Avoidance Reduction Therapy: A Success Story

true colors

I was interviewing for assistant positions at our summer speech and language camp when I first met Ben Goldstein.  Ben is a graduate of the University of Maryland and was in the midst of taking his pre-requisite courses to apply for graduate school to become a speech-language pathologist.  Ben also happened to be a person who stutters (PWS).    As the interview continued he shared that he was introduced to avoidance reduction therapy by Vivian Sisskin at the College Park campus of UMD.  I had already been applying aspects of avoidance reduction therapy with my clients,  however Ben helped solidify my feelings on this approach.  Ben was kind enough to answer some questions and walk me through his experience with avoidance reduction therapy, which is included below.

Avoidance reduction therapy is an approach to stuttering therapy that can be used with both school-aged and adult clients.  This approach views stuttering as an approach-avoidance conflict; a theory that states that a PWS experiences the desire to speak and interact with others while simultaneously experiencing an urge to hide their stuttering.   The result of these competing desires culminates in the maladaptive secondary behaviors that interfere with communication (ex. eye blinking, leaning forward, use of fillers, etc.).  These competing desires also result in a feeling that one can not partake in certain activities and situations due to their speech.

Avoidance reduction therapy works toward reducing these maladaptive behaviors, leaving in its place a more comfortable, forward moving form of stuttering.  It also works toward reducing the handicap of stuttering, whereby increasing a person’s willingness to participate in various activities and situations, whether or not they show some stuttering.   Unlike other approaches that focus on fluency, this particular approach views a person’s strong desire to be fluent as perpetuating the problem and ultimately what contributes to their word and situational avoidances, as well as much of the struggle behaviors you see in their speech.  Avoidance reduction therapy does not put an emphasis on fluency, but rather on improving a person’s ability to successfully communicate in the “real” world.

How do you incorporate avoidance reduction therapy into your sessions?  Start by helping your client to identify their own stuttering patterns and assist them in recognizing how much of their pattern is “true” stuttering and how much of what we see is actually habits they formed in an attempt to mask stuttering.  Challenge clients to allow themselves to show true stuttering (or perhaps use voluntary stuttering), beginning in the safety of the therapy room and eventually branching out to different “real-life” situations.  As you work through these challenges, clients will often discover ways in which their stuttering was holding them back that they may not have realized before.   Read on to learn about Ben Goldstein’s first-hand experience with avoidance reduction therapy.

Before jumping into avoidance reduction therapy, how would you describe your speech intervention experience leading up to it?

Ben: Prior to avoidance reduction therapy, I saw two SLPs as a private client. Both focused primarily on common fluency shaping techniques (easy onset, breath control, continuous phonation). My parents felt that the therapy helped me sound better, but I don’t remember sounding better. I also don’t remember feeling better about myself or my stuttering through therapy.

Can you describe your stuttering pattern prior to beginning avoidance reduction therapy?  Do you feel like stuttering impacted your quality of life?   

Ben: When I showed my stuttering I usually blocked for long periods of time, contorted my lips and mouth, tapped my leg to release a block, used fillers such as “umm” and “you know,” and closed my eyes. There was little actual stuttering going on. It was mostly secondary behaviors.

In particularly scary situations, I would avoid talking altogether if I felt that I was going to stutter.  If somebody asked me a question and I felt a disfluency coming on, I would often pretend that I didn’t hear the person. I would constantly change words that I thought I was going to stutter on. I would not go to parties and avoid hanging out with friends sometimes.

All of that avoiding had a huge impact on my life. For one, I never showed my real personality. If I had a joke I wanted to tell or a comment I wanted to say, I usually wouldn’t say it. My mindset everyday was “Let’s get through today without showing stuttering. Say only what you absolutely have to say.” That kind of mindset suppresses one’s personality and it can lead to a lot of feelings of shame, guilt and feeling less than others.

How were you introduced to avoidance reduction therapy?  

Ben:  After my first semester freshman year at the University of Maryland, I found my way to the on-campus Hearing and Speech Clinic.  It was there that I was introduced to avoidance reduction therapy.

How would you define avoidance reduction therapy and the rationale behind this approach?  

Ben: I think the most basic definition of avoidance reduction therapy is to reduce one’s avoidances related to stuttering, speaking, and really, in life.  In other words, the goal is to reduce how often one actively avoids stuttering, avoids various speaking situations, and avoids different opportunities in life. The rationale behind the therapy is that stuttering is perpetuated by habit and fear.  If I have a fear of speaking in class, every time I keep silent in class, I reinforce that behavior and the fear of speaking in class grows. Avoidance reduction therapy is about reversing that process.  If you face your fear head on and with a different attitude of what is a success and what is a failure, the fear eventually dissipates, and once the fear of speaking weakens, you can start to make choices to stutter in a more comfortable and effective way.

Most clients seek therapy to try and reduce or eliminate stuttering and may be initially concerned with the premise of avoidance reduction therapy. How long did it take for you to “buy in” to this approach?  

Ben:  Great question. For me, I bought in pretty quickly. No one before in my life had explained to me the cycle of avoiding stuttering, the feelings and thoughts that I had, and how those feelings and thoughts perpetuated and worsened my speech.  Once these ideas were laid out for me it was almost like a lightbulb went off in my head. “Yes, finally what I’ve experienced my entire life makes a little sense.”

Can you explain what a typical therapy session would look like?

