NIMTR: Not In My Treatment Room!

poison

You’ve heard of NIMBY, “not-in-my-backyard” haven’t you?  Well there’s a new acronym, NIMTR or “not-in-my-therapy-treatment-room!”  Speech-language pathologists are inundated by catalogs filled with wonderful colorful, fragrant, pliable toys as treatment materials.  We use these every day with our students, our clients in clinics, our bedside patients.  But how much do we really know about the safety and makeup of those therapy materials your shrinking budget dollars are purchasing every year?

Some interesting facts about toys.

Toys are BIG business. Just visit any mall in America or website such as Amazon.com.  Worldwide, over 80 billion dollars were spent on toys in 2009, with more than a quarter of that money consumed in the United States. The latest figures by the Toy Industry Association Inc., places the annual U.S. domestic toy market at $22 billion in 2012.  Of this, $6.63 billion covers toys and articles for infants and toddlers, puzzles and games, and arts and crafts.  I mention these specific categories because they are materials most likely to be used by SLPs working with young children in early intervention, preschool, or school settings.

So many toys … but are they safe?

The United States imports many more toys from foreign countries compared to its exports. China, Japan, Mexico, Canada and Denmark lead the way in toy imports.  Since other countries do not implement the same environmental protections in manufacturing as we do in the states, the question of safety looms large.  The Consumer Product Safety Commission (CPSC) is the main body responsible for overseeing the safety and recall of unsafe toys and products manufactured in or imported into the United States.  In 2012, the CPSC released a new risk assessment tool to help improve the screening of imported products. About 5 percent of the total number of these screenings identified children’s products.  One example: a shipment of 28,000 baby bottles imported by Dollar Tree was seized after determining they were defective and unsafe using the new risk assessment tool. You can read more about the successes of CPSC online.

The Consumer Product Safety Improvement Act of 2008 made it mandatory for all toys aimed at children under the age of 14 to meet new federal safety standards.  Some of these include testing lead content and concentration of phthalates (DEHP, DBP and BBP* in particular). Here is a video to see how CPSC works collaboratively with other government agencies to seize toy imports that are unsafe for children.

Even though we have protections, toys of questionable safety continue to enter the consumer market.  Recently DNAinfo in New York released this alarming report, which shows many toys in stores tested positive for elevated levels of toxic substances, including phthalates, which have been found to be associated with asthma, birth defects and hormone disruption, among other health problems. One item on the list, a Teenage Mutant Ninja Turtles pencil case manufactured by Innovative Design was found to contain 150 times the legal phthalate limit for toys. But alas, currently, it does not qualify as a toy under federal regulations.

What if it is not a toy?

And that’s a good point: Sometimes SLPs use materials in their practice that are not toys. Like the pencil case mentioned above or what about commonly used rubber tubing that a speech-language pathologist may use during treatment for oral exercises?  Would such rubber tubing be considered a toy, a medical device, or something else?  Who oversees the safety of products such as these?

Two organizations responsible for developing standards of safety are the International Organization for Standardization (ISO) in Switzerland and the American Society for Testing and Materials International  based in Pennsylvania.  Both provide standards to industries that produce just about everything, from iron bolts to bathmats.  Each provides standards for purchase to companies, who in turn use the standards to manufacture and distribute their product to specification.  I contacted both these organizations to find what standards exist for the rubber tubing example.  As of this writing, no responses to my request have been received.

What is an SLP to do?

So what can you do to ensure that the materials you use with your students and clients are safe?  Here are a few suggestions:

  1. If you are purchasing from a distributor online, check their website for more information. For example, SuperDuper Publications places a Product Safety statement on their website and invites customers to email them for more information.  Companies who openly provide statements such as these make it easier for the consumer to trust the safety of their purchases.  If you cannot find information on product safety or product testing, email the company and ask for it.
  2. Check the CPSC’s website for toy and product recalls. You can find the latest recalls, search for recalls by product name or by country of manufacture, and also report an unsafe product.
  3. Read the manual! Electronics such as iPads and tablets come with a manual that will often provide the ISO or ASTM Int’l standard used to insure safety and will list potential hazards.
  4. Contact the manufacturer of the product and ask for the MSDS – materials safety data sheet.  This would be a good choice if the product you have or consider purchasing lacks a manual or an information sheet on standards testing.  You also can look up a product by name and manufacturer on the MSDS website. On this site a search for “rubber tube” gave me 34 hits.  While searches can be daunting and time consuming, the insurance of safety provides peace of mind to you and the clients on your caseload.
  5. Avoid buying inexpensive toys or materials from questionable sources such as street vendors.

