You Want My Kid to Play in Food? Seriously?

1messykid
Yep, seriously.  For many kids, food exploration begins with just learning to tolerate messy hands and faces. Many parents who bring their kids to feeding therapy have one goal in mind:  Eating. In fact, as a pediatric feeding therapist, a common phrase I hear when observing families at their dinner tables is, “Quit playing with your food and just eat it!”

What parents may not understand is that the child is not avoiding food—the child is experiencing it. For the hesitant eater, this may be where a child needs to start. The palms of our hands and our fingers are rich with nerve endings, but the mouth has even more. Playing with food provides the child with information about size, texture, temperature and the changing properties of food as little hands squish and squash, pat and roll, or just pick up and let go: splat!

Here are three silly ways to play in food!  Give it a try—some of it just may end up in your child’s mouth in the process. But if it doesn’t, don’t  worry. Learning to be an adventurous eater takes time and the most important part of the journey is keeping it fun!

  1. Pudding Car Wash: For kids who can’t tolerate the feel of purees, learning to play in a consistently smooth puree, like chocolate pudding, is the preliminary step to eventually playing in more textured foods, like mashed cauliflower. The key is water.  Most kids who hate to get messy enjoy water play, for obvious reasons.  If they can’t tolerate water play, then that’s the place to start, and eventually they will progress to pudding.  You’ll need:
  • Cookie sheet
  • 2 large bowls—one filled with water and soap bubbles and the other with clean water
  • Small toy cars
  • Chocolate pudding
  • It’s simple! Dump some “mud” (chocolate pudding) on the cookie sheet and you now have a “muddy run raceway” to drive through till the cars are coated!  Pushing a toy car through the mud is much easier than just playing in the mud with a bare hand.  The bigger the car, the easier it is to tolerate the sensation, because less mud gets on the hesitant child’s hand.  Plop the car in the “wash” (the soap bubble water) and then fish it out.  Plop it in the clear water and begin again.  The water adds a bit of relief for the kids who are tactilely defensive, but the fun of driving the cars through the mud provides the reinforcement for getting messy. Warning: This could go on all day—kids love it!
  • Variation: Use plastic animals and wash the entire zoo!
  1. Ice Pop Stir Sticks: For kids who cannot tolerate icy-cold in their mouths, add cups of water to take off the chill. There is a significant difference between straight-from-the-freezer-frozen and just icy-cold.  When fruity ice pops on a stick are dipped in cool water, the surface of the ice pop immediately begins to melt.  Now, when your kiddo takes a lick, they’ll lick off just flavored cold water. Keep stirring and the water becomes darker and more flavorful.  Add a skinny straw so kids try a taste. Coffee stirrers work well for this, because the narrow diameter of the stir stick allows just the tiniest taste to land on the tongue.
  2. Hand Print Animal Pictures: I always shudder when I see kids in daycare having to make “hand print” pictures if I know they have sensory challenges including tactile defensiveness. The well-meaning teacher grabs the child’s tiny hand and pushes it into a paper plate of paint before pressing it onto a piece of construction paper to make the infamous hand print, which is later transformed into an animal to be displayed in the classroom. Or, and for some this may be worse, the kids get their hand painted with a tickly paint brush.  That can be very upsetting for a child who doesn’t like to get messy.  Instead, try starting with the teacher’s own handprint, then encourage the child to use the tip of his index finger or the side of his little thumb to make the eye of the handprint animal. That’s the part of the hand where most kids are willing to tolerate a little mess. Think about how you pick up a slimy worm on the sidewalk…you snag it with just the tip of your index finger and the side of your thumb and then toss it quickly back into your garden. That quick release is key—kids need that too. Over time, they’ll work their way up to making an entire zoo of hand print pictures!  Here’s a video that will help you create three African animals—your own handprint safari!

So, the next time you get frustrated with your child for playing in his or her food—think of the child as a little explorer discovering all the properties of food! Encourage it…. it just might lead to a closer food encounter with the mouth!

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.

 

Beyond Articulation: Don’t Forget Reading

readingal

I have sometimes felt overwhelmed with the number of children on my caseload who struggle with reading.  It shouldn’t surprise me, as spoken language and hearing speech sounds is the foundation for reading text. We know that children with speech and language delays are at risk for reading failure. It’s important for the speech-language pathologist to understand how delays in early sound productions interfere with the process of reading and learn simple interventions to remediate both articulation and early literacy skills at the same time.

It is common to see many children in preschool, kindergarten and first grade struggling with articulation of sounds. Underneath that struggle is a child whose sound/symbol system is weak. That means this system may also be weak in hearing sounds, learning to read sounds and in learning to write sounds. This is the perfect time to get involved with the classroom teacher and use your skills to help all children make sense of sounds and print.  I have found it essential to teach an overlap of skills to the students on my caseload who present with moderate to severe articulation errors.

