Three Easy Ways to Collaborate with Teachers

teach

 

Like many of you, as a school speech-language pathologist, I left graduate school ready and excited to jump into classrooms. I realized the benefits of reaching my students in their own environment and so I set out to reach them there by “educating” teachers on speech and language. And then… reality hit. With all the added responsibilities, how do I go about adding one more task to my ever-growing list and collaborate with teachers?

Are you like me? Often, school SLPs feel lost when it comes to reaching their students in the classroom. Typically, we fall into one of two camps. Either we feel the need to completely take over the classroom lesson to “teach” the teacher something about language or we become too afraid of looking like a “know-it-all” and so do not offer any suggestions. Neither of these offers a solution. Here are three easy ways to collaborate with teachers that provide a balance between the two:

1. Provide a monthly newsletter. This is one of the easiest ways to stay in touch with teachers. If you have monthly themes, give them an idea of what you’re working on. Provide a “vocabulary word of the month,” a tip on how to serve students in their classrooms, a good resource or website, or even a practice sheet stapled to your newsletter for teachers to provide to students. Teachers will appreciate the time you took to reach out to them and will also gain information on both their students and how we service them.

2. Give a student snapshot to your teachers. This is most beneficial at the start of the school year. Unfortunately, with all of our responsibilities, important information is often not communicated and students’ services often suffer as a result. Relay any accommodations on students’ Individual Education Program (IEP) that the teacher is responsible for providing in the classroom and make sure they understand what each one means. It is also helpful to provide an overview of the goals you are working on with their students. For example, a simple statement such as “During Johnny’s speech and language session, he is working on increasing his vocabulary and reading comprehension,” would give the teacher an idea of what he works on with you.

3. Hop into the classroom during independent reading. Many classrooms now schedule a chunk of time devoted to practicing independent reading and writing skills. My district uses a structure for this called “The Daily 5” created by Gail Boushey and Joan Moser. When I walk into a classroom during Daily 5, I can immediately sit with students and listen to reading, ask questions about what they are reading, teach vocabulary and assess and monitor articulation skills while reading. What does this type of intervention mean for us as SLPs? We can easily monitor and work on skills within the classroom setting all while requiring minimal if any planning time. This type of intervention also sets the tone for easily working with the teacher on their turf without taking over the entire classroom.

I hope this next school year finds you rested and ready to try new ideas. Reaching out to teachers often feels like one more to-do, and can fall to the bottom of our priorities. By making a goal each year of trying just one new idea, it can seem less overwhelming. I guarantee it: by reaching out to our students in their environment, we will be making a huge impact on their lives.

Nicole Allison, MA, CCC-SLP, has a passion for creating materials that benefit the school SLP, especially when it comes to data collection and the Common Core State Standards. She currently works in a public school as the only SLP (yes, that’s right, all 13 grades and loving them) and is the author of the blog Allison’s Speech Peeps (speechpeeps.com). She also serves on The Ohio School Speech Pathology Educational Audiology Coalition as secretary. Her and her husband recently had a baby and are loving parenthood. She can be reached at nrallison@gmail.com.

What School SLPs Want to Know

pitt

If you want to know what the real talk is at an ASHA Schools Conference, you need to pull up a chair at the lunch tables. That’s where you’ll hear chatter about the most top-of-mind topics for the speech-language pathologists and audiologists who attend.

So it was that this roving blogger sat down to share a sandwich and some conversation with this year’s attendees. Here’s what a sampling of them report are the most burning issues that brought them to Schools 2014 in Steel City: Pittsburgh.

Brianne Young, SLP, Renfrew, Pennsylvania
I want to know how we’ll use the Common Core State Standards. We’re switching to the Common Core totally but we haven’t yet transitioned the speech-language piece of it 100 percent. We started adapting the reading and language standards last year, and nobody’s sure how this will all work. I also want to know more about incorporating Common Core with RTI.

Amy Shaver, SLP, Hamden, Connecticut
As a former stay-at-home mom just getting back into it—I just got hired fulltime by a school for next year—I want to learn more about iPad apps for speech. The technology has changed so dramatically and rapidly in eight years. It’s kind of an odd place to be because as a mom, technology can seem like a big negative. I’m always limiting my kids’ screen time. So it’s an interesting shift to think of it as an educational tool.

Sabrina Hosmer, SLP, Manchester Public Schools, Connecticut
As a bilingual evaluator, I’m here to find out how other SLPs have made systemic changes to their school districts. In our district we have problems of overidentification of speech-language disorders among bilingual children. The children are tested in English, and they’re not supposed to be, but we don’t have enough bilingual SLPs to do appropriate assessments or to serve the bilingual kids who really do have speech-language disorders.

India Parson, SLP, Prince Georges County, Maryland
What’s on my mind? The Common Core—how do we use the literacy standards with children with severe disabilities? And what’s going to happen with tying them to performance evaluations of SLPs, which they’re doing with teachers and are talking about doing with us? The other issue is the shortage of bilingual therapists. We have a big problem of overidentification of disabilities in the bilingual population. We need folks making better diagnostic decisions up front.

Christine Bainbridge, SLP, Ithaca, New York
What’s burning for me is wanting to learn more about central auditory processing disorder—what is the research evidence base on CAPD, how does it truly change children’s functioning in the classroom, and how do we intervene with it in an evidence-based way?