Ben:  A typical therapy session usually begins with the client talking a bit about how their week went. The client might talk about a speaking-related success they had the previous week (talking about my successes helped me feel good about myself as a communicator), a situation that is really bothering them (these always helped me relieve some anxiety and develop a plan), or a topic unrelated to speech altogether. While the client is speaking, the SLP is taking note of the client’s speaking pattern and assessing how successfully they are hitting their target from the previous week.

After the client has spoken for a bit, he or she usually receives feedback from the SLP. This feedback can be related to the thoughts and feelings of the client (dependent on what the client was saying) and/or his /her motor pattern (dependent on how the client was saying it.) Following feedback, the client and SLP engage in some specific practice where the client has the opportunity to put the SLP’s suggestions into action in a safe speaking environment. This allows the client to play around with the new assignment (whether motor-based or cognitive-based) and allows the client to begin to reinforce the new behavior.

Following target practice, the client and SLP finalize the client’s assignment or plan for the week. The client is told what the rationale behind the assignment is, and how that target or goal fits into the client’s longer-term plan.

What aspects of avoidance reduction therapy do you think are most beneficial to you and to the individuals in your group? 

Ben:  I can’t speak for everyone in my group, but to me, the lessons I’ve taken from avoidance reduction therapy are that it’s OK to stutter, it’s OK to be vulnerable and it’s OK to not be perfect everyday. Contrary to what I used to think, stuttering is not some giant, evil monster that I need to run away from for the rest of my life. It’s a part of me and not a negative thing. Perhaps most importantly, my goals have changed since starting avoidance reduction therapy. In the past, my priority was to avoid stuttering at all costs regardless of how it affected the way I connected with others and how I felt about myself. Today, my goal is to be true to myself, connect with other people, say what I want to say, and enjoy life as much as I can. If stuttering wants to come along for the ride, that’s OK.

How do you think your stuttering has changed?  Does stuttering affect your life in the same way it did prior to receiving avoidance reduction therapy?

Ben:  A lot has changed since starting avoidance reduction therapy. For one, my stuttering pattern has definitely changed. Now, I keep eye contact during disfluencies. The habit of tapping my knee is gone. I no longer use interjections with the same degree of frequency. I still contort my lips and mouth sometimes, but hey, it’s my next goal to tackle.

In terms of life impact, it’s night and day. Now, I say most of what I want to say. I show my personality. I also have a completely different perspective of what constitutes a success for me at this point and time and what is a failure. I recently gave a short talk in front of 600 people and stuttered a great deal. Four years ago, I wouldn’t have even thought of doing it, and if I had been forced to, I would have viewed my immense amount of stuttering as a failure. Today, I recognize what an accomplishment it is for me to voluntarily speak in front of that many people. I’m slowly chipping away at avoidances and those are my successes.

Do you think that there are individuals who would not benefit from this approach?  

Ben:  I think one really has to be motivated to change to undertake avoidance reduction therapy. It’s not easy work. Doing things that petrify us is so counterintuitive. If one has never talked in class before, talking in class that first time is going to be really scary. But talking the second time is going to be a little easier.

My experience of diving right into the therapy isn’t the common one. (And my initial experiences with avoidance reduction therapy probably weren’t as smooth as I’m remembering them). It takes time to truly change one’s attitudes and beliefs. This isn’t an intensive, short-term kind of therapy. But in my experience, and the experience of many of my peers, it’s a therapy that leads to real, meaningful, long-term change.  The motto “short-term pain, long-term gain” really applies here. I do think everyone is capable of receiving meaningful benefits from it, but they’ve got to put a lot in as well.

If you want to learn more about Avoidance Reduction therapy, I highly suggest Vivian Sisskin’s video Avoidance Reduction Therapy in a Group Setting, available through the Stuttering Foundation of America.

Brooke Leiman, MA, CCC-SLPis the fluency clinic supervisor at the National Speech Language Therapy Center in Bethesda, Md. She is an affiliate of ASHA Special Interest Group 4, Fluency and Fluency     Disorders. This blog post is adapted from a post on her blog, www.stutteringsource.com, which focuses on      fluency disorders and their treatment

 

Ben Goldstein is a graduate of the University of Maryland. He will begin work toward a master’s degree in Speech Pathology in the Fall of 2014.  Ben is a member of the Rockville Chapter of the National Stuttering Association and formerly served as it’s co-chapter leader.  He can be reached at bagoldstein@gmail.com.

On Becoming an Interprofessional

teamwork

According the authors of “The Interprofessional Healthcare Team: Leadership and Development,” interprofessionalism refers to the active participation of different professionals, which may include persons with professional licensure or certification in nursing, occupational therapy, physical therapy, speech-language pathology, social work, and other health-related professions who are collaborating to provide quality services to the patients they serve. Through a steadfast commitment to collaboration, interprofessional practice among healthcare professionals seeks to enhance the quality of health and medical services, which lead to improved patient outcomes. Developing synergy between through shared knowledge and decision-making promotes positive change in work settings and builds meaningful relationships with patients and their families. But, say the authors, shaping efficacious teams depends upon fundamental knowledge of the represented field, the use of evidence-based practice, interprofessional leadership, and members who are prepared to collaborate effectively in a team, which we believe can be accomplished through interprofessional education (IPE).

 
The Institute of Medicine Committee on Health Professions Education provides recommendations for developing a strong team: “health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics.” Because of ongoing changes to the U.S. healthcare system, including insurance policy initiatives, technological advances, and innovative service delivery models, it is imperative for all professionals, including speech-language pathologists and audiologists, to embrace a new spirit of interprofessional collaboration and cooperation. Leading health organizations, such as the Pew Health Professions Commission, the Institutes of Medicine, and the World Health Organization, support the concept that health professionals have received adequate education to work in healthcare settings only if it includes experience participating in interdisciplinary teams to collaboratively solve complex problems.

