Bridging the Divide Between EBP and Practice

becky blog

How well does your program integrate clinical practice and research education? It’s a question definitely worth asking. Today, clinicians are expected to use evidence-based practice in all of their clinical encounters, but does it ever seem as though research evidence is pulling clinicians in one direction while clinical experience is pulling the other way?

EBP requires you to consider current best research evidence, clinical expertise, and patient perspectives in your clinical decision-making. Clinicians who did not receive a proper balance and integration of research and clinical practice in their graduate classes may be feeling thinly stretched to meet these demands. In an ASHA survey fielded in 2011, 24 percent of respondents indicated that EBP created unrealistic demands on clinicians.  CSD programs need to provide students with the knowledge and tools to evaluate and apply research. Additionally, faculty members need to think about how well they model a fusion of research and clinical practice in their own teaching.

Some help

To help, ASHA has updated a tool, the Academic Program Self-Assessment: Quality Indicators for Integrating Research and Clinical Practice in Communication Sciences and Disorders (CSD) Programs. The Quality Indicators (QIs) were developed originally in 2007 and were updated in 2014. They can act as a tool to stimulate discussion among academic and clinical faculty members and students about the program’s strengths and needs in integrating clinical practice and research education. The QIs are divided into five sections:

1) Curriculum and Department Goals

2) Course Work

3) Faculty

4) Students

5) Clinical Practica

They are designed to be flexible in their application–some programs may choose to formally survey a broad group of faculty and students using the tool, while others may choose to use the QIs to guide discussion during a faculty meeting.

A test drive, if you will

Beginning in November of 2013, ASHA asked several academic programs to try out the updated QIs and report back on how they used the tool. Here’s what they said…

It took most responders about one hour to complete the QIs, and most programs judged the length, appropriateness, and comprehensiveness of the tool to be “good.” Most of the programs (82 percent, 9/11) had academic faculty, clinical faculty, and the program director/administrator complete the QIs individually and then discussed the results in a meeting. Alternatively, one program provided time for faculty members to complete the QIs during a faculty meeting rather than asking that the QIs be completed on their own time. A few programs (27 percent, 3/11) also included students in the process.

A handful of challenges also were reported. Some faculty members did not have time to complete the QIs, and some students and faculty were not familiar enough with certain aspects of the department to respond to all items. ASHA is currently working to address these challenges; for example, revising the QIs to include a “Don’t know” response option and providing additional online resources.

The QIs did reveal areas of need and areas of poor knowledge exchange between clinical and academic faculty for some pilot programs. Roughly half of the pilot programs used the QIs to develop department goals for further integration of research and clinical practice. Southern Connecticut State University developed and shared with us three of their goals:

  1. To provide opportunities for discussion of contemporary research and clinical topics, faculty will rotate presenting their research and related topics to faculty/staff/students each semester.
  2. The department curriculum committee (DCC) will conduct annual reviews to ensure that EBP concepts are included in syllabi in accordance with the department mission and vision.
  3. NSSLHA will host monthly meetings to discuss research topics of interest.

Jayne Brandel of Fort Hays State University stated that following completion of the QIs, “We are reviewing our curriculum at the undergraduate and graduate level. In addition, we are exploring new clinical opportunities and having clinical instructors participate in courses.”

ASHA plans to follow up with several of the participating CSD programs after 6 to8 months to gain more insight into the longer-term role of the QIs for these programs.

Whether you are a program director, faculty member, or student, the QIs are a great resource to check out to get your program thinking about and talking about the integration of research and clinical practice. It is imperative that new clinicians are adequately prepared for the changing healthcare landscape with knowledge and application of EBP as soon as they enter the workforce. Thus, Academic programs need to be focused on both providing and modeling the foundations of EBP consistently throughout CSD education. The QIs are freely available for download.

 

Rebecca Venediktov, MS, CCC-SLP, is a Clinical Research Associate for ASHA. 

 

Why Growing a Healthy Green School is Golden

green school

Remember dioramas from first and second grade? Last fall I was invited to attend the opening of the U.S. Environmental Protection Agency’s “Lessons for a Green and Healthy School” exhibit, a giant, life-sized, walk through diorama on how to create a green environment in schools. Located at the Public Information Center of US EPA’s Region 3 offices in Philadelphia, what I learned there about sustaining a healthy school for students, teachers, and community was exciting…and I heard it from the students themselves. [How to Build A Healthy School]

The Green Ribbon Schools Program is a joint endeavor between the U.S. EPA and U.S. Department of Education. The program honors schools and districts across the nation that are exemplary in reducing environmental impact and costs; improves the health and wellness of students and staff; and provides effective environmental and sustainability education, which incorporates STEM (science, technology, engineering, mathematics), civic skills and green career pathways.