Informed SLPs can now approach their materials purchases with a new savvy.  Next time you are tempted to buy inexpensive therapy materials composed of questionable ingredients, just say “NIMTR”!!!!

 

Anastasia Antoniadis is with the Tuscarora (PA) Intermediate Unit and works as a state consultant for Early Intervention Technical Assistance through the Pennsylvania Training and Technical Assistance Network. She earned a Master of Arts degree in speech pathology from City College of the City University of New York and a Master’s degree in public health from Temple University. She was a practicing pediatric SLP for 14 years before becoming an early childhood consultant for Pennsylvania’s early intervention system. Her public health studies have been in the area of environmental health and data mapping using geographic information system technology.  You can follow her on Twitter @SLPS4HlthySchools.

Collaboration Corner: “Out of my Mind” Speaks Volumes

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This year, I worked with a fifth grade class who was reading “Out of my Mind” by Sharon Draper. The story is about a nonspeaking 11- year-old girl with cerebral palsy. Her classmates, teachers, and even  her doctors underestimate her abilities. Little do they know she has a photographic memory. One day after months of fighting with insurance, Melody (the protagonist) is given the gift of voice through an AAC device; the drama unfolds from there.

The teachers read a little of this book every day to the class, but wanted the students to get a better understanding of Melody’s struggles. They asked me to come in and show students various kinds of AAC devices.

This was the perfect launching point for a lesson on inclusion and AAC. This was one of the most effective ways I’ve worked with teachers and students regarding the challenges AAC users face everyday.

Here’s all I used:

  • A PECS book;
  • Two iPads with two different communication apps;
  • An alphabet board;
  • Low-tech battery operated voice output device;
  • A sheet with a picture of two “thought bubbles” and two hearts (see below);
  • Index cards with written scenarios; and
  • A sheet of emotion cartoons.

First, the class gathered together, and I gave them an overview of how people might communicate. Most understood body language, words, and some mentioned sign language. Then I brought out the different systems. Their eyes lit up. Then they started to make connections to other children in the building who used these systems. They were hooked.

Next, the children broke up into groups of four or five. Each table had two AAC systems. Within each group, students paired off. One student had a “speaker” card, and the other a “listener” card. Speaker cards had clues like, “you can’t speak, but you can point and read. You really want to tell your friend about the movie you saw last night.” The partner’s card (“listener”) read, “Your friend can’t speak, but she can point and read. She really wants to tell you something, find out what it is.”

I wish I had taken a video. The interactions were amazing, and the students really dove into the activity. Each group got a turn with a different kind of system. A nice, unexpected experience: Teachers went by and facilitated interactions with tips like being closer to the speaker, or waiting and not interrupting.

Finally, I collected the devices. Each group received a copy of a words related to emotions and a worksheet, which they worked on individually. This gave them a chance to reflect.

On the worksheet were only two fill-in the blanks on top:

When-I-was-the-speaker

On the bottom were two more:

When-I-was-the-listener

And then the teaching part happened! Here were some of the responses:

  • I was thinking, why can’t he understand me!!! I was outraged!
  • This is so hard! I felt like giving up.
  • I don’t have enough words. I felt like oh, well, never mind.
  • I wanted to help you, I’m sad and frustrated for you
  • I can’t understand you, I felt impatient.
  • Keep trying! I felt helpless.
  • I can’t spell, this takes too long! I felt annoyed.

I kept copies of every single sheet, I’m not exactly sure what I’m going to do with them, though I’m fighting the urge to wallpaper my office with them.

