Top Ten Apps for Adolescents and Adults with Developmental Disabilities

10 apps

Have you ever downloaded apps that you weren’t satisfied with? Here’s some help  if you work with older adolescents and adults with developmental disabilities.

Within the past 15 years, I have worked with a variety of populations, including adults with developmental disabilities.  In the past, I have used predominately workbooks, adapted books, social stories, and age appropriate therapy materials during my sessions. Within the past five years, the use of the iPad has changed my therapy sessions dramatically.

Within the past couple of years, I have found excellent age appropriate apps that are motivating for my clients and help meet their goals with regard to their social skills, literacy, life skills, language, and increasing independence in the community. I use these apps listed below on a regular basis and find them functional and useful during my therapy sessions. I have received promo codes for a couple of apps listed below but all of my recommendations are solely based on my own personal experience as a speech language pathologist and do not reflect the views of anyone else.

These apps are best used when combined with other therapy materials and real life situations. For example, if I am working with a client who is going to be visiting the library, I would work on that specific topic using Community Success by Attainment Company. I also like that many of these apps can be trialed before purchasing them.

Apps Adults DD 2

Please comment if you have any app recommendations of your own!

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 discusses the benefits of reading to young children during mealtime, shares recipes with language tips and carryover activities, reviews children’s books for typical children and those with special needs as well as educational apps. 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.

 

Schools Serving Students with Telepractice Deserve Parity in Medicaid Reimbursement

United

Aesop coined the phrase “United we stand, divided we fall.” But what do we do when we cannot find partners to stand with?

Nationally, a shortage of speech-language pathologists often prevents children from receiving services they desperately need.

The State of Telepractice

Spurred by ASHA’s 2005 recognition of telepractice, thousands of SLPs have participated in telepractice so far. Telepractice is thriving; more than 10,000 SLPs have applied to PresenceLearning alone and many more are interested in telepractice considering the many other providers like Visual Speech Therapy and Vocovision.

The fast adoption of telepractice was driven by the well known shortage of SLPs, offering clinicians new work/life and professional choices. However, as accumulated research–40 peer reviewed studies at last count–has shown that telepractice is just as, if not more, effective than traditional, onsite therapy, the uses of telepractice have broadened.

Telepractice is now used to bring children together for social pragmatic groups, connect kids with bilingual therapists, strategically alter the frequency and intensity of therapy, improve SLPs’ schedules, bring in specialists, and re-engage students in middle and high school.

The Problem With Medicaid

One obstacle remains in many states that prevents SLPs from working via telepractice: Medicaid reimbursement. This is a critical issue, as schools can receive reimbursement for up to 50 percent of costs from Medicaid and are often unable or unwilling to adopt telepractice services without this reimbursement. ASHA, to its credit, has been a leader in advocating for school-based Medicaid reimbursement.

State policies preventing Medicaid reimbursement are oversights rather than outright bans. Policy has simply not kept pace with advancements in our field. In fact, most state policies don’t even comment on telepractice.

Many states, including California, Colorado, Virginia, Minnesota, Ohio, have updated their regulations, creating a precedent for other states to follow. These states handle Current Procedural Terminology (CPT) coding in the same way as before, but with a modifier indicating tele-delivery.

In the remaining states, the impact is large and negative:

  • SLPs wanting to work via telepractice, many of them retirees or recent parents seeking flexible work, effectively cannot do so within their state.
  • Hundreds of thousands of students not receiving services because of the SLP shortage will continue without the care of a SLP and fall further behind in critical areas like reading, writing and communicating.
  • Schools struggling to fill their share of the 5,000+ unfilled SLP openings will remain at significant legal risk from non-compliance.

Unfortunately, underserved districts and their students in rural areas and the urban core will continue to be hit the hardest until this blind spot in Medicaid policy is remedied.

What Must Happen

Medicaid reimbursement inequality must be resolved in all 50 states. There are important issues of equity for rural and urban core students, as well as the viability of access to telepractice for SLPs and students alike.

How can you help?

The only way to help is, in the words of Aesop and others, stand together for this cause. Here’s how we can stand together:

  • Review your state’s current policies for Medicaid reimbursement regarding telepractice.
  • Contact your state administrator of Medicaid for education to express your concern on this issue.
  • Cite specific examples of how tele-therapy reimbursement would benefit students in your district and similar districts in your  state.