A healthy green school is toxic free, uses sustainable resources, creates green healthy spaces for students and faculty, and engages students through a “teach-learn-engage” model. Examples of greening techniques include the using building materials for improved acoustics; installing utility meters inside the classroom as a concrete aid for teaching abstract concepts in math; and incorporating storm water drainage systems within a school’s landscape design to teach and practice water conservation. What are some environmental concerns to address when you are growing a healthy school?

  • Asthma and asthma triggers (indoor air quality)
  • Asbestos and lead (especially in older buildings)
  • Carbon monoxide (from old furnaces, auto exhaust)
  • Water fountains
  • Chemicals in the science lab (think mercury)
  • Art and educational supplies
  • Managing extreme heat
  • Upkeep of athletic grounds
  • Mold, lighting fixtures
  • Waste and recycling

Now more than ever, we must educate new generations of citizens with the skills to solve the global environmental problems we face. How can we have a green future or a green economy without green schools?

Benefits of green schools

1. Cost/Energy Savings:Daylighting” or daylit schools achieve energy cost reductions from 22 percent to 64 percent over typical schools. For example in North Carolina, a 125,000 square foot middle school that incorporates a well-integrated daylighting scheme is likely to save $40,000 per year compared to other schools not using daylighting. Studies on daylighting conclude that even excluding all of the productivity and health benefits, this makes sense from a financial investment standpoint. Daylighting also has a positive impact on student performance. One study of 2000 school buildings demonstrated a 20 percent faster learning rate in math and 25 percent faster learning rate in reading for students who attended school with increased daylight in the classroom.

2. Effects on Students: Students who attended the diorama presentation in Philadelphia expressed a number of ways how their green school changed personal behavior and attitudes. One young lady spoke of how a green classroom helped her focus and stay awake. Another student said being in a green school made them happier. There was more interest in keeping their school environment cleaner by monitoring trash disposal, saving water by not allowing faucets to run unnecessarily, picking up street trash outside the school, sorting paper for recycling, and turning off lights when room were no longer in use. Some students went so far as to carry out their green behaviors at home. Small changes in behavior and attitude such as these are the foundation for a future citizenry who will be better stewards of the environment.

3. Faculty Retention: Who wouldn’t want to be a speech-language pathologist in a green school? Besides, there would be so many opportunities for a therapist to embed environmental concepts in to their session activities. Think how a quieter environment would foster increased student attention. How about having the choice of conducting a small group session in the pest-free landscape of the school yard? Research supports improved quality of a school environment as an important predictor of the decision of staff to leave their current position, even after controlling for other contributing factors.

How to make your school green

  • Have a vision for your school environment. You can start small at the classroom level or go district wide. Focus on one area or many (healthier cafeteria choices, integrated pest management, purchase ordering options, safer chemistry lab) Maybe you already know what environmental hazards affect your school – if you do then start there.
  • Get a committee going. It helps to have friends. Is there someone you can partner with? School nurse, building facilities manager, classroom teacher, PTA, students?
  • Conduct a school environmental survey. This doesn’t have to be complicated, you can poll your colleagues, or discuss at the next department meeting, or over lunch. If you like, check out EPA’s “Healthy SEAT – Healthy School Environments Assessment Tool” for ideas.
  • Have a plan. Select a time frame, short term first and use it as a pilot to evaluate whether a green school is possible. Pick something small to work on.
  • Monitor and evaluation your progress. It’s always a good idea to collect data but it doesn’t have to be too sophisticated. Use “before and after “ photos or video student testimonials.
  • Embed the green environment into the student curriculum and activities. Create speech lesson plans with green materials or photos of your green school project. Growing Up Wild is an excellent curriculum for early childhood educators.

Anastasia Antoniadis is with the Tuscarora (PA) Intermediate Unit and works as a state consultant for Early Intervention Technical Assistance through the Pennsylvania Training and Technical Assistance Network. She earned a Master of Arts degree in speech pathology from City College of the City University of New York and a Master’s degree in public health from Temple University. She was a practicing pediatric SLP for 14 years before becoming an early childhood consultant for Pennsylvania’s early intervention system. Her public health studies have been in the area of environmental health and data mapping using geographic information system technology.  You can follow her on Twitter @SLPS4HlthySchools. 

 

 

 

The Effectiveness of Language Facilitation

 

 

natural talk

A while back, I posted on the ABCs of ABA. Within that post, I described the basics of ABA, a method of therapy that I believe is often a bit misunderstood. I also promised to follow that post with a more thorough description of the shades of grey that exist within the broader field of ABA.

Before I do that, though, I want to touch on the effectiveness of an approach that often seems to be the very opposite of ABA: indirect language stimulation. And before I do that (hang with me here), I’m going to briefly explain the idea of a continuum of naturalness that exists within the field of speech-language pathology. This term was first coined by Marc Fey in 1986 in “Language intervention with young children,” and I think it is a wonderful way to help us wrap our minds around the variables that exist when we think about the various methods of therapy.