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

 

 

 

 

How to Provide Bilingual Services (Even When You’re Monolingual)

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Evaluation is one huge hurdle to working with English Language Learners (ELL). The second is providing therapy. Once you’ve determined there is a disorder, what do you do? Do you provide treatment in English? What goals do you target? Can you provide competent treatment in English only?
It may be easier to address some of these ideas for specific age ranges. For the children under 3 years of age, working with an interpreter in the primary language with the family on how to talk with toddlers and babies is your best friend. It is important to be mindful of possible cultural differences in how adults and children relate to each other. Not every culture values parent-child verbal interactions as the stereotypical white middle class family might. How to address these differences is like a dance. If one person is too powerful of a leader the other cannot follow, might stumble, and ultimately will quit dancing. A parent/caretaker who does not share the value we place on parent-child interactions will most likely not follow through on our recommendations. In which case it may be better to train a sibling how to model language for a younger sibling. Make sure you understand the family and/or cultural relationships as much as possible first.
For preschool age children (depending on family views of preschool) your efforts should go toward encouraging the family to enroll the child in Head Start, preschool, daycare, or even scheduling consistent “play dates” to expose the child to typical language development. If possible, encourage both languages (primary language and English). What about therapy? Targeting social language, the Basic Interpersonal Communication Skills, in English is essential. Children will need these skills to be successful in the academic world.
For school age children, research suggest that there is a strong correlation between ELL students with a language learning disorder and poor and/or inappropriate social skills and therefore, have fewer friends when compared to other students who are ELL. Social skills groups are very important for these students. Simultaneously, targeting Basic Interpersonal Communication Skills and Cognitive Academic Language Proficiency will help close the language gap these students have. One approach to do that is by teaching root words, suffixes, and prefixes (morphology). As we learn in linguistics, they are like puzzle pieces. For example, you can take the root word “view” and the prefix “re-“ and teach students that the view means “to look” and re- means “again.” When added together form “review” or “to look at again.” Then applying context, “The teacher tells you to review your work,” what does she want you to do? Helping students understand contexts for which they might hear the word and then additional contexts for when they might use the word is important. How does your work in English translate over to the primary language? Here is where parents come into play. Most parents I’ve worked with prefer you send the list of “academic” words (from curriculum and/or state standards) home in English. They can then use their personal dictionary to look up the correct correlating word in their home language, versus us guessing on a translation website. Have the parents talk with the child about these words in their home language. This builds the foundation for carryover from primary language to English. When using root words you can also can help students make educated guessed on definitions for words. Once students have a decent grasp on root words, some great games to play are Scrabble, Boggle, or Balderdash. An added benefit for teaching root words, is it’s included in the Common Core State Standards.
Here is some personal evidence. Last school year I had a 5th grade student who scored Level 1 (Beginning) on an English Language Proficiency Assessment for all of his academic years, Kindergarten through 4th grade. His 5th grade year we implemented a social skills group and taught root words from the curriculum. With the entire team’s support (student, parents, teacher, SLP) this student scored a Level 3 (Intermediate) on the same assessment. Some beliefs for such success was that our intervention targets were meaningful to him. Social skills helped his friendships and the root words helped him understand and communicate in the academic setting, which is the majority of his day Monday through Friday.
I am sure that there are other evidence-based therapy approaches to working with this population and they should all be founded on the same principals. 1) It is better to target both BICS and CALPs together that waiting for BICS to be mastered well enough to move to CALPs. Reason being, the language gap will only increase exponentially. 2) It is also better to work with the family.
I’d love to hear about other approaches. How do you address therapy for children and families who are not fluent in English?

 

Leisha Vogl, MS, CCC-SLP, is a speech-language pathologist with Sensible Speech-Language Pathology, LLC, in Salem, Oregon. She can be reached at leisha@sensiblespeech.com.

 

How to Navigate the Profession One Binder at a Time

Binders

 

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

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

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

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

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

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

Kid Confidential: Using Thematic Instruction in Speech Therapy

pirate

I have seen many speech and language activities labeled as “themed” therapy activities just by the mere coincidence that they may sport graphics or clip art associated with a particular theme or holiday.  However, simply pasting an associated picture on a stimulus card while asking a student to perform a generic speech or language task is the not the same thing as participating in a themed activity.  Until I learned from my educator colleagues what it truly meant to teach via themes, I made this same mistake, too.  Regular and special educators are taught to understand the importance of themes and how they relate to child development and learning.  However, at least based on my own personal experience, newly graduated speech-language pathologists lack the instruction needed to fully understand what thematic teaching is really all about.

I see myself as an educator first and foremost.  Therefore, I learned many valuable things about education through colleagues and by reading educational research and textbooks.  This particular topic has been no exception.  Marjorie Kostelnik, Anne Soderman and Alice Phipps Whiren, spend an entire chapter explaining what thematic units really are and how they can effectively be used within the academic environment in their book titled, Best Practices in Early Childhood Education.  The following information is adapted from this source.

