The Possibilities are Endless!

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Having been an SLP since 2004, I know the feeling of “burn out” as well as being comfortable. I have learned that there is far too much opportunity in this field to settle for status quo or unhappiness. Perhaps the most valuable lesson I learned was recognizing that simply venting to family, friends and fellow SLPs was only a short-term solution.  I had to learn to be a doer and motivate myself within my chosen profession.

I often see many Facebook posts about SLPs feeling tired of the profession, often citing endless paperwork, disrespectful supervisors, caseload overload, lack of resources, unreasonable expectations and unfair pay. They are often looking to change careers for a “quick fix” to these problems, but overlook the changes they can make within their profession.

I was feeling frustrated at my district job six years ago and my lack of connection with other SLPs. I did my best to reach out to others and was ultimately nominated by my colleagues to become the lead SLP. That experience empowered me to talk to administration about changing to the 3:1 service delivery model. My presentation worked!

From then on, monthly SLP meetings were built into our indirect weeks and the 15 of us worked and supported each other throughout the school year. Our motto was “we’re all in this together,” because we are the only people who knew what our jobs are like on a day-to-day basis.

Fast forward six years, I loved my position as lead but craved a change. One fateful day I happened to be talking to a friend/fellow SLP in my district who said, “Annick, why don’t we just quit and start our own private practice?” My response, “Why don’t we?” My friend laughed but I wasn’t joking.

That was the question I needed to ask myself. I hadn’t thought about that option before. Coming out of our master’s program, the questions on everyone’s mind were: Are you going to the schools? Hospital? Or private practice? We never asked each other: “Do you think you’ll ever start your own practice?” For me, that question was life altering. Although my friend was kidding, her words were far from a joke for me. Within months, I registered my business, created a website and printed business cards.

I now grow my practice while working as a part-time, school- based SLP. But it doesn’t end there. I supervised three graduate students earlier in my career and one them recommended me to a professor as a possible lecturer. I jumped at that opportunity and have made yet another discovery: I love teaching adults! I am about to begin my second semester teaching college courses.

Looking to the future, I want to continue to teach more classes, build my practice, present at conferences and perhaps look into other areas of our profession such as telepractice and corporate speech therapy. Whatever I do, it is comforting knowing the possibilities are endless within our field.

 

Annick Tumolo, MS, CCC-SLP is currently a school based SLP, lecturer at San Francisco Sate University and founder of Naturally Speaking San Francisco, a private practice specializing in home-based speech and language treatment. She is Hanen certified in It Takes Two To Talk ® and holds a Augmentative and Alternative Communication Assessment and Services Certificate awarded by the Diagnostic Center of Northern California. Like her on Facebook, follow her on Pinterest or contact her at Annick@naturallyspeakingsf.com.

Ten Speech and Language Goals to Target during Food/Drink Preparation

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Food and/or drink preparation can be an excellent way to help facilitate speech and language goals with a variety of clients that span different ages and disabilities.

Below are 10 speech and language goals that you can target during food or drink preparation:

  1. Sequencing: Because recipes follow steps, sequencing can be an ideal goal. If there are too many steps in a recipe then break them up into smaller steps. Take pictures of each step and create a sequencing activity using an app such as Making Sequences or CanPlan.
  2. Literacy: If a recipe has complex language that your client has difficulty reading and processing, modify it. I often rewrite recipes with my clients or use a symbol based writing program like the SymbolSupport app.
  3. Expanding vocabulary: Recipes often contain unfamiliar words. When beginning a recipe, target new vocabulary. If your client is an emergent reader, create visuals for the vocabulary words and use aided language stimulation as you prepare the food and/or drink with her.
  4. Articulation: Target specific sounds during food preparation. Are you targeting /r/ during sessions? Prepare foods that begin with r like raspberries, radishes and rice, or even a color like red!
  5. Describing and Commenting: Food/drink preparation can be an excellent time to describe and comment. Model language and use descriptive words such as gooey, sticky, wet, sweet, etc. Encourage your client to use all five senses during the activity (e.g. It smells like ____, It feels like ______).
  6. Actions: Actions can be an excellent goal during food and/or drink preparation. For example, when baking a simple muffin recipe, the actions such as measure, pour, fill, mix, bake, eat, can be targeted.
  7. Answering “wh” questions: As you are preparing food, ask your client open ended “wh” questions, such as “What are we baking?” or “Why are we adding this sugar to our recipe?” and more.
  8. Problem Solving: Forget the eggs? Hmm, what should we do? How about forgetting the chocolate in chocolate milk? Ask your client different ways of resolving specific problems with food preparation, such as: “What do you do if you are missing an ingredient?” or “What do you do if we add too much of one ingredient?”
  9. Turn Taking: Whether you are working with one or two people, turn taking occurs naturally during baking and/or food preparation. If you are working in a group, make assignments before beginning.
  10. Recalling Information: As you prepare the food/drink, ask your client to recall specific After you are done with the recipe, model language and then ask your client to recall the steps of the recipe.

