She Didn’t Eat a Thing at School Today!

school lunch
It’s that time of year again and little kids are climbing onto big yellow buses, tiny hands clutching lunch boxes that are packed full with a variety of choices, with their wishful parents praying that they will “just eat something!”  But at the end of the day, especially if the child is a picky eater, parents sigh as they open the lunch box latch and see that lunch has barely been touched.

For children in feeding therapy, treatment doesn’t stop when a child is eating well in the clinic setting.  Once a child has begun to eat even a limited variety of foods, I prefer to generalize new skills to the community environments as soon as possible, even as clinical treatment continues.  The school cafeteria in the one hot spot in the community that most kids visit five times a week.  It can be a chaotic setting, as described in one of my first blog posts for ASHA, which offered some tips on how to help kids eat in the Café-FEARia.  But what can a parent do at home to encourage kids to bring a healthy lunch, even when they only eat only five to 15 foods?  Here are six tips to encourage even the most hesitant eaters to not only eat preferred foods, but phase-in eating those new options showing up in their lunchboxes:

  1. Begin with Exposure: Kids may need to see a new food multiple times before they may even consider trying it.  That means they need to see it at school too.  If you’re thinking, “But he won’t eat it, so why pack it?” remember that the first step is helping your  hesitant eater get used to the presence of that food in his lunch box again and again.  The link to this ASHAsphere post will explain more, including why food doesn’t have to be eaten to serve a purpose in food education.
  2. Pack All the Choices under One Easy-Open Lid: For my school age clients, I use a compartment or bento-style lunchbox, such as EasyLunchboxes® or Yumbox®.  Even little fingers can open the lids quickly to reveal their entire lunch, so no time is wasted when most kids in the public school system have about 20 minutes to enter, eat and exit the cafeteria.
  3. Give them Ownership in the Lunch Packing Process. Kids like predictability and need to feel a part of the process, especially when it comes to food exploration.  For my clients in feeding therapy, once they have the oral motor and sensory skills to eat a few foods, those foods get packed along with other safe choices in their lunchbox.  A child who is receiving tube feedings may still take a lunchbox if he or she is able to eat even a few foods orally.  To make them the Lunchbox Leader, we create a poster board together that has a photo of the inside of their bento box, essentially creating a “packing map.”
    Packing Map #2
    Using colored markers, I help the child list the foods they can eat with arrows pointing to where the foods go in the box. For example, the Yumbox® has compartments with fun graphics representing dairy, grains, proteins, fruit and veggies. If the child is limited to purees, we write “applesauce” next to the fruit compartment on the poster. But we also write a few more future purees that he/she just needs to be exposed to, and those show up too. Parents and kids pack the lunchbox together the night before, and the kids choose from their short lists what goes in each compartment.  If they have exactly five preferred foods and there are five compartments, then we create a rule that they need to pick a new food for at least one of the compartments.
  4. Include a Favorite, But Just Enough:  Selective eaters always eat their favorite foods first, so be sure to include their preferred food, but not too much.  Provide just enough so that you won’t be worried that they are starving, but not so much that the other less-preferred choices don’t stand a chance.  That’s why the bento boxes work so beautifully, because the individualized compartments, along with the “map” to fill them, guide the packing process.
  5. No Comments Please!  When the lunchbox comes home, resist the urge to unpack it immediately. Give everyone a chance to breathe, especially those kids with sensory challenges who have difficulty with transitions from one environment to another. When you eventually open it, no comments about the contents please!  Nothing, not positive or negative. For many kids, it creates too much focus on whether they ate or not.  That’s addressed in feeding therapy. For now, just wash it out and set it on the counter for your child to pack again later that evening.
  6. Keep Up with Other Strategies: Parents who have kids in feeding therapy understand that it’s a steady, step by step process.  Keep  up with strategies listed in this ASHAsphere post or this one and/or those recommended by your child’s therapist.