With a cohesive message and ample support from fellow educators, gaining Medicaid reimbursement for tele-therapy for school-based speech-language therapy services can be a reality sooner than you think.

 

Melissa Jakubowitz, MA, CCC-SLP, is the Vice President of SLP Clinical Services at PresenceLearning. She is a Board Recognized Specialist in Child Language with more than with more than 20 years of clinical and managerial experience. She is the past-president of the California Speech-Language-Hearing Association and is active in ASHA, serving as a Legislative Counselor for 12 years.

Baby Led Weaning: A Developmental Perspective

blw

One of the things I like best about teaching courses on feeding to parents and professionals around the United States is learning what new trends are evolving around family mealtimes. Over the past year,  one of the common questions I’m asked is, “What about Baby Led Weaning?”

Baby Led Weaning (BLW) is a term coined by Ms. Gill Rapley, co-author of “Baby-led Weaning: The Essential Guide to Introducing Solid Foods.”  Rapley graciously chatted with me about her philosophy and explained that although she did not invent BLW, she found the method to be successful in her work as a former health visitor and midwife in the United Kingdom and continues to study the topic today while earning her PhD.

In a nutshell, BLW centers on the philosophy that babies are developmentally capable of reaching for food and putting it in their mouths at about 6 months of age. As stated on the BLW website “You just hand them the food in a suitably-sized piece and if they like it they eat it and if they don’t they won’t.”  Please note that the word “wean” is not referring to weaning from breast or bottle, but instead refers to a term commonly used in the United Kingdom for adding complementary foods to the baby’s current diet of breast milk or formula.  According to the BLW website, ideas for first foods include “chip size” steamed vegetables such as a broccoli spear with the stem as a handle, roasted potato wedges, meat in large enough pieces for the baby to grasp and chew, rice cakes, cucumber, celery and dried apricots.

As a SLP who focuses on pediatric feeding, I view feeding as a developmental process.  Whether I’m working with a child experiencing delays in development or offering advice to a parent whose child is meeting milestones with ease, I always ask myself “How can I respect and support this family’s mealtime culture while guiding this child safely through the developmental course of learning to eat?”  Thus, for families who are interested in following the BLW method, whether their child is in feeding therapy or not, I try to support their wishes if the child is capable,  while offering the following BLW points to consider:

BLW encourages parents to eat with their children, since everyone is eating the same food. 

In today’s busy culture, it feels easier to many parents to feed the baby prior to the adult or family meal, and in BLW the thought is that jarred purees contribute to this habit and it’s important to include baby at the table at an early age.  Even in feeding therapy,  the ultimate goal is for families to be able to gather around the table at mealtimes with everyone enjoying the same foods.  Plus, Columbia University reports that consistent family dinners are an integral and valuable part of raising children.

BLW emphasizes that babies must be the ones to put the food in their mouths.

Feeding therapists encourage self-feeding  for all kids because it allows them to get messy.  Babies are programmed to explore the world with all of their senses, especially their hands and mouths, and often the two together!  BLW notes that the time to begin self-feeding is at 6 months when baby can sit upright on his/her own. I explain to parents that first, every child must have the gross motor stability to support fine motor skills, including reaching and raking for food and controlling their grasp to bring the food to the mouth to be chewed.  For children who have this capability, I feel comfortable with large pieces of food that will not snap off (or allow a solid chunk to fall into the mouth) in addition to short spoons and chewable toys for practicing the skills that will eventually lead to self-feeding.

BLW follows the baby’s cues rather than the parent controlling the feeding via the spoon.

I explain that whether presenting food to your child by placing it on the high chair tray in front of them, directly on a spoon or even mouth to mouth as done in some cultures, reading baby’s cues for readiness is crucial.  Like a beautiful, flowing conversation, feeding children is a reciprocal experience.

According to the BLW blog, BLW introduces chip-size foods (rather than purees or mashed foods) so that baby learns to chew first and then spit out if unable to swallow, noting that with purees on a spoon, babies learn to swallow first and then chew.