Preparing even a simple beverage such as chocolate milk can be an excellent activity to engage in during a session. Although it’s made up of only two ingredients, you can still work on a variety of speech and language goals including sequencing, describing, problem solving (e.g. what to do if you put in too much chocolate), actions, turn taking and recalling information.

Here are some helpful apps to use during or after food/drink preparation:

I Get Cooking and Create Recipe Photo Sequence Books

Making Sequences

CanPlan

Kid In Story

SymbolSupport App

For more suggestions, check out my post here on getting a child with special needs involved in the kitchen.

 

Rebecca Eisenberg, MS, CCC-SLP, is a speech-language pathologist, author, instructor, and parent of two young children, who began her website www.gravitybread.com to create a resource for parents to help make mealtime an enriched learning experience. She has worked for many years with both children and adults with developmental disabilities in a variety of settings including schools, day habilitation programs, home care and clinics. She can be reached at becca@gravitybread.com, or you can follow her on Facebook; on Twitter; or on Pinterest.

Six Vocal Myths: Practical Therapy Applications

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We all have a tree of knowledge that represents the intricate experiences that make each of us different and wonderful. Our branches stretch, flower and die only to grow into a more complex labyrinth of information. Once this tree is rooted in ideals, it is difficult to pull out any of the roots, especially if they have been supporting a perfectly healthy tree for many years.

I like science. I find a certain solace in knowing that a randomized control trial was completed in order to prove that I’m not just making you hum through a straw for fun. On the other hand, I completely give merit to the occurrences you can’t explain or rationalize. Some very important moments in my life, especially in my speech-language pathology career, cannot be measured and explained scientifically.

When I was younger, I was petrified that eating before a performance would screw it all up. I can remember vividly, sitting at a Texas Music Educators Association competition as a kid near me consumed an entire slice of pepperoni pizza before disappearing into his audition room. He leaned over and smiled, “It’s always good luck for me.” I was aghast, and I hope my face did not reflect what was going on in my head. Food? I thought. Before singing? NEVER! But, why did I believe so strongly that the voice gods would shun me if I ate a bite of anything? Should superstitions be revered? Is it really all in my head?

I posed that question to a few forums I belong to, both vocal pedagogy and vocal pathology. Along with comments and emails that flooded my inbox, the University of Minnesota and Truman State University brought me a study by Julia Edgar and Deirdre Michael that surveyed almost 400 singers about their beliefs in vocal health. The only thing everyone could really agree on? A whopping 97 percent believed that warming up before performing benefits the voice. That’s it. The rest of the answers were as scattered as an Admission, Review, and Dismissal team after the final meeting before summer break.

I pulled together the most interesting beliefs and did my best to find scientific evidence to aid in proving or refuting. I have questions from the professional singers I treat about many of these subjects, so what better way to debunk the myths? What I found was that many people hold their beliefs dear and are not willing to lend an ear to anything that might refute what gets them through a gig. So, what are we as SLPs to do? Do we believe in Grandma Sue’s recipes? Do we believe in science? Do we believe in experience? Do we believe in life after love? Sorry, Cher kind of snuck in there.