Audrey Webb, SLP, Charlotte, North Carolina
I’m just coming into the K-12 schools this year after working as a preschool SLP for many years, so what’s going on with the Common Core will be big. Of course, a lot of that’s up in the air now because our state legislature just repealed it, but we’ll still be using it for the time being. I’m also big on RTI. I’m a fan of it, and always interested in ways to get teachers on board with it.

Mary Pat McCarthy, SLP, Clarion, Pennsylvania
My reason for going to Schools every year is always to see what the current buzz is. It’s no one thing I want to know. It’s everything, really. I know if I go, I’ll get what I need for the coming school year. This year I’m especially interested in hearing about working with teachers on improving our work on phonology and articulation with kids. But this conference is always a great professional recharge during the summer.

 

Bridget Murray Law is managing editor of  The ASHA Leader.

SLPs in the Home: What’s Pot Got to Do with It?

brownie

I never thought I’d be writing an article for ASHA about marijuana, but because I live in Colorado, I’ve got the latest news on weed to pass along to my fellow SLPs. In fact, if you were sitting here with me in the privacy of my own home (and you were over 21), we could chat about it while lawfully smoking a joint, munching on an edible cannabis-laced cookie, sucking on a marijuana lollipop or even, inhaling the vapors from an e-cigarette packed with marijuana oil. That’s just a sampling of the options we have to get high in the “mile high city.” Before you shout “I’m coming over!” I should probably disclose that I’m not a marijuana user, medical or recreational. If your next thought is “But I DON’T live in Colorado (or Washington) so this doesn’t apply to me – at least professionally” please read this entire article. Colorado law is considered a “springboard for other states” to legalize marijuana soon. Plus, illegal shipping to other states, often discovered during a routine traffic violation committed by the average Joe next door, has increased significantly. According to the El Paso Intelligence Center & National Seizure System, the mini-vans and SUVs bringing home “souvenirs” from Colorado aren’t just from the states bordering the Rocky Mountains. New York, Florida, Illinois and Wisconsin were some of the most popular destinations and consequently, you may experience some unexpected safety issues if you are providing home-based care for children and adults.

In an effort to educate therapists on the new laws and our responsibility to inform our families of issues that may arise with recreational marijuana use, Jane Woodard, the executive director of Colorado Drug Endangered Children, is traveling the state providing health care professionals the necessary information to keep ourselves and the families we serve safe. SLPs are required by law to report suspected conditions that would result in neglect/safety issues or abuse of children and adults. However, many of our families are simply not aware of the safety concerns and home based therapists are often the first resource for educating those families who choose to partake in using, growing or processing recreational marijuana.

Given the various populations that we serve, here is an overview of some of the safety issues:

Infants: As a pediatric feeding therapist, just one of the populations in my care are babies who require support for breast and bottle feeding. In this Colorado culture of embracing our new freedom, mothers are commenting to me without restraint that they’re using marijuana to combat nausea during pregnancy or enjoy “a little pot now and then” while breastfeeding.Studies indicate that by age four alarming changes occur in children that have had prenatal exposure. It’s noteworthy that the studies focused on a much lower amounts of delta-9-tetrhydrocannibinol (THC: the chemical that produces the psychoactive effect) than what is present in today’s super-charged marijuana products. The children demonstrated “increased behavioral problems and decreased performance on visual perceptual tasks, language comprehension, sustained attention and memory.” Marijuana use while breastfeeding is contraindicated because the THC is excreted into breast milk and stored in fat and is suspected to impact a baby’s motor development. There are no established “pump and dump” guidelines for THC and it stays in the bloodstream for much longer than other drugs. Consider the increased risks from both second-hand smoke and third-hand smoke or the “contamination that lingers” after smoking, including an increased risk for SIDS and more. For the home-based SLP, exposure to second and third-hand smoke or residue means that I will likely carry that aroma with me to the next home. I am responsible for the safety of all of the children I treat, and many are medically fragile and/or have sensory challenges and would be impacted by these odors. Today, I am faced with difficult conversations with parents that I never imagined I would have.

Children: In four short months, from January to April 2014, Colorado’s Poison Control Center has reported 11 children who ingested edibles, one as young as five months old. Over half of those children had to be hospitalized and two were admitted to the ICU. Consider that those are the reported cases – and what goes unreported is difficult to ascertain. While the law requires that the packaging cannot be designed to appeal to kids, current practices are questionable. Some argue that edibles are packaged too much like junk food, with boxes of “Pot-tarts” similar to the popular toaster pastry, bottles of fizzy “soda-pot” and candy bars with labels that rival Mars® and Hershey’s®.  In April 2014, Karma-Candy was the marijuana candy that a father in Denver consumed just before hallucinating and killing his wife, who was on the phone with 911 dispatchers at the time. She could be heard yelling to her kids to go downstairs as she desperately tried to get help for her family.

