CSD Students Use Their Skills in Ethiopia This Month

   

The CSD program at Teachers College Columbia University is in Ethiopia this month visiting schools for students with autism and a center for adults with intellectual disabilities. The TC Team—nine master’s students and three ASHA-certified SLPs: Lisa Edmonds, Jayne Miranda and I—used our experiences in Ghana and Bolivia to prepare for the trip.

At a vocational center for adults with intellectual disabilities the TC Team created “Seller’s Market Cards,” so the adults can independently sell their products. These low-tech Augmentative and Alternative Communication cards, laminated with packing tape, introduce the seller and list products for sale with their prices. We worked with the sellers to create the cards and then immediately tried them out at an impromptu market at the center!

At the Nehemiah Autism School, 20 teachers and our team spent the day collaborating to identify ways to bring more communication opportunities into an otherwise excellent school. We made 70 flash cards for weather, a large calendar, practiced social stories, and talked about ways to introduce literacy and math.

Right now, we’re presenting a five-day cleft palate speech institute at Yekatit 12 Hospital. Smile Train and Transforming Faces supported 14 cleft palate team professionals who attended from East and West Africa.

Please follow our adventures on the blog.  We love to see comments and are just halfway through our trip.

 

Catherine J. Crowley, CCC-SLP, JD, PhD, Distinguished Senior Lecturer in speech-language pathology at Teachers College Columbia University, founded and directs the bilingual/multicultural program focus, the Bilingual Extension Institute, and the Bolivia and Ghana programs. An experienced attorney, Crowley is working with NYCDOE on a multi-year project to improve the accuracy of disability evaluations. 

Our Profession’s Biggest Open Secret

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What’s the biggest open secret in our field? Each of us might have slightly different answers. Here’s mine: the reason so many students are blocked from receiving needed services is because their home states have not updated their Medicaid telepractice policies.

Children who qualify for Medicaid coverage, by definition, are from low-income families. My experience is that these children are disproportionately affected by the shortage of SLPs and could therefore benefit a great deal from access to treatments delivered via telepractice.

In addition, many schools, when faced with tight budgets, simply do not have the money to hire additional SLPs–telepractice or not–without Medicaid funds.

This places an unfair burden on the rural and urban schools that need telepractice the most. They struggle more than their affluent peers to find qualified SLPs. One reason is that those wealthier districts can pay substantially more for treatment delivered via telepractice if state Medicaid policies haven’t been updated to reimburse for online services.

This isn’t the most surprising part of the secret, however. That honor goes to how easily states can make the change. Consider this:

  • The federal government, which partners with each state on its Medicaid plan, has already approved billing for telepractice. That’s right, the Centers for Medicare & Medicaid Services already has an approved billing treatment for treatment delivered via telepractice.
  • All reimbursements for telepractice are paid for entirely by the federal government. This means that states don’t pay for additional reimbursements out of pocket. Let me repeat that one more time: allowing reimbursement for telepractice increases access to services without requiring additional funds from your state’s Medicaid program.
  • For all states that PresenceLearning has researched—aside from Indiana—allowing reimbursement for telepractice is as simple as publishing a clarifying policy memo. The memo should say that online services can be billed with the same codes as traditional sessions as long as a “GT” telepractice modifier is included for tracking purposes.

It is important to keep in mind that telepractice is just a different delivery method for services already approved by CMS and reimbursed by Medicaid in schools.  SLPs provide online services using the same approaches and materials they would use if they were physically at the school site. 

What can you do to help students get the treatment they need by motivating your state to write that memo?

  • Speak to stakeholders to build a consensus. Stakeholders include: ASHA, state licensing boards, special education directors, state departments of special education and directors of child health programs for your schools.
  • Consult state-level billing agents on the best way to document services to ensure program integrity.
  • Network with colleagues using telepractice to find out which states currently approve Medicaid funding for telepractice.

