Kid Confidential: Parent Education and Training, Part 3

1videokid

I began this series noting the positive effects of parent education and training and sharing tips for how to provide it.  Then, in part 2, I discussed how I implement parent education/training in my therapy sessions.  Here, in part 3, I discuss how I use digital recording to support parent training and education.

Although I own a tablet for therapy, my most valued device on that tablet is the video camera. Most of the time you will not find me with some speech or language app open on my tablet. Rather, you’ll see me with toys all over the floor and my tablet set up with the camera ready to record.

When working closely with parents during therapy, I find that digital recordings provide helpful feedback on a parent’s use of therapy techniques.  It works especially well during real-time education and training (you can read about this in part 2 of this series), as so much of language development depends on the ways caregivers communicate with young children.

The following are some personal rules I like to follow when using digital recordings in therapy:

  1.  Be careful of confidentiality when recording:  This seems so basic but I always get parents’ permission prior to recording their child.  Also I am very cautious when sharing digital recordings of clients as I always worry about secure emails, websites and such.  I tend to use thumb drives, when I can, to share the digital recordings with parents in person just to ensure security. If I cannot provide the parents with a thumb drive on the spot week to week (the one big problem I have found using my tablet camera) I will be sure to still review the digital recording on the spot during the session for educational purposes.
  2. Record only portions of the session:  I understand parents do not have a lot of time to review recordings, so I try to only record simple models of techniques by myself, followed by parents’ trials with my positive feedback and suggestions for modifications or changes. This way, if parents question how to implement the techniques, they have a quick refresher ready for them. My rule of thumb is to try and keep these recordings to five minutes or so. This way parents can quickly access the information they need.
  3. A few things I like to record when I can:
    1. Initially, I always try to record basic parent interactions and hopefully PLAY with their child (this is not about telling the parent how “wrong” they are in the way they interact with their child, but rather it’s about increasing parental awareness of the types of interactions they tend to have with their child.  For example, are they always asking their child questions? Are they talking “at” rather than “to” their child?  This video review is non-judgmental but educational in nature.
    2. Sibling interactions can also be very helpful as well if the sibling is older and can understand and learn to use various techniques to help the younger child.
    3. Sometimes taping sibling interactions is a great way to teach parents how to play with their language delayed child.
    4. I try to record “before” and “after” the use of strategies. Parents love to see how they themselves have changed over time and I love to show them!
  4. Record great parent and sibling interactions:  The last things I like to try to record are moments of wonderful interactions between the child and his parent and/or siblings. I love sharing those moments and reviewing all the great techniques used by the family members. This is not only a great review, but continues to encourage and empower parents to keep up the good work. I also like to keep previous recordings so that parents can see their personal progress over time.  It is amazing to watch their faces when they see how far they have come!

In my experience, digital recordings can really enhance parent education and training, can be a great reminder and resource for parents, and can encourage and empower parents to continue to use good therapy strategies and techniques at home to continue fostering language development in their child.

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.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of ASHA Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced in New Jersey, Maryland, Kansas and now Arizona.  Maria has a passion for early childhood, autism spectrum disorder, rare syndromes, and childhood apraxia of speech.  For more information, visit her blog or find her on Facebook.

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.

Kid Confidential: Parent Education and Training, Part 1

parents

 

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.

Kid Confidential: The Latest on Treatment of Ear Infections

ear infection

For those of us speech-language pathologists who serve the birth-5 year old population (or have young children of our own), it is always important for us to know the most recent health and safety regulations that can affect our clients/students. Here are the newest regulations regarding the medical treatment of ear infections.

As otitis media affects three out of four children by the age of three, and there is a correlation between chornic otits media and communication delay, it is likely that we as SLPs will treat students with acute or chronic otitis media.  As a result we must understand the American Academy of Pediatrics (AAP) guidelines regarding the medical treatment of this condition.

Although, these regulations were initially released in 2004, it appears there is still much confusion among the medical community and, as a result, a second publication of the same AAP medical regulations for treating otitis media was released in 2013.

The regulations were written in response to antibiotic overuse and resistance in children.  Traditionally children are treated with antibiotics as the first line of defense for acute otitis media.  As there are a number of causes for ear pain, it is crucial that pediatricians firstly make an accurate diagnosis of otitis media prior to administration of antibiotics.  Doctors are urged to diagnose otitis media only when a moderate to severe bulging of the tympanic membrane (i.e. ear drum) is present.  Mild bulging and recent ear pain (i.e. meaning within 48 hours) exhibited along with other signs of ear infection (e.g. fever) also may be diagnosed appropriately.  Therefore, if the pediatrician is unsure of the diagnosis of otitis media he/she is discouraged t to prescribe antiobiotics.

Although pain is present, antibiotics are not necessarily to be considered the first course of action. In fact, in response to ear pain and/or low grade fevers, pain relievers are to be recommended initially as “about 70 percent of kids get better on their own within two or three days, and giving antibiotics when they aren’t necessary can lead to the development of superbugs over time” reports Dr. Richard M. Rosenfield, professor and chairman of otolaryngology at SUNY Downstate Medical Center, Brooklyn.