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The ends of this continuum represent the relative naturalness of a treatment context. On one end of the continuum, we have indirect language stimulation approaches. These are highly natural, often embedded within the child’s daily routine, tend to be unstructured, and are built on the idea of being responsive to the child. On the other end of the continuum, we have highly structured ABA approaches, which tend to be highly decontextualized (*not* in the context of daily activities and play), very structured, and highly adult-directed.

In this post, I’m going to cover the left hand side of this continuum: indirect language stimulation. In a nutshell, this approach to language intervention involves describing what a little one is seeing, doing, and feeling. I’ve described different techniques within this broader method before, in various posts such as All Kinds of Talk, Self Talk & Parallel Talk, and Expansion and Extension. As you use these techniques, you are providing models of language that are a match for the child’s language level. So, if a baby mainly points and vocalizes, you use one and two word phrases; if toddler uses one and two word phrases, you use three and four; if a preschooler uses short sentences without grammar, you respond with longer sentences with appropriate grammar (you get the idea, right?).

These techniques are generally used in the context of on-going activities that happen every day, and are used in a way that is responsive to the child. In other words, you watch what the child is doing, listen to what she is saying, observe what she is watching, and then you respond to that. Watch. Listen. Observe. Describe. Put it all together, and general language stimulation looks a little something like this.

It pretty much looks like nothing is happening, right? Just a mom and her child having a snack. This is what it should look like! It’s natural- that’s why it’s on the far left hand side of the continuum of naturalness. But there is more going on than meets the eye. Notice how the language is simple, and related to the activity at hand. Also notice mom’s responsiveness–language models are provided in response to the child’s utterances (Child: “Please?” Mom: “You want apple.” “Apple please!”). And when the little one tries to get mom’s attention by saying “mmm,” again, mom responds with another “mmmm.” They go back and forth a few times–this is turn-taking, and within it lies the beginnings of conversation. Eventually, mom uses a language model directly related to the “mmmm”: “Yummy apple.”

One more example. This activity is a little more structured, but the approach used is the same. Notice how mom’s language is in response to the child’s language (Child: “Ride…” Adult: “You’re riding the bike!”) and take note of the fact what mom says is just slightly longer than the toddler’s language. And, as an additional bonus, observe how the child’s language changes– from one word sentences at the beginning, to a two-word phrase at the end of the clip. Indirect language stimulation doesn’t always work immediately in the moment like this…but it’s pretty cool when it does!

Despite the fact that indirect language stimulation looks quite simple, research shows that it can be very effective. As I described in All Kinds of Talk, research indicates that the more parents use conversational talk with their typically developing child, the larger that child’s vocabulary will be. When parents are responsive in their conversational interactions with their child, their child’s language grows.

Indirect language stimulation approaches have been shown to be effective for late talkers, too. In their article, Evidence-Based Language Intervention Approaches for Young Talkers, Finestack and Fey summarize the evidence in support of both general language stimulation and focused language stimulation. General language stimulation involves the techniques I just described in, well, a very general way. This means that there are no specific language targets (say, increasing verbs, or increasing nouns, or getting a child to use a specific type of two-word phrase). Instead, the goal is broad in nature: increase overall language skills. Finestack and Fey describe a randomized controlled trial (in other words, a well designed, scientific study) of a 12 week program that used general language stimulation (Robertson & Ellis Weismer, in Finestack and Fey, 2013). The researchers compared late-talking children who received general language stimulation to late-talkers who received no intervention and found that, compared to the children who received no intervention, children who received the intervention made more gains in vocabulary, intelligibility, and socialization. Importantly, the parents of the children who received intervention felt less stress. And who doesn’t want less stress in their life?!

Focused language stimulation is very similar to the general language stimulation except that it’s (you guessed it…) focused. The language models that are provided by adults are chosen specifically for that particular child. So, an adult might model mainly verbs if these are lacking in a child’s language. Or, the adult might model specific nouns. Or, the adult might model a specific type of early grammar marker, such as -ing (one of the earliest ways that children start marking verbs). This type of language stimulation, too, has been shown to be effective. Girolametto, et al, 1996 (in Finestack and Fey, 2013), taught parents to use focused language stimulation with their children. They compared the gains made the children of these parents to the gains made by children whose parents were not trained in use of these methods (don’t worry – the non-trained parents got trained at the end of the study, too!). By the end of the study, the children whose parents were trained in focused language stimulation had significantly larger and more diverse vocabularies, used more multi-word phrases, and had better phonology.

