech-language pathologist at the Children’s Center for Early Learning in New York City. This post is adapted from a guest post Natalie Romanchukevich wrote for Tatyana Elleseff’s blog Smart Speech Therapy. Natalie can be reached at natalieslp@gmail.com.

Collaboration Corner: Finding the Common Core of Social Skills

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A few months ago, I wrote a blog about making speech and language goals integrated throughout the IEP. One person commented, “We need to work smarter, not harder.” I completely agree. Our caseloads will continue to increase, and our students will become more and more complex.

Now we have this Common Core thing to worry about, right? Forty-five states have adopted the Common Core Standards related to math, language, science and social studies, all focused on developing a well-rounded student ready to take on the challenges of college and career.  So with that in mind, I took to trip to the website.

I was checking out the speaking and listening, section under English Language Arts, when what to my wandering eyes did appear? First grade standards:

  • CCSS.ELA-Literacy.SL.1.1 Participate in collaborative conversations with diverse partners about grade 1 topics and texts with peers and adults in small and larger groups.
  • CCSS.ELA-Literacy.SL.1.1a Follow agreed-upon rules for discussions (e.g., listening to others with care, speaking one at a time about the topics and texts under discussion).
  • CCSS.ELA-Literacy.SL.1.1b Build on others’ talk in conversations by responding to the comments of others through multiple exchanges.
  • CCSS.ELA-Literacy.SL.1.1c Ask questions to clear up any confusion about the topics and texts under discussion.

(Core standards, 2012)

Why doesn’t that look just like … wait a minute, something familiar … social pragmatics! In my district our schools are busting at the seams with kids needing social pragmatics skills. We even have city-wide social thinking educators that run groups all focused on social skill development.

Here is how we are going to work smarter—by haring our expertise with others. It is fantastic that the need for social skill development has hit the national education scene, this gives some street cred to our social skills groups and lunch bunches. Now we need to bring it to the next level: get it out of the speech office, and back into the classroom.

Some things to consider:

1) Make your consult time be staff development time: Train your teachers, paraprofessionals, whoever will listen to use social skill strategies you are using with students.

2) Set a reasonable goal for adoption: Maybe it’s visuals for the first grade classroom one year, or key words and phrases for whole class lessons and expectations using the social thinking curriculum by Michelle Garcia-Winner.

3) Use the Common Core to guide IEP objectives: Look at the standards, and then simply make them achievable and measurable, and hold everyone accountable for following them.

4) Market your tools as “good teaching” rather than “special education” tools: A total pet-peeve of mine … there are no “special education” tools to learning—there are just tools.

5) Run a couple of whole group lessons, model for the teachers, and gauge what is doable.

Your presence in the target classroom reminds teachers to use you as their point person, their resource. They won’t know you’re there unless you make yourself present, and that’s when the good stuff, the collaborating, starts.

 

Kerry Davis, Ed.D, CCC-SLP, is a city-wide speech-language pathologist west of Boston. Her areas of interest include working with children with multiple disabilities, inclusion in education and professional development. The views on this blog are my own and do not represent those of my employer. Davis can be followed on Twitter at @DrKDavisslp.

Showing Our Stuttering Moves

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We may not know all the reasons for stuttering, but one thing’s for sure—children who stutter want to be heard!

People who stutter want to express themselves, but sometimes fear of potential embarrassment can overwhelm them. Luckily, movies like “The King’s Speech” and celebrities such as Lazaro Arbos from “American Idol” have put stuttering in the spotlight and can help inspire our kids. Together with information offered by the Stuttering Foundation on its website and in books, videos and conferences, the increased attention can help our students tackle the emotional side of stuttering and learn how stuttering can affect their lives in a positive way.

I am lucky that my school allows me to work once a week with a group of students who stutter. We work voluntarily during lunch time to tackle some of the emotional issues related to stuttering, with support from Margarita Torres, a student teacher from Adelphi University. I intend for the sessions to operate much like a support group—a forum in which students can discuss their feelings and thoughts about stuttering. I have tried to adapt desensitization and acceptance approaches outlined in Peter Reitze’s book “50 Great Activities for Children Who Stutter: Lessons, Insights and Ideas for Therapy Success” as I work with the students.

The group consists of two fifth-grade girls, a fourth-grade girl, a third-grade boy—and a fourth-grade boy who does not stutter but is friends with the other group members. One day as we were eating lunch and talking about famous people who stuttered, I shared with the group the story of Lazaro Arbos’ audition on “American Idol.” We showed the students the video and discussed his performance.

A few minutes later, one student broke out into song! He sang only one line, “I got the bounce like Darth Vader,” to the tune of Maroon 5’s “Moves Like Jagger.” We all giggled and were impressed with his musical talent. That one line stuck with me and my student teacher. Then I remembered the New York City United Federation of Teachers Speech Improvement Chapter’s Better Speech and Hearing Month Contest. My student teacher Margarita Torres, the students and I worked quickly to create a music video to submit for the contest.

The March 15 deadline was approaching fast and meeting once weekly was not going to be enough. So we decided to meet three times a week and work on modifying the rest of the song’s lyrics. We changed the lyrics to include information about stuttering (for example, famous people who stutter, including Darth Vader), tips for others when speaking to people who stutter, and feelings about stuttering. The group did an amazing job memorizing and working on the lyrics, and the script before the music video discusses why speech therapy is important.

Hopefully this experience has taught the students that being a person who stutters does not limit their potential. It only can enhance potential.

Kelly M. Enamorado, MS, CCC-SLP, is a bilingual speech-language pathologist at Public School 36 in New York City. She can be reached at Kenamorado@gmail.com.