Packaging of certain products must also be in an opaque and re-sealable container, but that law only applies to the time of purchase. Plus, most edibles contain multiple servings and it’s not unusual for one cookie to serve six people. Even adults are mistakenly eating whole cookies and in April 2014, one visiting college student consequently jumped to his death from a hotel balcony after eating too much of an edible. A New York Times columnist visiting Colorado ate a whole candy bar labeled as 16 servings, and “laid in a hallucinatory state for 8 hours.” Home baked marijuana options are equally confusing. As a feeding therapist, I used to be comfortable offering foods to a child from a family’s pantry. But now, a tempting plate of brownies may be more than just a plate of brownies. By law, edibles, like any marijuana product (even plants), must be in an “enclosed, locked space.” However, it is not unusual for Colorado therapists to arrive for their home visit and find a bong, topical lotions or a half-eaten edible on the living room coffee table. Early intervention and home health care agencies are considering how to educate families on the first day of contact, during the intake process. Susan Elling, MA, CCC-SLP, who treats both children and adults in the home, notes that “It will be very important to have an open and honest conversation with a patient (and their family) regarding marijuana use as part of taking the medical history – just as we do for alcohol and smoking.”

Adults: Ms. Elling reported that “the population in need of homecare services may be more likely to use marijuana to control pain and nausea” because family members are more likely to suggest it and there will no longer be a need to obtain a medical marijuana card. Ms. Elling also notes that marijuana “affects sleep, balance, coordination, and cognition.  This may be amplifying the conditions a patient is already dealing with related to medical issues.  It can also significantly raise anxiety.  These are all factors that increase fall risk, confusion, lead to poor judgment, and can setback a patient’s recovery. It may be very difficult to determine what issues are related to the patient’s medical condition and which are related to the marijuana use.  Interventions, progress and prognosis may be affected.” Edibles in particular are a safety hazard for this population, because of the inability to self-regulate. There is no predicting how an edible will effect one person or another.

“It’s not your grandmother’s marijuana,” reported Dr. Richard Zane, who is the head of the Department of Emergency Medicine at the University of Colorado Hospital. Well-meaning family members, hoping to control their loved one’s discomfort, may not realize that the strength of today’s marijuana is significantly higher than the pot your cool grandma smoked in the 60’s. In fact, THC levels represent a 121% increase just from 1999 to 2010. Family members may not understand that the strength and effect of the drug varies from product to product. For example, compare two hits on today’s joint and an individual will ingest approximately five mg of the chemicals that produce the psychoactive and/or sedative effects compared to up to 100 mg in one packaged edible. Plus, even using the exact same method of ingestion does not guarantee the exact same dosage every time. Zane reported in this interview with Colorado Public Radio that the “drug isn’t always spread evenly through food or candy, so several people eating the same amounts can be ingesting different quantities of marijuana.”

The uncertainty of dosage and effects has Elling on guard: “I am concerned that the high potency, unpredictable effect, easy availability, and unclear dosage information of edibles may have serious consequences for homecare patients with already fragile health. It is also misleadingly considered quite “benign” and safe compared to alcohol consumption and smoking.  I feel the need to know the signs and symptoms of a marijuana overdose and know the contraindications with any other prescription or OTC drugs they may be taking and be able to educate my patients and their caregivers regarding this issue.”

Additional Safety Concerns: In the course of this short article, it’s impossible to cover all of the safety issues, including those related to growing and processing marijuana in the home. These concerns include electrical hazards from impromptu wiring (not to code); cultivation hazards such a mold and poor air quality for medically fragile patients;  increased carbon dioxide and carbon monoxide necessary for growing; chemical exposures and improper storage of pesticides and poisonous fertilizers; THC on household surfaces and airborne exposure; and exploding hash oil labs. From January to April 2014, hash oil explosions occurred on a weekly basis in Colorado, some triggered just by turning on a nearby light switch.

Consider Family Functioning: The impact on safety is the tip of the iceberg. Woodard explained that home health professionals must consider a parent’s behavior when using marijuana, the impact on a child’s behavior and family functioning overall. Difficult but often necessary questions to ask include: What steps have you taken to protect your children and family members? How do you store your marijuana and paraphernalia? What are you like when you use? Most importantly, she recommended asking yourself “Do I believe that the conditions in this home could reasonably result in harm” to anyone in this household? If so, educate the family and be mindful of mandatory reporting laws.

 

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.

10 Trillion Microorganisms versus Your Toothbrush

dental

“The mouth is dirty,” Dr Kenneth Shay stated frankly; AND, it is “the biggest hole in your body!”

Warning: You may want to finish eating, brush your teeth, floss, use mouthwash, and then come back…

OR

If it is early morning, and you haven’t brushed your teeth yet: then scrape the gunk off your teeth with your fingernail. You may have found 10 billion microorganisms in that cubic millimeter.

There are 1 trillion to 10 trillion microorganisms in your mouth. Simply brushing your teeth can get rid of that nasty bacteria film in your mouth. It can also prevent “some of that schmutz” from getting into your lungs. If you are having trace aspiration (saliva, food, and/or liquids getting into your lungs), try to make what gets into your lungs less nasty. You can prevent pneumonia. Pneumonia due to poor oral care is a major avoidable infection, per Shay.

Ross & Crumpler (2006) noted that despite strong evidence in the literature on the role of brushing the teeth in preventing pneumonia, medical staff continue to view oral care as a comfort measure and only use foam swabs.

“Toothette sponges are wimpy,” stressed Shay. They don’t get the gunk (plaque) off the teeth. Plaque is sticky. If not removed, it hardens into tarter (also known as calculus). Then a visit to the dentist is needed to get it off (debridement).