It’s important to note that general and focused language stimulation enjoy the most research support when used with late-talkers who don’t have any other delays. The research is mixed when it comes to the efficacy of these methods with children with more significant delays and disorders, such as those with autism or cognitive disorders. Because of this, having other tools in our toolbox is very important. This is where the rest of the continuum of naturalness becomes important – and where my passion for contextualized ABA approaches begins. But, that’s a post for another day. For today, we’ll stop here, secure in the knowledge that when we surround our typically developing children and late-talkers in language models, their language grows.

Finestack, L. and Fey, M. (2013). Evidence-Based Language Intervention Approaches for Young Talkers. In Rescorla & Dale, Eds. (2013). Late Talkers: Language Development, Interventions, and Outcomes

Becca Jarzynski, M.S., CCC-SLP, is a pediatric speech-language pathologist in Wisconsin. You can follow her blog, Child Talk, and on Facebook.

Seven Lessons for Newly-Minted SLPs

graduation

It’s graduation season and I can’t help but notice all of the brand new speech-language pathologists coming out of graduate programs across the country. What’s more is that I can’t help but be so happy for them! Here’s why: It seems as if it was just yesterday that I was a free spirited sophomore who decided to take a random class in phonetics. Little did I know this class would influence my life’s work. The class was taught by a young Ph.D., Gloria Weddington, who helped to focus me and, much to my mother’s delight, give me a purpose.

As a senior, Dr. Weddington took me to my first ASHA Convention where she introduced me to all the leaders in our profession.  What impressed me most was how well liked and respected she was by everyone. She would introduce me to her colleagues  as her “little student”  who was going to be a great addition to our profession.  She believed in me and I believed in myself. Once I received my master’s degree, I was ready to set the world on fire!

I vividly remember my first experience as an itinerant SLP in Los Angeles Unified School District. I was so eager and excited to have my first real job with my first real paycheck. I loved my schools and my kids and had a great master teacher who served as my CF supervisor.  I enjoyed my work and continued to grow seizing every new opportunity that came my way.  I absolutely loved my job! A few years later I left my very secure job to strike out on my own and opened a small private practice. I was the secretary, the receptionist, and the SLP,  but most importantly, I was happy again.  That was 35 years ago and I have never looked back.  In fact, I discovered another side of myself, that as an entrepreneur who was able to develop and sustain a thriving private practice in Los Angeles.

Today, many of my friends and colleagues are happily retiring. I have to admit, I feel a little conflicted when I think of what it must be like to wake up each morning and to not having any professional responsibilities.  However, I also can’t imagine life without my professional responsibilities, especially since there is so much more for me to do. The truth of the matter is that I feel as passionate today about our esteemed profession as I did when I was 24.

Young staff often ask me what’s my secret?  It’s no secret–it’s living and learning from life’s experiences. I am approaching 40 years “young” in our great profession and here are seven lessons learned along the way that continue to feed my spirit and nourish my soul:

  1.  Find a role model, a hero whom you admire, respect and trust. Listen, watch, and learn from him or her. If you are lucky they will be your mentor.
  2. Make your CF year count. Get the clinical supervision and support that you need to grow strong and healthy in our profession.
  3.  Be willing to rebuild your dreams.  Protect the joy and excitement that you experienced upon entering the profession. Remember there are no victims, just volunteers.
  4. Continue to grow, learn, and maintain high standards.  Make it a priority to attend ASHA conventions or at the very least your state conferences.  Learning is critical in our ever-changing profession
  5. Keep plenty of mirrors around.  Look closely at whether the person you see is the person you really want to see.  And, when in doubt refer to our ASHA Code of Ethics.
  6. Don’t burn bridges. You never know who you will need to give you that last cup of water.
  7. Have fun.  There is always work to be done!

Congratulations and welcome to our great profession!

Pamela Wiley-Wells, Ph.D., CCC-SLP, is the president of the Los Angeles Speech and Language Therapy Center, Inc. and the founder of The Wiley Center, a 501 (c)(3) organization dedicated to providing direct services and support to children with autism spectrum disorders or other developmental disabilities. The practice includes early intervention programs located in South Gate, Lawndale, Los Angeles, and Culver City as well as two satellite speech therapy clinics in Studio City and Downey. Wiley is a frequent lecturer on how to effectively deliver services to the increasing number of children diagnosed with ASDs who have social cognitive deficits.  She has written several professional articles and has co-authored two therapy workbooks; Autism: Attacking Social Interaction Problems for children 4-9 and 10-12 years of age as well as a separate parent resource guide available in English and Spanish. You can follow her private practice on Facebook.

 

Language Time with Curious George

 

banana

I can’t remember a time in my life that I didn’t love the character Curious George. He is a cute, sweet and lovable character with a curiosity that most children and adults can appreciate. Curious George books were originally written by Margret Elizabeth and her husband Hans Augusto “H.A.” Rey. They were first published in 1941 by Houghton Mifflin.