 
Due to changes in service delivery models that have resulted in an increase of members within healthcare teams, interprofessional practice is rapidly becoming an expectation in most healthcare settings. Universities and training programs in speech-language pathology and audiology are only recently beginning to embrace models of IPE. In some universities, students from several disciplines are enrolled in the same courses, teamed for practicum experiences, participate in field-based experiences, and ultimately learn to work as effective, interprofessional teams. A unique way for IPE to be learned has recently occurred though simulation-based education in the College of Health Professions at The University of Akron.

 
Simulation-based education is an innovative process for creating authentic situations in which groups of IPE students learn to collaborate. Specifically, this technique can assist in overcoming some of the challenges that exist in healthcare: inadequate communication among professionals, focusing on specific needs rather than the whole patient, lack of knowledge of other professionals’ roles, the inability to work as an effective team member, and a lack of conflict-resolution skills. IPE conducted as a simulation activity may supplement traditional classroom strategies to enhance the performance of healthcare providers, ultimately resulting in reduction of errors in the workplace and an increase in the quality of care provided to patients. Although this strategy has been recognized by various international professional societies, including the World Health Organization and Institute of Medicine, as foundational to achieving safe, high-quality, accessible patient-centered care, not many healthcare training programs are on board.

Fortunately, as graduate students in speech-language pathology at The University of Akron, we were given the opportunity to participate in an IPE simulation activity. It included more than 90 students studying in the fields of nursing, nutrition/dietetics, social work, medicine, and pharmacy. Groups of five or six students from each discipline worked together to treat a specific, simulated patient. This particular simulation portrayed a young female combat veteran primarily diagnosed with a traumatic brain injury, with secondary diagnoses of depression, binge eating, insomnia, post-traumatic stress-syndrome, and cognitive deficits. Working as a team, our goal was to assess, diagnose and create a treatment plan for this patient to help alleviate her daily struggles, such as her inability to maintain a healthy diet, pay attention during class, and communicate effectively with loved ones. To develop an effective treatment plan, these challenges needed the knowledge and skills of each of the disciplines that participated in the simulation activity.

As the simulation began, we quickly recognized the need for strong interpersonal skills. It was a challenge figuring out when to speak, when to listen, and how to deliver opinions appropriately. Common observations of group dynamics included students promptly stating their opinions on how the patient should be treated before discussing a rationale or their role; students aggressively prioritizing needs of the patient without consultation; and many students reported they were unaware or had misconceived ideas about the roles of other professionals, especially speech-language pathologists. From these experiences, the need for this type of training was even more apparent. We learned that professional roles, especially speech-language pathologists, may be unclear to others, and we found ourselves advocating for our field and its importance in making treatment decisions. We also found that many students were very knowledgeable about their discipline but lacked good communication skills. This challenge resulted in a struggle to connect constructively with other students in other courses of study. We now recognize how vital  interpersonal skills are to delivering optimum patient-centered care.

 
From this exercise we now believe an IPE approach to teaching and training can have a tremendous impact on the preparation of speech-language pathologists and audiologists. With this training, students will enter the workforce with experience collaborating with other professionals and will understand the power of teamwork to accomplish a task. When students practice interprofessionalism and see the power in collaborating with other professionals, greater progress can be achieved in the workplace. Participating in the IPE simulation has boosted our confidence by showing us how to apply our clinical knowledge and skills in a safe but functional learning environment, but most importantly, it has given us a sense of how to work as a team to improve the life of our patient, which is the essence of patient-centered care. We have definitely taken our first critical steps toward becoming truly interprofessional!

Crystal Sirl, BA, is a graduate student in the School of Speech-Language Pathology and Audiology at The University of Akron.
Grace Bosze, BA, is a graduate student in the School of Speech-Language Pathology and Audiology at The University of Akron.

 

 

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.

Continuing Education: The Options; The Reality

conted

Kids, my own or those I work with, are often slightly astonished that I like school—genuinely like school.  They can’t believe I willingly went to school beyond college and even now happily sign up for multi-day seminars.

Apart from the fact that it’s required for us to maintain our certification (30 hrs or 3.0 CEUs/3-year maintenance period) and the ethical obligation to stay current with best practices, I truly enjoy hearing about new methods, gathering information and collaborating with others in our field.

As a result, I’ve racked up a lot of CEUs over the years and  have found not all CEUs are created equal.  There are marked differences between the types offered and unless you’re really just trying to cross off credits, you need to know which will best suit your needs.

ASHA or State Convention

ASHA provides up to 2.6 CEUs; or up to 3.15 if you register for pre-conference activities.  State conventions will vary, but .6-1.4 CEUs seems to be the standard.

Pros:

  1.  There are lots of different topics available, sometimes on very niche issues that wouldn’t make sense, or be cost effective, for an entire seminar.
  2. If you realize 10 minutes into a session that it isn’t what you expected or that the speaker is so dry you’ll be nodding off if you stick around, you can simply hop up and move to another session.  At ASHA you can follow the Twitter feed to find out where the good stuff is happening
  3. Go with a friend and you can double the amount of information you receive (though your credits stay the same).  It’s a certainty that you will find some times slots overflowing with sessions your dying to hear—split up the work.
  4. It’s also a certainty that some time slots will have no compatible sessions to your interests.  No worries, head to the exhibit hall!  The exhibit hall at ASHA requires you to set aside a decent chunk of time, but even the state vendors are worth a look.  This is an outstanding opportunity to see new products, have someone walk you through scoring on a new assessment tool, or find resources for referral in your area.  And don’t forget the giveaways—you won’t need new pens for a year!
  5. Networking is a huge opportunity, especially at ASHA when participants are staying in the area for a few days.  You can meet up at the ASHA sponsored events or join smaller groups like the #SLPeeps at dinner.  You’ll get more information, recommendations and camaraderie than you thought possible and head home reinvigorated about the profession.