Why is the mouth forgotten in healthcare? We help the dependent elder go to the bathroom many times a day. So why don’t we help brush his teeth?I’ve heard some nurses say they are squeamish about the mouth! It makes them gag! Well, we should be gagging over the costs of neglecting the mouth.

This simple prevention technique of brushing costs pennies a day against the cost of a pneumonia. Based on CDC numbers from 2011, there were 157,500 Hospital Acquired Pneumonia infections that year. CDC states the average extra cost of that hospital acquired infection is $22,875. This equals over 3 billion dollars!

Why are we not protecting this wide open gateway to the body? Imagine your gingival space between the tooth and gum as a huge parking lot. Germs love these 1-3 millimeter deep parking spaces. If germs park in the gingival space for more than 24 hours, they become calcified into plaques. Bacterial loves to stick to plaque. Only brushing removes it. No brushing leads to a build-up of plaque in the gingival space and inflammation (gingivitis).

It only takes 48 hours of hospitalization in a critically ill patient to change this bacteria from the usual gram-positive streptococci to gram-negative microorganisms (the nasty pathogenic bacteria that cause pneumonia).
Maybe we don’t brush our patients teeth because the gums bleed? Blood is okay, per Shay, even if you are on a blood thinner. Shay stated that bleeding is a sign that you need to brush more. It is due to the inflammation, and regular brushing will prevent bleeding. Shay warned that bleeding is only risky if the patient has a blood disorder or disease that causes excessive bleeding.

Most cases of gingivitis do not progress to the more serious periodontitis, but…Immune-compromising events can cause an autoimmune response that can lead to periodontitis, per Shay. Examples of immunocompromising events are not only hospitalization and critical illness; they could also be the following:

• life stressors
• flu
• depression, and
• pregnancy

Periodontitis is inflammation caused by bacteria that affects the attachment between the tooth and the bone. It is an irreversible destruction of the supporting tissues (i.e., the periodontal ligament to alveolar bone). Then bone-absorbing cells eat away at the bone. The bone will not be regenerated. Additionally, with the gums receding, “there is more surface area to collect gunk,” said Shay. The periodontal pocket that is formed creates a larger “parking garage” of 6-8 millimeters deep. Lots of gram-negative anaerobic bacteria can park there! Pathogenic microorganisms. “These are the same things that cause aspiration pneumonia,” stated Shay.

See the full blog post at www.swallowstudy.com.

Karen Sheffler, MS, CCC-SLP, BCS-S, graduated from the University of Wisconsin-Madison in 1995 with her master’s degree. There, she was under the influence of the great mentors in the field of dysphagia like Dr. John (Jay) Rosenbek, Dr. JoAnne Robbins, and Dr. James L. Coyle. Once the “dysphagia bug” bit, she has never looked back. Karen has always enjoyed medical speech pathology, working in skilled nursing facilities and rehabilitation centers in the 1990s, and now in acute care in the Boston area for more than 14 years. She has trained graduate student clinicians during their acute care internships for more than 10 years. Special interests include neurological conditions, esophageal dysphagia, geriatrics, end-of-life considerations, and patient safety/risk management. She has lectured on various topics in dysphagia in the hospital setting, to dental students at the Tufts University Dental School, and on Lateral Medullary Syndrome at the 2011 ASHA convention. She is a member of the Dysphagia Research Society and the Special Interest Group 13: Swallowing and Swallowing Disorders. Karen obtained her BCS-S (Board Certified Specialist in Swallowing and Swallowing Disorders) in August of 2012. You can follow her blog, www.swallowstudy.com.

Kid Confidential: Parent Education and Training, Part 1

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This is part 1 of a three part blog series on the topic of parent education and training.  Look for part 2 and part 3 coming up over the next two months.

Parent education and training is not only an important part of our job as SLPs it is an essential part of our job.  Still, I’ve spoken to many SLPs over social media who still feel like they are lacking this particular skill for a number of reasons. For SLPs in the schools, their caseloads are so high and paperwork demands so daunting, they are left with little time to collaborate with school staff let alone contact parents on a regular basis. For private practitioners, speaking from experience, I think we are so focused on targeting the necessary skills and making gains with our clients, that we forget how important parent education can really be.

We know that parent involvement in general education is certainly beneficial. Children whose parents are involved in their school tend to have better academic performance and fewer behavior problems. It makes sense that parental involvement in speech services also would result in positive effects such as increased home practice of target skills and generalization of learned skills to the home environment.  In fact, there are whole therapy models (i.e. DIR/Floortime, Hanen, etc.) that incorporate parent education and involvement as key factors in their models and have the research to back it up.  The DIR/Floortime model’s portion of parent education and training has been tested and retested among various populations all resulting in positive effects, faster progress and improved generalization of social skills for children with ASD (see list of additional resources below).