There are eight states that reimburse for telepractice services. They include: Colorado, Maine, Minnesota, North Dakota, New Mexico, Ohio, Oregon and Virginia. In addition, reimbursement for telepractice services are pending in California and Michigan.[Note from ASHA editors: This list was published in July 2013, so it may have changed. Our December issue focused on telepractice and has a slightly different list of states offering reimbursement.] 

Contact state speech and hearing associations or state-level Medicaid directors to find out how you can assist in getting Medicaid reimbursement for telepractice services. Let’s work together to ensure students who need our services receive them and schools receive the appropriate funding from Medicaid.

Melissa Jakubowitz M.A. CCC-SLP, vice president of clinical services at PresenceLearning, is an SLP with more than 20 years of clinical and managerial experience, Melissa is a Board Recognized Specialist in Child Language. She is a past-president of the California Speech-Language-Hearing Association and is also active in ASHA, serving as a Legislative Counselor for 12 years. Melissa began her career working in the public schools and can be reached at melissa@presencelearning.com

Be an Advocate for Your Clients

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This summer I had an interesting experience with a major insurance provider. The company initially approved treatment for a 3-year-old client, who I evaluated and diagnosed with severe apraxia of speech. This little guy had maybe five words in his lexicon, all unintelligible to an unfamiliar listener. He could not even consistently attempt to imitate monosyllabic words. His receptive language skills were at least at age level with cognition the same.

After several months of treating him with a motor-planning and sound-sequencing approach, his parents received notification from the insurance company that his treatment was denied because “it was not medically necessary” and his apraxia was deemed “developmental.” The communications stated that my client would “outgrow” his issue in time.

I have been in private practice for almost 28 years and ardently disagree with the insurance company’s reasoning. I consulted with Janet McCarty, at ASHA headquarters, and she provided me with excellent professional advice plus solid evidence to fight for my client. I organized my information then consulted with the family to get their green light to proceed. I went all in to fight this decision with the big insurance company’s medical director.

It became a step by step process to help this medical director understand that apraxia is NOT a developmental disorder, but rather a neurologically based disorder that results in disruptions to a child’s ability to sequence the necessary motor movements to produce speech sounds. My favorite part of this story is when I asked the director how much time I had to discuss my client with him during our peer-to-peer scheduled review, he informed me that “he did not want to be lectured about apraxia because he had Googled it and saw the word ‘developmental’ tossed sporadically around the literature and that was all he needed to see to be convinced that apraxia was not a medical condition with neurological basis.”

I quickly lifted my jaw off my desk, hit my reset button and proceeded to help this “medical expert” understand more about apraxia from this expert in the field of speech and language. While our exchange made some positive impact, he still felt the need to take this case to the next level by calling in a third party pediatric neurologist. I knew that this was going to be a medical professional in my corner. The neurologist and I spoke about my client and I was able to answer specific questions about his treatment and progress. Sure enough, her recommendation was absolutely in favor of this severe speech disorder being neurologically based and treatment medically necessary. She agreed that my client would not outgrow it in time or improve through weekly sessions in small groups.

My point for sharing this story is to say that while it is often frustrating to deal with insurance companies, you have to fight for your clients. When you meet, evaluate, work with a child and their family and you know a child needs treatment, you must advocate and spend the time to fight for this child, no matter how BIG these insurance companies are or how much they try to shut you down.

I need to correct my earlier statement when I referred to my “favorite” part of the story…in fact, my favorite part of this story is that my client, who is now 3.6 years old, was approved for intensive therapy to treat his motor planning disorder. He is making remarkable progress and I am quite confident he can tell Santa what he wants in a complete sentence. Maybe with Mom’s help interpreting, but still excited and able to convey his message!

 

Lorraine Salter, MS, CCC-SLP, has been in private practice in Reading MA since 1986. She studied and earned both degrees from Emerson College in Boston, after deciding that a career in performing arts was not going to pay the bills.  She enjoys the ability to create a strong team for the children she serves through interaction with her clients’ families. You may contact her at lorraine@northshorespeechandlanguageservices.com.

June is Aphasia Awareness Month—Join the Celebration!