What is a theme and why would we use them in speech interventions?  A theme can be defined as the creation of various meaningful activities planned around a central topic or idea. The activities are then integrated into all aspects of the curriculum (i.e. language arts, reading, math, science, social studies, etc.).  Thematic instruction has been researched and observed to help children learn about concepts (i.e. ideas about objects and events in a child’s world) and facilitates in connecting various concepts together cognitively. In SLP lingo, this means thematic instruction helps to teach our children about categories. Through first-hand experience and additional learning activities, our students are improving their semantic mapping/networking skills thus improving receptive and expressive vocabulary, understanding and using synonyms and antonyms, word retrieval skills, story comprehension and story retelling skills, answering “WH” questions, as well as improving their ability to make inferences and predictions, thus resulting in improvements in overall language skills.

How do we create effective thematic lessons for our speech sessions?  According to Kostelnik, et al., there are five necessary components to creating an effective theme:

  1. Relevance: The theme must be relevant to your student’s real-life experiences and timely in that themes should be targeted based on your students’ current interests.  For example, a field trip to the pumpkin patch may be planned in the fall. Creating a theme-centered around fall harvest/fruits and vegetables, around this time would be an appropriate time to maximize your students’ interest in learning about this topic.
  2. Hands on activities: Concepts whose informational content can be accessed through hands on activities are appropriate for students 3-8 years of age.  These activities can be offered via exploratory activities, guided discovery, problem-solving activities, group discussions, cooperative learning, demonstrations or direct instruction.  I think as SLPs we tend to be very good with demonstrations and direct instruction (i.e. speech/language activities, what I like to call “drill and kill” activities) as well as guided discovery (particularly in book reading when asking student’s to infer or make predictions), however we miss opportunities for students to use self-talk to problem solve or use cooperative learning to have a discussion with peers.  These are important executive function and social skills that should be trained at an early age so as to generalize to other environments as our students mature.  If, during our group therapy sessions, we step out of the equation as facilitators, will our students educate each other on the necessary skills for continued development (e.g. teaching each other to self-monitor speech production or how to use appropriate social skills in real-time, or even help each other use correct grammar in sentence formulation)?  We must create opportunities for our students to use what they learn independently to help themselves and their peers.
  3. Diversity and balance across the curriculum:  Many of you might be reading this and think, well this doesn’t apply to me because I teach speech and language skills.  However, the truth is, you are already doing this!  Through your planning of speech therapy activities you are incorporating science (e.g. matching pictures of clothing to correct seasons, mixing red and blue paint to make purple, etc.), social studies (e.g. discussing community helpers and matching up the helpers to the objects/tools they use), math (e.g. counting and sorting animals into correct categories), and language arts (e.g. recalling details of a story or retelling a story in correct sequence).  Therefore, the use of “academic” or “curriculum-based” materials in the upper elementary grades, middle school and high school is, more than likely, what most of you have been doing for years!
  4. Primary and secondary sources of information must be available:  When planning a theme, thought must be given to the primary and secondary sources of information.  Primary sources of information are seen as what the child already knows (background knowledge) or can determine via concrete information present.  Secondary sources of information are sources that provide students with additional information they had not known nor can determine via concrete information present.  For example, when focusing on “farm animals” as a theme, a child may already know that a pig says “oink” and can see from a picture that it has four legs.  This is known as primary information.  An example of secondary information would be using books, pictures or other additional resources or materials to explain the role of pigs on a farm or the types of pigs and where they live.  So in a nutshell, a good theme uses the background knowledge your students already have and builds on that by providing additional new information.  Doesn’t this sound a lot like reading comprehension strategies (background knowledge, pre-teaching vocabulary, introducing new information, recalling information, etc.)?
  5. Potential for projects/“discovery learning”:  A good theme must lend itself to discovery learning. Discovery learning simply means you present your students with opportunities to problem solve and/or reason information not factually presented to them.  These projects are child-centered and/or child directed.  This piece is very important in planning themes because as you introduce information to your students you want to follow their lead and listen to the questions they have about the information presented.  Then you want to create a “project” that addresses the student’s questions or concerns.  For example, if when discussing farm animals a child asks have you (as the SLP) ever been to a farm? Your student is expressing the interest to learn more about others personal experiences about farms.  So you guide a “project” where your student asks the other students in your therapy group (language practice in formulating appropriate questions) or classroom if providing in class therapy, and you graph their responses.  Now you’ve just incorporated math (graphing, counting, adding, concepts of more/less) into a “project” your student directed and by the end your student has problem solved a way to survey his/her peers to find out more information about themselves.