Whether you have a child in feeding therapy or a “foodie” with a palate that rivals a Top Chef, I encourage you to have all the kids in your family create a packing map and be responsible for their own lunch packing, with the kids choosing from each category while the parent provides the healthy food options and keeps the kitchen stocked.  You might be surprised to see some of your young foodie’s choices shift to the more hesitant sibling’s packing map over time!  Remember, it starts with exposure and builds from there.

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.

What It Takes to Get SLPs and Teachers Working Hand-in-Hand

SLPscollaborate
Lately, I feel there is a division between classroom teachers and speech-language pathologists in the schools: an “us” and “them” mentality. Working parallel to one another hoping to reach the same goal is not what is best for our students. While it is true that the professions are separate, they do share a goal—student progress. I believe collaboration is the key to achieving that mutual goal.

Here are a few of the most common situations in which SLPs and teachers have opportunities to collaborate for the benefit of students, and some tips for those situations.

When a student begins to receive speech-language treatment.

The SLP can:

  • Offer a few minutes to sit down with teachers and walk them through the student’s IEP. Explain the terminology, how speech-language treatment goals will be addressed in the therapy room, and how the classroom teacher can help to target those same goals when the student is in his or her room.
  • Encourage teachers to speak candidly with speech students. The students are in the classroom more than the therapy room. They will progress further when they are supported and encouraged to use speech-language skills and techniques in all environments.

The teacher can:

  • Ask for an opportunity to view a therapy session in person or via a recording. Note hand signals and specific wording the therapist employs. Carefully listen for the correct speech sound productions. Witnessing some of the successful techniques will help when targeting these same needs in the classroom.
  • Support the SLP’s work in the classroom. Students will be motivated to use good speech and language skills when they are aware of shared expectations between the teacher and the SLP.

When the team is gathered for an IEP meeting.

The SLP can:

  • Provide teachers with a short list of items to think about prior to the meeting.
  • Encourage teachers to list areas of observed improvement or areas of need, and reference this list during the meeting.

The teacher can:

  • Speak out about concerns. Some classroom teachers seem to feel they do not know enough about speech-language treatment to comment on progress during IEP meetings. Teacher input contains vital information. Students do not always present speech-language issues in small-group settings.
  • Share in the ownership of the student’s speech/language success. The teacher is an integral part of the IEP team.

When students miss curriculum content because of pull-out services.

The SLP can:

  • Involve teachers as much as possible when creating a speech schedule. A little flexibility here can go a very long way. Be willing to adjust the schedule as needed. For example, push into the classroom for speech one week instead of pulling out, if appropriate.
  • Provide a full (HIPPA-compliant) schedule to teachers highlighting openings for make-up sessions. Keep this schedule updated as the year progresses. You can access a copy of what I use here.

The teacher can:

  • Ask the SLP if having access to lesson plans might be beneficial. Make the lesson plans available to the SLP in advance of the speech sessions.
  • Send classroom materials to be used in treatment sessions. Have a new unit in science? Send vocabulary words with your student to speech. Need help with an oral presentation for English? Send the rough draft to speech. Having trouble with basic concepts or following directions in math class? Let the SLP know. All of these things can be worked into a speech session.

Teachers and SLPs serve the needs of students in different ways, but we are all working on expanding children’s knowledge and skills. When we are cognizant of our colleagues’ needs and comfortable in our roles on the team, collaboration will be the start of something amazing: tremendous student progress.

 

Ashley G. Bonkofsky, MS, CCC-SLP, is a private-practice and school-based SLP in Utah, where her husband is stationed with the U.S. Air Force. She enjoys creating materials for teachers and SLPs and is the author of the blog Sweet Speech (sweetspeech.org). She is an affiliate of ASHA Special Interest Groups 1, Language Learning and Education; and 16, School-Based Issues.

Kid Confidential: Parent Education and Training, Part 2

dadandkid

Last month I discussed why parent education and training is important and offered tips to effectively train and educate parents.  Today I’ll be discussing how I realistically implement parent training and education.

There are two main ways in which I incorporate parent training and education: at the end of a therapy session and during real-time.

