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

 

ASHA always welcomes new blog contributers. Interested? Apply to here become an ASHAsphere blogger.

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.

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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

“Cuz You Know I’m All About That Case, Node Trouble”

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Meghan Trainor’s song is so popular that excellent covers are popping up everywhere and I think there is a strong possibility of another definition of “bass” being added to the dictionary by next year. Now, while Meghan has no history of voice issues that I am aware of, others in the spotlight have suffered from vocal pathologies so severe that they have had to cancel tours and even rehabilitate their singing voices for years before performing live again.

Voice care has been in the media recently and I think it is important for clinicians to understand exactly what is going on with these popular cases because it will help them answer tough questions. I am always reading whatever I can get my hands on. I know that most SLP’s and AuD’s out there barely have time to dash to the bathroom during a work day, let alone to thoroughly read a peer-reviewed research study. It is our duty as clinicians to have a strong commitment to lifelong learning because our abilities as competent care providers are supported by the information we can synthesize on the spot. It is always okay to say, “I don’t know,” however, I always feel extra special when I can say: “I read about this last week.”

Not having enough information on a topic usually leads to accusations and rash decision making. I had a client recently ask about the procedure that was performed on Joan Rivers, which ended up causing her death. “Don’t you do that?” she asked. I explained that although I do not biopsy vocal cords, I do look at them with a camera and the patient needs to be awake so he or she can say “eeeeee.” I went on to explain that topical anesthetic is sometimes used when the gag reflex is particularly sensitive, but no patient of mine is ever sedated for an exam. Joan Rivers had some unplanned things happen during her procedure and because her healthcare information is private, just like any patient’s, we are left to read and watch news stories compiled with some facts missing.

Most of us know that Julie Andrews had great success with “The Sound of Music” and “Mary Poppins,” but many might not know that she battled with vocal nodules, also called nodes, in the 1990’s. Speech-Language Pathologists know now that vocal nodules usually respond to behavioral voice therapy without needing surgical intervention. Julie had her nodules removed in 1997, but the surgery left her with the inability to sing. We wonder, as we do in Joan’s case, what actually happened. If Julie had noncancerous nodules and her behaviors were addressed, perhaps surgery wouldn’t have been necessary at all. Nodules shouldn’t come back if the vocally abusive behaviors are replaced with efficient vocal production techniques. We don’t know if Julie had any voice therapy, but we can speculate that she most likely had scar tissue develop where the nodes were removed. Scar tissue inhibits the vocal fold tissue’s elastic properties resulting in pitch breaks or periods of aphonia.

Nodes have also been addressed by mainstream media in the movie “Pitch Perfect.” Chloe tells the Bellas she has vocal nodes in a dramatic scene, but reveals she has continued to sing despite the diagnosis because she loves it so much. We can’t be expected to know every movie or pop-culture reference to our profession, but it helps to be aware so we can connect to younger clients. Chloe’s story is all too familiar. Some clients find it very difficult to follow treatments because their jobs depend on voice use or they are passionate about performing. It is essential to communicate the importance of adhering to all voice therapy recommendations. Explain that while you understand their passion for their craft, you know that they will have more heartache later if they don’t take time to correct behaviors now.

John Mayer very recently opened up on Twitter to discuss his long and emotional struggle with a granuloma. He says, “It’s 2 years to the day that I had my vocal cords paralyzed so they could heal. It took about as long to get all of my voice back. I can’t tell you how good it feels to hit those notes. Especially on new songs. I’m free again. So grateful.” Well done, John. As clinicians, it’s important that we educate our clients about the length of recovery time, especially for professional voice users.

Polyps have plagued singers like Adele and Keith Urban. Adele reportedly used an app on her phone to speak for her while she was on voice rest for her hemorrhagic polyp, but I wonder if she knew about this avatar program. Technology is readily available these days to improve success for any clients on vocal rest. Both performers underwent surgery to correct these conditions, and hopefully some voice therapy too, as polyps and hemorrhages are functionally caused vocal pathologies. There are four different classes of voice disorders: Functional, Neurological, Organic and Idiopathic. With Adele and Keith’s conditions falling under the functional category, voice therapy could reverse bad habits and keep them from developing any future lesions.

