Collaboration Corner: Must-Have Books for Building Language and Literacy

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I can’t believe it’s September! For those of us in public schools, that means re-organizing and replenishing our bag of tricks. Books of course, are an easy and engaging way to expand language.

If parents are looking for some ideas on stocking up their bookshelves (or yours) this list may help.

I also rely upon my librarian colleagues for other ideas. If I can find the board book version of anything, I usually opt for that version; board books are durable and allow you to do things like add pictures with a little bit of Velcro for matching, like this:

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For very young children, or children with language delays, I generally use a couple (or five) quick pointers when perusing the bookstore:

  • Engaging pictures that aren’t too visually complicated but have a clear character and setting.
    • Targets: Who, what, where, when questions, descriptive language.
  • Books with repetitive words and phrases.
    • Targets: Oral/expressive language and literacy skills through  predictable text patterns and repetitive lines.
  • Books that aren’t too long, maybe 10-12 pages.
    • Target: Maximize engagement for short attention spans.
  • Books that can allow the adult to target core language concepts, either through text or illustrations.
    • Target: Syntax, vocabulary.
  • Books that enable the adult to expand beyond the text.
    • Targets: Commenting, labeling how a character feels or what they are thinking.

There are many books from which to choose, but here are some good starters for your collection:

  • Good Night Gorilla: Peggy Rathmann
  • The Very Hungry Caterpillar: Eric Carle
  • Have You Seen My Cat?:  Eric Carle
  • Good Night Moon: Margaret Wise Brown
  • Blue Hat, Green Hat: Sandra Boynton
  • Where’s Spot?: Eric Hill
  • Go Away Big Green Monster: Ed Emberley
  • Big Red Barn: Margaret Wise Brown
  • Good Dog, Carl: Alexandra Day

Not every book on this list follows every guideline perfectly,  but all allow for a positive learning experience that supports child language and preliteracy development.

Have an inspired school year colleagues!

 

Kerry Davis EdD, 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-language pathologist and consultant for Step by Step Guyana, a school for children with autism in South America. The opinions expressed in this post are her own, and not those of her employer.

 

Finding the Right Fit: Social Pragmatics Groups in Middle School

1kidgroupThe recent explosion of social pragmatics curricula and materials for students with social challenges like autism spectrum disorder is both a blessing and a curse to those of us SLPs who work in private practice or outpatient settings. On the one hand, I am grateful for the selection of topics and target goals. On the other hand, how can we best weed through it all and offer a group curriculum that is the most functional and change-inspiring for this tricky but very deserving population of pre-adolescents?

There are many benefits of conducting groups outside the school environment in an outpatient setting, including more time spent on concepts, practice in a “safe” and diverse environment (participants may not have to see each other again), making new friends (participants may like to see each other again), parent/caregiver education and training, and parent/caregiver networking opportunities.

Along with the benefits, there are challenges that are unique for private practice and outpatient SLPs as we try to help these children and their families. These challenges can be grouped into two categories: logistical and content-related.

Logistics are tricky, but are definitely the easiest barriers to overcome. A typical group series for outpatient settings lasts 8 weeks. Group sessions range from 1-2 hours, depending on the number of participants. Costs to families for each session can be substantial, despite the Health Care Affordability Act, whether it be insurance co-pays or out-of-pocket. And there are also transportation costs and challenges for families who live in rural areas. These barriers mostly belong to the families of our group participants, but SLPs can help reduce their impact by strategies such as offering the group at “family-friendly” times (evenings or Saturdays), as well as choosing a central location for the meetings.

Once logistics are met, the real work begins. This brings me to the content of this post: content-related challenges. As a former instructional designer and journalist, my foremost consideration is “know my audience.” It may be a funny way to initially think about a therapy group, but it’s a basic tenant that I find critical.

Unlike the school setting where therapists can get to know the child in their “natural environment,” outpatient SLPs must somehow determine which kids can best go together in groups. Finding the right fit may sound like a logistical challenge, but is actually content-based.

From experience, placing the right kids together can make or break the success of the group, particularly at the tween/middle school age. Knowing this however, is only the beginning of the solution. My colleagues and I have whittled out three main areas of need for this age group:

  • Basic Social Rules—skills associated with being with another or group, such as eye contact, body language, expected behaviors, thinking about others.
  • Conversation Rules—skills associated with communication with another or group, such as establishing a topic, asking and answering questions, staying on or switching topics, social wondering.
  • Higher-level Social Skills—skills associated with making others comfortable and making/keeping friends, such as social problem-solving and perspective-taking.

Regardless of diagnosis or age, these three areas seem to be a good way to group kids so that behaviors can be managed equally and everyone learns. I have tried pragmatic assessments such as the CELF-5 Pragmatics subtest. I have given self-made parent/caregiver surveys of functional skills that coincide with the teaching concepts of the group. I have given their referring SLPs surveys of functional skills. Sometimes I have used all three methods. So far, I have not found a combination that can qualify everyone accurately. In every group, there always seems to be at least one kid whose skills are significantly more advanced or significantly more impaired than the rest.