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June is National Aphasia Awareness Month and this year’s host group is the Big Sky Aphasia Program in Missoula, Mont.. This year’s theme is “ It’s Never Too Late To Communicate” and the National Aphasia Association (NAA) is encouraging professionals, consumers, community support groups and aphasia centers nationwide to raise public awareness about aphasia in June and has a poster and resource packet available.

Thanks to Senator Tim Johnson (D-S.D.) and Senator Mark Kirk (R-Ill.) for, once again, co-sponsoring the resolution to proclaim June as National Aphasia Awareness Month! You can find the resolution here.

This year we launched a month-long social media contest to help the public understand aphasia and how to communicate with people who have aphasia. We are proud to introduce our new social media intern, Laura Cobb, whose first assignment is serving as spokesperson for the Aphasia Awareness Month contest. Laura is 27 years old and lives in St, Louis, Mo.. In September 2008 she was a student at Washington University majoring in psychology and hoping to work in the field of autism when her car was struck by a drunk driver as she returned home from studying. Laura suffered a stroke resulting in aphasia along with other injuries including a partial hearing loss for which she wears bilateral hearing aids.With intensive speech services, Laura has been able to regain a good portion of her ability to communicate. She continues to receive speech and language treatment and continues to improve. We first met Laura when she created her own video for You Tube on “How to Talk to Someone with Aphasia.” Her video has received more than 200,000 views to date and she was interviewed for an article in the Huffington Post.

“I’m excited to work with the NAA now,” says Laura in the first of her weekly video clips discussing the NAA’s contest, which encourages people to post about aphasia on Facebook, Twitter, Instagram and YouTube using the hashtag #AphasiaAwarenessMonth.  Each week, participants are tasked with a different challenge. For example, in week one, people were asked to answer the question “What is aphasia?” In week two, participants shared their tips for communicating with people with aphasia and in week three they posted pictures of themselves with the June poster. Click here to learn about this week’s challenge.

“It’s never too late to communicate. So, we want your tips. My favorite tip: speak s-l-o-w-l-y,” says Laura. At the end of each week, a winner will be selected randomly and awarded a series of aphasia-related prizes; then a new weekly challenge will be announced. At the end of the five-week contest, the top prize, an iPad Mini, will be awarded on June 27. There is no cost to participate. The more people post using #AphasiaAwarenessMonth, the more chances they have to win and the more we can raise awareness of aphasia!

But that’s not all you can do. Here are some other suggestions as to how you can celebrate National Aphasia Awareness Month in June:

  • Provide training at local hospitals, clinics, senior citizens centers, nursing homes, etc.
  • Send packets of information to doctors and other professionals and staff who work with aphasia (e.g. physical therapists, occupational therapists, social workers, nurses). Training for these groups would be very helpful in dealing with the communication difficulties.
  • Provide training workshops and support groups for family and caregivers.
  • Provide workshops for local religious groups – many of these have existing programs for helping people in the community.
  • Display posters and disseminate materials in local shopping centers, libraries and supermarkets about aphasia.
  • Set up an information table to educate employees, patients and families about aphasia.
  • Get your city/town to pass a resolution proclaiming June as National Aphasia Awareness Month- we can provide you with the template.

Remember, aphasia advocacy and increasing awareness is a year round activity so join the effort! For more information or to receive your Aphasia Awareness Month packet, contact the NAA’s Response Center at 800-922-4622 or visit the NAA website.

 

Ellayne S. Ganzfried, M.S., CCC-SLP, is a speech-language pathologist and the Executive Director of the National Aphasia Association. She is Past President of the NYS Speech Language Hearing Association (NYSSLHA), Long Island Speech Language Hearing Association (LISHA) and the Council of State Association Presidents for Speech Language Pathology and Audiology (CSAP) and remains active in these associations. Ellayne is a Fellow of the American Speech Language Hearing Association (ASHA). She was a site visitor for ASHA’s Council on Academic Accreditation (CAA) and a practitioner member of the CAA for four years. She is currently on ASHA’s Committee on Honors. Ellayne has created and managed several speech, hearing and rehabilitation programs in New York and Massachusetts. She is an adjunct instructor at Adelphi University-Garden City –NY. Ellayne has written articles and presented regionally and nationally on a variety of topics including aphasia, rehabilitation and leadership skills.