Antibiotics are only to be prescribed when the child is exhibiting several signs or symptoms of otitis media (e.g. pain, swelling for at least 48 hours, fever above 102.2 degrees Fahrenheit, etc.).  Immediate prescription of antibiotics should be recommended in the event a child’s tympanic membrane ruptures.

Although it is important to understand the medical treatment of otitis media, perhaps it is more important for us to understand the simple preventive measures a parent can take to help avoid the development of ear infections in the first place.  In addition to this medical treatment plan, the guidelines also stress avoidance of tobacco exposure, receiving the influenza vaccination, and breast feeding exclusively for the first 6 months (if possible) as additional ways to prevent infant ear infections.

Medial guidelines for “silent ear infections” (i.e. middle ear fluid without presence of other symptoms typically following acute otitis media or colds) consist of “watchful waiting.”  If a child is diagnosed with “silent ear infections” also known as otitis media with effusion the pediatrician should initially provide no medical treatment.  A follow up reexamination should take place three to six months later.  If fluid persists for more than three months, the pediatrician should recommend a speech/language and hearing assessment.  If middle ear fluid persists more than four months and signs of hearing loss are evident, a pediatrician may recommend placement of PE tubes or refer their patient to an ENT for further assessment.

I very much appreciate the AAP for adding in the guideline of further assessment in the areas of speech/language and hearing if fluid persists longer than three months.  This demonstrates the AAP’s understanding of the important of communication development and the need for a quick resolution to such delays rather than the typical “wait and see” attitude that parents often report to encounter particularly in instances of “late talkers.”  Now we, as SLPs, have guidance and support from the AAP for our clients/students with long-term persistent middle ear fluid.

Please refer to the resources below for further information.

Resources:

Jaslow, R. (2013, February 25). Antibiotics for ear infections: Pediatrician release new guidelinesCBS News.

New guidelines for treating ear infections. (2004). The Harvard Medical School Family Health Guide.

 

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.

Kid Confidential: Data Collection Using Thematic Therapy

data collection

In December’s Kid Confidential column, I discussed the advantage to using thematic lessons in speech therapy.  Last month, I explained how I write goals when using thematic lessons in therapy and the need for additional sources of data throughout the academic environment.  Today, I’m going to discuss how I record data during thematic therapy sessions as well as how I have gotten other school staff members on board to collect data.  Please note that the below information is based solely on my clinical experience.

Data Collection of SLP in Thematic Therapy Sessions

There are three main ways I can think of to collect data using thematic therapy.  The first of which is to do so throughout the entire therapy session.  The second way is to collect data for certain activities during each session.  The third option is to use periodic data collection among several therapy sessions.

Target goals throughout the entire session

Once you know exactly what skills you are targeting with each student you can determine how you will do this in thematic lessons.  One way to do this is to simply target at least one skill for each student in every thematic therapy activity.  I tend to use this technique most often when working with small groups of students who demonstrate emerging skills.  I will choose language rich thematic activities and incorporate ways to target at least one goal/objective for each student during each activity.  For example, if I have a student who is struggling with pronouns, I will be sure to ask questions during every activity that would require that student to label or expressively use pronouns in order to answer my questions.  This way I am targeting that one specific goal for the entire session for that student. This technique allows me to continue to take data throughout the session for each student and performance in this way tends to demonstrate generalization of skills to other activities as well.

Multiple Short Activities Targeting Different Goals

Now there are times when it is necessary to “drill and kill” a skill for students who have yet to demonstrate emergence of skills and who seem to require multiple trials in one session to facilitate learning.  When this is needed, I will choose to have my students participate in several different short thematic activities where each student is given time to repeatedly target an individual skill within an activity I created just for them centered on the theme and interest of their choosing.  In that manner, all students participate in each activity however data may not necessarily be collected for each student during every activity.  Time for each activity should be flexible depending on your goals, the time it takes to complete the activity and students’ interest.

For example, let’s use the recent holiday season as a possible theme for therapy.  In a small group of 5 students, I may have one that is working on understanding and using prepositions, another student working on increasing overall vocabulary skills, two students working on auditory comprehension skills and recalling details of a story and one student working on articulation skills.  What can I do?  Well I can have a quick craft in which my student working on articulation skills can read directions with different prepositional phrases.  This activity will allow me to collect data on the student who requires assistance in learning prepositions, the students who are working on improving auditory comprehension skills, as well as allowing me to tackle articulation skills of my fourth student.  The next activity could be a thematic book in which my students take turns reading the pages (or if I want to save some time, I may read the book).  Of course this allows me to ask WH questions about the book, possibly ask for synonyms, antonyms or even definitions of words within the book and finally have the students attempt to use a graphic organizer to “map the story” thus requiring them to recall details in sequential order.  Now I have targeted at least one goal for each of my students.  As the book activity would most likely take longer than the craft, this is an instance where my second thematic activity may have a longer duration as compared to my first activity.  By the end of the session, I should have data on at least one goal/objective for each student from at least one activity.