Cons:

  1.  Though there is tremendous variety in topics some of them can be fairly obscure, but, hey, that means there really is something for everyone.
  2. The title and even the couple sentence description can be misleading.  You may not really know what you’re walking into until you’re in it.
  3. The sessions are short!  Unless you pony up for a short course, the sessions are 30min-2 hrs.  Sometimes I feel like we’re just getting started when they start wrapping it up!
  4. There can be, for better or worse, a lot of anonymity at a big conference.  If you want to network, you’ll need to put yourself out there otherwise you’re one person in a very large sea.  I think I saw that ASHA broke records this year with over 14,000 attendees!

Seminars

This will vary widely depending on the topic and number of attendance days.  Most will provide up to .6 per day.

Pros:

  1.  You can really delve into a topic at a seminar and the sign-up literature is usually very specific as to what will be covered.
  2. Seminars move around quite a bit and you might get to see one of the stars of our profession in a smaller setting that allows one-on-one interaction at some point (yes, I’ve asked for autographs).
  3. Seminars tend to be more clinically based, rather than strictly research, so you will usually find yourself implementing new techniques, maybe even materials, the day you get back.
  4. Seminars tend to have more participatory components.  You might get to try out techniques on other therapists, write plans/goals, or play a “patient” yourself.
  5. Keep your eyes peeled and you can attend something very close to home, even if you don’t live in a metro area.  This can cut down on costs substantially.

 

Cons:

  1.  If you’ve made a bad decision, you’re pretty much stuck.  Get a cup of caffeinated coffee, try to muddle through awake and ask a lot of questions.  Some speakers will improve with participant interaction and at least you’ll get some of the info you were looking to find.
  2. You can get quite a few hours in with a one or two day seminar, but it will likely take a few to cover your total CEU requirements.  You need to consider travel costs, but seminars themselves are usually pricier/hour.
  3. Some seminars have a bit of a cult-like feel.  If you’ve drunk the Kool-Aid yourself, that’s fine, but if you’re a dissenter and question the theory … you might find the room gets a little chilly.  Oops.

At Home Options

Again, this varies widely.  You can take on-line courses as short as an hour (.1 CEU), or sign on to a webcast and get a few hours.  An ASHA on-line conference like the one on Neurodegenerative Disorders (2/19-3/3) can earn you up to 2.6.  There are also DVD or CD courses and self-study journal article options.

Pros:

  1.  The convenience of CEUs earned at home can’t be ignored.  You can do them at your leisure, devoting just a bit of time each day or make it a marathon session and knock it all out at once.  You can do it before the kids wake up or after they go to sleep, or during a snow day.
  2. With no travel expenses, the cost can be much lower than other alternatives.  ASHA SIG members can earn very inexpensive CEUs through self-study as well as discounts on other related ASHA courses.  SpeechPathology.com offers a yearly subscription for unlimited on-line courses.  Specific organizations such as The Stuttering Foundation have very economical DVD classes.
  3. You have a lot of flexibility in terms of topic.  There are lots and lots of courses available and you don’t need to wait for it to arrive somewhere near you.

Cons:

  1.  You’ll need some discipline.  Make that quite a bit of discipline.  It’s really easy to let a stack of DVDs sit, and sit…and sit some more.  It’s even easier to start a course only to find you never finished it.  Be honest with yourself and what you are likely to accomplish.
  2. The quality of the DVDs/CDs will be fine, but in a world of surround sound and fast paced cable shows you will be astonished at how slow a lecture moves.  Speakers that are dynamic in person are often diminished on film when you lose the energy of the audience as well.  And beware if you stop a DVD and try to find your place again later!  When the “scene” never changes, it can be frustrating to try and relocate your stopping point.
  3. Interaction is often limited.  Live webinars and conferences will give you an opportunity to ask questions, but other options lack this ability.

In the examples above, I’m referring to ASHA-approved course,s which are required for the ACE award and can be tracked through the ASHA CEU Registry.  However, ASHA does permit other CEU credits to count toward your certification maintenance.  Check the guidelines for information on continuing education credits without pre-approval.

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

How to Navigate the Profession One Binder at a Time

Binders

 

My entire professional career can be summarized by what binder I was holding, and where I was while holding it. I waltzed into my interview for graduate school with a small binder, and a ton of nerves; I entered the current school I’m working in (my first job, ever!) holding my giant binder containing my portfolio. However, the most important binder in my very “speechy” timeline is the one I took to my school practicum.

Many departments offer different variations of clinical experience, whether they’re in a clinic, school, or hospital setting. Everyone gets their hours, but sadly to say, some either have poor experiences or don’t make the best use of their time. When I entered into the first day of my school practicum, I was chock-full of bulletin board ideas, and holiday-themed crafts. I almost exploded with Velcro and stickers! Then it hit me–I was going to have five faces staring at me every day as I navigated teaching them everything they needed to know. All while attempting to be as entertaining as their Xbox or iPhones. I began to panic.

