Helping Middle Schoolers With Organization and Time Management

Students often find the transition from primary to secondary school a challenge. Especially those who experience issues with executive-function skills. Many of my students (and even their typically developing peers) particularly struggle with organization and time management. For example, kids spend most of their time in one classroom in elementary school, while from 6th to 12th grade, they move through classes with different teachers and subjects.

I spend a lot of time working with my kids to develop these skills for many reasons. I stress that if they think it’s hard now, it will only get trickier as academic demands increase. Below are just a few ways I work on organization and time management with my students:

1. Folders
Students should use separate folders for each class. Many students already do this, but my kids must work harder to keep them organized. They pile everything into one folder and can never find what they need. Spend a session going through your students’ folders and putting papers where they belong. We also discuss what’s important to keep versus what they should throw out.

2. Planners
I don’t think I could get through life without some kind of planner or organizer. Introduce students to how and why to use a planner. It’s a visual reminder of what they need to do each day and for planning steps for future tasks or assignments. Check if your school has free planners. Also, you can print out weekly planning pages for your kids and make them a planner. If your students are tech savvy, show them how to use a calendar app. Or check out the many downloadable planning apps to see which ones they might like to use.

3. Check-lists/Schedules
Similar to a planner, checklists and schedules provide students with a visual reference of tasks they need to accomplish.

  • Checklists are great to organize all the things needed to get done for the day or week. We feel accomplished when we cross things off. Help students generate a checklist of what they need to get done. It can include homework, projects, reading, chores, etc…. You can also show them how to break down projects into smaller chunks, so they’re not as overwhelmed with assignments. For example, if they have a five-paragraph essay due, they spend each weekday working on just one paragraph, versus facing the WHOLE thing in one day.
  • A student struggling with time management may find a daily schedule helpful. Drafting a schedule together will help you see what the student does or can do with his or her time each day. It’s also a good opportunity to help that particular student come up with a plan.

4. Backpacks
I don’t know if it’s just my kids, but their backpacks are a MESS! Sometimes I take a look inside and wonder how they find anything. I’ve spent entire sessions just organizing and cleaning out bags. The kids are amazed at the things they find—lost homework or projects due months ago, for example. As with folders, this is a good time to discuss what they need to carry with them and what they should leave at home.

I hope these ideas will help your students with executive-function challenges. I like to try different strategies and see what’s successful. If one thing doesn’t work, try something else!

Gabriella Schecter, MS, CCC-SLP, is a full-time SLP working in a grade 6-12 school. She posts regularly on Instagram (@middleschoolSLP), sharing ideas and activities for this age group. Check out her blog or email her at MiddleschoolSLP@gmail.com.

 

When Patients Won’t Practice

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You give 100 percent in each session, but end up repeating last week’s activities because your patient didn’t practice. Who’s at fault?

We all tend to get complacent with the materials and techniques we use. Thankfully, we also take CEU courses to keep ideas and implementations fresh. But what if you try everything in your bag of tricks and your patient still doesn’t improve?

I discussed this exact issue with two of my patients recently. Each one had a different situation, but both were making limited progress. “John,” for example, sought treatment with the hope that others would stop complaining about his voice quality. He says he stopped doing the diaphragmatic breathing exercises I assigned, because his voice wasn’t any better. I replied that it takes more than a week of doing only breathing exercises to make improvement. Breathing is just the first component of coordinating a new voice.

He and I talked about the real reason he was here. I discovered that although he felt his voice sounded disordered, it was really only affecting those around him. It really didn’t bother him that others thought his voice was annoying, so he decided not to continue sessions. Fair enough.

“Sara’s” case was different. She and I worked together for several weeks and ended up going through almost the same session each time. She reported practicing, but I didn’t see evidence of that in her productions. Frustrations arose and she felt like she was getting nowhere.

In our most recent session, we talked at length about life and the projected outcomes of her condition. Her voice issues affect her life, which upsets her. This emotional roadblock gets in the way of her dedicating time to practice outside the treatment room. She also feels guilt and blames herself for the issue, even though it’s not at all her fault. She realizes that these feelings are holding her back, so she’s taking time off from sessions and coming back when she’s ready to commit.

We should try to build up patients when they come to us feeling down on themselves. That might be tricky, however, because we also point out their mistakes in order to correct them. Sometimes sharing personal experiences as encouragement helps. It’s never a bad idea to refer clients to a therapist or counselor as supplemental treatment—it’s even in our code of ethics and scope of practice.