  1. Smoking marijuana and vaping is not damaging to the vocal folds like cigarettes are Reinke’s Edema, tissue damage in the form of gelatinous goo just below the top layer of the vocal folds, commonly occurs from smoking.  A study here discusses the effects of cigarette smoke on the delicate tissues of the vocal folds. Even the vocal folds of rats changed after passive inhalation of smoke. So that sets you straight…right? Not quite. A student told me that an alarmingly high number of voice performance students at her school claimed smoking marijuana and vapor cigarettes will not damage the vocal folds. Although there are not yet any published studies specifically about the effects of vaping on the vocal cords, a study here found that electronic cigarettes contain less carcinogenic ingredients than their tobacco counterparts, however less does not mean none. There is also concern that propylene glycol irritates the respiratory tract. (PG is just a fancy word for stage smoke.) Despite more than 1,000 studies on electronic cigarettes, conclusions cannot be made on their safety or danger because of contradictions and inconsistencies in methodology. Get it together people…I think people are learning this and deciding ECs are safe to smoke because of the lack of evidence. Perhaps they are fishing for an excuse. Perhaps they are avid consumers of research. In my clinical opinion, you are still inhaling something that is manufactured and exposing your most delicate tissues to foreign materials that may or may not be toxic. An article in the Guardian states that those who smoke ECs think the water vapor is safe, they brush off the PG as an irritant, and smoke them anyway. As for the marijuana, aside from altering perception and most likely performance, it is heated just like cigarette smoke and any smoke will irritate your tissue.

Bottom Line: Smoke can change the composition of your tissue. If you don’t inhale foreign material, your vocal folds will likely maintain their health.

  1. Throat Coat Tea and Entertainer’s Secret are a sore throat cure-allA 2004 study on the effects of laryngeal lubricants, like Entertainer’s Secret, revealed that even if a spray affects the vocal fold vibratory pressure, after 20 minutes it is like you never used it. Throat Coat tea contains slippery elm bark, a demulcent that soothes irritated tissue, and is not FDA approved to cure anything. There are no studies on how it directly affects the voice, but the steam from a hot beverage most likely will topically hydrate your vocal folds as you inhale, so that’s a plus. A hydrating beverage will provide you with internal hydration to lubricate the vocal folds from within the body. Like any pain, though, if your throat is hurting, don’t mask the problem by using numbing spray or another band-aid.  Your body is trying to tell you something and if you silence it, you could injure yourself further. Know your body.  I’m all for throat coat tea, ginger tea, lemon water, whatever–If you say it helps you feel better. I am against using any of that to hide pain so you can perform. If you are not giving your body time to heal, you’ll end up with a bigger problem.

Bottom Line: Using any crutch will usually get you through a performance, but “getting through” something may backfire on you. Instead, try to maintain a balance by keeping your body healthy, listening to it, and caring for your vocal folds even more fervently because you can’t see them.

  1. Whispering is a good idea to save your voice when on vocal rest. I was informed when I received voice therapy myself that I was not allowed to talk or whisper for a week following my surgery. Some people say the real myth is that whispering is as bad as shouting. Is it? For her own voice issues, an SLP who received treatment like me, was told that whispering would save the voice, but she found it to increase fatigue and pain for her. Go figure. Shouting and whispering differ in placement and technique, but whispering can sometimes turn into a hyperfunctional breathy voice where vocal production is made with an incomplete vocal fold closure. Ah, there’s the danger. A study in 2006 examined 100 patients with a fiberoptic camera. Only 70 percent of the patients showed supraglottic hyperfunction while whispering, meaning some of them had no hyperfunction at all. Other muscles are involved in whispering, and people whisper differently, so some studies suggest that whispering, when low in effort, can be considered for post-op patients.

Bottom Line: Whispering could turn into a poor vocal production habit in the majority of patients, so better to avoid it or monitor it closely on a case-by-case basis. If you were to whisper with a completely relaxed larynx, it’s hard to get adequate volume anyway. Tell them to text. Don’t we all have smart phones glued to our thumbs?