I can hear the collective frustrated sigh from many of you out there reading this. “I have my students for 30 minutes, two days a week.  How am I supposed to use thematic units to teach them what they need to learn in that time?”  The first thing I would suggest to do is to start small.  Focus on the use of thematic teaching for a small portion of your language delayed students. Listen to what they are interested about learning and begin to create activities based around those topics. Remember you need to know what your students already know (primary source) so you can provide appropriate expansion materials/activities (secondary source).  Then compare your results.  See how the use of themes aid in learning and language development for this group as compared to the therapy groups for which you do not provide thematic lessons.

Another important key to successful themes is the stay flexible.  Follow your students’ lead.  Remain on one theme only as long as your students’ interest in the topic lasts.  This means, you don’t have to perform five or six thematic activities within your two therapy sessions a week. You can take as long or short a time as needed.  You might even take two sessions to participate in one activity.  I used to work with a colleague who used two or three sessions of repeated book reading as part of thematic teaching and it was amazing to see the improvements in numerous linguistic skills of her students after these sessions.  It just depends on your students’ current level of skills and interest.

So the next time International Pirate Day rolls around on the calendar throw out those multi-step direction cards that have nothing remotely related to learning about pirates. Rather, spend a week or two reading pirate stories while increasing the use and understanding of pirate-associated vocabulary (e.g. treasure, map, spyglass/telescope, etc.), and pirate lingo (e.g. “Shiver me timbers!” “Matey” and “Land ho!”), recalling details and or retelling the stories read (language arts), discussing famous historical pirates and from where they originated (history, geography), creating a “treasure hunt” for your students to cooperatively complete (following directions with pirate lingo, problem solving and reasoning, use of appropriate social skills), and spend time creating a pretend play scenario about pirates (hands-on, expansion activity) using all the information your students’ learned throughout your therapy sessions.  I promise you that your students will have just as much fun learning from you as you will have teaching them.

 

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

Remembering Sandy Hook: How to Live Like a First Grader

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As a speech-language pathologist who works with young children in their homes and schools, it’s impossible for me not think of the heartbreak at Sandy Hook Elementary School this time of year. Shortly after the tragedy in 2012, I made a list of some simple things I can do to honor those precious lives taken on December 14th. Every year, I plan to add to the list. This new year, I promise to embrace life more like a first grader in memory of the children and the young-at-heart adults who will always be missed by their families and communities. I plan to:

• Break into random acts of dancing in the most quiet places, like the doctor’s office.

• Use words like “sparkly.”

• SKIP. Everywhere.

• Stop in my tracks and squeal at the sight of anything furry: squirrel, neighbor’s dog, or the ring of fur on my best friend’s winter hood.

• Learn to read…new books, that is. Something happy – something meaningful, like “Oh, The Places You’ll Go,” by Dr. Seuss.

• Sing silly songs. Loudly. In public.

• Eat a peanut butter and jelly sandwich masterfully created with a dinosaur cookie cutter. This will make any co-worker at the office jealous and he will ask his mom for the same lunch.

• Gallop, because I love horses. Skipping is so over-rated when you can gallop.

• Pretend.

• Buy a Whoopee cushion and burst out laughing every single time someone sits on it. Whoopee cushions never, never get old.

• Finger paint. Do crafts. But first, let go of perfection.

• Hold it up and yell, “I made this for you!” and then give it to a stranger.

• Bring an apple to a teacher.

• Stomp in a puddle.

• Make a homemade card to brighten someone’s day.

• Eat snow.

• Open your lunch in front of co-workers and announce, “I got a juice box today!”

• State emphatically every 20 minutes “I’m hungry.” Oh wait, I already do that.

• Dress up. Wear party shoes even when there is no party.

• Take every opportunity to play… especially in the rain.

• Truly believe in the power of a found penny (head-side up, of course).

• Demand a full set of birthday candles on my cake EVERY year, and blow them out with vigor.

• Lick the spoon.