I do this occasionally when sessions frequently turn into “therapy.” If I think a patient would benefit from talking through issues with a trained professional, I always refer out. That way when the patient comes to our sessions, we focus on the voice disorder and I know the other issues are being addressed.

If your patient isn’t practicing, it’s time to find out why. Is it motivation? Is it you? Do your best to figure out what else the patient needs from you to be successful, and offer many options. Sometimes all you have to do is ask.

 

 

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

 

How Do You Know When it’s a Language Delay Versus a Disorder?

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Editor’s Note: This is an excerpt from a blog post that originally appeared on Special Education Guide. 

How do you know when it’s a language delay versus a disorder?

Unfortunately, there is not always a straightforward answer to this question. A language delay is just that—a delay in acquisition of language skills compared to one’s chronological and cognitive/intellectual age-peers. A young child with a language delay may exhibit a slower onset of a language skill, rate of progression through the acquisition process, sequence in which the language skills are learned, or all of the above.

However, there is a subset of children who continue to demonstrate persistent difficulties acquiring and using language skills below chronological age expectations (by preschool or school age) that cannot be explained by other factors (for example, low nonverbal intelligence, sensory impairments or autism spectrum disorder) and may be identified as having a specific language impairment (language disorder).

In contrast to a delay or a disorder is a language difference. With a language difference, communication behaviors meet the norms of the primary speech community but do not meet the norms of Standard English. This difference can exist whether the person in question is a child from a different country or simply from a different neighborhood in the same city.

So, what are some options for addressing language delays and disorders?

Intervention for a delay may take on several forms:

  • Indirect treatment and monitoring
    • Provide activities for parents and caregivers to engage in with the child, such as book-sharing and parent-child interaction groups.
    • Check in with the family periodically to monitor language development.
  • Direct intervention, including techniques such as:
    • Expansions—repeating the child’s utterance and adding grammatical and semantic detail.
    • Recasts—changing the mode or voice of the child’s original utterance (for example, declarative to interrogative).
    • Build-ups and breakdowns—the child’s utterance is expanded (built up) and then broken down into grammatical components (break down) and then built up again into its expanded form.

Intervention for a language disorder is child specific and based on that child’s current level of language functioning, profile of strengths and weaknesses, and functioning in related areas, including hearing, cognitive level and speech production skills. The overall goal of intervention is to stimulate language development and teach skills to enhance communication and access academic content. The developmental appropriateness and potential effectiveness on communication and academic and social success should be considered when developing treatment goals.

 

Aruna Hari Prasad, MA, CCC-SLP, is ASHA associate director of school services.  ahariprasad@asha.org

An SLPA Eases a School SLP’s Load

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With only two years in the profession as a certified speech-language pathologist, I started in the schools not knowing  if the workload is overwhelming or just the norm. The 2013-2014 school year was my clinical fellowship experience. I excitedly trudged my way through the paperwork system, found my footing as a therapist and emerged with nothing but wind in my sails.

Yet wind always ebbs and flows. By December of 2014, I realized the overwhelming paperwork leading to canceled sessions was more than what my colleagues were experiencing. I spoke up at our quarterly staff meeting and made it clear I needed some help. I was done sacrificing students’ treatment time for paperwork. With only three speech-language pathology assistants in the district, I didn’t expect much, to be honest. The request was more for my sanity, so that if someone found me under a stack of Individualized Education Programs, there was a story to tell.

To my great surprise, on the first day back after winter break, I read a delightful email from one of the SLPAs reporting she would be with me every Friday till the end of the year. Yay!!

I then immediately started realizing all the things that come along with having an SLPA. I share my (small) office space, walk her through my goals for each student, supervise her with students and sign off on all the paperwork. I almost regretted my decision to ask for the help. But no, no…It was worth it, right?

Then came the self-doubt, all my insecurities crept in. How unorganized I can be with materials, how behind I get with Medicaid billing, how I feel like no one could handle the kids like I do. No, no, it will be fine, I reassured myself. And it was.

My new SLPA arrived on her first Friday. We got right to work going over the day’s schedule, reviewing goals and discussing student’s current skills. Within 35 minutes, she looked through my materials, set up her lessons and was ready for the day. She’s been an SLPA longer than I’ve been an SLP, so it was just another Friday for her. There I was, nervous and excited and she was just wondering where the staff lounge was. Funny how things work out.