So the question we need to ask ourselves is why we aren’t tapping into this wonderful resource and effectively educating and training parents of our clients?  For myself, I can tell you that it took some time to become effective in this manner. Initially it seemed as if I was more of a teacher explaining the rationale for various techniques however I was missing some very important steps. Over time, I have improved upon my ability to educate and train parents and I will share with you my tips for effective parent training:

  1.  Trial techniques:  The first thing I usually do is trial various techniques to determine which techniques the child responds successfully.
  2. Explain rationale:  Once I determine the most effect speech therapy techniques for the child (which we have to accept will change over time, maybe even at each session depending on the child’s ability and behavior), I will explain the rationale behind the techniques to the parent(s) present (either in my therapy room or in their homes when providing therapy).
  3. Model technique(s):  Modeling the technique(s) immediately after explaining the rationale will demonstrate the effectiveness of the technique(s) and make more sense to the parent(s).
  4. Parent’s turn: Allowing the parent(s) to take turns trying to eliciting the communication skill via the use of determined techniques will give them much needed practice in the safety of the therapy session.
  5. Give Feedback: Giving feedback is necessary to training.  It allows parents to feel successful with the skills they currently exhibit and provides additional ideas for the areas in which they are weaker.
  6. Follow up: I think it is so important to follow up with parents session to session to determine how well the techniques are working at home, how comfortable they feel using the techniques and if there are adjustments that need to be made for more effective use.

These are my basic tips for effective parent education and training.  Next time I’ll be talking about how I realistically incorporate parent education and training in my speech therapy sessions.

DIR/Floortime Resources:

  • Casenhiser, D., Shanker, S., & Stieben, J. (2011). Learning Through Interaction in Children with Autism: Preliminary Data from a Social-Communication-Based Intervention. Autism, 17 (2), 220-241.
  • Pajareya, K., & Nopmaneejumruslers, K. (2011). A pilot randomized controlled trial of DIR/Floortime™ parent training intervention for pre-school children with autistic spectrum disorders. Autism15 (5), 563-577. doi: DOI: 10.1177/1362361310386502
  • Solomon, R., J. Necheles, C. Ferch, and D. Bruckman. “Pilot study of a parent training program for young children with autism: The P.L.A.Y. Project Home Consultation program.” Autism, 2007, Vol 11 ( 3) 205-224.

 

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 NJ, MD, KS and now AZ.  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.

Collaboration Corner: 10 Easy Tips for Parents to Support Language

ice cream

As we make our way through the lazy days of summer, schedules change, and things relax. My usual theme is collaboration; parents can be one of our biggest assets in promoting language development. Parents of young children usually want to know what they can do to support their child’s language development in the absence of a structured day. Though I teach children with disabilities, I find I continually revisit the following tips with parents of young children regardless of whether a child is typically developing or needs a little more support. Here they are in no particular order of importance:

  1. Pay attention to body language, when a child is looking toward or reaching for something, they are communicating. Talk about what they are reaching for, “Oh, you want the bubbles!”
  2. Avoid the “say this” tendency. Don’t pressure the child to speak; keeping the experience positive is important. Instead, model what the child might say when he/she is ready.
  3. Take time to sit and read with your child every day. Label everything you see, and encourage them to point to the words and pictures as you talk about them. Books with repetitive lines are great.
  4. Be playful. Sing songs. Use lots of inflection. With familiar songs, leave some of the words out and see if your child will hum or sing the words.
  5. Provide limited choices when you aren’t sure what your child wants. Holding out 2 items, lessens the stress of having too many choices.
  6. Talk with your child about what you are doing, then provide the opportunity for your child to reciprocate. “I’m making some cookies, do you want to help?”
  7. Use first/then language to guide behavior, and then be consistent, “First you need to eat, then you can read.” Use this language even when moving between activities that are preferred or less preferred.
  8. Use pictures: Take pictures of your child’s day and talk about what is coming up next, or make a photo album of fun activities (vacation, going out for ice cream) to talk about.
  9. Remember language is everywhere, even if you child doesn’t understand everything you are saying, he or she needs the exposure. Car rides, walks outside, blowing bubbles are just a few examples. Describe what you see, and ask questions, e.g, “I see a cow. What does a cow say?”
  10. Simplify your props. Sometimes the simplest toys can bring out the best language. Summer is full of such opportunities: A spinning toy, taking a turn kicking a ball, bubbles…all can support your child’s development, simply by talking to them.

Kerry Davis Ed.D., CCC-SLP,is a speech-language pathologist in the Boston area, working with children who have significant communication challenges. She conducts trainings and workshops, and serves as a volunteer speech pathologist and consultant for Step by Step Guyana, a school for children with autism in South America. The opinions expressed in this blog are her own, and not those of her employer.

CFY (Coming For You)!

stage

I’m a big fan of musical theater (I was so excited Jessie Mueller won a Tony this year.  She was wonderful.). I’m in awe of the performers who seem to sing, dance and act with equal aplomb.  And then they go out and do it in front of a live audience.  Every day.  Twice on Wednesday and Saturday. Where do they find the endurance?

Well, baby, I’ve got news for you.  You’re about to star in your own show.

There is no denying the difficulty of grad school. You’re taking classes in everything, even the stuff that might not be your cup of tea.  Ideally, your clinical fellowship year is in an area you particularly enjoy and the everyday implementation of book learned skills will certainly give you many ah-ha moments. What can be difficult is the frequent observation, knowing, or maybe not knowing, that someone is on the other side of that two way mirror.  There is a feeling of being constantly “on.”  Even paperwork remains a performance. I would drop into bed at night, completely spent.