End-of-therapy session Education/Training

I typically use this type of parent education and training for older children (school-age and up) who are working on specific speech and language goals that require some traditional “drill and kill” therapy.  I will also use this type of training for young children who have been receiving speech therapy from myself for some time, long enough that parents are already familiar with implementing techniques at home.

Tips for effectively implementing end-of-session training and education:

  1.  Time management:  I ensure that I end the speech session with adequate time left (usually 10-15 minutes) to effectively educate and train parents (following the tips I shared in part one of this series).  If I feel rushed, due to numerous parent questions, parents requiring more assistance when demonstrating skills, etc. I take a mental note and end my therapy activities a bit earlier the next session so I can provide appropriate training and education.
  2. Review the session:  I then quickly review the session’s activities.  As parents are usually in the room/area where therapy is being provided they are already familiar with the activities I have provided and will quickly know and understand the goal of therapy that session.
  3. Technique(s)—Explain, Model, Take Turn, Feedback: Then, as in last month’s column, I will follow the same steps: explaining the rationale for the technique(s) used, model the technique(s), have parent(s) take their turn and provide feedback.
  4. Follow up:  I always begin the next session with follow up on how implementing the previous week’s techniques are going.

Real-Time Education/Training

This type of education and training is so effective for my very young clients (birth-5 years) as parents are such an integral part of language development at this stage, that it is necessary they are involved the entire therapy session.  This can sometimes propose a problem with there are numerous siblings present, however I tend to incorporate siblings into therapy in order to save time as well as train siblings how to use communication techniques as well.  My motto in this instance is “if you can’t beat ‘em, join ‘em!”.

Tips for effectively using Real-Time Education/Training:

  1. Techniques—Trial, Explain, Model:  The first thing I do with these young kiddos via play therapy is to trial a number of techniques.  Then I determine the most effective techniques and explain to the parent(s) the rationale for using them.  I then model the use of each technique, one by one, and demonstrate the positive effects of its use several times in a row (I strive for 5-10xs in a row to demonstrate the effectiveness to parents).
  2. Questions: I then ask the child’s parent(s) if they have any specific questions before they trial the technique. Usually they do once they realize they will be asked to perform the same technique.  If I need to provide specific step by step instructions, this is the time.
  3. Parent Model:  Then I have the parent’s take a turn using each technique a number of times (again I strive for several in a row-5 to 10xs-to build confidence).
  4. Feedback:  I provide feedback on each use of the technique.  I share the strengths that I see, I note the positive child responses, and of course address any weaknesses or modifications as needed.
  5. Make a list: For parents new to using therapy techniques, I will sometimes write a list of the techniques or the process of implementing a technique so they can refer to it between therapy sessions.  For my most basic language facilitation strategies/techniques I have created my own parent training/education handouts which you can find here.
  6. Follow up: I always begin the next session with follow up on how implementing the previous week’s techniques are going.

Yes, real-time education/training can eat up a lot of your therapy time.  However, it is time well spent as long as the training is effective and parents can demonstrate independence with the use of the chosen techniques.  In my experience, using real-time parent education/training actually brings up several questions and concerns parents either do not think of prior to our discussions or are reminded of during therapy.  It’s a wonderful way to make the connection between the parent’s ability to change their communication approach and their child’s improved language development.  The goal of course with any parent education/training is to leave the parent feeling empowered in their ability to help their child.  A small amount of training can go a long way!

Next month, I will be sharing how I use digital recording to support parent education and training.

Maria Del Duca, MS, 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.

Interviewing Rehab Companies: How to Find an Ethical Job

jobinterview
The most frequent questions I see on forums about finding a job or interviewing are:

  • What do you know about X company?
  • What is a good hourly rate for SLP in X location?
  • What kind of questions will they ask during an interview?

These are good questions, but, given the concerns many of us have about ethical practices in skilled nursing facilities, I believe we could focus on better questions. Why? Well let’s take a look at the common questions:

What do you know about X company?
In my experience talking to therapists about ethical dilemmas, I have not come across one company that is through and through unethical. There are some really great directors of rehab who will buffer corporate productivity pressures and advocate for clinical autonomy. They are dedicated to patient-centered care. Make sure you are able to interview the person that would be your immediate supervisor.