That’s when I recalled the power of supervision. I had almost forgotten the wonderful woman who showed me around the building on my first day. Oh yeah–that nice lady is going to hold my hand through the first few weeks of this! Thank the Speechy Powers That Be!

Not only did my supervisor support me through my practicum, but she let me fly. Our first sessions with the students from the self-contained classroom left my head spinning. Were we shaking maracas and throwing scarves? Did I need to invest in Velcro’s stock? How many times can we sing that song? Oh, and when will this song leave my brain!? By the third week, I was singing, shaking, and velcroing with the best of them. We had an intense caseload with fantastic kids. Everything my supervisor uttered, handed me, sent me, all went in my binder. I knew I only had this window of opportunity for so long and I had to keep it all. binder1 I left my cozy clinical experience and now have embarked upon my Clinical Fellowship Year. I went to pick up one of my first students, and was met with a non-verbal child with autism spectrum disorder. He, of course, did not have his AAC device. I grabbed his hand, said a small prayer to the Speech Gods, and we went to the classroom. It was scary, sure, but I had this; I knew what to do. Not only did I have the materials from my binder, but I had the training to go with them. Skills I learned in a classroom are necessary and invaluable (especially when I pull out those technical words in a meeting to prove a very Speechy point!). However, the knowledge I gained from my supervisor, and my school practicum, is what makes me a good speech-language pathologist.

So my advice is this: Take the time to cherish, learn from, and stumble during your school practicum. Rewrite things, ask questions, and most importantly, make sure you’re in the placement where you will learn best. I’m now navigating my CF in a new building, with new students, new faculty, and a new non-graduate student version of myself. I’m surviving and, even better, also learning something every second (or so it seems). However, I always say that if I had not had the practicum experience that I did, or my handy binder that absorbed it all, I most likely would be crying in a corner hugging my Praxis book!  

Alexis Gaines, MA, CF, is a speech-language pathologist for the New York City Department of Education. She is using Instagram to document her clinical fellowship and you can follow her @practicallyspeeching and #instacfy! You also can follow her blog “Practically Speeching.” She can be reached at practicallyspeeching@gmail.com.

Taming the Wild Editor: How to Get Published in The ASHA Leader

lion

All around the world, wherever their presence is tolerated, editors are notoriously cranky and unreasonable. Some are so ill-tempered, they’re like wild animals. Can you blame them? They would rather be writers to begin with. Instead, these stunted authors toil in bumpy office chairs, sip stale coffee, and cultivate eye strain and stooped shoulders … while they pore over a seemingly endless pageant of manuscripts. Their profession is based almost exclusively on spotting others’ errors—in short, being insufferable curmudgeons. And this wretched life stamps its mark all over a person’s demeanor.

Right about now, you may be thinking: Thank goodness I’m not an editor. Most reasonable readers would agree and share your relief.

But here’s the bad news: If you’re a prospective author for The ASHA Leader, editors not unlike the ones we described above will decide whether your carefully crafted proposal is accepted or rejected. Like hungry (and angry) lions locked in a cage too long without Starbucks coffee, these ferocious editors seek out any signs of weakness in your proposal … and pounce. Call it instinct.

On the other hand, nothing is as soothing to these savage editorial beasts—nothing shines so bright a ray of light into their cluttered lives—as a well-crafted, compelling story proposal. Editors feel satisfied when they find an error, but finding a storyteller fills them with joy. It’s like catnip for editor lions.

So how can a prospective author brighten a downtrodden editor’s life? How can you find a path to safety—and publication—through the famished, circling lions? We’re about to arm you with the chair, whip and confidence you’ll need to tame a pack of wild editors.

In the Leader’s general guidelines, we ask prospective writers to submit a proposal form before they spend time completing an entire manuscript. This is designed to save everyone some time, rather than writing an entire story that may not be suitable for the Leader, or for its upcoming content. And the proposal form includes a checkbox for authors to affirm that they’ve read the Leader’s writer’s guidelines.

The catch, however, is that reading the guidelines typically isn’t sufficient. The Leader’s editors look for proposals that exemplify the guidelines: lively, entertaining stories that provide practical advice or enlightening information about communication sciences and disorders. Every story needs a “hook” to draw the reader in, and should be conversational enough to keep them reading. Write sentences in an active voice. Avoid technical terms, jargon and overuse of acronyms. And per the Associated Press Stylebook, don’t include parenthetical citations in the text.

In short, if an author checks the box affirming he or she has read our writer’s guidelines, we expect the proposal to demonstrate the guidelines. If it doesn’t, the author’s chances of being invited to submit a manuscript are greatly diminished.

Some have wondered whether the Leader is still a science magazine. It absolutely is. But it is not a scholarly journal. As far back as April 1962, James Jerger declared in Asha Magazine his belief that scientific writing can be readable—that it can inspire and inform while appealing to a wide audience. (The full article [PDF] is worth a read.) The Leader’s editors share Jerger’s belief. Instead of presenting concepts only to fellow clinicians, using specialized language and tangled verbiage, we see the redesigned Leader as a vehicle for clinicians to show the public and other professionals (those in CSDs’ many and varied areas) what they do—in language most readers can understand.

So what are the most important things you can do to ensure your proposal’s best chance for acceptance? The first four come straight from Jerger’s article:

  • Write short sentences. Use a new sentence for each new thought.
  • Avoid artificiality and pompous embellishment. Write it the way you would say it.
  • Use active verb construction whenever possible. Avoid the passive voice.
  • Use personal pronouns when it is natural to do so.