I actually had two CFY experiences.  The first was my dream job. I was a preschool therapist in a local school system and my job included home visits/evaluations, lessons within the preschool handicap classroom, individual pull-out therapy for many of those same kids, other children that came only for speech, and screenings–lots and lots of screenings.  I’d been working at my school practicum the previous spring in the same location so I knew the staff, some of the kids and had a relationship with my supervisor.

Then life intervened.  My husband and I married in early August which gave us time to honeymoon before the first day of school.  But as the saying goes, “the best laid plans of mice and men….”  Within the first month my husband was transferred to Atlanta, a five to six hour drive from where we were living, and needed to move immediately.  I gave notice that I would leave at the Christmas holiday, started packing our wedding gifts and began to look for a new placement.  (Yes, my husband left a couple months before I did.  Not an auspicious start to married life, but we made it work.)

My second placement was equally as dreamy–out-patient rehab for a large children’s hospital with lots of experienced therapists, including OT and PT, to learn from and watch. The experience I gained there truly shaped the clinician I am today.  So much so, that if I were to give one bit of advice to a new therapist starting out it would be to work where you have lots of interaction with more experienced clinicians. I know you’re sick of being watched, guided, and yearn to start doing your own thing, but…for me, it was the best possible thing that could have happened. (This is where I spent two years exhausted.  I was finally starting to get my feet under me, doing some mentoring myself, and feeling less stressed by the whole process when, guess what, transferred again.)

I share this because I think we get so close to a situation we aren’t seeing it anymore. My situation was unique, but these things come up for lots of reasons.  Sometimes CFYs take place in more than one location or setting.  There might be a short “pause” right in the middle. It’s ok.  Show close and new ones open.  Break a leg!

 

Kim Lewis is a pediatric clinician in Greensboro, NC and blogs atActivityTailor.com.  Attendance at the ASHA convention this fall qualified her for an ACE award (7.0+ CEUs in a 36 month period).

 

Favorite Resources: Fiction and Non-Fiction Texts

reading

School based SLPs often look to align their intervention goals with academic content standards to increase student success in the classroom. Many of these goals align with English Language Arts standards. Goals for vocabulary, comprehension, and articulation can be targeted easily using fiction and non-fiction texts. Using reading passages is a perfect way to support reading skills and curriculum. It’s also an easy way to incorporate current events or seasonal information as well. I wanted to share four different resources I used for my caseload this year.

The

1. Newsela.com
Newsela is a site that takes regular news articles and changes the lexile level for a variety of readers. You can select the article, then pull it up on your screen. On the right side of the screen you can select a variety of lexile levels from 3rd grade up to the regular adult version.This is perfect for mixed groups.
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I love to use it for middle schoolers reading at lower lexile levels.
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We also use these in my articulation groups. This 7th grade student went through and highlighted each /r/ word.
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As he reads the page, I marked each sound with a +/-. Then we go back and work on the words he missed. This resource is free.
2. ReadWorks.org
ReadWorks is another fantastic free resource. I love their units for seasonal reading. Sign up for a free membership. You can search using the calendar at the bottom of the home page. There are resources for Kindergarten and up.
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They even have whole units for free for common books you already have on the shelf! Take time to search through and find units that are made to teach specific skills.
3. ReadingA-Z.com 
Many  districts pay for teachers and SLPs to have access to ReadingA-Z.com. I use it a lot and would recommend it to any SLP working with school aged students. I also have access to VocabularyA-Z. Let me show you some favorite resources within it.
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Leveled books used to be the meat of ReadingAZ. Lately they have added a whole lot more, but these are still my Go-To!
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Once you open a leveled book, you have many options. Print the book, share on a Smartboard, or print additional worksheets.
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I love the vocabulary connections most of all.  Since we have a subscription to VocabularyA-Z there are sets of  vocabulary lessons for EVERY BOOK!
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This is such a huge time saver for me. It takes the planning out of vocabulary practice!
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There are special lessons for ELL/ESL. These are great for language learners and for daily living skills units.  There are printable books that focus on feelings, vocabulary (vegetables, money, etc.), and places (neighborhood, school).
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The website also includes decodable books.  They are divided by sounds and even blends. These are  great for articulation practice.
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One section of ReadingAZ features comic books. Lots of my reluctant readers /language delayed  kids love comic books.
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The last feature I frequently use is the write your own story books. Most of the lower leveled books are available in the ‘write your own’ format. You can either print the regular book or print the wordless book. This is an easy way to progress monitor a variety of grammar and narrative skills. Of course it’s great for direct instruction, too! If you’re working on retell you can read the story with the words first and then use the ‘write your own’ version to support retell.
ReadingAZ is a paid subscription. Look into the free trial if you haven’t used it before.
4. N2Y.com
News-2-You is a symbol based weekly newspaper. It’s my ‘go-to’ for daily living skills classes and autism classrooms. I love the predictability and the symbol support. You can also download many levels of  instruction.
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This is the ‘regular version.
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The simplified version has less text.
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This is the ‘higher’ version (but still not the highest offered.)
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Did you know they have a spanish edition?
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I love the pre-made communication boards and the recipes included. I use the app frequently with my students.N2Y is a subscription based program. You would not be disappointed if you purchased it. I promise!
Those four resources are websites I use every week to support my instruction.  SLPs can use them as part of their instruction or as a way to provide homework, align their intervention goals with academic content standards in order to increase student success in the classroom.