From a developmental perspective,  this doesn’t quite fit with my understanding of how infant reflexes integrate  and babies acquire oral motor skills. Babies can begin the process of BOTH spoon and finger feeding between the ages of 5 and 6 months using both purees and soft, safe foods.  Why?  Because this is when babies acquire better lip control and movement as they suck the puree off of a parent’s finger, their own hands or a spoon.  As noted in Diane Bahr’s book “Nobody Ever Told Me (or My Mother) That!” this is when babies use their rhythmic bite reflex to bite off soft pieces of safe, soft or meltable foods that they can hold in their tiny fists or when presented by a parent to their open mouths. If the food is placed onto the gums where we will one day see molars, a rotary chew pattern will begin to emerge over time, thanks to reflexive patterns that soon become purposeful movements.  It’s a developmental process and BOTH purees and finger feeding facilitate the progression of skills. It makes sense to me to transition gradually from thinner  liquids (breast milk/formula) to thicker (thus, a smooth puree) to consistently mashed or chopped  while introducing soft meltables over time.  Keep in mind that I also encounter families who are moving too slowly through graduation of textures, as noted in this article by Bahr.  But, jumping straight to only large pieces of foods to be chewed and then either swallowed or spit out feels like skipping crucial steps in the developmental process.  “Feels like” is the key phrase here: We need research to determine if children who follow this model eventually acquire skills traditionally learned prior to chewing chunks of food as listed in this article found in ASHA Perspectives.  Unlike my previous post on sippy cups, where therapists have raised concerns based on their professional experience over several years and observation of prolonged sippy cup use,  consistent BLW practices are a relatively new phenomenon in the United States.  So, when any parent asks “What about Baby Led Weaning?” I try to integrate my own practitioner expertise and knowledge of feeding development while honoring the family’s preferences and mealtime culture.  Still,  my biggest concern for any 6 month old child is choking.

BLW encourages parents to become comfortable with gagging episodes and understand the difference between gagging and choking. 

Gagging versus choking are two different experiences.  Typically, an infant’s gag reflex is triggered when the back three quarters of the tongue is stimulated, but by the time a child reaches  9 months of age, the reflex covers less area, lying on the back third of the tongue. Eventually, the gag reflex shifts posteriorly even more as the child learns to tolerate the stimulation. Gagging is nature’s way of protecting the airway, where true choking occurs.  Choking happens when food (or other substances) obstruct the airway and thus, often has no sound or intermittent, odd sounds.  Other signs of choking include but are not limited to: gasping for breath, turning blue around the lips and beneath the eyes and/or staring with an open mouth while drooling.

Gagging is an uncomfortable sensation where the soft palate suddenly elevates, the jaw thrusts forward and down, and the back of the tongue lifts up and forward.  It is not unusual for a child to vomit after gagging.  In between the gags, the child is still able to breathe, cry and make vocal noises.  The occasional gag is an important built-in safety mechanism, but frequent gags and/or vomiting can lead to an aversion to food.

In summary, when asked for advice from any family that would like to follow Baby Led Weaning principles, I stress the importance of reading baby’s cues and monitoring them closely for safe feeding while supporting them through the developmental process of learning to eat, no matter what age.  This includes proper positioning in the feeding chair for optimal stability and presenting only manageable pieces of safe, meltable and/or solid foods that do not pose a choking hazard.  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.

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.

Thirty Million Words

Jan 30

Spreading the Words: the Thirty Million Words® Initiative

It’s no secret to speech/language and hearing professionals that children’s early language environments are critical to their speech, language, and academic outcomes.  Yet millions of children fail to receive the input they need to be ready for school when they start, and they fall only farther behind as school continues.

But it doesn’t have to be that way.  Parents, caregivers, speech/language and hearing professionals, teachers, and community members can join in what we at Thirty Million Words® call ‘Spreading the Words.’  By ‘Spreading the Words’ about the power of parents talking to their children to grow their children’s brains, we can ensure every child is ready to learn when they start school.

The Thirty Million Words® Initiative is an evidence-based parent-directed program designed to encourage parents to harness the power of their words to enrich their young children’s language environments, build their brains, and shape their futures.  The Thirty Million Words® and Project ASPIRE (created specifically for children with hearing loss) curricula utilize animation and real parent-child video to teach parents about early brain and language development, along with strategies to encourage and support development.

Watch how your words build your child’s brain

The curricula are supported with LENA® technology, which works as a ‘word pedometer’ to count how much parents are talking with their children and getting their children talking with them.  This feedback from the LENA® helps parents track their progress as they advance through the Project ASPIRE and Thirty Million Words® programs.