The question is this: How can we most effectively figure out where each child fits? How do we qualify a child for the right group when the reality is that most of our candidates demonstrate a constellation of challenges across two or all of these areas?

That is the question I am posing to this ASHAsphere community. Thank you in advance for your responses as we problem-solve together.

Lisa Lucas, MA, CCC-SLP, is a speech-language pathologist in Cincinnati, Ohio. She practices as an outpatient SLP for Cincinnati Children’s Hospital and as a telepractice SLP for Presence Learning. She is an affiliate of ASHA Special Interest Group 18, Telepractice.

Audiologists, You Know the Science of Hearing but Do You Know the Art of Listening? 

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As audiologists, we learn about anatomy, physiology, psychoacoustics, pathologies, technologies, and interventions. We are experts in assessing hearing sensitivity, diagnosing hearing loss, and providing audiological (re)habilitation with technologies and counseling.

Here’s a question, though: Are we experts in listening? To be an effective listener, you need to focus on the meaning of what you hear and take in to gain understanding. Have you ever taking a listening test? Have you ever given your patient a listening test?

There are many types of listening styles, and there’s also depth of listening. In reviewing the literature, I identified 27 different styles of listening and six depths of listening. I believe we use different listening styles and depths of listening based on what is happening in the moment. So, I am a client, I may, during a hearing test, be a discriminative, deep listener. Or if I am the patient learning about the new hearing aids you just fitted for me, I may be a content, full listener.

These are the four most common types of listeners.

People-oriented (empathic) listeners, who:

  • Build relationships and interpersonal connections
  • Search for common areas of interest
  • Tune into the speaker’s emotions, body language and prosody of speech
  • Ask, “Tell me all about it – what happened?”

Action-oriented (evaluative) listeners, who:

  • Prefer information that is well organized, brief and error-free.
  • Will digress when a speaker goes off on a tangent.
  • Evaluate information heard and do not take things at face value.
  • Ask, “What am I supposed to do with all this information?”

Content-oriented listeners, who:

  • Enjoy listening to complex, detailed information.
  • Ask questions to test speakers (are they credible?).
  • Focus on issues and if information is credible.
  • Ask, “Is that so?”

Time-oriented listeners, who:

  • Love “to do” lists.
  • Are overbooked, so they want messages delivered quickly and briefly.
  • Enjoy the role of keeping people on task during the meetings (the time keeper).
  • Ask, “And, what’s your point?”

If you are a people-oriented listener and your patient is a time-oriented listener, then your patient may feel that you are intrusive and not respecting their time. If you are a content-oriented listener, then be careful not to “throw the baby out with the bathwater”: When taking a patient’s history, you don’t want to ignore what could be key information because you believe there’s a lack of sufficient evidence.

And those audiologists who are action-oriented listeners may need to watch that they aren’t perceived as inpatient and not caring. Knowing your listening style can help you better understand how to adapt to various listening situations. Knowing your patient’s listening style will help you with how to deliver quality care!

There are multiple tests available to assess your dominant listening style.  Here are a few that I have used:

In establishing relationships with your patients, the importance is not so much in what you say as how you listen. Knowing hearing thresholds is only part of the evaluation. Listening to what your patient shares with you will drive your overall outcomes in patient care.

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.

Fulltime Evaluator: An Effective New Role for the Speech-Language Pathologist  

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You’re an SLP at an elementary school who sees 42 students each week (most of them twice), attends individual education program meetings that are often scheduled back to back, reports for recess duty three times a week, and writes daily therapy notes and Medicaid reports, all while trying to squeeze in materials preparation for the next therapy unit. Now, how can you possibly find time for a two- to three-hour autism evaluation?

Sound familiar?

This was a typical week for the SLPs in the Albuquerque Public Schools until they created a new role group—”the SLP evaluator.”

APS is the 28th largest urban school district in the country, with over 90,000 students and approximately 10 percent of them receiving speech-language services in 143 different educational sites. The district employs 200 SLPs, but, due to a budget shortfall the past few years, faces challenges updating and replacing all the SLPs’ testing materials, such as the newly revised Clinical Evaluation of Language Fundamentals-5 or Oral and Written Language Scales-2. In addition, the New Mexico Public Education Department redesigned educational disabilities (such as specific language impairment, specific learning disability and autism spectrum disorder) in 2011 to standardize initial and reevaluation criteria. This required more training for those working in special education.

With these obstacles in mind, APS created a new SLP role—that of evaluator—to reduce caseloads, provide consistent eligibility criteria, and save some money in materials and training.

The evaluator group is made up of 22 SLPs (several of whom are bilingual) and is divided into one of three diagnostic centers across the city. We work side by side with educational diagnosticians, psychologists and others assessing students for all initial evaluations. We test students at the centers or at the schools, write reports and share the results with the diagnosticians, interpret test results with the parents, and attend the Educational Determination meetings at the school. We also collaborate with the SLP at the school who writes goals based on the findings of the assessments.