Jenna Rayburn, MA, CCC-SLP. is a school based speech-language pathologist from Columbus, Ohio. She writes at her blog, Speech Room News. You can follow her on facebooktwitter, instragram and pinterest.

Three Reasons Why Kids Get Hooked on “Kids’ Meals”… and How to Change That

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Let me say this up front: I’m not condemning the American Kids’ Meal that is so common in fast food chains and family restaurants, but clearly I’m not keen on eating that type of food when there are other choices.   My own kids have certainly had their fair share of chicken nuggets, mac n’cheese and French fries, just to name a few of the comfort kid foods that predictably reappear on kids’ menus day after day.   This is not a blog about good vs. healthy nutrition, because most parents (including me) know that the traditional fast food fare is not healthy…and that’s exactly why parents want to change the statistics that 15 percent of preschoolers ask to go to McDonald’s  “at least once a day.”    The millions of dollars spent on advertising and toys to market kids meals certainly makes many of us frustrated when much less is spent on marketing a culture of wellness.  By hooked, I don’t mean addicted, although there is research that suggests that food addiction may be a serious component for a subset of the pediatric population Plus, the added sugars in processed foods have been found to be addictive in lab experiments.  But, for the purposes of this short article, let’s keep kids’ meals in this very small box:  Most kids love them.

Why am I writing about this for ASHA? As a pediatric SLP who focuses on feeding, one of the frequent comments I hear from parents is “As long we’ve got chicken nuggets,  then my kid will eat.”   Besides the obvious “just say no” solution, what parents truly are asking is,  “How do I expand my kid’s diet to include more than what’s on a kids’ menu?”  Whether we are considering our pediatric clients in feeding therapy or simply the garden-variety picky eater, that is an excellent question with not a very simple answer.

In feeding therapy, therapists take into account the child’s physiology (which includes the sensory system), the child’s gross motor, fine motor and oral motor skills  and also behaviors that affect feeding practices.  Therapists then create a treatment plan designed to help that specific child progress through the developmental process of eating.  While the nuances of learning to bite, chew and swallow a variety of foods are too complex to cover in a short blog post, here are just three of the reasons why kids get hooked on kids’ meals and some strategies to avoid being locked into the standard kids’ menu and begin to expand a child’s variety of preferred foods:

  1. Kids barely have to chew.  The common fast food chicken nugget is a chopped mixture of …well, if you want to know, click here.  Warning: it will ruin your appetite for chicken nuggets, so if your kids can read,  clicking might be the first solution.  However, in terms of oral motor skills, bites of chicken nuggets are a first food that even an almost toothless toddler can consume with relative ease.  Simply gum, squish and swallow.  Macaroni and cheese?  Oily French fries?  Ditto.  There’s  not a lot of chomping going on!
  • In feeding therapy, SLPs assess a child’s oral motor skills and may begin to address strengthening a child’s ability to use a rotary chew, manage the food easily and swallow safely.  Many of the families we work with eat fast food on a regular basis and we might start with those foods, but slowly over time, more variety is introduced.
  • For general picky eaters or those progressing in feeding therapy, the key is to offer small samplings of foods that DO require chewing, as long as a parent feels confident that their child is safe to do so.  Starting early with a variety of manageable solids, as described in this article for ASHA, is often the first step.   For older kids, the texture (and comfort) of “squish and swallow” foods can contribute to food jags.  Here are ten tips for preventing food jags, including how to build your child’s familiarity around something other than the drive-thru.
  1. At restaurant chains and drive-thrus, kids’ meals are readily available.  Helpful hostesses grab the crayons and the matching kids’ menus as soon as they spot a parent walking in with little children.  Kiddos quickly become conditioned to ordering mac n’ cheese or hot dogs.   Parents want a peaceful, enjoyable experience dining out, so naturally they like the kids’ menu option because it appeases everyone.  But it’s just that–an option.
  • In feeding therapy,  SLPs assess and often treat a child’s ability to be flexible with food at home and in the community.  A hierarchical approach is often utilized, where exposure to new foods occurs as a gradual process over time.
  • As a parent, if your child likes to stick to the same routine at a restaurant, begin with helping your child order from the “adult” menu, knowing that you can request adaptions to certain dishes if needed.  If the prices feel too steep, order a side for the kids, and give them samplings of everything on your plate.  Keep in mind that often the goal is simply experiencing the presence of new foods, so order a side dish that is a favorite food plus present a selection of new options from your plate if you are concerned your child will not eat anything.  Now you and your child have a new routine and the tasting piece occurs once the routine is established.   If you order a salad in the drive-thru, consider skipping the kids’ meal and creating a kid’s sampling of grilled chicken cubes, sunflower seeds, mandarin oranges or other options directly from your salad when you arrive at your destination.   Request an extra packet of dressing if your kids like to dip.
  1. Kids Meals are QUICK! Quick to buy, quick to eat and quick to raise blood sugars and thus, feel satisfied.  I get it – part of today’s hectic lifestyle is shuttling kids to and from activities and often, mealtimes happen while riding in the mini-van.  Fast food chains understand this too – that’s why it’s marketed as “fast food.”
  • In feeding therapy, this reliance on drive-thru food affects progress in therapy.  For example, it’s not uncommon for elementary school kids in feeding therapy to  have trouble eating in the chaotic school cafeteria and be “starving” when a parent picks them up from school.  The quickest, easiest solution: The drive-thru every day after school.
  • In today’s quick-fix society, our children are losing the valuable skill of waiting.  Feeling hungry and then making a snack or meal together to satisfy growling bellies is one way to practice the art of waiting.  Have some pre-cut veggies ready in the refrigerator to nibble on if waiting for the meal is too challenging.  Besides, it’s the perfect time to place them on the counter while your prepping the entrée because you’ve got hunger on your side!  Hint: Blanched veggies, patted dry and then chilled, hold more moisture and taste slightly sweeter to some kids.  The higher moisture content makes them easier to crunch, chew and swallow.  Most blanched fresh vegetables last for several days in the refrigerator.  Remember, keep presenting fresh foods so that the more common option is a healthy one, rather than the oh-so-well marketed processed foods found on many kids’ menus today.