The Thirty Million Words® and Project ASPIRE curricula offer parents strategies to enrich their interactions with their children without adding more to their already busy and often overstretched lives.  When parents are equipped with three key tools – the 3Ts – a world of rich language engagement is unlocked.

Tune In: Pay attention to what your child is focused on or communicating to you and change your words to match.  The signals your child gives will change rapidly since her attention span is short while she’s young – staying Tuned In is a dynamic activity!

Talk More: Think of your child’s brain like a piggy bank – every word you say is another penny you invest.  There’s no limit to how many words you can invest to fill your child’s bank and build his brain!  Be as descriptive as possible to build your child’s vocabulary.

Take Turns: Your child is never too young to have a conversation with you!  Respond to your child’s signals to keep the turns going.

Parent talk is the most powerful tool for building children’s brains and sending them to school ready to learn.  With a community of professionals, caregivers, and parents ‘Spreading the Words’ about the power of parent talk, every child can get on track for school.

Hear from Shurand, a Thirty Million Words® graduate.

Learn more about the Thirty Million Words® Initiative at tmw.org.

 

Kristin R. Leffel, BS, is the Director of Policy and Community Partnerships for the Thirty Million Words® Initiative at the University of Chicago.  Her primary focus is curriculum development of Thirty Million Words® and Project ASPIRE, program design and implementation, and evaluation.  Her academic interests focus on health disparities, particularly the social determinants of health and the health of socially disenfranchised populations. 

 

Dana L. Suskind, MD, is a Professor of Surgery and Pediatrics at the University of Chicago Medicine, Director of the Pediatric Cochlear Implantation Program, and Founder and Director of the Thirty Million Words® Initiative. Her research is dedicated to addressing health disparities, specifically early language disparities, through the development of novel intervention programs. She has conceptualized and initiated development and evaluation of two parent-direct, home-visiting interventions: Project ASPIRE and the Thirty Million Words®. These interventions, for parents of children with hearing loss and parents of typically developing children respectively, aim to improve child outcomes through parents’ enrichment of the early language environment.

 

 

 

Tuesdays Are Made for Research

researchtuesday

Why Read Research?

I believe in delivering the best service possible to my clients. I want to see the greatest gains in their progress. I really enjoy my work with geriatric clients. It pleases me immensely to advance goals and help people improve their quality of life.  Staying up to date on research is a great way to help our clients achieve the greatest gains. Using the newest tools in the ideal way can bring great value to client care. We can learn more about recent research through conferences, reading journal articles, and continuing education.  But staying up to date on research isn’t always easy. As busy clinicians we have increased demands on our time at work and balance our family life at home. While reading research is a valuable practice, it’s not always the most engaging activity (especially for those of us who are extroverts).

Why Research Tuesday?

I started Research Tuesday for three reasons:

  1. Increase accountability for those wishing to read and writing about recent research.
  2. Expose readers to recent research through blogs. I envision speech-language pats reading blogs and filing the information away. Then a few weeks or months later a client comes along and they think, “Oh! I read something about this recently!” They may go back to the journal article and it may influence their treatment.
  3. Start conversations regarding recent research. Many people need to talk about research or write about it in order to really process how it might be applicable to their caseload and practice. I have seen many conversations on blogs, Facebook, and Twitter after a Research Tuesday post.

What is Research Tuesday?

Once a month (the second Tuesday of the month) SLP bloggers from around the world review a recent journal article of their choosing. Then they write a blog post using information in the article for their audience. Some participants write for other SLPs and some write for families or patients. Either is fine. The goal is to engage in the research topic.   Participants email me a link to their article and I develop a summary of all of the Research Tuesday blogs over at Gray Matter Therapy. You can see recent summary posts here. These summary or round up posts get shared through social media to increase exposure to our conversations about recent research.

How Can You Get Involved?

If you write a blog, we would love to have you join us for Research Tuesday. Just sign up here to learn all the details and get started. It is a once a month commitment and a great community of bloggers to join.   If you would like to receive notifications of Research Tuesday summary posts, then sign up for the Gray Matter Therapy newsletter. You will be notified of all Gray Matter Therapy blog posts, including Research Tuesday posts and summaries.  So mark your calendars for Tuesday, February 11, and see what Research Tuesdays are all about and how they can help you help your clients. 