That being said, there are some companies that foster patient-centered care from the top. I am interviewing them and featuring them on my blog Gray Matter Therapy as I am connected with them. (If you have suggestions, contact me.)

What is a good hourly rate for SLPs in X location?
I believe SLPs provide an outstanding value to their rehab teams and should be compensated appropriately, but as an advocate for patient-centered care rather than profit-centered care I think about my wage in a different manner. In talking with therapists who work for ethical companies, I find we have something in common. We get paid a little less, but we never feel pressured to work off the clock and we are allotted time to complete important non-billable tasks.

Use ASHA’s salary data as a starting point, but consider the entire compensation and benefits package. I consider my quality of life and work-life balance to be a benefit. And I feel better about myself when I can focus my energy on patient care rather than number games.

What kind of questions will they ask during an interview?
This varies drastically. Most companies asked me logistical questions such as: When can you start? Can you work weekends if required? Can you be X% productive? I have been to a few interviews where I was asked how I would handle a particular client situation. I like those questions. It is evidence to me that my interviewer cares about the quality of the therapy patients receive, rather than just the quantity.

Turn the tables: You ask the questions
Take another look at the title of this post, “Interviewing Rehab Companies.” That’s not a typo. It’s not supposed to say “Interviewing With Rehab Companies” or “How to Answer Interview Questions Perfectly.” In my previous career, I interviewed job candidates. The candidates who brought thought-out questions (writing them down is OK) were my favorite. They did a little research beforehand and thought about what they could give to the team. They were thinking about continual growth. They made great employees.

Another reason to ask questions is to learn the answer to the question I get most often: “Is this an ethical company?” The only way to find out is to ask. Ask the interviewers questions, such as:

  • How would you handle a situation when a patient is on a particular “resource utilization group” (RUG) level; however, at the end of their assessment period they have a stomach bug and don’t want to participate in therapy?
  • How are discharge dates (from each discipline and the facility) determined?
  • Will you provide an example of how activities and restorative nursing coordinate with therapy in order to best serve patients?

Your interviewer might be a little surprised if you ask tough questions. Don’t worry about this. One of three things will happen:

  • It will be a good surprise. Your interviewer will see your concern, care and critical thinking and know you’ll be a good team member.
  • They won’t like it. You might be considered someone who questions authority. You won’t get hired. That’s OK. One of the big complaints I hear from therapists is the lack of clinical autonomy they have in jobs. You’ve just screened a potential employer and avoided that situation.
  • They won’t like it, but they are desperate to fill the position. They offer you the job. That’s OK. Now you get to practice saying “no.” If the job doesn’t meet your expectations, don’t take it.

By agreeing to work only in ethical workplaces, you are advancing the bottom-up approach to affecting change. Thank you, from all of us!

If you are looking more suggestions on finding an ethical job, read the “Interviewing Tips for Finding Ethical SNFs” post at Gray Matter Therapy.

Please join us at the ASHA Convention in November for the session, “Productivity Pressures in SNFs: Bottom Up and Top Down Advocacy.” Check the program planner for details.

 

Rachel Wynn, MS, CCC-SLP,  specializes in eldercare, and, as the owner of Gray Matter Therapy, provides education to therapists, healthcare professionals, and families regarding dementia and elder care. She is an affiliate of ASHA Special Interest Group 15 (Gerontology) and an advocate for ethical elder care and improving workplace environments, including clinical autonomy, for clinicians.

Ensuring a Warm Send-Off for Your Clients

handoff

Those of us working in hospital settings hear about discharges all day long. And we track everything about them: monthly rates, handovers, discharge summaries, patient’s perceptions of them.

In the outpatient world, discharges are just as important. When the patient leaves your office, do they know what they need to do next?

No matter the setting, we health care providers have a responsibility to ensure safety and efficiency when discharging a patient from care.