  1. Dairy products thicken my mucus. Recent publications have demonstrated that dairy products do nothing to chemically increase mucus production or viscosity, but why does the myth remain? A group of investigators from New York examined 21 individuals, half with asthma and half without, to see if milk increased mucus. It suggested that airway resistance was not altered by milk consumption, so no thicker mucus here. Perhaps if there is a milk allergy, the body will have a reaction to it? That might explain the widely-held belief that mucus will “gunk up vocal cords” and should be avoided. Unfortunately, I could not find any research studies about mucus thickening after eating or drinking dairy. Another study states that some people with asthma may see an improvement after eliminating dairy from their diets, however, it does not definitively prove that mucus production increases because of dairy products.

Bottom Line: You can throw science at your patients, but they may remain convinced that milk will gunk things up. You might be fighting a losing battle, but hey, at least calcium comes from other sources.

  1. Eating or drinking certain foods (or abstaining from them) will improve your performance. Okay, here we are with pizza singing boy again. He obviously thought that the pizza was his golden ticket for the American Idol of Texas choir competitions. Some performers believe licorice before a gig helps improve vocal range. One singer would consume an entire bag of licorice prior to a performance. Is this a placebo? After discussing, he stopped and the range remained the same. Hmm…. What about those singers that tell you eating Lays potato chips will lubricate their throats? Is this only in Nashville? What you eat and drink will not touch your vocal folds, it only touches the tongue, soft palate, throat walls and esophagus. If it is touching your vocal folds, you are aspirating! A recent post on a professional voice teaching thread inquired about what teachers advised singers to drink to lubricate their cords. Home remedies included vinegar, garlic, ginger, olive oil, sugar, and even aloe vera. None of these have scientific evidence that they are harmful to the voice, so if you think it helps, then by all means. Nothing really lubricates the cords from the outside, but drinking hydrating beverages lubricates from the inside, so this is kind of true…kind of…Just make sure you don’t become a yummy snack for your speech therapist if you come in smelling like an Italian dish.

Bottom Line: Hydration, Hydration, Hydration. There is no scientific evidence that certain foods or beverages will improve or hinder your performance. Water will always benefit the friction and heat created by your vocal folds by lubricating them on a cellular level. See also, my previous blog on beta-blockers and performance if your patient is considering anti-anxiety meds along with the olive-oil rub.

  1. Cold beverages, caffeine and alcohol are bad for your voice. A student at one of my lectures saw me drinking ice cold water in my handy Tervis cup. Those things are indestructible and I have one for every day of the week. Obsessed? Maybe. There is no evidence to suggest that cold water is bad for your vocal cords, I told him. Beer actually counts toward hydration, interestingly enough. These researchers found that when you are dehydrated, drinking beer will not only get you drunk, but hydrate you as well. Caffeine was found to usually not impact vocal acoustics if consumed conservatively (100mg), and this study showed that caffeine did not adversely affect voice production at all. Also, not related to voice specifically, this study suggested that coffee even hydrated similarly to water.

Bottom Line: Cold or hot, it’s your choice. And when there’s a choice, go with water over alcohol. Caffeine consumption should be examined along with other factors when recommending cessation in the therapy room. When I look at this, I think, Starbucks? Why not.

We have to be careful when presenting new information. Try hard not to claim information already known to be erroneous. Many established teaching professionals have been molding and creating performers for years, and trying to reveal a “new” truth might be unwelcome. Can we not bridge this gap between pedagogy and therapy? Between art and science? After all, the voice is both, isn’t it? Many SLPs told me they are afraid to challenge any voice teacher because they might get brushed off. I want to change this “challenge” to “suggest.”

If we are cognizant of the training and education of others, we can present information in a way that is not patronizing. And if we are open to new ideas from different sources, (I am so guilty of this too) then we might find that it works in our studios and clinics. One contributor had the most poignant response. “People become defensive sometimes when they are confronted by their own knowledge gaps, but hopefully they’ll internalize the information and emerge the better for having heard it.”

 

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She provides voice, swallowing and speech therapy in her own private practice, a tempo Voice Center, LLC. She also lectures on the singing voice to area choirs and students. She belongs to ASHA’s Special Interest Group 3-Voice and Voice Disorders. She keeps a blog on her website at www.atempovoicecenter.com. Follow her on Twitter @atempovoice or like her on Facebook at www.facebook.com/atempovoicecenter.