Aural Rehab: Getting an “A” in Listening

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

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

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

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

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

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

 

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

 

Mission Impossible: Collaboration (Are We Succeeding?)

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

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

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

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

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

 

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

Are You Ready for Better Speech and Hearing Month?

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Better Hearing and Speech Month is a mere week away, and ASHA is gearing up for an exciting month! By now, we hope you’ve seen some of the resources we developed specifically for members—press release and media advisory templates, our 2014 poster, a Facebook cover photo, a letter to parents, our 2014 product line, and much more. We also encourage members to utilize the Identify the Signs member toolkit during May, as the campaign will be front and center for this year’s BHSM. The campaign’s message of early detection is a great tie-in to the 2014 BHSM theme of “Communication disorders are treatable.”

If you’re still looking for ideas on ways to celebrate, it’s not too late to plan something. We’ve got a list of suggestions here, and you can check out our new interactive map featuring stories of how your fellow ASHA members have recognized the month.

If you do have a fabulous event or activity in store, we want to see it! Take a photo and post to Instagram with the hashtag #BHSM. One winner will be randomly selected to receive a package of 2014 BHSM products. More details can be found on the BHSM member resource page. The contest will run from May 1st – 12th.

In addition to member resources and contests, ASHA will be conducting a lot of public outreach during the month to raise the profile of communication disorders and the role of ASHA members in treating them. Some highlights this May include:

  • Google Hangout—A live, online Google Hangout to mark BHSM will be held on May 6th from 1:30 – 2:30 p.m. ET. Moderated by ASHA CEO Arlene Pietranton, the event will convene experts from a wide range of backgrounds to discuss the critical role that communication plays in daily life—and the importance of early detection of any speech, language, or hearing difficulties in children to allow them to reach their full potential academically and socially. Guests will include Elizabeth McCrea, ASHA’s 2014 President; Libby Doggett, deputy assistant secretary for policy and early learning at the U.S. Department of Education; Sara Weinkauf, an autism expert from Easter Seals North Texas; Patti Martin, an ASHA-certified audiologist from Arkansas Children Hospital; and Perry Flynn, an ASHA-certified speech-language pathologist at the University of North Carolina – Greensboro. The panel will take questions from the public, and members are encouraged to participate. Questions can be posted to ASHA’s Google+ page, or use the hashtag #BHSM on Twitter. You can RSVP for the event here.
  • Twitter Party—A Twitter party hosted by lifestyle technology and parenting blogger Michele McGraw (@scrappinmichele), and co-hosted by five other leading parenting bloggers, will be held on May 20th from 12 – 1 p.m. ET. During the party, parents and other interested parties will have the opportunity to learn, and ask and answer questions, about speech, language, and hearing disorders. No RSVP is required; members who are interested in joining in should just follow the hashtag #BHSMChat at that time.
  • New Infographic—A new infographic illustrating the prevalence and cost of communication disorders, as well as the benefits of early intervention, will be posted online at www.asha.org/bhsm and http://IdentifytheSigns.org, and distributed widely to traditional and new media.
  • Podcast Series—Four new topical podcasts featuring ASHA members will be rolled out weekly during the month. These are: Newborn Hearing Screening—In the Hospital and Beyond (May 1); Noise-Induced Hearing Loss in Children: A Preventable Problem (May 12); Autism Diagnosis and Treatment of Today and Tomorrow (May 19); and Building Language and Literacy Skills During the Lazy Days of Summer (May 27). These will be available at http://IdentifytheSigns.org.
  • International Communication Project 2014—During May, ASHA is going to be disseminating digital messaging that relates to the International Communication Project 2014 that was launched earlier this year—and promoting signatories to the Universal Declaration of Communication Rights. Members are encouraged to sign the Declaration and invite others to do so to show their support for people with communication disorders. Watch the February Google Hangout to learn more and hear from the participating countries.