In addition, we conduct reevaluations when a change in eligibility is being considered, and for some schools we do all the reevaluations. Schools that have high caseloads, multiple district programs, or employ SLPs who are clinical fellows or who work part time may be designated a “Full Reevaluation” school. When a student is due for a reevaluation, we review past test results and current information and decide if the student needs another formal assessment. If one is needed, the SLP evaluator administers it. If a performance evaluation is appropriate, then the school-based SLP conducts it.

Last year, the evaluator role group performed over 1,900 evaluations; that’s 1,900 evaluations that the school- based SLPs did not have to do, which gave them the time they needed to focus on their therapy. And by using standard eligibility criteria, students in each school were correctly identified, which reduced the number of students with speech or language needs. The district was also able to save over $100,000 by not having to order the new CELF-5 for all 200 SLPs.  Now in its sixth year, the evaluator role group not only has been cost effective, but has proven to be an effective use of SLPs.

Rachel Hawkins, MA, CCC-SLP, is a speech language evaluator with the Albuquerque Public Schools.  She has worked in the public schools since 1993 in New Mexico and Colorado.  She can be reached at hawkins_r@aps.edu.  

As Adults With Intellectual Disabilities Live Longer, They Need More AAC Support

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Communication for adults with intellectual disabilities and complex communication disorders is a team effort. People with these disorders are living longer, higher quality, independent, and more productive lives thanks, in part, to alternative and augmentative communication technology.

Speech-language pathologists need to understand the settings in which these adults live. No longer do they live in large institutions but in more intimate and natural independent or small group homes.

A crisis may also be at hand as aging caregivers, whose adult children with intellectual disabilities and complex communication disorders live at home, can no longer care for them. According to The State of the States in Developmental Disabilities (2013), in 2011, 71.5 percent of people with these disabilities lived with family caregivers. Over the next few decades this group will flood the group home system as their parents age.

Communication is always important and critical for a person’s independence. Family caregivers may tend to speak for the adult with a disability and anticipate needs more than staff at a group home. Independent means of communication becomes that much more important once that adult moves into a new environment. This is where the SLP has a major responsibility in finding the most appropriate, functional evidence-based AAC intervention.

Many factors exist beyond the skills of the adult with intellectual disabilities and our AAC recommendations, however. Future AAC success is a team effort between the SLP, families and paid caregivers/group home staff. Some staff members are highly supportive; some are not. Informal assessment of the environment in which the affected adult lives is crucial. It can be a delicate process to help the staff member see the purpose of AAC. If the group home staff does not “buy in” to the AAC device recommendation and plan, there is a high risk of abandonment.

Group homes, although typically a better solution than nursing homes for those without complex medical conditions, have their own challenges. Moving to a group home is a major life change for people who have typically lived their whole life with their families and who often have a significant difficulty adjusting to change. In the state of Pennsylvania, where I practice, I have been encouraged to see that the group home system has placed a high level of priority on communication over the past few years. As a result, I have been seeing more adults with intellectual disabilities and complex communication disorders in my practice.

Another challenge in group homes is staff turnover. The State of the States in Developmental Disabilities (2013), reports that hourly wages for workers in community intellectual/developmental programs averaged only $10.14 per hour. A report published by the Paraprofessional Healthcare Institute in 2011 noted that almost half of direct care workers (including group home staff) live below the federal poverty level. Meanwhile, their work can be rewarding but is often psychologically and physically challenging, so it is clear why staff turnover is high. And, unfortunately, frequent staff turnover is confusing, frightening and can lead to a lower quality of life for these adults.

I have seen many adults with intellectual disabilities and complex communication disorders go years if not decades without AAC intervention. It is especially painful when, as children, they used AAC in school and transition into the adult world with no reliable means of expression because either the device was returned to school or the device had become obsolete. There is also a high level of abandonment of AAC devices once the school support is gone. In nursing homes, there can be speech therapy support available. In group homes residents must be seen for therapy as outpatients. Once the resident is back home, it becomes the responsibility of the group home staff to ensure the AAC device use is supported and maintained.

As part of the intervention plan, we must assist the group home staff to add communication goals to their mandated plan of care. We must also train the staff members in the care, maintenance and programming of the recommended device. Adults with ID are living longer, and, as technology has become an accepted part of all of our lives life, AAC interventions will continue to be a necessity. We should remember that an AAC device recommendation is not a once and done process. An adult with ID may need numerous device upgrades throughout their lives. Determining the best AAC device is not the end of the process, it is only the beginning.

Carrie Kane, a speech language pathologist at the Good Shepherd Rehabilitation Network in Allentown, Pennsylvania,  specializes in AAC assessment and treatment for adults with communication disabilities. She developed and is the coordinator of the adult outpatient AAC program in Good Shepherd’s Assistive Technology Center.