Happy New Year, ASHA Family!

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Happy New Year to my whole ASHA family – those dedicated to helping people achieve “human wholeness!” I am so proud to be part of this profession and believe I was predestined to be an SLP. The first movie I remember seeing in a theater was My Fair Lady. I’ve since become a modern-day Henry Higgins and even have worked with university teaching assistants on accent reduction! I was also a recipient of the care engendered by those in my as-yet-unchosen field when an amazing neurologist and SLP “asked me questions” (a child’s interpretation of diagnostics) and guided my family during my recovery from a head injury significant enough to require last rites in 1971. 

Although a practicing member for more than 25 years, I didn’t attend my first ASHA convention until 2013. I went to update my clinical and research skills, but also to visit school friends from Northwestern who still live in Chicago. I particularly enjoyed the courses presented by a then recent ASHA fellow and complimented her in our hotel elevator. I also asked a question about spring 2014 events. She not only answered my questions, but allowed my family to stay in her family’s home during our visit!

One Chicago friend (an organizational psychologist) was shocked at the friendliness and trust exemplified by even the offer of such hospitality and further astounded when I told her nearly 15,000 people attended the 2013 conference. I explained that ASHA members are friendly, helpful people. That presenter and new acquaintance was no fool, however, she did her due diligence and called my current work ‘family’ to vet my responsibility.  I, in turn, offered her the use of our Orlando lake home as she celebrated being named “Fellow” with her family.

That story shows how I, and many of my peers, view ASHA as a large extended family, which was reinforced by my encounters at the 2014 “Generations of Discovery” convention. Harry Belafonte, along with his daughter and granddaughter, highlighted how family focus has directed their lives. At the awards event, Annie Glenn explained how services such as her 1973 stuttering therapy, “save us from being solitary souls,” while father-son TV journalists the Geists received her “Annie” Award for their communication contributions. Honors of the Association recipient, Nan Bernstein-Ratner, gushed that obtaining the Glenns’ autographs on a photo and copy of  the Geists’ book, The Right Stuff, for her son were her most moving moments of the convention. Voice expert Daniel Boone shared how excited he was that his son and granddaughter were visiting from Tampa. We were saddened by Jeri Logemann’s passing, but her impact is ever present, from the pins at an exhibitor’s display to shared remembrances of a holiday party at her home.

None of us are “solitary souls” and our uniquely human abilities to enjoy conversing and sharing with our families and friends are a testament to the vital work each of us has chosen to undertake. For the new year, I wish my ASHA family wisdom (recalling John Rosenbek’s closing session’s  “Neuroplasticity” message that we “First do no harm”), a wealth of well-wishers (for our world has its woes), and work as we help heal the world in 2015!


Denise Dancull, M.A., CCC-SLP
is a pediatric SLP with more than 25 years experience specializing in cleft palate and cochlear implant services. Please feel free to contact this proud parent, bibliophile and theater fan at denise.dancull@nemours.org.

Picky Eaters in the Preschool Classroom: 7 Tips for Teachers

Two scoop sizes allow children to select a smaller portion for unfamiliar foods.

Two scoop sizes allow children to select a smaller portion of unfamiliar foods.

As a pediatric feeding therapist, part of working in the child’s natural environment is making regular preschool visits to offer teachers and staff guidance when a child is not eagerly participating in mealtimes. Whether a child is a selective eater or the more common picky-eater, here are seven tips for teachers that focus on the seven senses involved in food exploration and eating:

  1. Sight: New foods are better accepted when the sight of them is underwhelming. When serving foods family style, include TWO utensils for scooping from the main bowl or platter [see above]. Present each food with one larger scoop and a standard spoon. The kids at the table can choose which scoop/spoon they would like to use, which allows the more hesitant eater to choose a small sample instead of what might feel like an overwhelming shovel-full. If meals are served pre-plated, offer smaller portions (1 tablespoon) of new foods and allow the kids to request more after their first taste.
  2. Smell: Warm foods often have a stronger aroma and for some kids, this can be a quick turn-off before the food ventures toward their lips. In regards to the hesitant eater, begin passing the bowl of warm foods so that it ends up at his seat last, when it will be less aromatic. For meals that are pre-plated, simply dish up his first but place it in front of him last, so that the food has time to cool a bit. Straws are an excellent option for soups, because they allow the child to sample by sipping. The longer the straw, the farther away they are from the smell. The shorter the straw, the less distance the soup needs to travel to reach the tongue, but the closer the nose is to the aroma. Consider what suits each child best and adjust accordingly. Thinner straws allow for a smaller amount of soup to land on the tongue, but if the soup is thick, you may need a slightly wider straw. Keeping the portion as small as possible also keeps the aroma to a “just right” amount for little noses. Try tiny espresso cups, often under $2, for serving any new beverage, soup or sauce.
    espresso cups
  3. Taste: Experiencing food doesn’t always mean we taste it every time. If the best a hesitant eater can do that day is help dish up the plates or lick a new food, that’s a good start! But when it comes to chewing, encourage kids to taste a new food with their “dinosaur teeth.” A fun option are these inexpensive tasting spoons commonly found in ice cream shops. Keep a small container in the center of the table for kids to take tiny sample tastes direct from their plates.
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  4. Touch: Like any new tactile sensation, few of us place our entire hand into a new substance with gusto. It’s more likely that we’ll interact with a new tactile sensation by first using the tip of one finger or the side of our thumb. Take it slow – and remember that touch doesn’t just involve fingers and hands. The inside of the mouth has more nerve endings than many parts of our bodies, so it may be the last place that the hesitant eater wants to experience a new texture, temperature or other type of sensation. Start with where he can interact and build from there.
  5. Sound: The preschool classroom is abuzz with activity and thus, noise. Beginning each snack or mealtime with a song or a ritual, such as gently ringing some wind chimes to signal “it’s time to be together with our food” is a routine that centers both teachers and children. Whatever the ritual, involve the most hesitant eaters in the process and encourage their parents to follow the same routine at home if possible. Kids do best with when routines are consistent across environments.
  6. Proprioceptive Input: The sense of proprioception has a lot to do with adventurous eating. One fun routine that provides the proprioceptive input to help us focus is marching! In one preschool classroom, we implemented a daily routine where the kids picked a food and marched around the table with it as a way to mark the beginning of a meal and provide that much-needed stomping that is calming and organizing for our bodies. Download the song “The Food Goes Marching” here (free till February 1, 2015) as the perfect accompaniment!
  7. Vestibular Sense: While we all know the importance of a balanced diet, you may not be aware that a child’s sense of balance has a lot to do with trying new foods! Our sense of balance and movement, originating in the inner ear and known as the vestibular system, is the foundation for allfine motor skills. In order to feel grounded and stable, kids need a solid foundation under the “feet and seat.” Many classroom chairs leave preschoolers with little support and feet dangling. Create a footrest by duct taping old text or phone books together or if you’re extra handy, create a step stool that allows the chair legs to sit inside the stool itself.
    footrest
    An inexpensive version can be made with a box of canned baked beans from COSTCO, like this one. Carefully open the box because you’ll be using it again to create the footrest. Simply remove the cans, empty just two, then rinse thoroughly and discard the lids. Now place the cans back in the box with the two empty cans facing up, so that the legs of the chair will poke through the box and into those two cans. Reinforce with duct tape. Instant footrest!

Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating.  She is the co-author of Parenting in the Kitchen: How to Raise Happy and Healthy Eaters in Our Chicken Nugget World (Aug. 2015), 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.  She can be reached at Melanie@mymunchbug.com.  

CSD Students Use Their Skills in Ethiopia This Month

   

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

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

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

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

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

 

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

Our Profession’s Biggest Open Secret

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

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

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

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

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

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

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

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

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

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

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

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

Pediatric Feeding Tops the Charts in 2014

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From stuttering to aphasia, hearing loss to hearing aids, early intervention to telepractice and more, ASHA’s blog posts are written by you—our members—sharing knowledge with peers on a variety of subjects. But there’s no doubt about it, pediatric feeding has been the topic on ASHAsphere in 2014!

