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.

Kid Confidential: “Join In on the Stim!”

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Autism Spectrum Disorders (ASD) is one of the great loves in my professional career. Persons with ASD are fascinating and wonderful and many times their behavior actually makes sense to me. I know what you are thinking, “This woman has got to be on the spectrum herself.” Well although I do believe that we all exhibit hyper- and/or hypo-sensitivities to various stimuli and that we all have what I like to call “a little autism in us,” it just may not be on the scale of persons who are diagnosed with ASD formally. It may not consume our entire interactions as it does for some students with ASD. So the question is, what do we do about it?

When I was in graduate school, the prevailing acceptable intervention was based on behavioral modification techniques. I was expected to spend time determining why that stimulatory behavior occurred (i.e. avoidance, stress, seeking sensory input, coping mechanism, sensory overload, etc.) and replace it with a more appropriate behavior. I still agree that this treatment strategy is appropriate in certain situations. For instance, if the student is seeking sensory input, let’s provide him/her with an appropriate sensory diet (under the supervision of an OT with the appropriate experience). If the student is exhibiting behaviors that are harmful to him or herself or others, they MUST be replaced by more appropriate safe behaviors. If the student is overloaded and attempting to escape/avoid a situation, let’s give him/her a break and/or modify the activity and expectations.

But are there times when we should actually encourage the stimulatory behavior? Are there times when we should not only support it, but “join in on the stim”? My answer to this is ABSOLUTELY! I know I just lost a few of you, but hear me out. The first time I read this idea, I was skeptical as well.

Jonathan Levy, author of “What You Can Do Right Now to Help Your Child with Autism,” challenges parents and therapists alike to do just this, join the child in his/her world by simultaneously imitating the stimulatory behavior. The idea is that for children who are profoundly affected by ASD and who spend all or most of their time exhibiting stimulatory behaviors actually need us to invade their world and physically pull them out of it by imitating them.

According to Levy, by joining your child/student in their stimulatory behavior you are telling them several things:

  • You understand their need to use this behavior.
  • You have something in common with them.
  • You want to interact with them and you are willing to enter their world.
  • They are safe to “be themselves” around you and you will not interrupt their need to stimulate themselves using these behaviors.

Does this actually work? According to Jonathan Levy, this is a technique Barry and Samahria Kaufmann, authors of the Son-Rise Program and founders of the Autism Treatment Center of America (ATCA), not only believe in, but have used successfully on their own child as well as numerous children nationally and internationally for more than 25 years. Anecdotally, I can tell you from my personal experience, I have done this and I have noted several positive changes with consistency:

  • Almost immediate increase in eye contact or facial referencing.
  • Students with ASD began to approach and/or gravitate to me whenever I entered their classrooms.
  • Students began to tolerate my touch or would take my hands and place them on their own bodies. For example, I had a female student once start pulling on my arms. I figured out very quickly she wanted me to do this to her. Although nonverbal, she made a request for the first time in her life! After I provided that sensory feedback, she was able to sit on the floor with her class during a large group lesson for the very first time.
  • And after a few weeks of joining in the stimulatory behaviors, I began to hear vocalizations. And for some of these children, it was the first time they ever vocalized!

Yes I was that therapist, jumping around in circles, flapping my hands, vocalizing various moans and groans along with my students. I was that therapist sitting at the lunch table filtering light through my fingers and screeching with my student as he attempted to eat. I was also the first person they made eye contact with; the first person, to which they handed a picture (i.e. PEC); the first person, with whom they exhibited joint attention; and the first person to whom they intentionally vocalized when making a request.

So does this technique work? I believe that it does if used properly for the appropriate students. This is not a technique that I believe every student with ASD requires or can benefit from, but it certainly appears to make significant changes in those who are so profoundly affected that they cannot find a way out of their own worlds without us stepping in and meeting them where they are.

Mr. Levy does leave us with a word of caution. Some children do not respond immediately to this technique as they are so far within their own worlds it could take them weeks to even notice your attempts to join the stimulatory behavior. But he ensures us, that this is not a reason to give up and believes that by giving the child adequate time, he will take note of your attempts to enter his world and you will break through the child’s barriers of stimulatory protection (Levy, 2007).

This has not been the case for me as I saw changes fairly immediately. However, I do believe that can be attributed to the fact that if the child is in a school setting, they are aware at some level that there are other people within the room, whether they seem to show it or not. I believe the school setting is unique in that just the setting itself forces the child with ASD to, even on a subconscious level, acknowledge there is a world bigger and different than what is found within themselves.

So the next time you have a student with ASD on your caseload that is profoundly affected and appears to spend all or most of his/her time exhibiting stimulatory behaviors, no longer ask yourself “What do I do with this child?”. Rather, make an attempt to enter their world and “join in the stim”. By doing this, you may just be the first person who has ever been able to connect with them.