What happens when discharge isn’t done well? Patients experience adverse events due to delayed or absent communication, inaccuracies in information exchange, or ineffective planning or coordination of care between providers, as found recently in a study by Gijs Hesselink and his colleagues. In fact, at least 20 percent of patients report adverse events following discharge, and least half of these adverse events could have been prevented.

So what is your discharge or “thank you, goodbye” practice?  Here are five take-aways to consider:

  • Write it down!  Discharge instructions should be written down for patient understanding, not for compliance and insurance companies.  Don’t worry about saving the trees, give the patient the recommendations/plan of care in writing.  And, if you have it available, the patient should be able to review them at any time on your secure, web-based patient portal that you have available.
  • Share your instructions/plan of care with the patient’s medical home, therapists, and those that need to know!  Handoffs are one of the biggest problems in patient care that leads to adverse events.
  • Check for comprehension!  Having the patient repeat back what they heard is essential.  Using techniques like “Teach Back” or motivational interviewing are great ways to check for comprehension.
  • Make the discharge follow-up phone callMultiple studies show that if a simple phone call is made within 48 hours of the patient being seen or discharged from the hospital, it is a win-win for everyone involved. For outpatients, not only will you keep that person as a patient, but you will get more referrals due to having a happy customer. For hospitals, research shows reduced readmission rates and significant cost savings.
  • Own the discharge process.  When the patient leaves your practice/hospital, everyone who directly and indirectly touched that patient needs to own the process.  Does the patient know when to return?  Does the patient know who to contact if they have problems?  Will the patient tell a friend about the great experience they had?

Are you already doing these five simple things to keep patients safe?  If not, consider one of these for your next Plan-Do-Study-Act (PDSA).

For additional information about discharge planning, visit leancare.wordpress.com.

Tamala Selke Bradham, PhD, CCC-A, is associate director of quality, protocols, and risk management in the Department of Hearing and Speech Sciences at Vanderbilt University. She is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood. This post was adapted from her blog leanhcare.

 

Audiologists: Are Your e-Records Putting You At Risk for an Audit?

EHR imageMedicare is encouraging the implementation and use of electronic health records, but the way some practitioners fill out these records is under scrutiny. The U.S. Department of Health and Human Services Office of Inspector General has made cloning (inappropriate use of the copy-paste feature) and over-documentation areas of high priority for 2014.

OIG has recommended that the Centers for Medicare and Medicaid Services  evaluate EHRs for fraud vulnerabilities. If fraud is suspected, practices will be subject to fines and penalties. It is essential that audiologists use EHRs effectively and not take too many shortcuts. As we transition from paper charts to EHRs, here are a few things to know.

1.) Review all entries in your note. Avoid repeating past information.
According to CMS 1995 and 1997 documentation guidelines, “A review of systems and/or a past medical, family, and social history obtained during an earlier encounter does not need to be re-recorded if there is evidence that the physician [audiologist] reviewed and updated the previous information.” In other words, in your note, refer to a previous note that has the comprehensive history. For example, you could write, “See note dated 1/1/2014 for a comprehensive history of patient X,” and update the present concerns/reason for the visit.

2.) Make sure all your diagnoses listed are relevant for that patient’s visit.
Many EHR systems allow the copying of all diagnoses listed in the problem list, even those that have been resolved or aren’t the reason for that day’s patient visit. Be sure to only list the diagnoses that are relevant for the reason the patient is seeing you. For audiologists, the first diagnoses code should be your treating diagnosis followed by the relevant medical diagnoses. Sometimes the treating and the medical diagnoses are the same and there is only one listed.

3.) Make sure your note is individualized for that patient’s encounter.
Many EHR systems also allow you to clone a previous note. Use extreme caution with this feature. Auditors are looking for patterns in documentation. If all your notes look essentially the same across time and across the patients you serve, then they will cite you for not providing individualized care. Review every item in your note to make sure they are relevant for that patient’s visit that day.