• Hold the door open for the rest of the line behind me.

• Never ever walk by a playground without stopping to swing.

• Go to the library.

• Post things that I am proud of on my refrigerator.

• Hug my mom and dad.

Never forget to be a kid! What do you plan to do in the New Year? Let us know in the comments below. Let’s keep this list growing in memory of Sandy Hook.

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

 

Kid Confidential: Tips for Working with Students with Hearing Impairment in the Schools

1114

This month I revisited the topic of classroom difficulties and possible accommodations and modifications for students with hearing loss in the School Matters column of the ASHA Leader.  As there is so much to discuss on this topic, I was unable to share some of the inside tips I have learned when working with students with hearing impairment in the academic setting.  So I thought I would share this information with you today.

Here are the top five lessons I learned when working with students with hearing impairment in the schools:

  1. Work with the student’s audiologist.  I am not a specialist in the area of hearing.  Therefore, every time I have a student with hearing loss referred to me or placed on my caseload, the first thing I do (after reading the audiological evaluation report) is contact the audiologist to ask all of my questions and voice any concerns.  I know, as school-based speech-language pathologists, you struggle to have enough time in the day to do everything you need to do but this is the first and foremost important piece of advice I can give you when working with children with hearing loss of any severity (including children with sound field amplification systems, hearing aids, and cochlear implants-CI).  Audiologists do not expect us as SLPs to know everything about their field.  In fact, they are more than happy to share their wealth of knowledge.  I have learned so much regarding simple tests I can perform for quick assessment of my student’s hearing perception at varying distances to determine how they are perceiving that audiological input (i.e. Ling 6 sound test), how and when to recommend a student with CI to return to their audiologist to once again MAP their CI, what classroom behaviors are evidence of improved hearing and understanding and conversely which suggest possible malfunction of hearing equipment.  Without an audiologist’s guidance, I would not be able to do these things today.
  2. Consult with your district’s teacher of the hearing impaired frequently.  Although, the teacher of the hearing impaired may not be an audiologist, he/she knows the practical strategies and techniques to use while teaching students with hearing impairments in the academic setting.  I have learned how to teach speech and language skills effectively in 1:1 therapy, small group therapy, and in-class therapy for children with hearing loss.  I have learned how to troubleshoot if a hearing aid isn’t working correctly, how to hook up the FM system “boots” to a CI, and what to look for in the classroom and therapy setting that may indicate the need for further analysis of hearing equipment.  Using the teacher of the hearing impaired as a frequent resource to share ideas and answer your questions can be an invaluable and integral part of your therapy plan.
  3. Record in-depth observations:  This is a technique I use to determine if growth is being made in all observed areas even if not specifically targeted on current IEP goals (e.g. improvement in social skills, changes in responding to environmental noises, changes during large group classroom lessons, etc.) or if current progress is not yet quantifiable.  Quality records can help you to share the changes effectively (positive or negative) in your student’s speech, language, or academic skills with the student’s audiologist and hearing impaired teacher to determine the next steps in the therapy process.  I have found emailing my in-depth observations to audiologists for my clients with CI is an enormous help when they are working on MAPping my client’s CI. Parents cannot notice nor may they fully understand the big and small improvements or difficulties a child may exhibit in the school environment.  Therefore, it can be a challenge for audiologists to determine MAPping changes and needs based solely on parent report and child response.  Noting these observations, such as environmental and speech sounds, to which the child no longer responds, assists the audiologist in making the appropriate adjustments to the students CI so as maximal learning can occur.  Don’t underestimate the importance of functional observations.
  4. Get the classroom teacher on board.  Many times classroom teachers just feel lost when expected to appropriately modify for students with hearing loss in their classroom.  They may be anxious about working with this population, which can manifest itself in what seems to be uninterest or even noncompliance.  However, the truth is the classroom teacher may not know what do to and may be looking to you, the SLP, for assistance.  Showing how simple modifications made in the classroom, in real-time, result in improved learning opportunities for their student is one of the quickest ways to get your student’s teacher on board.  Also frequent classroom visits can help you in identify and address additional situations that may be inhibiting your student’s learning (e.g. environmental noises affecting hearing, lack of sufficient visual support in the classroom, classroom instructional language used is too complex, instructor not appropriately amplified at all times, etc.).  Helping to address and make the appropriate changes and adjustments needed in the classroom environment throughout the school year, can be extremely helpful for your student as well as for the classroom teacher.
  5. Do not be afraid to say “I don’t know, but I’ll find out.”  This is the best tool to use when working collaboratively with a number of various professionals.  You can bring your current knowledge and clinical experience to the table, however, no one expects you to know everything about treating every disorder or deficit.  It really is OK to say “I don’t know,” but just make sure you follow that with “but I’ll try to find out for you,” because ultimately classroom teachers, parents, staff members, and other therapists just want to know you are there to help and support them.  Since you already established a great working relationship with your student’s audiologist, I would recommend you start there when you have additional questions you cannot seem to easily answer or research.