Reading and speech tips

Here are some general pointers on working on both speech and reading:

  • Review with the kindergarten staff how to teach all students how sounds are made, feel, look and touch as they are introducing alphabet sounds.
  • Talk about where the sounds are made in their mouths. Do they make the sound in the front of their mouth? Do they use airflow? Did their voice turn on or was it off? Was the sound made with their lips or their tongue? This practice helps students connect hearing the sounds to what their mouths are doing when saying them.
  • Teach children the correct way to produce sounds, making sure they don’t begin to add a “schwa” sound like ‘uh” onto the end of their productions. For example, the “f” says /f/ not /fuh/, the “h” says a silent /huh/ not a voiced /huh/, the “t” says /t/ not a voiced /tuh/, the “p” says /p/ not a voiced /puh/ and the “k” says /k/ not a voiced /kuh/. When children learn to produce sounds with the added schwa they may have trouble when they are sounding out words.
  • Be an active participant with the classroom teacher when they begin to assess the letters and sounds a child knows. Offer to help give the assessments and take a close look at the results. It’s amazing what you can learn about a child’s speech sound productions and early reading skills just by a simple sound assessment.
  • Consider an initial sound DVD that is very visual, repetitive and kinesthetically rich. Children can solidify alphabet sounds very quickly when given access to repetitive song-type DVD’s.
  • Phonemic awareness skills taught in the early grades are extremely important for children with speech articulation difficulties. Children need to be able to hear and play with sounds in words. Work with the child on the skills of blending and segmenting simple CVC words using sounds they are working on.
  • Teach classroom teachers and children about voiceless and voiced sound pairs. Make a chart and post it in the classrooms. When children understand how these sounds are related, spelling skills improve.

 

Voice Off Voice On
       f      v
       p      b
       s      z
       t      d
       k      g

 

When a child is reading text

Here are specific things you to can do to help when children read:

  • Use visual reminder cards with children to remind them to use certain reading strategies. A simple strategy card may include strategies such as “Get your mouth ready” or “Say what you see.”
  • “Say what you see” is helpful to say to children when they make an error when reading an initial sound in a word. So when a child is trying to read the word “dog” and he says “fat”, explain that if he sees a “d” in the beginning of the word his mouth has to make that sound.
  • Make simple books with beginning sight words tied to words with the sounds the child is working on. Books like “I see____” or “I like____”. Use blank page books or take a simple book that you own and replace the text with your own, targeting the sounds a child is working on.
  • Every time a child reads out loud they are practicing oral speech sounds.
  • Use highlighter tape to visually highlight the sounds a student is working on. Use the tape in books they are reading or in their writing to draw attention to sounds. Students love to use the tape to cover their sounds while another student in a group is reading.

Sue Lease is a speech-language pathologist at Glacier Edge Elementary School in Verona, Wisconsin. She has a particular interest in emergent literacy in young children.

Kid Confidential: Parent Education and Training, Part 3

1videokid

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

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

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

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

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

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

Maria Del Duca, MS, CCC-SLP, is a pediatric speech-language pathologist in southern Arizona.  She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of ASHA Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced in New Jersey, Maryland, Kansas and now Arizona.  Maria has a passion for early childhood, autism spectrum disorder, rare syndromes, and childhood apraxia of speech.  For more information, visit her blog or find her on Facebook.

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

1book

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

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

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

1horsepic

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

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

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

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

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

Have an inspired school year colleagues!

 

Kerry Davis EdD, CCC-SLP, is a speech-language pathologist in the Boston area, working with children who have significant communication challenges. She conducts trainings and workshops, and serves as a volunteer speech-language pathologist and consultant for Step by Step Guyana, a school for children with autism in South America. The opinions expressed in this post are her own, and not those of her employer.

 

Finding the Right Fit: Social Pragmatics Groups in Middle School

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

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

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

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

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

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

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

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

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

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

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

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

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

blogevaluator

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

Sound familiar?

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

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

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

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

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

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

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

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

AACpic

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

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

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

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

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

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

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

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

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

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

She Didn’t Eat a Thing at School Today!

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

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

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

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

Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating.  She is the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is  offered for ASHA CEUs and includes both her book and CD for each attendee.  She can be reached at Melanie@mymunchbug.com.

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

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

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

When a student begins to receive speech-language treatment.

The SLP can:

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

The teacher can:

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

When the team is gathered for an IEP meeting.

The SLP can:

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

The teacher can:

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

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

The SLP can:

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

The teacher can:

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

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

 

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

Kid Confidential: Parent Education and Training, Part 2

dadandkid

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

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

End-of-therapy session Education/Training

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

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

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

Real-Time Education/Training

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

Tips for effectively using Real-Time Education/Training:

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

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

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

Maria Del Duca, MS, CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona.  She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name.  Maria received her master’s degree from Bloomsburg University of Pennsylvania.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ.  Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech.  For more information, visit her blog or find her on Facebook.