Curious George books are generally predictable, which can be an advantage for those children struggling with speech and language disorders including issues with narratives and sequencing. Already knowing and understanding the characters and the mischievous ways of George can help a child engage in each individual story and increase motivation.  In the more recently published books, there also includes a carryover lesson and activity. With so many Curious George books published (hundreds but I haven’t counted), it is easy to find a book for younger and older children depending on particular interests. There also are some e-books available, as well. I recently wrote an article on comparing e-books and print books.

Growing up with such a fondness for Curious George naturally led me to reading this series of books to my own kids and clients. I wanted to share some language tips in this article to use for the Curious George series. Language tips include:

  1. Expanding vocabulary: Within each book you will find new vocabulary to work on and define. For example in “Curious George Goes to the Chocolate Factory” discuss and define vocabulary such as “chocolate”, “treat”, “sale”, “factory”, “store”, etc. Words that many children do not know may include “truffle,” “caramel,” and “tour guide”.
  2.  Sequencing: Within each story, there are basic events that occur in a specific order. For example in Curious George Makes Maple Syrup, there are clear and concrete steps to make the maple syrup.  In order to work on sequencing, take some photos and upload them to sequencing app, such as Making Sequences.  With this app, a child can put the story in order and then retell you the story in their own words. Another way I work on sequencing is to use blank comic strips.
  3. Recalling information: Throughout the story, ask simple questions and help your child recall specific information about the story. For example, during Curious George Makes Pancakes, encourage conversation about George and his involvement in making pancakes. Why does everyone love George’s pancakes? Why is he running away from the chef?
  4. Describing: Encourage your client to explain what is occurring in the story. For example, in Curious George Makes Maple Syrup, encourage your client to explain to you how the maple syrup might taste and what a maple tree looks and feels like. If possible, bring in some maple syrup and a piece of a tree bark and ask your client to describe the feel and smell of the syrup and bark.  If you don’t have the manipulatives, search for videos or pictures describing what is in the book. For example, with the book, Curious George and the Plumber, I found a photo online to show my client what an “auger” was and other equipment that the plumber used in the book. It helped connect specific ideas with the book and make it more concrete and engaging for the child.
  5. Answering “wh” questions: Throughout the book, ask “wh” questions and encourage your own client to ask specific questions about the story. Work on pragmatics by staying on topic and taking turns within a discussion.
  6. Problem solving: There are many opportunities to problem solve during any story with Curious George because he is always getting into trouble due to his curiosity. Discuss the problem and ask your client to figure out what he might have done differently to deal with a problem. For example, in Curious George and the Puppies, George decides to let all of the puppies out because he wanted to hold them. All of the puppies ran out and now George had a big problem. Before you move onto the next page, discuss what George should do, etc.
  7. Pragmatics: George and his friend, the Man with the Yellow Hat, have a wonderful relationship. Although George is always finding himself in trouble, it is obvious that both characters love and care about each other. They have a mutual respect for each other which can be a great model for children. Also, the Man with the Yellow Hat always forgives George for his mischievous ways which can be great discussion for many children.
  8. Literacy and Reading Comprehension: Work on improving your client’s ability to read the words in the story and comprehend what they are reading. Another way to work on literacy is having your client draw a scene from the story and then have them write a sentence about it.
  9. Emotions: George and the Man with the Yellow Hat have many emotions throughout each story. Both characters are often happy and then sometimes sad, scared, confused and regretful. Describe these emotions and begin a discussion about them.
  10. Narratives: use a story map such as this one with the story. This story map was created by Layers of Learning. There are many other story maps available, but I liked this one….

Rebecca Eisenberg, MS, CCC-SLP, is a speech-language pathologist, author, instructor, and parent of two young children, who began her website www.gravitybread.com to create a resource for parents to help make mealtime an enriched learning experience . She discusses the benefits of reading to young children during mealtime, shares recipes with language tips and carryover activities, reviews children’s books for typical children and those with special needs as well as educational apps. She has worked for many years with both children and adults with developmental disabilities in a variety of settings including schools, day habilitation programs, home care and clinics. She can be reached at becca@gravitybread.com, or you can follow her on Facebook; on Twitter; or on Pinterest.

Aural Rehab: Getting an “A” in Listening

listening

There is no denying that aural rehab is critical for patient success with amplification. Unfortunately, most hearing care professionals do not implement a structured, patient-focused aural rehab program. They report lack of time, lack of patient compliance, and lack of reimbursement as the common challenges. As a practicing audiologist, I face these challenges on a daily basis, which prompted me to develop the 5 Keys to Communication Success and the Cut to the Chase Counseling program. The 5 Keys to Communication Success are:

dusty graphic

Educating our patients about these five simple keys to successful communication will help them to understand a few important points:

  • Communication is like a puzzle that requires several pieces to work properly.
  • Hearing aids are only one piece of this communication puzzle.
  • Involvement of family members, friends, and caregivers is essential.