 

Many of these resources won’t be available until May 1 or later, when they are debuted to the public. We encourage you to visit our member resource page www.asha.org/bhsm frequently to see the latest, and hope you can share the information with your networks. These resources will also be posted to http://ldentifytheSigns.org, the home of the Identify the Signs campaign and a site designed for consumers to easily find information tailored to them.

We hope this year’s BHSM will be one of the best yet, and look forward to hearing how you’re celebrating the month. Send us any stories, questions, or comments to bhsm@asha.org.

 

Francine Pierson is the public relations manager at ASHA. She can be reached at fpierson@asha.org.

Understanding Autism: Restaurant Meltdowns

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I sat in a popular restaurant chain and watched an 8 year old boy have a major meltdown at his table.  His mother cringed as lunch time patrons stared.  An irritated couple at a nearby booth got up and moved, but only after glaring at the mother.  I’ll be honest, the child was disrupting my lunch too, but one thing I suspected was that this child had autism.  He appeared to be just like any other child, but the intensity of his outburst was out of proportion to the issue he was yelling about: The waiter had served him waffle fries and he had expected “skinny fries” just like the french fries served at home.

April is National Autism Awareness Month.  The U.S. Centers for Disease Control and Prevention (CDC) reports that 1 in 68 children are reported to have autism (ASD) and most are boys. Chances are, you know someone with autism.

What distinctive characteristics of ASD can affect a child’s ability to adjust to unexpected life events, even something as incidental as waffle fries?  Let’s look very briefly at some of the central features of ASD, while keeping in mind that this a spectrum disorder, with symptoms ranging from mild to severe and this list does not encompass all of the elements of a diagnosis. Just some of the central features that kids with ASD have difficulty with are:

  1. Social interaction, often including social reciprocity or that back and forth communication exchange known as conversation.
  2. Restricted behaviors and the need for “sameness” or the inability to be flexible with change.
  3. Hypersensitive and/or hyposensitive “to sensory aspects of the environment” which can hinder their ability to tolerate different tastes, temperature and/or textures of food and deal with change in general.

As a pediatric therapist,  I assess and treat a child’s ability to allocate specific cognitive resources in the brain to manage day-to-day life.  As adults, we too have to utilize many different parts of our brains throughout the day.  But what happens when we are bombarded with sensory input and suddenly, we have to adjust to unfamiliar stimuli? To understand what it’s like, consider this example:

You are driving the minivan full of kids to soccer practice, radio blaring, kids chattering.  Your brain is operating relatively smoothly, filtering auditory, visual, tactile and other sensations, while remembering to use your turn signal, maintain the speed limit, etc.  Suddenly, the weather changes and it starts to hail.  What’s the first thing you do?  Turn off the radio and tell the kids “Shush…Mommy needs to concentrate on the road.”  Perhaps you even slow down so that you can focus on the sudden change in driving conditions.  You have eliminated as much sensory input as possible so that you can concentrate on the task at hand – driving safely.  Isn’t it interesting that  you were driving perfectly fine until one unpredictable event changed in your environment?

Now consider the child with autism as he attempts to engage in mealtimes.  The reality is that daily life changes as easily as the daily weather report and for him, some days are just like driving through a hailstorm.  This child is already challenged by poor sensory processing; he has limited ability to take in information through all of the senses, process it and filter out the unimportant info, and then act upon only the relevant sensory input.

Now, bring that child to the family dinner table, which is all about social interaction and conversation.  Put a plate of food in front of him which looks and smells completely different from the last meal he was served.   Then, tell him to try that steamed broccoli for the very first time.  He doesn’t get to turn down the sensory input bombarding him at the table and focus just on the broccoli.  Because he has autism, he can’t always filter out which stimuli might be inconsequential and it feels so much safer to follow rigid behavior patterns and never try anything new.  Life for a child with autism is all about sticking to sameness. My role as a therapist is to help the child learn to deal with change.