4.) All notes should be signed by the licensed professional, correctly dated for when the services were rendered, and the time associated with the visit.
Lawyers, auditors and accreditation organizations look when the notes are completed. All notes should be started on the day services were rendered and finished within 24 hours. The note should have not only the signature of the provider but the time and date on the note. If your notes are not completed in a timely manner, then be prepared to answer, “What are you trying to hide?” or, “How many patients did you see that day? How could you remember what to write if you did your note a week later?” Any notes that are placed in the medical chart greater than 24 hours after the patient was seen is subject to concern.

5.) Avoid saving the note on the wrong date—a common mistake when a professional does not complete documentation on the day of service.
Two things to know:

  • If the note is not there on the day of service, then the patient was not seen.
  • If you dropped charges on a day of services that the patient did not have an appointment and was not seen, then this is considered fraudulent billing and you could be subject to not only losing your license to practice but also significant fines. If this happens, amend the note immediately to the correct day of service! To prevent this from happening, try to incorporate your documentation during the day or at “bedside” when you are with the patient.

6.) Develop a policy on the use of cloning, the copy-paste feature, and over-documentation in EHR technology. CMS has been charged with reviewing your policy if your site is selected for audit. OIG reported that only a third of practices audited had a policy. Be prepared!

Documentation should not be considered additional work but an extension to your patient care activities. Finally, remember our ultimate goal is to provide the best possible care that is timely and based on evidence-based practices. Having timely and accurate information in your note, and nothing else, will help provide the best possible care to your patients. The consequences are too serious to do anything less.

For additional information about documentation, visit leancare.wordpress.com.

Tamala Selke Bradham, PhD, CCC-A, is associate director of quality, protocols, and risk management in the Department of Hearing and Speech Sciences at Vanderbilt University. She is an affiliate of ASHA Special Interest Group 9, Hearing and Hearing Disorders in Childhood.

 

 

Bringing Speech-Language Services to Taiwan and Beyond

1lights
As far back as I can remember, I was always very curious about speech, language and communication. When I was a little girl I noticed some people could not talk fluently and I wondered why. I also noticed that some people spoke with a lisp and I wondered why.

In our neighborhood , there was a beautiful young girl who simply could not add five and five and I also wondered why. One of my cousins kept running around and around and he never stop running—and I also wondered why.

A friend’s older sister went to her first day of school, and she came home crying because she lost her hair ribbons, notebook, pencils and her school bag. The kids in her school were laughing at her. She never went back to school and she looked a little different. (She was a child with Down syndrome.) The father of my classmate never talked when we went to visit her home. During dinner he never uttered a sound and was hiding behind a newspaper—and I wondered why.

I have devoted the last 45 years of my life doing exactly what I love: speech-language pathology.

I began returning to Taiwan, the place where I grew up, beginning in 1980. I returned to Taiwan every summer for five years, teaching the various subjects of speech and language pathology. I helped to organize many symposia on human communication disorders in Taiwan. Over the last 30 years, many speech-language pathologists and audiologists have been trained there, and there are now five programs of speech language pathology and audiology in Taiwan.

In 1984, former ASHA President David Yoder took a group of us to Taiwan to attend and speak at the first Sino-American symposium on speech language pathology and audiology. In 1986, former ASHA presidents Kay Butler and David Yoder went to Taiwan and attended the third symposium on speech language pathology and audiology. 30 years later, in April of 2014, I again organized a symposium to advance the knowledge about our understanding of human communication. This was held in Taipei, and colleagues Barbara Hodson, Carol Westby, Kathee Christiansen and Kenneth Tom also went to Taiwan to support this symposium on child language development and disorders. The symposium was well attended, and we celebrated 30 years of work in the development of programs and services for Taiwan.

In addition, I also began to work with the Education Bureau of Guangzhou in China with a proposal to provide training in speech-language pathology for special-needs populations by organizing professionals from Taiwan, Hong Kong and the United States. Colleagues Geraldine Wallach and Vicki Reed also participated in this program. More than two thousand teachers and special education teachers attended these training programs.