When patients fully grasp the complexity of communication, and understand that each piece of the puzzle is critical for communication success, they are much more likely to be satisfied with their hearing aids and to comply with our recommendations.
My previous blog went into detail about the first key, The Speaker.
Today I’ll dive deeper into the second Key to Communication Success: The Listener. Most of the listener strategies we attempt to teach our patients are critical for all listeners, including those with perfect hearing. However, the importance increases exponentially when the listener is challenged by hearing loss. We must impress upon our patients that implementing these strategies is just as important as wearing their hearing aids.
Listener strategies revolve around the concept of active listening. The listener is no longer allowed to sit back and passively expect communication to happen effortlessly. Even with new hearing aids, this is an unrealistic expectation. I encourage my patients to earn an “A” in listening. To accomplish this, they must:

  • Be aware of their surroundings.
  • Anticipate what might be said.
  • Take action to make sure they can clearly see the speaker’s face.

As with all of the communication keys, I find it works best to classify the listener strategies by environment. For example, in a restaurant environment I instruct the listeners to read and discuss the menu ahead of time, to focus on the facial expressions and lip movements of the speaker, and to actively “tune out” the noises that aren’t helpful for communication. We also discuss listener strategies for the following environments: around the house, in the car, dining out, on the phone, and public events. While repetition of strategies is common between environments, I find that patients are more likely to retain and implement the information when it is applied to a specific situation where they experience listening challenges. It is also easier for patients to grasp the importance of these strategies when they see them repeated across environments.
The ultimate goal is to equip and empower our patients with a multitude of tools that will facilitate successful communication. The simple structure of the 5 Keys to Communication Success makes this easier and more efficient for both clinicians and patients alike. Next month I’ll discuss the third key: Environment.

 

Dr. Dusty Ann Jessen, AuDis a practicing audiologist in a busy ENT clinic in Littleton, Colo. She is the founder of Cut to the Chase Communication, LLC, a company dedicated to providing “fun, easy, and effective” counseling tools for busy hearing care professionals. She is also the author of Frustrated by Hearing Loss? 5 Keys to Communication Success. Dr. Jessen can be contacted at info@CutToTheChaseCommunication.com.

 

Learning About New Foods Without Eating: 5 Surprising Tips for Parents

new food

Wait … isn’t the idea to get the kid to eat Brussels sprouts?  Yes, ultimately.  But exploring food with all of our senses is often the first step to eventually, tasting new foods.  Whether your child is in feeding therapy or you’re just trying to raise a more adventurous eater, here are 5 strategies for encouraging kids to discover various sensory aspects of new foods before they muster the courage to take that very  first taste:

  1. Still Got Easter Eggs?  The plastic ones, that is.    Take the 2 halves and line an egg carton with red, yellow, green and/or orange eggs.  Cut up fruits and vegetables into dime-sized pieces and practice matching colors.  Each time your child picks up the new food, tell him “Red tomato with Red Egg!” and help him find the red egg so he can drop in the tomato.  Now you have a kiddo who is picking up all kinds of fruits and veggies, even the slightly wet, cut-up pieces, which many kids hesitate to touch.
  2. Pop in a DVDCopy-Kids created a DVD of adorable kids eating fruits and vegetables, “because children learn best from other children.”  Sit down and watch it with your child, along with a colorful snack tray of bell peppers, broccoli, avocado, blueberries…you get the idea.  Keep it positive and don’t emphasize the eating part.  Just pick up the same food you see on the TV and say something silly about it.  Roll it down your cheeks and talk about how it feels.  Give it a big kiss and proclaim your love for orange, red, yellow and green peppers!  It’s not always about biting into a new food – that comes later.  But, if taking a bite happens in the course of playing and watching a silly DVD, then that’s terrific!
  3. Create Your Own Food Network Show with your kid as the host!  If the best he can do is direct the show behind the camera while you cook, that’s still a great start.  At least he’s in the kitchen, interacting with the food (albeit from a distance)  in a positive, fun way.  Later that evening, invite the whole family to watch his creation together and serve the food you made on film.  Soon, he’ll be hosting the show and cooking new dishes while you operate the camera.
  4. Watch More TV.  Before you think I’m obsessed with television, let me share 2 terrific resources that will help your kids explore new cuisine.  The Good Food Factory is the Emmy award-winning kids’ cooking show televised in California.  But, you can still watch vintage episodes as well as 2 newer episodes on line.   Or, check out the tiny tasters on the Doctor Yum videos.  Created by a pediatrician, the website includes lots of how-to videos featuring kids doing the cooking.  Using videos to introduce the joy of food to your kids is just that – an introduction.  Afterward,  head to the grocery store.  Pick out that new produce you saw on a Doctor Yum video – like a prickly pear or a lychee or a dragon fruit.  Cut it open…take a lick…one thing might just lead to another!
  5. Make Handprint Pictures Using Purees.  First, include your child in the process of making the edible “paint” puree.  Anything will do: yogurt, pudding or even cauliflower blended to a smooth paste.  Add a touch of color to the cauliflower by using natural food dyes or blending in real food, such as carrot juice or spinach leaves, letting your child pick up the spinach and add it through the safety top of the blender.  Spread the puree onto a cookie sheet or flat plate.  For the child who is tactilely defensive, you may notice that he will touch the puree with either just the side of his thumb or the tip of one finger.  That’s a fine place to start!  Over time, he’ll progress to tolerating his entire hand flattened into the plate of puree and then, pressing  his messy little hand onto paper to make a handprint.  For ideas on various animals you can create with hand or even footprints, click here.