Most important, craft your proposal so its inspiring, informative qualities jump off the page. Use a hook. Include sample content that whets the appetite for more. Make the Leader’s editors sit up, take notice and demand to know where your story is going. At the very least, take pains to follow the writer’s guidelines in your proposal.

After all, when you’re fending off wild animals it’s usually best to throw them a bone.

Matthew Cutter is a writer/editor for The ASHA Leader.

How One Bold Adventurer Survived the Opening of Exhibit Hall at Convention (We Think)

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At approximately 8:35 pm on the evening of Thursday, November 14, a sheath of papers and an undeveloped roll of film were recovered by a custodian working in the Posters section of the Exhibit Hall at McCormick Place in Chicago. Tucked snugly under a (still warm) seat cushion, the yellowed, tattered handwritten manuscript and frayed film were rushed to the Leader’s office in Rockville, where they were subject to the most intense scrutiny and interrogation. Satisfied with the integrity of contents, astonished at the revelations contained therein, and aflame with ardent desire to share a unique eyewitness account of a quintessential ASHA convention event, the Leader presents the discovered manuscript in its entirety. For intelligibility, we’ve translated from the original Most Distant, Really Dullest, and Certainly Deadest Tongue.

DEAREST READER: Months of arduous sojourn across twilight epochs and treacherous terrain have brought me to this place, this moment, to this gathering of likeminded intrepid explorers poised to shatter the boundaries of convention and assail terra incognita. Mine is a wandering soul consumed by curiosity and troubled by siren calls beckoning through forbidden entryways. Standing and milling with hundreds of students and professionals outside the Exhibit Hall before it opens on the first day of ASHA convention, I am at last after all these long years among my own kind, again. We all want in, through that entrance blocked by McCormick Place staff. Right now. We’re just not always sure of the reason.

Someone pray tell—why are we here, waiting?

Huddled on the carpet some 20 feet away from the others, three students rapid-fire last night’s anecdotes and today’s possibilities while flipping through convention programs. Purses, askew tote bags and half-drunk cups of coffee ring them. Hmmm…perhaps their obviously keen attention to detail lends insights into why hundreds of us are all just, well, standing here ready to spring into whoknowswhat beyond yonder guarded entranceway.

After a lengthy, cross-city quest for a men’s restroom to change from elegant breeches and ruffles into roughen jeans and a too-plain button down shirt, I approach, ever hopeful, pen poised.

“So, are you waiting to get into the Exhibit Hall?”

Two nods, one dismissive glance back to the program.

“If you don’t mind me asking, why?”

Smiles and a chorus of replies. “I hear there’s lots of cool stuff in there—giveaways.” “My friend’s in charge of a poster session.” “I want to visit the bookstore.”

The latter speaker pauses, leaning forward. “We didn’t realize,” she hiss-whispers, “that there’d be so many people here when it opens!”

“Um…” I try to reassure. “You do know it’s open for all of convention, right?”

Shrugs. Blank stares. Heads return to programs and chatter resumes.

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I next squirm, dodge, and dart my way mightily to the front, hoping to converse with those possessing a vast reservoir of experience with such opening day events. One of the security staff is more than happy to chat.

(Me out of breath after crowd-tunneling extravaganza) “Why…in the world…are there so many people waiting… to get in?”

(Chuckle) “It’s always this way, sir.”

“Any reason for it?”

(Slight shake of head and sigh). “It’s just the way these things go.” (Mt. Vesuvius yell eruption) “MAKE SURE YOU ALL HAVE YOUR BADGES READY FOR INSPECTION!!!”

I scuttle-crawl away, none-the-wiser and God help me, somewhat deafened.

gary2

It’s now about 10 minutes before the opening of the Exhibit Hall, and a most fascinating ritual is occurring. The crowd without prompting or dispute is self-organizing into a single, momentously long, serpentine line that curls and stretches into the distance across the palatial hall. Sitters and standers fall into place; no disputes, just a low murmur of expectancy rippling up and down the line. Calling upon fifth-column skills well-honed for decades in His Majesty’s Most Glorious Topsy-Turvy Revolution, I slip into line, one-third back, without incident.

There’s still time to uncover the answer.  Hmm…perhaps another direction. My laborious research en route here did uncover the venerable Black Friday tradition of frenzied mob trampling while seizing limited time deals. Maybe exhibitors likewise promise opening hour deals?

“Hey, is anyone here to nab a bargain?” I call forward and back.

Universal acknowledgment of query but a stunning silence of reply. A few shakes of heads; one roll of eyes.

Dearest reader, I…still don’t understand. But, what the heck, let’s go along for the ride.

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11 am, zero hour. The line begins moving into the Exhibit Hall past security staff…steady…steady…the quick-stepping of hundreds of feet…we’re a millipede slowly picking up steam…and then the hounds unleash. Back segments of the line press forward and come alongside; we’re now four—nay, eight—across and coming on strong.

Faster. Faster. Oh boy.

A backpack-toting student a few millipede steps in front turns to me, brown eyes flashing and giggling. “Hey mister, you know why we’re here?? Because…it’s FUN!” Bursts of laughter.

We’ve just zipped past security and through the entranceway…rows upon rows of exhibits (staffed by some who seem rather startled by the human torrent) flash by to the right.

Goodness—most of us are surging left, a millipede in mad pursuit of the Poster sessions. Or NSLHA. Sustenance, perhaps? Wafts of downright delicious offerings pour in from 2 o’clock.