Maria Del Duca, M.S. CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona. She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name. Maria received her master’s degree from Bloomsburg University of Pennsylvania. She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues. She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in New Jersey, Maryland, Kansas and now Arizona. Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech. For more information, visit her blog or find her on Facebook.

Giving Peruvian Children the Power of Communication

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In March, I traveled to Lima, Peru, with our Mercy College communications disorders program director, Helen Buhler, and a team of 27 physicians, surgeons, nurses, technicians and other SLPs. We were there as part Mercy College’s partnership with Healing the Children, Northeast, which provides primarily surgical services to children in need in the United States and abroad.

Over the week we were there, 37 children had surgery; some had traveled for 7 days to reach the hospital. We SLPs worked on parent training, peer training and direct service delivery. Here are some excerpts from the blog I kept during our visit.

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I cried when Dr. Manoj Abraham—a surgeon from Vassar Hospital—put the last stitch into the baby’s lip.

On Friday, Helen, Marianella Bonelli—an SLP and Mercy alum—and I visited with all the parents on the ward. For those whose children had had a lip repair, we celebrated together, admiring their beautiful babies. For those who had their lips repaired but still would need palate surgery in the future, we also gave advice on helping the kids develop good speech habits now to establish good airflow from the mouth after the palate is closed. We worked directly with the kids who had newly closed palates and their parents, teaching about how to bring the sounds out through the mouth and not the nose. Needless to say, there were many therapy materials, toys and goodies passed around, ensuring we went home empty handed but the kids did not.

After speech rounds, we put on fresh scrubs and went to surgery. Dr. Abraham was operating on a baby with a cleft lip that went up into her nose all the way, and welcomed us to observe him.

He was putting this baby’s nose together, carefully making it match the other side as much as possible. He worked some more on the deep layers of the lip, making sure it would be able to have free movement. Then he sutured the philtrum, the raised line that runs down from your nostril to the beginning of the red part of your lip. Suddenly, this baby had a sweet Cupid’s bow of a mouth…a mouth that would pout and pucker, shout, whisper…

Even though it was my second time in the OR and I thought I was over it, I cried and cried. Writing this now, I’m crying again.

What a gift.

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As I came into the speech office (a commandeered storage room), I saw Helen doing…arts and crafts? 

Helen always says we do cowgirl therapy on these trips—shooting from the hip. When an 11-year-old girl with cerebral palsy arrived with very few spoken words, and those few only intelligible to her mom, Helen created an old school low-tech augmentative communication device. She used paper, a sheet protector and some of our speech materials to create a board with some basic vocabulary.

The mom was thrilled to have a way for her daughter to communicate some wants and needs to others in her life. Helen showed her how to create more pages for the board as the child mastered its use. The mom’s eyes were shining—it was so obvious that the board would be implemented immediately.

Based on a quick evaluation, it was clear that the child understood a lot more than she could say, so we hope this is a way she can start to “say” something to the world at last.

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We also worked with a four year old boy with hearing loss due to a malformation of the external and middle ear. He has had recurrent ear infections and had drainage from one ear. He was taking an assortment of antibiotics, and his mom had a thick folder of medical records with her. Although his audiological testing shows a hearing loss, he is not currently a candidate for surgery (Dr. Ryan Brown graciously gave him an exam on the fly to double check).

Helen spent some time with the mom, teaching about behavior management, and I taught her about sign language. I taught them three signs: “go,” “more” and “eat.” The kid chased me around the grounds of the hospital, as we worked our way over to our surgical consult, and I would only run if he signed, “go.” We went from hand-over-hand to slight physical prompt, to following a model for the sign “go.”

The mother was shocked at how positive our interaction was—he was laughing as he chased me. Soon, this kid will experience the power of controlling his world through communication.

Score one for the speech department.

Shari Salzhauer Berkowitz, PhD, CCC-SLP, is an assistant professor at Mercy College in Dobbs Ferry, N.Y. She is an affiliate of ASHA Special Interest Groups 10 (Issues in Higher Education) and 17 (Global Issues in Communications Sciences and Related Disorders). Her research interests include cross-language and bilingual speech perception, multi-modal speech perception and integrating technology and instrumentation into the communication disorders curriculum.

 

Putting the Scope Back Into Your Practice

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Have you ever found yourself doing tasks or odd jobs as part of your speech-language pathology role and then think to yourself, “‘I don’t think that was in my job description?”