Those are my top five tips for working with students with hearing impairment in the school environment.  Do you have additional tips you’d like to share?  Feel free to comment below.

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

Harnessing Learning Styles

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How many times have you heard someone say, “I’m a visual learner” or “I need to do it to understand it.” These are styles of learning. Depending on what research you find, there are 20, 16, 7, etc… types of learning. Among those styles of learning, I have seen a trend of seven to be the most common: visual, aural, verbal, physical, solitary, social, and logical. While some people can strictly use one style of learning, most are a combination. So let us take a closer look at these learning styles and how we can incorporate them into our speech sessions.
1) Visual (Spatial). People who are visual learners learn best when pictures, images, and spatial understandings are used. A lot of our students tend to be visual learners. They benefit from color coding, picture schedules, and graphic organizers to help understand material and process information. Students who are visual learners may benefit from using a story with pictures when addressing listening comprehension or photos of actions being done when working on verb tenses.
2) Aural (Auditory). Those who are aural learners do best when sound (speaking), music, or rhythms are used. These students may remember something best when it is put to a familiar tune or rhythmic pattern. Tapping or clapping out concept/word meanings can be used to help them improve storage and retrieval of information.
3) Verbal (Linguistic). People who are verbal learners prefer to talk out their questions and thoughts to understand. These are the students who may take the ‘long way’ to answer a question because they are ‘talking’ out their thought process. Give them time and listen closely as they explain. Does their explanation make sense? Is there a logical sequence to their thought process? If you are having trouble determining if they are truly understanding, have them write down ( in quick points ) or draw their thought process out as they explain it.
4) Physical (Kinesthetic). Those who are physical learners, learn best by doing and feeling, rather than seeing and hearing. These students can benefit from crafts and activities that relate to their speech and language goals. These students may benefit from performing actions when working on verb tenses or basic concepts/following directions.
5) Logical (Mathematical). People who are logical learners do best when material is presented in a direct, no fuss manner. They pick up on patterns quickly which makes them stronger with numbers (math). When presenting speech and language concepts to logical learners, try and pair the concept with a real-life, relatable example and keep everything as straight forward as possible. If you are targeting pragmatics, emphasizing expected lunch room conversation and behavior, you may choose to have your session in the lunch (if possible) and create the situation you are attempting to address. Be sure to give clear direction and explanation, for example: “Your friend has your favorite cookies in their lunch and you want some. It is rude to take without asking, so if you want some you need to ask politely. Can you show me how to do that?”
6) Solitary (Intrapersonal). Solitary learners prefer to study alone and teach themselves when possible. These students may say they understand a concept when they don’t in order to allow themselves time to look at and process the information in their own way. When introducing a new speech and language concept or area, give these students time to examine the information themselves. This may be difficult due to the length of sessions, but try to provide them some time, at least 5 minutes. Once they have had time with the material invite them to explain it to you. This will allow you establish their understanding.
7) Social (Interpersonal). Those who are social learners prefer to learn within groups and do best when they can bounce ideas of someone. They do well communicating verbally and non-verbally with others. Students who are social learners may enjoy ‘teaching’ a fellow student a concept they are working on. This will require them to focus and understand their own goal to ‘teach’ the other student.
How to Determine Learning Styles
Now that you have some background about some different learning styles, how do you figure out which of these profiles fit your students? Depending on their age there are a few options.
Early Intervention: Just because your clients are young doesn’t mean they don’t lean toward a particular learning style or two. Parent questionnaires and your observations can help to compile information about how to set up your sessions to be engaging and productive while presenting material that fits their learning style. Babyzone has an online quiz for parents to help gather information about what style of learning their little one may prefer.
Elementary: For elementary students, trial and error and parent questionnaires may be used to gather information. Since elementary students are younger and still learning about themselves, getting insight from parents will probably be the most reliable source of information. Once collected, it will allow you to test out some methods in your sessions to find what works best and what doesn’t. Scholastic has an online questionnaire for parents to fill out about their child’s learning style, just make sure the age parameter is set correctly for the child.
Junior High: These students are a bit more mature than elementary, and have had the time and experiences to hopefully learn a bit more about themselves. You may be able to have students fill out basic learning profile questionnaires or quizzes with you. Piedmont Education Services and Edutopia both have short questionnaires that students can fill out with you. Then you can discuss what the results indicated and if the student’s agree. They may even be able to give you suggestions about what they think may help them.
High School: Oh high school students. If you work within this setting I am sure you have been informed how they already know how they can and cannot learn what works for them and what doesn’t. Allow them to humor you and take another look at their learning style. Accelerated Learning has a 35 question quiz to see what learning style characteristics your high school students demonstrate. Who knows, they may learn something new about themselves. I would also suggest including them in discussions about how to target their learning styles.