A 2013 study from the Department of Pediatrics at Emory University indicated that kids with ASD are five times more likely to have feeding problems compared to their peers.  Once feeding difficulties are addressed in the home, restaurants are the next step for their families.  Here, the visual input is completely different and it changes constantly, the inconsistent auditory input can be overwhelming, the fluctuating smells may be interpreted as noxious, etc.   Every input to every sense has changed.   Once again, the child with autism is encountering a hailstorm and has to learn to tune out the distractions and focus on the task at hand – in this case, eating a meal away from home.  In this young man’s case, waffle fries were just too much to handle after managing all of the other sensory stimuli at the restaurant.

Perhaps you are a parent of a child with ASD.  Perhaps you have observed a child whom you suspect may be dealing with the daily challenges  of autism.  Thank you for considering what mealtimes feel like for him and his family.  It does get better, but it is a journey that requires patience from family, friends and the community.

Please share this article with a friend so that we can continue to raise awareness of autism spectrum disorder and if you know someone who loves a child with ASD, do something special for them this month in honor of National Autism Awareness Month – thank you!

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.

Aural Rehab: Are We Getting the Job Done?

tin can 2Aural rehabilitation was once the root of our profession. ASHA defines it as “an ecological interactive process that facilitates one’s ability to minimize or prevent the limitations and restrictions that auditory dysfunctions can impose on well-being and communication, including interpersonal, psycho-social, educational and vocational functioning.” Audiologists know the importance of providing our patients with education, counseling, and training to overcome the challenges presented by hearing loss. However, the most recent MarkeTrak survey results indicate that very few of us are actually providing these services to our patients. This is an unsettling finding to say the least.

I truly believe that most audiologists attempt to provide their patients with adequate education and counseling. However, these MarkeTrak survey results prove that our attempts are not being received by our patients. I believe there are two factors at play: technological overwhelm, and unrealistic expectations. Patients are often so overwhelmed by the vast array of technology at their fingertips that their sole focus is on the technical workings of the hearing aids and wireless accessories. In addition, the vast improvements in technology lead our patients to believe that the hearing aids alone should address all their communication problems. What we are missing is a standardized, effective, and efficient aural rehab protocol that helps our patients to retain what they have learned, and use the strategies we teach them.

As a practicing audiologist, I face these challenges on a daily basis. As technology progresses, I find myself spending more clinic time educating my patients on the technical aspects of their new hearing aids. In a busy ENT clinic, time is of the essence, and this leaves very little time for counseling about realistic expectations, communication strategies, and auditory training. I tried various educational handouts as well as group AR classes, but struggled with patient compliance. I also found it difficult to engage family members in the rehabilitation process. When I read the MarkeTrak survey results, I realized I wasn’t the only audiologist facing these challenges. So in 2013 I set out to develop a fun and effective approach to aural rehab that would be easy for patients to comply with, and efficient for professionals to implement. I call it Cut to the Chase Counseling. There are three simple steps to this aural rehab approach:

1. Education: Patients need to be educated in a fun, easy, and efficient way. While there are many great educational materials on the market, I chose to create my own patient guidebook that organizes communication strategies into five simple keys (see below) that are easy for patients to remember. It is also important that our education addresses realistic hearing aid expectations as well as the importance of family member involvement. Our aural rehab approach defines the following components as the “5 Keys to Communication Success.” I will discuss these further in future blog posts.

2. Action: Patients need to immediately act on what they’ve learned to begin creating new communication habits early in their rehab process. We start this action with personalized Successful Communication Plans that guide the patient and their communication partners as they apply the five keys to their most challenging communication situations.

3. Follow-up: Patients simply cannot absorb and retain all of the education and counseling during their hearing aid trial period. They are often so overwhelmed by their hearing aids, that they may actually remember precious little from what we have been teaching them. For this reason, they must receive some kind of regular follow-up education. Studies show that consistent long-term follow-up drastically increases patient compliance and satisfaction. We provide this follow-up in the form of weekly emails that patients receive for an entire year following their hearing aid fitting. These emails reinforce effective communication strategies and encourage the patients to return to their hearing care professional with any questions or concerns.