Over the last 30 years, I have traveled to many parts of the world with a focus on the Chinese-speaking populations in China, Hong Kong, Taiwan, Thailand and Singapore. The need for quality services for individuals with communication challenges is urgent. I feel blessed to be part of the development of many programs and many seminars. I know that there is so much more work to do. Over the last 30 years I have had the privilege to serve on the Multicultural Issues Board of ASHA, the Board of IALP, the Taiwan Speech and Hearing Association and many other organizations.

Growing up in a multilingual environment, I was very much aware of the many languages people speak. Thanks to ASHA for giving me the opportunity to continue to serve in the area of multilingualism and multiculturalism. I hope that there will be many more opportunities for my colleagues from ASHA and around the world to continue to advocate for the human right to communication and to improve the quality of life so many through our relentless effort to excel. Global civic engagement is a lifelong learning process.

I wish the best of luck to all my colleagues and happy journeys.

 

Lilly (Li-Rong) Cheng is professor in the School of Speech, Language, and Hearing Sciences and director of the Chinese Studies Institute at San Diego State University. She is the past chair of ASHA’s Multicultural Issues Board.

Using Comic Strips in Speech Intervention

comic

For the past couple of years, I have used Carol Gray’s materials extensively during my work with adults with developmental disabilities. Creating comic strip conversations has been extremely helpful in facilitating conversation, resolving social issues between peers, taking turns in conversation and providing different social scenarios within various contexts.

Since I have worked in creating my own comic strip conversations with my clients for some time now, I decided to experiment using the comics section in the newspaper. My clients are motivated by the local newspaper for many reasons. They enjoy browsing through current events, looking at the pictures in the sports section and reading the comics.

The comics within a local paper are inexpensive (in my area it is just $1.00 for the local newspaper), easily accessible and age appropriate for older children, teenagers and adults. Therapy using comic strips has been surprisingly motivating and beneficial to my clients. I never realized how effective using the comics section could be!

I like to keep my favorite comics and laminate them for future use. I have also created a game around using the comics section. My clients take turns choosing from a pile of comic cards and then have a discussion about each particular card. When one client doesn’t understand a particular comic and why it’s funny, I have him ask his peer for assistance. As a group, we have had many extensive and interesting conversations related to the comics. Here are some speech and language goals that can be facilitated with the comics:

1. Expanding vocabulary: The comics are full of language, which make it an ideal time to discuss and define new vocabulary. It will be difficult for a client to understand a particular comic without understanding the actual definition of some of the words. For example in a recent Garfield comic, Garfield thinks “This is a perfect day to stay in bed and contemplate life’s truths.” Discuss what “life’s truths” means with your client. Defining the “contemplate” can help build vocabulary and build in conversation. Ask your client, “What do you contemplate about?”

2. Abstract Language/Humor: The comics are excellent in discussing abstract language and humor. In many comic strips, there are often multiple meanings of words. In a recent comic, the discussion between the characters was about “trail mix.” To one character trail mix was the snack, to the other character trail mix was a bunch of items that you picked up along a trail in the woods (e.g. dirt, sand, rocks). This comic began a conversation about the multiple meanings of words and how they had a miscommunication. Discuss the humor in the comic and why it may be funny to the reader. This can be a tricky exercise for many clients especially with autism, but it can be extremely useful as well. Helping a client recognize humor can help build friendships and improve conversational skills.

3. Taking Turns in Conversation: Between characters, there are natural turns in conversation. This can be a great model for conversation. As a carry-over activity continue the comic with an extra blank comic strips. This can help your clients create their own conversations.

4. Improving Literacy/Punctuation: Having your client read the comics can help improve literacy and reading comprehension. Point out different punctuation markers within the comic such as exclamation marks, periods, question marks, etc. Also, discuss the difference between the characters thinking a particular thought versus actually speaking it.

5. Interpreting Facial Expressions and Feelings/Emotions: In many comic strips the characters have extreme emotions. In other comics, the feeling and emotions of a character can be a little tricky due to the high levels of sarcasm. Read the specific comic strip together, discuss the language and then ask your client how the character is most likely feeling.

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.