Are you feeling a little burnt out? Stuck in a rut? A little unenthused at the prospect of attending more meetings, completing endless IEPs and filling out more paperwork than clients you see? I have felt like this and I know other SLPs have cycled through the same dilemma so I sought my own solution …

As the sole speech-language pathologist working in a special needs school in Samoa, some of the questionable roles and responsibilities I undertook included:

  • Toenail clipper
  • Inventor of new dance moves for health class
  • Instructor of brushing teeth
  • Shaver of beards and trimmer of moustaches
  • Wound management officer

It would be an understatement if I said that I felt a little under-utilized or that my skills were not being put to best practice. Proud of my qualifications, I wanted to yell “I’m a speech-language pathologist! This is NOT what I do”’ but I didn’t. I just sunk a little lower, burnt out that extra bit more until one day I decided to do something productive with my new duties. I thought of ways that I could put speech-language pathology into these roles because I can tell you this much; no one could invent new dance moves like me!

Hence, the Scope of Practice Challenge was born.

The first and only time you looked at the ASHA Scope of Practice document may have been for a college assignment and then you tucked that hefty piece away. Out of sight, out of mind. But I assure you, the Scope of Practice wasn’t created for a one-time essay. I believe it was written to inspire forlorn, burnt out or plain ambitious SLPs! I challenged myself to apply one new scope each month and see if it improved my job satisfaction because, like you, I just wanted to make the biggest difference possible. It might not have been what I thought I would be doing but, like the cunning therapist I was trained to be, I made things speech-language pathology related without people even realizing!

I reluctantly took a side step from assessments and therapy and did things that were in my scope that I never would have thought of doing. I helped to create a policies and procedures manual, gave phonologic awareness input toward a basic language-arts curriculum, taught social skills and made locally appropriate social stories, provided in-service training, did team teaching and had local special education students work shadow me to learn more about speech-language pathology. To be honest, it was a liberating experience because it showed me that there was so much more to being a speech-language pathologist than simply providing therapy. It also made realize that I could strive to be better and do more.

So why should you take up the Scope of Practice Challenge? It will broaden your skills and make you into a more rounded therapist. It can help provide new direction and inspire your work if it has become a little predictable lately. Or it could be a creative means to get more out of bus and lunchroom duty!

Here are some sample roles outlined in ASHA’s document to get you thinking about how simple it can be to initiate your own Scope of Practice Challenge:

  • Fostering public awareness of communication and swallowing disorders and their treatment: Why not create some cool informational resources with your students to send home? Make speech-language posters and hang them around your school. Get active with Better Speech & Hearing Month in your local community and have a quiz night or set up a little booth at the local markets for Q&A with some colleagues.
  • Educating and providing in-service training to families, caregivers, and other professionals: Offer in-service informational sessions to parents about how to complete therapy in the home environment or on speech sound development. Present to your team on language stimulation techniques. Do a quick five-minute vocal hygiene session with peers during cold and flu season.
  • Recruiting potential speech-language pathologists into the profession: Get in touch with your local high school, college or university and do a talk with students on how awesome it is to be an SLP!

So instead of saying “this is not part of my job,” think about your scope of practice and how you can make it part of your job.

Rebecca Visintin is an Australian-trained speech-language pathologist. She is currently working in elementary and middle schools in Washington state after experience in the Australian outback and as the sole speech-language pathologist in Samoa. She provides information for SLPs working abroad and free therapy resources on her site Adventures in Speech Pathology.

Welcome from the Leader Team

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Recently, ASHAsphere became part of The ASHA Leader, joining a celebrated constellation of content for and about ASHA members, including The ASHA Leader Live e-newsletter as well as the print and online editions of the Leader. We at the Leader are delighted with this news, the first phase of a dastardly-but-so-elegantly-orchestrated master plan to annex the entire WorldWideInterWebs.

As these bold, mildly inspiring words spasmodically spew from my hunt-and-peck typing, phalanxes of Leader editors are on the march, blood-red pens in full brandish mode. No domain with the faintest acronymic whiff of CSD is safe from us—and that includes you, Community School of Davidson, North Carolina.

All kidding aside, welcome.

During the inaugural year of the brand spanking new ASHA Leader, ASHAsphere plays a crucial role in supporting the Leader’s renewed commitment to serve both as a valued source of information for ASHA members as well as an engaging showcase of your lives, interests and goings-on. Indeed, this blog’s been a preferred gathering place for many of you, an excellent, lively sounding board for noteworthy and trending topics.

We at the Leader strongly encourage you all to keep doing what you’re doing—discuss in depth, debate vigorously, share your experience and perspectives, and keep the questions coming. We’ll be dropping by every now and then with news, highlights of particularly useful articles, and, just perhaps, some astonishingly wry commentary.

I’ll be quiet now so you all can get back to your blog.

Gary Dunham, PhD, is ASHA publications director and editor-in-chief of The ASHA Leader.