Pant. Pant. Fasterfasterfaster.  Woops–someone’s foot. Ouch—stand back, good sir. I must confess it’s most difficult to pen this narrative and properly capture visuals while honoring the press and pace of the crowd.

Oh my God, I can’t believe it! There’s hundreds of–

The narrative unfortunately breaks off at this point. The Leader has no reason to suspect that the author came to a grim, bone-crunching, nasty little end. We suspect that the tantalizing offerings of the Exhibit Hall were enough to draw him away from his sordid tale.

Gary Dunham, PhD, is the director of publications at ASHA. He can be reached at gdunham@asha.org.

Collaboration Corner: Supervision 101

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As a school-based clinician in the Boston area, I’m grateful to have access to some of the greatest learning institutions in the country. As an off-site clinical supervisor, I feel particularly obligated to make all that learning translate into something meaningful. In a public school placement, the school day can become insanely busy. This month I’ve decided to share a few tips that guide me both as a clinical supervisor and a professional.

Create a clear contract of expectations: Provide a copy of the school calendar with holidays, early release days. Provide a week-by-week schedule of expectations, including which specific clients your student will see, and how much supervision will be provided. Include any evaluations, reports and meetings your student will be expected to attend. Provide a mid-term check-in (even if the institution does not require it) and review academic expectations, this way you can give structured and specific feedback.

Know your learner, know thyself: Figure out early in the game, how she or he prefers to get information to you, including email or text messaging. Establish up-front what kind of feedback your student finds helpful, and how/when it is most helpful.  Generally, this seems to work if the student has pretty good insight as to how they function real-time. If they aren’t sure, provide examples. For example, do they mind if you jump in during a session, or do they prefer notes afterward?

Don’t assume anything: I usually get a list of the student’s academic resume and personal experiences. This doesn’t provide me with much information, so I go into the relationship assuming nothing. First, even if my graduate student has experience in a school, each school runs different, and has a unique culture. Second, I can’t assume they have any experience (or minimal experience) working with students like mine. Third and perhaps most importantly, don’t assume reading translates easily into application. A very clever mentor of mine once said, “Remember, you are only as smart as the last thing you read.” This is an important perspective, because not only are you teaching methodology, which brings text to life, but as a supervisor, you are setting the foundation for students’ clinical skills. Show them what they need to learn.

Encourage your student to journal: Reflective learning is the most important part of clinical growth. There is a ton of research supporting opportunities for reflection and professional development. I don’t ask students to show me their journal. I do ask them to take 10 minutes out of their week to sit down and write about two things: something that they learned that week, and something that they need to work to improve. I also encourage them to think larger, not just clinical skills, but interpersonal skills, and how they handled a difficult situation. Then, every other week or so, I have a heart-to-heart on how they think they are doing, and what they think their biggest accomplishes and challenges are thus far.

Leave at least 15 minutes twice daily for check-in: Once in the beginning before school starts to review lesson plans, and then once around lunch or at the end of the day. The first opportunity provides guidance on how to run the lesson; the second should be a chance to discuss how your student perceived the lesson-in-action.

Don’t take the little things for granted: Your students are always learning from you; this includes the good and unfortunately, the not-so-good-but-human moments. How you approach a conflict with a student or co-worker is a lesson. How you are able to comment on your mistakes (a good thing) is a lesson. So remember you are always a role model, not just as an SLP, but as a successful professional. Here’s the best part, I find students make us be the clinicians we want to be; even after a long week of parent conferences, a full moon of behavioral outbursts, or after one too many caffeine-fueled moments, they keep us accountable.

After all, after 16 years, I’m still learning, too.

Kerry Davis, EdD, CCC-SLP, is a city-wide speech-language pathologist in the Boston area. Her areas of interest include working with children with multiple disabilities, inclusion in education and professional development. The views on this blog are her own and do not represent those of her employer. Dr. Davis can be followed on Twitter at @DrKDavisslp.

How to Put the ‘Super’ in Supervisor

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Being a supervisor in any setting brings to mind a myriad of responsibilities. Is it best to guide or direct, monitor or inspect, influence or manage? As a supervisor to well over 120 speech-language pathologists in school settings during the past 15 years, I have learned a lot about duties and people.

Each situation or SLP calls for different handling at different times, but staying true to one’s own supervisory style is most important, I feel. Consistency helps everyone stay connected and working toward mutual goals.

Over the years I have developed a list of seven skills that have, time and again, helped me stay on track and support staff, even when I really had no idea how to handle a particular situation! If the following list can help even one person, I offer it with humility, as I am still learning and growing:

  1. Listen! Actively listen to staff (and parents!). Do not interrupt or begin to form a response until the person is done speaking. Sometimes people only need to be heard.
  2. Be available. Let staff know how, when, where to find you helps alleviate concerns.
  3. Take responsibility for your actions and for those on your staff. Do what you say you will do.
  4. Give credit where credit is due. Usually the best ideas have come from the staff.
  5. Lead, follow or get out of the way. Okay, I stole this one from Thomas Paine, but it is true. Often it is necessary to lead, but recognize and follow a good idea when it is offered. At times, you have to let a staff member figure out a solution for him or herself (this I learned from a seasoned supervisor).
  6. Stay informed. Stay current with knowledge and skills for your area of the field; it is fine to learn from other staff or supervisors.
  7. ACT. Be accountable, credible, trustworthy

Your list may be very different from mine, and I would be happy to compare notes. Supervision has been, by far, my most challenging and interesting job during my 30+ year career in speech-language pathology. And I am honored to be able to work with a dedicated and professional group of individuals! Each one has taught me valuable lessons about coaching, guiding, monitoring and supervising. The staff is truly the most valuable asset, and, as such, honing one’s supervisory skills is critical to your and their success. Good luck!