SLPs and parents, what strategies do you use do limit traditional kid food and help kids become more adventurous eaters?  Please comment and share your tips!

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.

How to Make Social Skills Stick

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At Communication Works, a private practice in Oakland, California, we’re passionate about partnering with parents and caregivers in the treatment process. When it comes to social learning, many children struggle to carry over learned skills from the therapy setting or school to their home environment. Parents are in a perfect position to help practice and facilitate those skills and help make them stick! As professionals, we can give parents the awareness and knowledge as well as the tools and strategies to help them embrace teachable moments and guide their children. Even though parents are busy and sometimes overwhelmed, we can enlist their help without making stressful demands on their time. Parents are usually eager to help as long as we offer specific, easy activities that fit within the family’s natural routines.

Whenever possible, try to support the things parents are already doing and to piggyback onto those activities, such as reading bedtime stories, doing chores, or eating dinner. As an example, if a child is working on conversational turn taking in therapy, families can pass a “talking stick” (a spoon or spatula) at the dinner table to signify whose turn it is to talk and facilitate taking turns when describing each person’s day. If the child is working on “wh” or “wonder” questions (who, what, when, where, etc.) and you are using a visual prompt to facilitate this in therapy, make a copy of that visual and send it home for parents to use with their children during meal times or when having conversations in the car..

If you’ve created a roadmap or social story for an event at school, share a copy with parents. If the child has an event coming up (a graduation, birthday party, holiday, etc.), offer examples of details the parent can share with the child about what is expected during that event. For example, if a child is planning to attend a graduation for the first time, the parent can explain about caps, gowns, and diplomas (and why students toss the caps into the air) as well as how much sitting still and listening time the child can expect. If the child hasn’t yet attended a July 4th celebration, the parent can prepare the child for a big crowd and loud noises. They can discuss the type of behavior expected in a crowd and how to make the event more enjoyable and comfortable for the child, perhaps by bringing earplugs or asking for a break when feeling overwhelmed.

Parents also appreciate simple suggestions for teachable moments that may occur during part of the family routine or in the community. For example, if you’ve worked on increasing observational skills and understanding nonverbal language, talk to the parents about setting up a time for them, to take their child out for a snack and do some “people watching.” This can not only be an excellent opportunity to generalize a skill learned in the therapy setting, but can be a great bonding experience for parents and children. Teach the parents how to play “social detective” with their child and identify how the other people in the coffee shop are related, how they are feeling, and possibly what they are talking about. If you’re teaching sequencing during a therapy session, show parents how to practice this skill by sequencing out the steps for baking cupcakes or making a birthday card. If you’re focusing on self-regulation strategies like calm breathing, show the parent how to practice by placing a teddy bear or book on the child’s belly and watching it go up and down. As you develop new lessons, think about how parents could easily adapt them for home use. Be sure to provide handouts or information for them to share with other family members, and keep activities “no fuss” for busy parents.

Therapists working in schools will have limited time with parents, but can communicate through notes, logs, or a binder that goes back and forth from home to school. If you work in a private setting, consider bringing parents into group or individual sessions for a portion of the time, and have the child(ren) show what they have learned. Take a few minutes to brainstorm with the parent about ways to practice at home. Parents appreciate knowing the why’s as well as the how-to’s. Without overwhelming them with pages of information, provide the reasoning behind a particular activity as well as specifics about how to carry it out at home.

Social learning is a 24/7 process, and kids need support to be able to bring learned skills into the home and community. If professionals don’t collaborate with parents, the child misses countless opportunities for practicing essential social skills. When we do engage parents in the process, they can serve as both coaches and cheerleaders for their children. If we give parents the right tools, knowledge, and encouragement, they can feel confident and inspired to play an essential role in bridging the gap between therapy and real life.

Elizabeth Sautter, M.A. CCC-SLP is co-director and co-owner of Communication Works, a private practice in Oakland, California, offering speech, language, social, and occupational therapy. She is the co-author of the Whole Body Listening Larry books. Her most recent book is Make Social Learning Stick! How to Guide and Nurture Social Competence Through Everyday Routines and Activities. She can be reached at makesociallearningstick@gmail.com or follow her: website; Facebook; Pinterest; Twitter.