Check out your five favorite posts from last year:

Step Away From the Sippy Cup!

SLP Melanie Potock specializes in pediatric feeding and explains that sippy cups were created to keep floors clean, not as a tool to be used for developing oral motor skills.

“Sippy cups were invented for parents, not for kids. The next transition from breast and/or bottle is to learn to drink from an open cup held by an adult in order to limit spills or to learn to drink from a straw cup. Once a child transitions to a cup with a straw, I suggest cutting down the straw so that the child can just get his lips around it, but can’t anchor his tongue underneath it.” – Potock

Baby Led Weaning: A Developmental Perspective

For parents interested in following the Baby Led Weaning (BLW) philosophy of pediatric feeding, which states that babies are developmentally capable of reaching for food and putting it in their mouths at about 6 months of age, SLP Melanie Potock shares some thoughts to consider.

“For children in feeding therapy, incorporating some aspects of BLW is dependent on that child’s individual delays or challenges and where they are in the developmental process, regardless of chronological age. My primary concern for any child is safety—be aware and be informed, while respecting each family’s mealtime culture.” – Potock

Collaboration Corner: 10 Easy Tips for Parents to Support Language

Paying attention to body language, reading every day and using pictures are just a few tips SLP Kerry Davis shares with parents to support their child’s language development.

“Take pictures of your child’s day and talk about what is coming up next, or make a photo album of fun activities (vacation, going out for ice cream) to talk about.” – Davis

What SLPs Need to Know About the Medical Side of Pediatric Feeding

To overcome pediatric feeding problems, SLP Krisi Brackett explains the importance of first figuring out why the child’s in a food rut.

“Whether the child is dependent on tube feedings, not moving to textured foods, grazing on snack foods throughout the day, failing to thrive, pocketing foods or spitting foods out, using medical management strategies can greatly improve a child’s success in feeding therapy.” – Brackett

Preventing Food Jags: What’s a Parent to Do?

For kids who only eat a limited number of foods, it can be difficult for parents to provide the right nutrition for their kids. SLP Melanie Potock shares her top 10 suggestions for preventing food jag.

“Food Left on the Plate is NOT Wasted: Even if it ends up in the compost, the purpose of the food’s presence on a child’s plate is for him to see it, smell it, touch it, hear it crunch under his fork and  perhaps, taste it.  So if the best he can do is pick it up and chat with you about the properties of green beans, then hurray!  That’s never a waste, because he’s learning about a new food.” – Potock

 

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Sara Mischo is the web producer at ASHA. She can be reached at smischo@asha.org.

“Play It Again, Sam”: How the Use of Music is Reawakening the Minds of Many Individuals Battling Dementia.

Man listening to music

To say there has been a recent increase of videos on the web highlighting the power of music with individuals with dementia would be a vast understatement. From caregiver videos flooding YouTube to more carefully crafted films, such as Alive Inside, exploding on the scene, the individual stories being told are nothing short of remarkable.

But what does this mean for us as speech and language pathologists? And what does research say about the overwhelming number of anecdotal stories being touted on the internet? The answer to both questions is, A LOT! Many resources, such as the nonprofit organization MUSIC & MEMORY, now offer an extensive list of research citations that highlight the clinical benefits that listening to music can have on cognition and communication. It’s not just researchers taking notice of the mounting evidence. As the Centers for Medicare & Medicaid Services makes a push to decrease inappropriate use of antipsychotic drugs in long-term care settings, some of its efforts go toward funding personalized music programs to help address agitation and other behavioral concerns in a non-pharmacological way. Many states are also embracing this approach with great clinical outcomes to report.

So do we all switch professions and become music therapists? Of course not. The need for skilled speech therapists to directly target cognitive-linguistic deficits in long-term care settings is more important now than ever as the aging of our population and the dramatic rise in dementing illness converge, but the research and these dramatic personal stories should make us take pause and reconsider the environments in which we practice. As therapists we have a unique opportunity and perspective to be client advocates.