Janice Tucker, SLP.D, CCC-SLP, is a supervisor of speech-language support programs in Pennsylvania. She is past president of the Pennsylvania Association of Speech Supervisors and past vice president of the Pennsylvania Speech-Language-Hearing Association. She is an affiliate of ASHA Special Interest Groups 16, School-Based Issues, and 18, Telepractice.

A New Twist on Vocational Training

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In April, 2013 I wrote an article challenging SLPs  who work with students with autism spectrum disorder to use our creativity to help our students identify their strengths, interests and even fixations and parlay them into career possibilities (“Gearing Up for Reality,” ASHA Leader Magazine April 2013).

As a result I decided to create a six-week pre-vocational summer camp counselor experience for eight  high school aged male students, many of whom I hadn’t seen for several years. I wanted to offer them the same summer intern experience that typical students are exposed to minus the stresses and fear of failure.  Staff and I wanted this to be a safe and nurturing environment with structures in place to help them navigate the world of work.

The criterion was quite simple; the students needed to commit to work in our summer camp at least three days per week and attend weekly job club meetings where I would address daily living, social, and pre-vocational skills.  Additionally, each student would receive a stipend of $200.00 in exchange for their participation but more importantly to make our discussions on money management real and tangible.  Our program would culminate in a trip to Clear Lake, Calif., for a weekend work experience.

Sadly, our  six weeks have come and gone. I vividly remember how I felt on that first day seeing the boys. I stayed on the verge of tears as they each filed into my office with their parents in tow. Despite their height, good looks, and deep voices I could still see in each of them the little boys who I once knew. As I extended my hand to greet them, each gave me a warm hug. My heart melted!

It was interesting to watch the boys interact with each other on that first day. Some were more socially adept than others but they had all come a long way. In many ways, they were like typical teens sizing each other up and looking for a common ground while seeking acceptance.

During the first week I began to see their personalities unfold.  We had an antagonist, a peacemaker, a social “dude,” a wanna-be grouch with a beautiful smile, a cool diplomat, an “honest Abe,” an easy rider, and the sleeper with a big heart who never ceased to amaze us.  As different as they all were, the thread that bound them all was ASD. I was curious to see how they would adjust to working with the staff who were their bosses, the children who were the clients or consumers and the other assistants who were their colleagues.

During our first club meeting, as I laid out the employee rules, the antagonist challenged me on the “no cell phone” rule.  He wanted to remind me that the phone could be used for more than talking or texting.  After all, what if he wanted to check the time?  I calmly repeated the rule and reminded him that this was a company policy and referred him to the clocks on the walls.  This was nonnegotiable.

Meanwhile, “honest Abe” complained of total exhaustion and became stuck on how challenging the little children were. Interestingly, my sleeper who appeared to not be paying attention, when asked for an opinion said.  “I was like that when I was four and couldn’t talk, but once I learned how,  I didn’t cry as much.” Our diplomat closed it out and reminded everyone that they should “want” to help the kids in the same way “we” had  helped all of them. My heart skipped a beat as I thought how amazing are my boys!

Staff and I marveled as we watched them grow and mature in just six short weeks.  Several of them had worked with the boys in their early years.  We remembered the “social dude” when he had a fixation with fans. He told us that he has turned his fixations into hobbies and then began to tell of his hobby.  We also reminisced about the peacemaker who as a child was extremely shy.  We watched in disbelief as he  reprimanded the group and pleaded for them to allow the antagonist to finish his statement.

On July 19th we boarded our flight to Sacramento, drove two hours to Clear Lake and settled into an unbelievable weekend at the Full Circle Sheep Farm with sisters Eva and Marty who embraced us as if we were family.

Our workday started at 7 am on Saturday and we painted barns, tended the sheep and their lambs, and played with pets Blaze and Malcolm X . We then returned to our Travel Lodge to swim and relax before returning to the farm to paint drawings of sheep on the barns.  The remainder of the evening was spent discussing TrayVon Martin and lessons we could learn from this and similar situations.  Their concerns were valid and we collectively developed strategies to deal with the unexpected.

On Sunday morning we returned to say our goodbyes. The boys surprised all of us as they spontaneously spoke from their hearts about what the experience meant to them and even what they meant to each other. The social dude suggested they should all return not for a weekend but an entire week.  The grouch flashed his beautiful smile and agreed unconditionally.  Honest Abe said, “Lets do it again but somewhere that’s not so hot!”   Our smooth  diplomat said “We are like brothers and I love all of you.”  The sleeper had the last word and said “  I feel so blessed. I want to bring my family here.”  All of the adults fought to fight back our tears of joy.

On the flight home all I could think was “mission accomplished.” My pilot pre-vocational program was a success. The boys have committed to staying in touch and having quarterly activities. They have gotten a taste of the world of work and more importantly, they have learned the importance of giving back. We all agreed autism is a label and it doesn’t define how far we can go in life.  The sky’s the limit.  In the words of my sleeper, I feel so blessed!

Pre-vocational training video

From the blog of Los Angeles Speech and Language Therapy Center, Inc.

 

Pamela Wiley, PhD, CCC-SLP, is the president and founder of Los Angeles Speech and Language Therapy Center, Inc. She can be reached at pswiley@speakla.com.