Rachel Wynn, MS ,CCC-SLP, is speech-language pathologist specializing in geriatric care. She blogs at Gray Matter Therapy, which strives to provide information about geriatric care including functional treatment ideas, recent research, and ethical care. Find her on Facebook, Twitter, or hiking with her dog in Boulder, Colo. 

Kid Confidential: Using Thematic Therapy to Write Goals

creative 

Last month I discussed the benefits of using thematic lessons in speech therapy.  Today I will discuss how I write goals using this type of therapy.  Please understand the following information is based solely on my own clinical experience and information shared with me from other licensed speech-language pathologists.

Taking data for thematic therapy does not differ as compared to taking data for non-theme based therapy activities in general.  However, it does depend on the specific goal for each student and the sources from which you are planning on collecting data.

In the school setting, working as a multidisciplinary team, there are a number of different ways goals can be targeted: in the speech room, in the classroom, in particular academic exercises, in small groups, in large groups, in functional language opportunities, conversation, play, etc.  I also have used data collected by a number of different individuals in the school setting to determine generalization of skills: the SLPA, the reading specialist, the classroom teacher, the special educator, the classroom paraprofessional, etc.  The key to determining effective data collection is to know what you want to target and who will be taking the data.

Goal Writing

First let’s discuss how goal writing can affect data collection.  Goals should always be objective and measurable in nature targeting the individualized needs of each student. However, we must guard against writing goals that are too specific, such as naming particular intervention programs, school curriculum, or technological devices that will be used in therapy.  The problem with writing goals that are too specific is that they are not always able to translate from one school district to another, especially if a new district lacks the same access to such named programs, have different school curriculum or different technological devices.  Therefore, I always like to say my goals must be objective, measurable, individualized and transferable (meaning no matter where this child may move, any SLP can work on each goal as it is written).

Goals to Be Used With Any Thematic Activity

How can an SLP write specific goals with the plan of using thematic therapy in mind?  I tend to write my goals using a particular percentage of accuracy as the measurement, however I base it on the number of opportunities per session.  For example, I may write something like:

“Johnny will receptively and/or expressively label subjective (he, she, they) and objective pronouns (him, her, them) during thematic therapy activities independently (or types of cues-verbal, nonverbal, visual, written, phonemic, semantic, etc., and level of prompting required-minimal, moderate, maximum) with 80 percent accuracy of total opportunities per session, across three consecutive data collection days.”

The reason I write my goals in this manner is because in natural conversation or in the classroom, there may not be an exact number of trials/opportunities to demonstrate a skill.  So functionally, if my student begins to demonstrate that skill successfully at 80 percent accuracy, regardless of the number of opportunities across three consecutive data collection days, then I feel I can confidently say this student has learned this skill.  Writing goals this way also allows me to easily take data throughout an entire session regardless of the number or types of thematic activities my student participates in that day.

Writing Thematic Vocabulary Goals

Thematic therapy is such a great way to improve semantic skills!  One way to do this is to use academic vocabulary within thematic therapy activities and keep a running record of the targeted and learned vocabulary words.  It is believed that the average child can learn approximately 10 new vocabulary words every day (from approximately 3 years old on through elementary school), setting a total number of vocabulary words a child would typically learn in a week at approximately 70, and the total number of words per school year (36 week) at approximately 2,520. Not all of these words will be useful in the academic environment; therefore, when working on vocabulary goals for school age children, I tend to rely on academic vocabulary to guide my therapy as I know giving a child words they can use in the classroom will translate into improved academic performance.  As some children who are receiving speech and language services may not be able to learn 10 academic vocabulary words a day, due to cognitive delays or other reasons, I prefer to write a goal of learning new academic vocabulary words over the course of a marking period (9 weeks) based on teacher input.  I may write goals that target learning anywhere from 10-20 new academic vocabulary words a week, depending on the number of new vocabulary words the teacher will present to the student in the classroom on a weekly basis, as well as the student’s learning ability.  A simple example of this type of goal would be:

“Over a nine week period, Johnny will increase his understanding and use of academic vocabulary as determined via the academic curriculum and classroom teacher by demonstrating improvement in defining vocabulary, correctly using vocabulary in sentences, and/or labeling synonyms and antonyms of vocabulary for at least 90 new words during thematic therapy activities in small group speech therapy sessions.”