Have you ever provided therapy to a famous client? I know you couldn’t tell anyone even if you have, but it’s pretty exciting, right? Sometimes we need a reminder that a high-profile client’s plan of care should be given the same attention as any other on our caseload. It is okay to feel star struck, but remember to remain calm and collected. Any famous clients will thank you for your professionalism and remember how your intervention helped them get back to doing what they love. Trust me on this one.

So whether your patient is red-carpet-ready or your average-Joe, be knowledgeable and treat clients with equal respect and care so you can “bring savvy back” and be “all about that case.

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.

 

On the Road Again: ASHA Convention and Telepractice

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I admit it. I am an ASHA convention regular attendee. I am the SLP you see year after year collecting large yellow tote bags, company pens and my new favorite—nail files. This year, I even lined up to have my professional photo taken for my LinkedIn profile. I take in all that the ASHA convention offers, and my schedule allows, year after year.

One reason why the ASHA convention is so important to me is that I rarely stay in one place very long. I am the spouse of an active duty military officer. Therefore, I move a lot. With each move (eight so far), I’ve attended ASHA with a new job title: Department of Defense school SLP, hospital SLP, staff SLP, Lead SLP… This year, I attended ASHA as an SLP that works via telepractice. I deliver services and perform assessments via an online, custom built platform. I’m several states away from my students but I am licensed in the state where they reside and the state in which I reside. Using my home computer(s), a headset, webcam and high-speed internet connection with plenty of bandwidth, I treat, assess and collaborate with other SLPs, school staff and parents daily.

At this year’s convention, I encountered some surprising conversations regarding telepractice. I was met with responses ranging from: “Telepractice. I’m not so sure how I feel about that,” to “Yes, I’ve been looking into doing that. How does it work?” When embarking on a career in telepractice as a service delivery model, I was skeptical too. Was it ethical, effective and authorized? After researching ASHA’s rules and state bylaws, I put my feet in the water. That was four years ago.

During the ASHA convention, I was pleased to attend an increasing number of sessions focused on telepractice. However, these sessions highlighted the work and research still to be done to prove the effectiveness of telepractice as a service delivery model (especially with regards to culturally and linguistically diverse populations).

I still wonder, does an increase in sessions and visibility at the ASHA convention translate to increased acceptance/adoption by SLPs on the ground?

Telepractice is established and has been used in the medical field for more than 40 years. The American Telemedicine Association states that “telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a variety of applications including two-way videos, smart phones, tablets, wireless tools and other forms of technology.” According to ATA, “the use of telemedicine has spread rapidly and is now becoming integrated into the ongoing operations of hospitals, specialty departments, home health agencies and private physician offices as well as consumers’ homes and workplaces.”

I am looking forward to next year’s ASHA convention in Denver. I am already wondering about the sessions, networking opportunities and of course the pens and highlighters. Most of all, I’m looking forward to attending ASHA again as a SLP working via telepractice and the discussions that will surely follow.

Lesley Edwards-Gaither , MA, CCC-SLP, is a Speech-Language Pathologist in the Washington D.C. area.  She is a Lead SLP with PresenceLearning and an affiliate of Special Interest Group 18, Telepractice. She can be reached at legaitherslp@gmail.com

 

Collaboration Corner: 5 Take-Aways to Support AAC, Apps and Language

TEchnology and augmentative and alternative communication

This past month, my colleague Sean Sweeney (AKA @speechtechie) and I had the opportunity to join forces and write about AAC, apps and literacy development. Our article will be in the next issue of SIG 12: Perspectives in Augmentative and Alternative Communication.

This gave us a great opportunity to discuss how AAC users can benefit from apps to enhance treatment outcomes. Here are five highlights:

Feature matching is important: When choosing AAC or apps for learning, the tool must meet the needs of the user. For AAC, this includes the size, layout and physical accessibility of features to maximize independent use. For apps, this includes Sean’s FIVES criteria, which examines the context, appropriateness, accessibility and therapeutic considerations for learning. Just like any other tool in your kit, if it isn’t a good match then opportunities for communication or learning are potentially lost.