Periodic Data Collection Across Therapy Sessions

The third main option, I believe we have as SLPs is to periodically record data.  This may mean, as an SLP, data is not collected every session but periodically among a number of sessions.  Some colleagues prefer this method of data collection for a number of reasons explained to me previously such as periodic data collection allows for a therapist to focus on the therapy itself without the additional distraction of data collection.  Periodic data can aid in time-management skills particularly for those with extremely high caseloads.  Some therapists feel this is a better indicator of a student’s skills over time without needing to filter out the variability of performance on a daily basis.  Additionally, some therapists believe using the “pre- and post-teach/testing” method of collecting data reflects the academic environment more accurately than daily data.  With all that said, I do want to share a word of caution to those thinking about using periodic data.  The most important thing to remember is to be consistent in taking that data.  Know ahead of time when you are planning on data collection and ensure that you have enough data collection days within each marking period to target goals effectively.  Meaning, if you write your goals for a skill to be performed with a certain amount of accuracy across three data collections days, then you must at least have three data collection days to determine if the skills has been achieved.  Also be diligent.  If a student is absent during those days, be sure to take data regarding that student’s skills the next therapy session.  Periodic data can be helpful in looking at a child’s performance over time if collected consistently.

Data From Other Sources

There will be times when we write goals and target skills in therapy but would like to determine generalization to the academic environment as previously mentioned in last month’s column.  In an instance such as this, data may be collected in a different way and from a different source. Periodic data can be just as effective as daily data collection, as mentioned above, if done with consistency.

With the implementation of RTI, I have found teachers are much more willing and confident in their own ability to take data within the classroom setting, if I take time to train them on how to collect data and express realistic expectations that data will only be recorded at specific times during the day/week or during specific assignments.  This way, I have gotten reliable data collection from teachers regarding a child’s articulation skills for specific sounds during small reading groups, qualitative data on social skills in cooperative learning situations among classroom peers, data on a student’s ability to expressively answer WH’s in the classroom, information on a child’s ability to recall details of a story, and data on the accuracy of a student’s ability to follow classroom directions.

How can all of this work when the goal is to use thematic lessons in therapy?  Well, here is an example for you.  Remember my student working on vocabulary skills?  Well it would behoove me to target academic vocabulary in the school setting as a means to hopefully translate to improved classroom function.  Therefore, I may be given a list of vocabulary words from my students’ teachers and incorporate those words into stories I create using the theme on which we are currently focusing.  I may pre-teach the vocabulary, use context clues to have my students’ define the same vocabulary in my created story, then I may have my students participate in a vocabulary definitions match-up page post story.  This may occur over the span of several sessions.  Once this is completed and I have my data as to how my students performed with this particular list of vocabulary words, I can then compare their performance in my speech room to that of their classroom performance to determine if carryover has occurred.  This way, I am actually using teacher data (e.g. score on the students’ vocabulary sections of their language arts assignments each week) to determine generalization all while still using themes in therapy.

How do I get teachers on board and how can I ensure data collection is occurring?  Here are few tips:

  1. Keep things a simple as possible by providing all materials needed for tracking data.
  2. Let the staff member choose when to take data:  I ask the teacher/staff member what time of day or which classroom activity would be easiest for them to track a student’s performance.  Teachers are more likely to take data during activities or times of day which are easiest for them.
  3. Training goes a long way: Once a specific classroom activity or time of day is identified by the teacher, I will be sure to go to the classroom during that time and train the teacher on how to take data for the specific skill being targeted.  I keep it as simple as possible and very rarely do I have to do this more than once.
  4. Accountability:  I randomly check the data sheets during class time and ask the teacher every few days how my students are doing in the classroom.
  5. Show gratitude:  When teachers and staff members understand how genuinely grateful I am to them for taking time out of their day to help one of our students by recording data, they are much more willing and likely to continue to take data.

What does the data collection form look like for the school staff?  Here’s an example of what I have used in the school setting.

data collection

I usually provide a folder for the data collection sheets for students so the staff member can pull out the data collection sheet, re-read the goal being targeted, and simply take data on the student during the agreed upon time/activity.

For more functional goals that require data collection in real-time during the classroom, such as using appropriate pragmatic skills or using age-appropriate receptive and expressive skills for functional conversational, I will provide teachers with the data collection sheets as well as a page of blank labels.  The teacher can simply take data on the labels in real-time and stick them onto the data collection sheet later.  This way, he/she does not have to stop the lesson to take data.

The possible ways to record data by ourselves as SLPs or collect data from other school professionals is numerous if we are creative and work collaboratively with others.  I’m sure there are a number of school speech-language pathologists using the above techniques as well as a number of others not mentioned today.  As long as we remain flexible, open-minded and always focus on improving functional skills of our students, I believe the ways in which we can do this are infinite.

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