Egg Carton Color Matching

What do all of these strategies have in common?  They’re fun and they involve YOU – the most important person in your child’s life!  Be silly, be positive and join in!  Get your hands messy,  model healthy eating and praise what your kiddo can do on that day.  Learning to try new foods involves all of our senses and remember,  tasting  often takes time.

 

Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating.  She is the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is  offered for ASHA CEUs and includes both her book and CD for each attendee.  She can be reached at Melanie@mymunchbug.com.

Mission Impossible: Collaboration (Are We Succeeding?)

collaboration

 

Ellie’s parents were optimistic about her transition from her private preschool for children with hearing loss to her neighborhood public school kindergarten.  After all, Ellie’s speech and language skills had improved greatly since enrolling her in the preschool. Ellie’s previous school had an audiologist who came to the school daily to check all the children’s equipment and interacted easily with Ellie’s speech-language pathologist and teachers of the deaf.  However, only a few weeks into kindergarten, Ellie’s mother was already concerned that the new speech-language pathologist was not checking Ellie’s cochlear implant on a regular basis.  The audiologist for the school district was responsible for 250 children at multiple schools throughout the county so how attentive could she be to Ellie’s needs?  Would Ellie tell her teacher if her implant wasn’t working, or if her battery was dead?  Would Ellie’s implant audiologist at the hospital share her test results with the speech-language pathologist, as Ellie’s mother had requested?

Scenarios such as this one are familiar to those of us who work with children with hearing loss.  Children are being identified and treated for hearing loss earlier than ever thanks to universal newborn hearing screenings and enhanced technologies.  The same children who 30 years ago would have been in specialized educational settings are now entering mainstream classrooms across the nation.  Clearly this was our goal, and we are excited to see the progress that has been made on this front.  However, when a child is in a general education classroom, sees her audiologist twice a year for programming at a hospital 50 miles from home, gets private speech therapy one hour a week at ABC Therapy, and sees the school SLP for 30 minutes twice a week, coordination of care can fall through the cracks.  It was this disconnect between the professions of speech-language pathology and audiology that first drove me to pursue both my Au.D. and SLP degrees and become dually certified.  I wanted to be able to treat the whole patient, from diagnosing the hearing loss to helping them achieve listening and spoken language outcomes.

In 2011-2012, I conducted a survey under the direction of Anne Marie Tharpe, Ph.D. examining this issue.  We wanted to know whether or not audiologists and speech-language pathologists believed they were collaborating effectively, and we wanted to see if the parents of children with significant (moderate-profound) hearing loss agreed.  We surveyed 189 individuals, essentially evenly divided between parents, audiologists, and speech-language pathologists.  Almost all respondents to the survey felt that collaboration between the two professions was important.  “Collaboration” meant everything from sharing test results to attending IEP meetings.  The take-home message from the survey results was that about 1/3 of the parents and audiologists, and 1/4 of SLPs surveyed did not agree that professionals were working collaboratively.  So one out of every three parents with whom you interact may feel there is something more we could be doing to work better as a team.

The most often-cited barriers by clinicians to collaboration included time constraints and large caseloads.  One of the most rewarding findings in the survey was that 100 percent of parents of children ages birth-3 years felt that professionals were working collaboratively.  This tells us that we have indeed done a good job in improving our service delivery to this population with a focus on family-centered care.  However, we are still challenged by how to provide collaborative hearing care to children and their families when they reach school.

So what are your thoughts? Do you feel you work well as part of the parent-audiologist-speech-language pathologist team?  What are your biggest frustrations? How might we improve our collaborations with other professionals – perhaps by embracing new technology that allows us to communicate and collaborate in a more timely manner? As we think about Better Speech and Hearing Month this May, let’s focus on working toward better collaboration with one another so that children such as Ellie have the best chance to succeed.