What information can we share, what videos can we show and whose life can we touch to be a catalyst for change in our communities? Consider your impact and take action today. Still need convincing? Let me leave you with one final image. Watch as Naomi Feil, founder of Validation Therapy, makes a power connection with Ms. Gladys Wilson. I wonder how many speech therapy screen forms were sitting in her medical chart stating she was “non-communicative” when this was filmed.

Robert Maxwell, MA, CCC-SLP is a speech-Language pathologist and clinical specialist for Genesis Rehab Services. He currently chairs the dementia special interest group for Genesis Rehab Services and has presented on the company, local, state and national level with regards to cognitive-linguistic and swallowing deficits related to the dementia population. He can be reached via email at: Robert.Maxwell1@genesishcc.com

Are You Wearing Your Play-Based Hat Today?

Importance of play

Ever leave the house and not know what to wear? As an early intervention SLP, I wear many hats, and there are days when I’m not sure which hat (or hats) I’ll put on. As any therapist knows, the nature of our job is not just treatment related, but often much more. Of course the hat I wear most often is my speech therapy hat but when I enter the homes of my “kids” every week I sometimes encounter life that requires me to be more than just an SLP.

There is a trust that forms when you regularly enter someone’s home. Families respect you not only as their child’s SLP, but also as a resource for other parenting questions. These questions might require my community resource hat, my fellow parent hat or my support hat. Because the parents of our clients trust us to meet many needs, it is important that when they ask questions or seek guidance we are there to help.

For example, many families today experience a societal pressure to push their child well beyond what is developmentally appropriate. Parents set unrealistic expectations for their children and panic if they feel their child isn’t “keeping up.” I’m concerned when I enter homes filled with obscene piles of toys, a television constantly going and a toddler who manipulates my phone and tablet more skillfully than I do! Through my sessions I model play, in the absence of fancy toys and electronic devices, hoping the parents will realize how simply PLAYING with their child is enough. There’s no better way to achieve developmental milestones and enrich children than through play.

Sometimes my example isn’t enough…well OK, it’s often not enough. So frequently I have a conversation about age-appropriate expectations, age-appropriate toys and what children need most from their parents.

When pondering how to start this conversation, I often find myself asking: What can I do to educate families on the importance of play? What can I say to drive home age-appropriate expectations? What are some of the most important points to stress to the families I serve? Professionally, I branched into owning a business devoted to play, plus I learned about how play is changing and why it matters.

Here are some tips you may find helpful to educate parents about the importance of simple play:

• Remind families that children need unstructured playtime and give specific examples of what is learned when a child does “nothing.” A toddler’s day should consist mostly of unstructured play and opportunities to experience their world with all their senses. Tell parents that this is the best way for their child to learn.

• Share with parents the American Academy of Pediatrics’ recommendation of no screen time before age 2 and only two hours per day for children older than 2. Parents are usually shocked to hear this, but even a television in the background distracts a baby/toddler and can make it more difficult for them to focus and learn.

• Inform parents that babies and toddlers do not truly learn anything from flashcards. The powerful marketing beast can sell just about anything to an anxious parent who wants that best for her child. However, research and experience do not support their use, particularly at such an early age. Share what you know about play-based options for teaching language skills.

• Encourage parents to slow down and follow their instincts. Oftentimes parents know what’s best for their child, but are influenced by outside sources. As professionals, we can reassure parents to trust themselves.

If you are an EI SLP I hope you realize your importance not only in the life of the child you serve, but his family as well. You are appreciated and trusted, so may you guide your families so that they are able to enjoy the miracle of their child to the fullest. Choose your hats wisely and don’t keep all that knowledge about PLAY under your hat. We all have a role in supporting families and enriching children’s lives.

Lacy Morise, MS, CCC-SLP of Berryville, Virginia works for the West Virginia Birth to Three Program as an early intervention therapist. She also owns Milestones & Miracles (with her EI PT bestie, Nicole Sergent, MPT) Read her blog and like her on Facebook, follow her on Twitter @milestonesm and Pinterest