Make CORE align with the CORE: Using generative language formats, including core and fringe word vocabulary, benefits the student two-fold: building in opportunities for language growth throughout the day, while also meeting those pesky Common Core Standards. For example, a first grade ELA standard CCSS.ELA-Literacy.L.1.1.c, “Use singular and plural nouns with matching verbs in basic sentences.” Using core vocabulary allows the student to meet this standard through basic sentence construction activities. A first grader may enjoy learning this through the “Collins Big Cat” series, a free app that reads stories out loud and then has the option of the student recording his voice (or in this case, synthesized voice). The app also has a more interactive component, which allows the student to build scenes and narrate his own version of the story.

Apps and AAC are powerful together: Students love the interactive nature of apps. “Toca Hair Salon” is a highly interactive hair salon studio allowing students to describe how they are going to cut, color or otherwise coif the animal or person of choice. Another simple app, “Pogg,” is a cute alien that hops, sings and performs other actions, all at your student’s direction during a session. Beyond paper flashcards, the apps give students immediate reinforcement, so then work feels less like work.

Separate communication tools from other tools: If you are going to use apps and AAC at the same time, one practical solution is to use separate tools. Toggling between apps and AAC is cumbersome, and slow session momentum. In addition, having separate systems prevents the user from confusing a communication device with other technology, which is an important distinction. If your tools look the same, change the colors of the cases. If you have students that like to surf and press that home key, enable guided access so that only the AAC app is available.

Model, model, model through apps and AAC: Finally, apps provide the opportunity to model AAC live, and in unpredictable ways. You have more opportunities to explore and learn together. Don’t have curling iron as a fringe vocabulary item when using your “Toca Hair Salon” app (it’s not there, believe me)? Show your student how you can give clues to what you mean and talk it through using what is available on your AAC: “Let’s see, it’s a tool, it’s hot and it makes your hair curly…what is it?

There’s your abridged version and takeaways…log in to your SIG 12 portal for more info, and to get CEUs….ASHA renewal is right around the corner!

 

 

Reference

Sweeney, S. & Davis, K. (2014). In press. Reading, writing and AAC: Mobile technology strategies for literacy and language development. SIG 12: Perspectives in Augmentative and Alternative Communication. American Speech Language and Hearing Association.

 

 

Kerry J. Davis, EdD, CCC/SLP is a speech-language pathologist in the Boston area. She holds a special interest providing services to children and adolescents with complex communication profiles, including AAC. Davis is a volunteer SLP and consultant to Step by Step Guyana, a school for children with Autism in South America.

 

“Use Your Speech Tools!” Why Your Child Who Stutters May Not Be Using His Strategies

Stuttering Tools

When a child who stutters demonstrates the ability to change his speech during a treatment session, it seems obvious that he’d want to use the same strategies to improve speech outside the session as well.  Children, especially teenagers, rarely want to stand out in a way that stigmatizes them, provokes questions or increases the chances of teasing.   So the question arises, “Why aren’t they using their tools?!”

Speech and stuttering modification techniques are often learned quickly and easily within the treatment setting.  However, SLPs and parents often feel discouraged when these tools seem to disappear as soon as the client gets to his car.  Is it laziness on the part of the child?  Is it the fault of the family for not following through with home assignments?  Is the SLP not teaching the best strategies?

Instead of placing blame, consider the following three reasons a child may have difficulty generalizing his skills:

Reason # 1: These Techniques Are Too Hard! 

Making changes to one’s speech becomes exponentially harder when you introduce factors that often are not present in the session, such as interruptions, time pressure and feelings of embarrassment or shame associated with stuttering. Learned escape/avoidance behaviors and increased language demands may make it very difficult to use these tools.  Suddenly, what felt like an easy decision to use a new technique, becomes complicated by the person’s desire to be heard in a large group of chatty peers or by the need to formulate an excuse about why he doesn’t have his homework.

How Can I Help?

Children will be more likely to use speech/stuttering strategies if they are first introduced in safe and supportive environments (i.e. home, session room).  To help with this, create a hierarchy of speaking situations and use it to guide where the client practices the strategies.  If a child who stutters is not yet using speech tools in certain situations such as the classroom, it is probably because of where that situation is on his hierarchy. Work with your clients to determine where they would like to use their strategies , while also identifying those situations where they would prefer to concentrate on things other than using their tools.

Reason #2: These Techniques Make Me Sound Weird! 