Maureen Wilson, M.S., CCC-SLP. is a school based speech-language pathologist from Illinois. She also holds a certificate in Inclusionary Teaching. Her blog, The Speech Bubble offers ideas and resources for speech therapists.  You can follow her on Facebook, Instagram, and Pinterest.

How to Put the ‘Super’ in Supervisor

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

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

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

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

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

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

Tips to Wrangle Your Most Unruly Speechies

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At the beginning of each school year, I have great expectations that this year is the year that all my little speechies are going to manage their behavior well in my treatment room with minimal incentives on my end. So much for great expectations. Because, of course, every year, I’m presented with new challenging behaviors to tackle because we educators know that “all kids are unique and different.”

Just when I think I have mastered all that I need to know about behavior management, one my little sweet speechies decides to bring a new unpleasant behavior into my speech room.

The good news is, I have learned much about managing these behaviors, both in the school setting and at home—from raising two little ones! These are my tips for keeping your therapy room calm and productive:

  • Say what you mean and mean what you say. Set the behavior expectations for your speech room at the beginning of the year and explain the consequences for not following your expectations. Each session, review these with students who need frequent reminders about their behavior. Visually post your rules and consequences, so they can see and hear them. Don’t be afraid to snap the whip and follow through with your consequences because it sends the message to the whole group that you mean business.
  • Bring on the visuals. Use visuals to remind students who struggle with transitions about the start and end of activities. I use a Time Timer and two to three warnings to let my students know when the activity will end. I am also creating a visual necklace that displays prompts to help show students what I want them to do. Visuals such as “all done,” “sit,” “clean up,” and “calm down” are on my list. I also use visual scheduling in treatment. For example, I might draw a chair with the child sitting down, then playdoh, cards for artic, and then clean up or a good-bye visual. As we complete each task, the child marks an X on it.
  • Empower students. We all want to be in control of our lives even when we can’t control our circumstances. This is the same for children. And although they cannot dictate the session, we can still give them choices, such as “You can sit in your chair or you can stand behind your chair,” or, “You can work for Legos or stickers,” or “You can finish your worksheet and earn your speech bucks, or sit in your chair and lose your speech bucks for the day.”
  • Encourage sensory integration. Some of your kids may struggle with focusing, staying still and controlling impulsiveness because their sensory regulation is off. Having fidget tools such as squishy balls available upon request may help your student. I explain that the squishy ball is a “tool” and if used as a toy, it will be taken away. Also, incorporating movement breaks or activities that infuse movement help keep our little speechies focused and in control of their body.
  • Abandon ship when necessary. We all plan wonderful, amazing treatment sessions filled with activities that we “think” all kids will love. Sometimes your most ideal therapy activities may not work for certain children. Don’t hesitate to abandon a toy or activity when a child does not appear interested in your fabulous board game! You will get more meaningful interactions with toys and activities that your students prefer, rather than trying to force them to like what you want to do. I always try to reintroduce an activity a couple weeks later to see if they may want to try it out again.

All in all, behavior management is an ongoing process that takes time, trial and error, and a willing SLP to dive in and try new techniques!

Felice Clark, CCC-SLP, is a school-based speech-language pathologist in Sacramento, Calif., and author of the blog, The Dabbling Speechie.