Keeping a simple running record of the academic vocabulary presented and learned during each nine week period serves as a simple way to collect data during therapy sessions.

When working in early childhood, I wrote goals specifically for thematic vocabulary that aligned with the weekly classroom themes for my preschool students.  An example would be:

“Johnny will demonstrate an increase in thematic vocabulary repertoire, by receptively and/or expressively labeling objects related to various developmental themes as determined by the classroom teacher (e.g. transportation, clothing, seasons, foods, etc.) via structured thematic therapy activities given phonemic and semantic cues with minimal assistance (cuing less than 25 percent of the time) with 80 percent accuracy of total opportunities, per theme presented.”

As preschool classrooms are based on thematic education, this particular goal could transfer to any preschool classroom.  Also adding in that this goal would be targeted for each theme presented throughout the academic year, helped to ensure that this goal would continue for each classroom thematic lesson.

Writing Goals to Accept Data From Other Sources

As I briefly mentioned above, another affective way to demonstrate if speech services are having a positive effect on a student in other settings is to accept data recorded from other sources within the academic setting–classroom teacher, classroom paraprofessional/aide, special education teacher, reading specialist, etc.  To do this, it should be identified within a goal that certain sources will be used for data collection.  For example:

“Johnny will demonstrate generalization of understanding and use of subjective pronouns (he, she, they) and objective pronouns (him, her, them) to the general education classroom by verbally expressing and/or writing the correct pronouns during class participation (e.g. responding to teacher questions, reading group discussions, etc.) or in classroom assignments (e.g. classroom journal, worksheets, homework, etc.) with 80 percent accuracy of total opportunities as per teacher report and graded classroom assignments, across 3 separate data collection dates.”

In this particular example, the goal here is to demonstrate generalization of a language skill to another environment. Therefore, as an SLP, I may continue to target this specific skill through various thematic therapy activities, however I will use teacher report and classroom assignments to determine if generalization has occurred.

Help from Other Colleagues

Some of the best goals I have found come from other speech-language pathologists.  Tatyana Elleseff, a colleague and owner of Smart Speech Therapy, LLC, has shared some of her preferences in writing goals with the use of thematic lessons in mind, which I very much like.  The following are examples simple skills one can target using thematic therapy.  Adding your own measurements systems and identifying ways in which data will be collected are necessary to complete these particular goals to create something objective, measurable, individualized and transferable.

Short-term Vocabulary and/or Grammar Skills:

  1. Child will be able to appropriately label 150 functional objects (nouns) related to his academic and home environment.
  2. Child will be able to appropriately label 70 functional actions (verbs) related to his academic and home environment.
  3. Child will be able to appropriately label 35 functional descriptors (adjectives) related to his academic and home environment.
  4. Child will define and use curriculum/related vocabulary words in discourse and narratives.
  5. Child will improve his ability to formulate semantically and grammatically correct sentences of increased length and complexity.

These particular skills lend themselves very nicely to SLP data collection simply by keeping running records or recording performance during therapy sessions.

Story Telling/Narrative Skills:

  1. Child will increase ability to produce cohesive age-level narratives containing 5+ story grammar elements
  2. Child will identify main ideas in presented text.
  3. Child will identify details in presented text.
  4. Child will answer simple inferencing and predicting questions (e.g., “How did this happen?”/ “What would happen…?”) based on presented text.

The above skills can be measured either in the therapy room by the SLP during specific language tasks, within classroom assignments and teacher report, or a combination of both depending on how many sources of data collection you would like to use.

Other Long-Term Language Skills

Receptive Language: Client will demonstrate age-level receptive language ability (listening comprehension, auditory processing of information) in order to effectively communicate with a variety of listeners/speakers in all conversational and academic contexts.

Expressive Language: Client will demonstrate age-level expressive language ability in order to effectively communicate with a variety of listeners/speakers in all conversational and academic contexts.

Pragmatic Language: Client will demonstrate age appropriate pragmatic skills in all conversational contexts.

As you can tell from the particular skills targeted above, data collection from an SLP alone is not going to be enough to demonstration functional skills throughout the academic environment or in all conversational contexts.  Therefore, using a number of data sources within the academic environment is necessary to accurately measure these particular skills.