There are several techniques that may be taught to a child who stutters. Some strategies involve prolonging the initial sound to ease into or out of a word with less physical tension or struggle.  Other techniques include inserting more pauses into speech.   All speech tools require a child to alter their speech in a way that is still different from how his friends sound.  Children may report that they have similar negative thoughts and feelings about using these strategies as they do about their stuttering.  This may play a role in why they are choosing not to use speech strategies outside their sessions.

How Can I Help?

Just as you might spend time trying to help reduce negative reactions to stuttering, you might also spend time desensitizing clients to hearing themselves use strategies through voluntary stuttering assignments.  Children can also benefit from improving their ability to handle listener reactions. This can be addressed by participating in role-playing activities that help the child create “scripts” for responding to curiosity/teasing.  For example: “Why do you sound like that?” “Sometimes I stretch my sounds like that to help me get out of a stutter.”  The more comfortable the child feels with his strategies and ability to respond to questions about his speech, the more prepared he will be to use these techniques outside the session.

Reason #3: These Techniques Aren’t Worth it!  

A cost-benefit analysis can be useful when trying to understand why a child may choose not to use speech/stuttering strategies.  At the surface, it may appear that there are many benefits of using strategies which include increased fluency and improved overall communication. However, SLPs and parents must be careful to consider the costs, as well.  Costs may include increased effort, difficulty concentrating on the content of message, the risk of showing more stuttering and the potential that the strategy doesn’t work.

How Can I Help?

Have discussions with clients about what they perceive as potential costs versus benefits of using strategies in a variety of different speaking situations.  As the child becomes more accepting of stuttering and is better able to tolerate both his feelings about stuttering and listener reactions, physical tension and struggles associated with speaking will decrease.  As this happens, tools become easier to use and costs may not feel so high.

The bottom line 

There are several strategies that may help reduce stuttering frequency and severity.  However, you often can’t offer these tools without first considering and incorporating goals that target how the client thinks and feels about his speech both while stuttering and while using tools.

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

 

 

Tales From Apraxia Boot Camp

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In August of this year, I was selected to be a part of The Childhood Apraxia of Speech Association of North America’s 2014 Intensive Training Institute, otherwise known as “Apraxia Boot Camp.” Twenty-four speech-language pathologists, including myself, trained with three mentors–Ruth Stoeckel, Kathy Jakielski, and Dave Hammer–at Duquesne University over four days. In its third year, the goal of the boot camp is to spread a high level of knowledge about Childhood Apraxia of Speech (CAS) assessment and treatment throughout the United States and Canada. This conference accomplished that and so much more.

This experience was different than any other continuing education seminars that I have attended. We did not listen to speakers discuss CAS. Instead, Ruth, Kathy and Dave became our mentors. This was powerful. They moderated discussions on evaluation and treatment approaches. We reviewed research papers and had long debates on the principles of motor learning. We highlighted and critiqued therapy methods for those brave enough to show videos of themselves. We problem solved and brought up more questions than we knew were possible.

In smaller groups, our mentors provided insights and personal perspectives on how they work. In this intimate setting, we felt comfortable asking questions and sharing our experiences. The mentors shared constructive criticism along with thoughtful suggestions. In all, they made me think, reflect and question everything I do. Why do I give that test? Why do I treat that way? What is the research behind it? They encouraged us to become critical thinkers.

As therapists, we often get used to using the same materials and therapy techniques we learned in graduate school or during our early experiences. Those methods are not always effective with every child we treat nor are they all proven effective with evidence based-research. Specifically, children with CAS require different therapy techniques than other children with articulation or phonological delays.

Ruth, Kathy and Dave provided valuable information in a small, engaging setting. Their mentoring and passion for CAS has inspired me and I hope to pass along this valuable information to others through mentoring, improving my competency in treatment and diagnosis of CAS, and, in the end, helping children to communicate.

Based on my experience, I’d recommend asking yourself a few questions when selecting your next continuing education event:

  • What am I passionate about? Is there a child or an area of speech pathology that truly inspires me?
  • How will it improve my skill set?
  • How will it help me better serve my clients?
  • Who is doing the most current, researched-based evaluation or therapy techniques?
  • How will it further our profession?

 

Amanda Zimmerman, MA, CCC-SLP, is a pediatric speech-language pathologist in Columbus, OH. She can be reached at azimmerman@columbusspeech.org.