I spent that first Friday observing from my desk while writing six IEPs for next Monday’s meetings and finishing an evaluation report, all before noon. None of my kids missed their sessions. If anything, treatment stayed more focused because their SLP wasn’t a crazed lady partially pondering when she was going to do paperwork versus how well they said their /s/ and /z/.

Having an SLPA, even just once a week, makes all the difference with the rest of my sessions. I plan my week out, factoring in the time I know I’ll have on Fridays. Time I spend doing evaluations, writing up extended school year data, monitoring progress for Response to Intervention, collaborating with my classroom teachers and making phone calls home. There are many things that get swept to the side when you have mandatory deadlines always approaching. Having an SLPA has already helped in ways I can’t put to words.

I didn’t realize just how stressed I was until my SLPA swooped in saved my sanity. We’re still working out kinks in the schedule and treatment details, but the benefits far outweigh any of these. If we both continue to coordinate and communicate the session progress, I know I’ll see exciting growth in those students during the final push to the end of the school year.

 

Katie Millican, MEd, CCC-SLP, is an SLP for the Matanuska-Susitna Borough (Alaska) School district. She graduated from the University of West Georgia with her bachelor’s and master’s of education degrees. Her interest in technology leads her to integrate it into day-to-day sessions. She enjoys connecting with her blog readers (SLP_Echo) through all things social media: Twitter, Instagram and Google +.

Snow Day Recap

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It’s a snow day here at ASHA and for many of our members on the East Coast. So whether (pun intended!) you’re snowed in or not, curl up with some of our most popular posts from 2014 in this compilation published earlier this year.

 

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.

Know Your CAS

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When I was pregnant, I remember dreaming about my new baby. My husband and I wondered aloud if she would be a musician like him, an athlete like me, or have some individual talent all her own. We had absolutely no doubts about what strong communications skills she’d have, however. Her mother was an SLP after all.

During her first year, my daughter lagged in all developmental milestones. I went to at least five different conferences on early intervention, but I couldn’t figure out why my daughter wasn’t a chatterbox. She met her first word criteria at one saying “hi” to everyone she met.

My husband’s mother reported he was late to talk and didn’t really say much of anything until after two. I had heard of late talkers, but because I worked at the elementary level, I never treated preschool kids. I brushed aside my pediatrician’s suggestion to seek treatment because I was convinced my daughter must be like her Daddy and that I could help her.

I finally took her in for an evaluation when she was close to three and received a diagnosis of childhood apraxia of speech and global motor planning deficits. After starting therapy based on motor learning principles, she made progress immediately.

Upset that I missed this diagnosis in my own child, I went on to endlessly and obsessively research childhood apraxia of speech. I was disappointed to find maybe eight pages on the subject in my graduate school materials. I know CAS is rare, but SLPs need to know about it and need to have the tools to diagnose and treat it correctly.

That summer I attended the national conference for CAS. The next summer I applied and was accepted into the Apraxia Intensive Training Institute sponsored by CASANA, the largest nonprofit dedicated exclusively to CAS. I was trained under three leading experts: Dr. Ruth Stoeckel, David Hammer and Kathy Jakielski.

If I could get one message out to pediatric SLPs, it would be for them to research and become familiar with the principles of motor learning and change their treatments accordingly for a client with CAS or suspected CAS. I know many like me get so little training or even information on it in graduate school. I’ve met other SLPs who were told it was so rare they would probably never treat it or even that it didn’t exist.

ASHA recognized CAS as a distinctive disorder in 2007. Taking the time to learn more about how treatment for childhood apraxia of speech differs from other approaches for speech and language disorders is crucial for kids with this motor speech disorder.  The importance of a correct diagnosis leads to a successful treatment plan. To briefly summarize, sessions should focus on movement sequences rather than sound sequences taking into account the child’s phonetic repertoire and encouraging frequent repetition.

For more information visit apraxia-kids.org and become familiar with ASHA’s technical report on the subject.

 

Laura Smith MA, CCC-SLP is a speech/language pathologist in the Denver metro area specializing in childhood apraxia of speech. CASANA-recognized for advanced training and expertise in childhood apraxia of speech, she splits her time between the public schools and private practice. She speaks at conferences and consults for school districts or other professionals. Email her at lauraslpmommy@gmail.com, Like her on Facebook, follow her on Pinterest, or visit her website at SLPMommyofApraxia.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.

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.
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  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-SLPtreats children birth to teens who have difficulty eating.  She is the co-author of Raising a Healthy, Happy Eater: A Parent’s Handbook – A Stage by Stage Guide to Setting Your Child on the Path to Adventurous Eating (Oct. 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