We know that our job as rehabilitative audiologists goes far beyond fitting hearing aids. I hope this simple three-step approach will provide an efficient way for professionals to ensure that education and counseling are an integral part of every hearing aid fitting. In the following five blogs, I will dig deeper into the five keys to communication success and give you strategies for integrating them into your practice.

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

Schools Serving Students with Telepractice Deserve Parity in Medicaid Reimbursement

United

Aesop coined the phrase “United we stand, divided we fall.” But what do we do when we cannot find partners to stand with?

Nationally, a shortage of speech-language pathologists often prevents children from receiving services they desperately need.

The State of Telepractice

Spurred by ASHA’s 2005 recognition of telepractice, thousands of SLPs have participated in telepractice so far. Telepractice is thriving; more than 10,000 SLPs have applied to PresenceLearning alone and many more are interested in telepractice considering the many other providers like Visual Speech Therapy and Vocovision.

The fast adoption of telepractice was driven by the well known shortage of SLPs, offering clinicians new work/life and professional choices. However, as accumulated research–40 peer reviewed studies at last count–has shown that telepractice is just as, if not more, effective than traditional, onsite therapy, the uses of telepractice have broadened.

Telepractice is now used to bring children together for social pragmatic groups, connect kids with bilingual therapists, strategically alter the frequency and intensity of therapy, improve SLPs’ schedules, bring in specialists, and re-engage students in middle and high school.

The Problem With Medicaid

One obstacle remains in many states that prevents SLPs from working via telepractice: Medicaid reimbursement. This is a critical issue, as schools can receive reimbursement for up to 50 percent of costs from Medicaid and are often unable or unwilling to adopt telepractice services without this reimbursement. ASHA, to its credit, has been a leader in advocating for school-based Medicaid reimbursement.

State policies preventing Medicaid reimbursement are oversights rather than outright bans. Policy has simply not kept pace with advancements in our field. In fact, most state policies don’t even comment on telepractice.

Many states, including California, Colorado, Virginia, Minnesota, Ohio, have updated their regulations, creating a precedent for other states to follow. These states handle Current Procedural Terminology (CPT) coding in the same way as before, but with a modifier indicating tele-delivery.

In the remaining states, the impact is large and negative:

  • SLPs wanting to work via telepractice, many of them retirees or recent parents seeking flexible work, effectively cannot do so within their state.
  • Hundreds of thousands of students not receiving services because of the SLP shortage will continue without the care of a SLP and fall further behind in critical areas like reading, writing and communicating.
  • Schools struggling to fill their share of the 5,000+ unfilled SLP openings will remain at significant legal risk from non-compliance.

Unfortunately, underserved districts and their students in rural areas and the urban core will continue to be hit the hardest until this blind spot in Medicaid policy is remedied.

What Must Happen

Medicaid reimbursement inequality must be resolved in all 50 states. There are important issues of equity for rural and urban core students, as well as the viability of access to telepractice for SLPs and students alike.

How can you help?

The only way to help is, in the words of Aesop and others, stand together for this cause. Here’s how we can stand together:

  • Review your state’s current policies for Medicaid reimbursement regarding telepractice.
  • Contact your state administrator of Medicaid for education to express your concern on this issue.
  • Cite specific examples of how tele-therapy reimbursement would benefit students in your district and similar districts in your  state.

With a cohesive message and ample support from fellow educators, gaining Medicaid reimbursement for tele-therapy for school-based speech-language therapy services can be a reality sooner than you think.

 

Melissa Jakubowitz, MA, CCC-SLP, is the Vice President of SLP Clinical Services at PresenceLearning. She is a Board Recognized Specialist in Child Language with more than with more than 20 years of clinical and managerial experience. She is the past-president of the California Speech-Language-Hearing Association and is active in ASHA, serving as a Legislative Counselor for 12 years.