In general, data collection does not change drastically when using thematic therapy lessons versus the “drill and kill” concept.  However, when planning to use thematic therapy, you may notice the way you write your goals and the sources from which you collect data can differ slightly from when skills are traditionally targeted by the SLP alone.

Next month, I will discuss how I collect data during thematic therapy and how I get teachers on board to become an additional data source as well.

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.

Collaboration Corner: Developing an IEP with C.A.R.E.

fragile

How can we make goal-writing and individualized education programs less daunting?  Recently I wrote an article for the upcoming March volume of SIG 16 Perspectives. I took the literature and combined it with what, in my experience working in public schools, makes the process collaborative.  Since I’m a visual person, I drew a model:

 

visual

 

So as you sit down as a team to write your next IEP, you may want to consider these four parts:

Context:

I apologize to those of you who have heard this from me before, but I can’t stress enough how important it is to remember that language is everywhere. Aside from basic artic goals, we really can embed our goals under most curriculum areas. Look to see how your speech and language targets may actually fit across other areas such as math (descriptive/comparative language), history (explain/describe/narrate), and science (using temporal language to order steps in a process, vocabulary).  If our ultimate goal is generalization, then it is logical to think broadly, holistically.

 

Assessment

Assessment doesn’t happen just at IEP time, it should be ongoing. If an IEP is collaborative, then data can be collected from a variety of general education activities and speech and language activities. Don’t reinvent the wheel; look at the assessments the general education teacher is giving your students and either analyze their findings or offer to provide the assessment. This is not extra work; it helps to inform your intervention. Recently I helped a Kindergarten teacher with a dictation assessment, and was it ever so enlightening!

Review & Reflect

Review your approach honestly; reflection is how we, as practitioners, learn and grow (Tagg, 2007). Since we have very little time in our crazy professional lives, this often falls by the wayside. As related service providers, we need to find time to discuss what we are seeing, and consult with teachers on how this can translate academically. In some cases, this may mean including in the IEP that the team will meet every certain number of weeks, to discuss and update one another on the student’s current performance.

Extend

Think about how to create goals that can extend beyond the immediate environment. For the majority of the students who I see, I am constantly looking for ways to connect academics with independence. A student learning math and money, for example, may need a trip to the store. A student working on following directions may bring a list to the store and come back to follow a recipe. These kinds of experiences make the abstract become concrete.

C.A.R.E is about creating a smooth, efficient and collaborative IEP process. This way we can move on from the paperwork part, and get back to the business of intervention and academic success. For more detailed information, please keep an eye out for my article entitled, “Autism in the schools: IEP best practices at work,” coming out in the next SIG 16 Perspectives issue.

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.

Five Ways to Empower Your Client

empower

For the past two years, I have shared an article with my graduate AAC class that a close colleague gave me. The article, titled Empowering Nonvocal Populations: An Emerging Concept was written by Sandy Damico in 1994. Although this article is now almost 20 years old, there are certain concepts that are timeless and empowerment is one of them. According to Ashcroft (1987), an “empowered individual is one who believes in her or his ability to act, accomplish some objective, or control his or her situation.”

Each time I read this article, it empowers me to do a better job as a speech-language pathologist and continue to empower the people around me. It also always gives me perspective on why certain clients are more successful than others. It also helps me reflect on how to empower not just my clients, but my own children. At a recent lunch with a friend who has two children with special needs, we started discussing goals for our children. She shared with me that she does not have high hopes for her children because they have special needs.  I talked to her about empowering her own children because if she didn’t believe in their ability, how can she expect them to believe in themselves?

Here are five ways that you can empower your clients:

  1. Complete a comprehensive assessment to create goals that are appropriate and attainable. If a proper assessment is not done, then the goals may not be appropriate. For example, we need to think about “What are my client’s strengths?”, “What goals will be most functional for him/her?” On the other hand, focusing on goals that have already been attained previously will not empower a person.  If a child or adult feels that a person doesn’t expect anything from them, then why try? We need to challenge our clients but in a way that is attainable with appropriate and functional goals.
  2. Tell your client, “You can do it,” and believe it yourself. This is a simple tip but has worked for me time and time again. There are two parts to this statement. Saying “You can do it,” and not believing it in yourself will not empower your client. We need to tell your client this statement, but in our hearts know they can do it. There have been many evaluation and therapy sessions where others have told me “He can’t do anything,” “He is very low functioning and doesn’t communicate,” etc. I strongly believe that everyone communicates in their own way and it’s our job to find that way and expand on it.
  3. Empower your client’s family. This is a very important tip. Some families may feel defeated or have given up on your client’s ability to communicate. They may have been told time and time again that their child can’t do this, can’t do that, etc. After awhile, a person can start believing it. Empowering families and giving them positive feedback and suggestions about their loved ones is key.
  4. Teach your client a new skill that will change their life (e.g. cooking, etc). Teaching a child or adult a new skill that can positively affect their life can be extremely empowering. I currently see a client who is independent in many aspects of his life as far as hygiene, transportation, etc. However, one skill he was lacking was his ability to prepare food for himself. He was limited to microwaving unhealthy foods because he did not know how to cook simple dishes.  To empower him, we decided to use cooking as an activity to meet his speech and language goals. I am a true believer in increasing independence because with independence comes empowerment.
  5. Don’t give up. Reach out to supervisors, colleagues, etc. It is important to reach out to others if you feel that your strategies and/or techniques are not working for an individual. If you feel defeated with a client, he or she will sense that and in turn feel disempowered. It may just take one or two sessions with some help from a supervisor or colleague to change your entire perspective of your client. If you still feel that you cannot meet their needs, it may be appropriate to refer your client.  Also, use outside resources. I find many excellent posts written on one of my favorite websites (written by Carol Zangari and Robin Parker).

 

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 discusses the benefits of reading to young children during mealtime, shares recipes with language tips and carryover activities, reviews children’s books for typical children and those with special needs as well as educational apps. 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.

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.

Step Away From the Sippy Cup!

sippy

Sippy Cups became all the rage in the 1980s, along with oversized shoulder pads, MC Hammer parachute pants and bangs that stood up like a water spout on top of your head.   A mechanical engineer, tired of his toddler’s trail of juice throughout the house, set out to create a spill-proof cup that would “outsmart the child.”  Soon,  Playtex® offered a licensing deal, the rest is history and I suspect  that mechanical engineer is now comfortably retired and living in a sippy-cup mansion on a tropical island in the South Pacific.

Geez. Why didn’t I invent something like that?  I want to live in a mansion in the South Pacific. By the way,  I also missed the boat on sticky notes, Velcro® and Duct Tape®–all products I encounter on a daily basis, just like those darn sippy cups I see everywhere.  I truly shouldn’t be so bitter, though – in my professional opinion, over-use of sippy cups is keeping me employed as a feeding specialist and I should be thankful for job security.  Thank goodness for the American marketing machine – it has convinced today’s generation of parents that transitioning from breast or bottle to the sippy cup is part of the developmental process of eating.  Problem is, those sippy cups seem to linger through preschool.

As an SLP who treats babies with feeding challenges, I frequently hear from parents how excited they are to begin teaching their baby to use a sippy cup.  They often view it as a developmental milestone, when in fact it was invented simply to keep the floor clean and was never designed 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.   That’s my issue with the sippy-cup: It continues to promote the anterior-posterior movement of the tongue,  characteristic of a suckle-like pattern that infants use for breast or bottle feeding.  Sippy cups limit the child’s ability to develop a more mature swallowing pattern, especially  with continued use after the first year.  The spout blocks the tongue tip from rising up to the alveolar ridge just above the front teeth and forces the child to continue to push his tongue forward and back as he sucks on the spout to extract the juice.

Here’s another important take-a-way on this topic:   A 2012 study by Dr. Sarah Keim of Nationwide Children’s Hospital in Columbus, Ohio reported that “a young child is rushed to a hospital every four hours in the U.S. due to an injury from a bottle, sippy cup or pacifier.”   Dr. Keim theorized that as children are just learning to walk, they are often walking with a pacifier, bottle  or sippy cup in their mouths.  One stumble and it can result in a serious injury.

Before I ever climbed onto the anti-sippy cup soap box, I let my own two kids drink from them for a short time.  I even saved their first sippy cup – I’m THAT mom who saved EVERYTHING.  If it’s too hard to let go of the idea of using a sippy cup, let the child use it for a very short time. Then, step away from the sippy cup if the child is over 10 months old or beginning to show signs of cruising the furniture.  In the near future, it will soon be time to conquer two genuine developmental milestones–mastering a mature swallow pattern and learning to walk.

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.