 

Adrian Taylor, Au.D., M.S., CCC-A/SLP is an audiologist and speech-language pathologist at the Vanderbilt Bill Wilkerson Center in Nashville, Tenn.  She works primarily in the area of cochlear implants and aural (re)habilitation in both the pediatric and adult populations. Adrian may be contacted at Adrian.l.taylor@Vanderbilt.edu.  

Dynamic Assessment: How Does it Work in the Real World of Preschool Evaluations?

dynamic evaluation

 

In a disability evaluation, we ask a child to point “to the triangle” or “to the author” as part of test developed to identify disorder.  An evaluator who uses this kind of test to identify disability must assume that all children being evaluated have had similar exposure to “triangle” and “author” including similar family, cultural, and educational experiences. It follows then, that if a child cannot identify “triangle” or “author” it is because that child has some kind of learning problem. But what if a child does not have a disability but simply did not have the same exposure to “triangle” or books as the majority of children his age? Dynamic assessment offers evaluators an approach to see whether a child can acquire new linguistic information from the environment. Here are some clinicians examples of how to translate the dynamic assessment research into their own disability evaluations, including some “dynamic” approaches to increase the accuracy of our preschool disability evaluations.

First, Let us consider nonword repetition tasks, one type of dynamic assessment. Nonword repetition tasks assess whether a child can hear, retain briefly, and then repeat nonsense syllables of varying lengths. Nonword repetition tasks give us insight into why a child may have a weak vocabulary. If the child has difficulty with nonword repetition tasks it may indicate a disordered ability to learn new words from the environment and will also affect the child’s ability to understand directors and spoken stories. Here are two modules analyzing videos of several children, both with and without language impairments, doing the same nonword repetition task. By seeing how different children of different abilities perform as they acquire the new words, clinicians acquire clinical judgment. Nonword repetition tasks are not classic dynamic assessment because there is no pre and post-test. But because we watch the child learning new syllables in front of us, it is dynamic rather than static.

Another dynamic approach is fast word mapping. In fast word mapping we evaluate whether a child can learn new words. Because the words are completely made up, no child has more or less experience with these words. In these videos of 4-year-olds, one child is typically developing, one child has low average to mildly delayed skills, and one child has mild to moderate delays. What is especially helpful with more dynamic approaches to assessment, we see a much greater range of information about a child’s skills, rather than simply did he identify the “triangle” or not?

A child’s cognitive skills, including the ability of children to describe cognitively challenging tasks, can also be seen through dynamic assessment. Here is an example of how a psychologist used dynamic assessment to evaluate the nonverbal cognitive skills of a 2 year 10 month old boy with Autism Spectrum Disorder (See 8:25 to 10:50). The psychologist described in his report what he saw as: Dynamic assessment demonstrated that George is intelligent and learns quickly. The evaluator showed George how to make a rubber duck fly into the air by placing the duck on the flat end of a spoon placed on the table and hitting the round end. George smiled and laughed and searched for the duck, although he did not make eye contact with the evaluator. George tried and had difficulty the first time, but after a second demonstration George was able to make the duck fly and seemed happy he made it happen.”

David’s dynamic assessment task reminds me of one that a great trilingual SLP, Barbara Dittman, showed me. She used the disappearing egg in the cup trick. Barbara would show the trick to the student and tell him how to do it. Then she would bring another person–a parent, teacher, or peer—and have the student do the trick and then explain to the person how to do it. Barbara learned about cognition and also about the student’s ability to explain a somewhat challenging task.

Recent articles demonstrate similar effectiveness of dynamic assessment in distinguishing bilingual preschoolers with and without disabilities. These dynamic assessment tasks for bilingual preschoolers include fast word mapping and a graduated prompting task with a novel word learning, semantic, and phonological awareness component.

Based on research going back several decades, the importance of dynamic assessment in accurate identifying a language disorder is well established. New studies continue to support its value. In addition to the videos on dynamic assessment and preschool assessment in general, the LEADERSproject.org has many resources available to anyone looking to sharpen their disability evaluation skills including test reviews, discussion of current law, regulations, and policies, and model evaluations.

Catherine J. Crowley, CCC-SLP, JD, PhD, Distinguished Senior Lecturer in speech-language pathology at Teachers College Columbia University, founded and directs the bilingual/multicultural program focus, the Bilingual Extension Institute, and the Bolivia and Ghana programs. An experienced attorney, Cate is working with NYCDOE on a multi-year project to improve the accuracy of disability evaluations. The LEADERSproject.org is a website dedicated to supporting quality clinical services and is funded by the Provost’s Office and several foundations.  Cate, an ASHA fellow, received the “2012 Humanitarian Award” from the National Council of Ghanaian Associations, and ASHA’s certificates for Contributions to Multicultural Affairs and for International Achievement.