An SLPA Eases a School SLP’s Load

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

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

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

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

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

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

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

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

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

 

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

Picky Eaters in the Preschool Classroom: 7 Tips for Teachers

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

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

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

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

Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating.  She is the co-author of Parenting in the Kitchen: How to Raise Happy and Healthy Eaters in Our Chicken Nugget World (Aug. 2015), the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is  offered for ASHA CEUs.  She can be reached at Melanie@mymunchbug.com.  

Our Profession’s Biggest Open Secret

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

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

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

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

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

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

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

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

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

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

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

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

A Student Information Tool to Help Itinerant Evaluators in Schools

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I remember attending a presentation by Dr. Wayne Secord at a conference at Stockton State College in New Jersey, back in the late 1980s or early 1990s. I couldn’t tell you the topic, however, I recall Dr. Secord saying something along the lines of “today ‘multidisciplinary’ means come together-go apart when it should mean come together-stay together.” That sentiment has remained with me all these years.

At the time the truth of this struck me like a lightening bolt. Twenty-five or so years later, this idea, by and large, still rings true. But despite our best efforts, the time we need for collaboration is sadly limited. We are overwhelmed by staggering caseload numbers, case management responsibilities, massive paperwork requirements, meetings, playground duty and more. In concert with our general duties come more and more highly involved students presenting with academic and medical challenges that require the need for continuing education and research. Never has the need for consistent collaboration been more crucial.

I am fortunate in that I work in one building. I have the luxury of having a quick conversation on the run. I also have the benefit of knowing the students in my building. However, the itinerant speech-language pathologist or evaluator does not have such luxuries of interprofessional access. Recently, several of my colleagues expressed concern that itinerant evaluators may not have the inside scoop on students, potentially posing challenges to testing accuracy.

As a result, I decided to create a document that could be completed by a classroom teacher or case manager and given to an evaluator to provide a better understanding of a student’s dynamics. I based some of the criteria on James Anderson’s Habits of Mind (HoM), but also included general information such as the types of prompting the student responds to best, preferred reinforcement, response speed, signs of fatigue or frustration, ways to redirect the student, whether breaks are needed and the preferred type of break. The document also includes demographic information and opportunities to incorporate work samples and class schedule.

The Habits of Mind present a way to think about the way students learn and are, to a large extent, a determinant in academic success or failure. The HoM include persistence, managing impulsivity, listening with understanding and empathy, thinking flexibly, metacognition, striving for accuracy, questioning, applying past knowledge, thinking and communicating with clarity, gathering data through the senses, creating and imagining, responding with wonderment and awe, taking responsible risks, finding humor, thinking interdependently, and remaining open to continuous learning.

Having an understanding of a child’s ability to manage impulsivity perhaps, or task persistence paints a more complete picture for an evaluator. Such knowledge would allow an evaluator to say, schedule movement breaks or encourage a child to take risks when responding. The upshot is, the information obtained could yield more accurate test results. I am hoping that this document provides evaluators with greater insight when administering tests and interpreting test results.

Anne Doyle, MA, CCC-SLP, is a speech-language pathologist in Bridgewater, New Hampshire, who is in her 31st year of practice in the schools. She is a graduate of ASHA’s Leadership Development Program and is an affiliate of ASHA Special Interest Groups 1, Language Learning and Education, and 16, School-Based Issues. This post is adapted from  the post “Help for Itinerant Evaluators” on her blog “Doyle Speech Works.”

Collaboration Corner: Must-Have Books for Building Language and Literacy

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I can’t believe it’s September! For those of us in public schools, that means re-organizing and replenishing our bag of tricks. Books of course, are an easy and engaging way to expand language.

If parents are looking for some ideas on stocking up their bookshelves (or yours) this list may help.

I also rely upon my librarian colleagues for other ideas. If I can find the board book version of anything, I usually opt for that version; board books are durable and allow you to do things like add pictures with a little bit of Velcro for matching, like this:

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For very young children, or children with language delays, I generally use a couple (or five) quick pointers when perusing the bookstore:

  • Engaging pictures that aren’t too visually complicated but have a clear character and setting.
    • Targets: Who, what, where, when questions, descriptive language.
  • Books with repetitive words and phrases.
    • Targets: Oral/expressive language and literacy skills through  predictable text patterns and repetitive lines.
  • Books that aren’t too long, maybe 10-12 pages.
    • Target: Maximize engagement for short attention spans.
  • Books that can allow the adult to target core language concepts, either through text or illustrations.
    • Target: Syntax, vocabulary.
  • Books that enable the adult to expand beyond the text.
    • Targets: Commenting, labeling how a character feels or what they are thinking.

There are many books from which to choose, but here are some good starters for your collection:

  • Good Night Gorilla: Peggy Rathmann
  • The Very Hungry Caterpillar: Eric Carle
  • Have You Seen My Cat?:  Eric Carle
  • Good Night Moon: Margaret Wise Brown
  • Blue Hat, Green Hat: Sandra Boynton
  • Where’s Spot?: Eric Hill
  • Go Away Big Green Monster: Ed Emberley
  • Big Red Barn: Margaret Wise Brown
  • Good Dog, Carl: Alexandra Day

Not every book on this list follows every guideline perfectly,  but all allow for a positive learning experience that supports child language and preliteracy development.

Have an inspired school year colleagues!

 

Kerry Davis EdD, CCC-SLP, is a speech-language pathologist in the Boston area, working with children who have significant communication challenges. She conducts trainings and workshops, and serves as a volunteer speech-language pathologist and consultant for Step by Step Guyana, a school for children with autism in South America. The opinions expressed in this post are her own, and not those of her employer.

 

Fulltime Evaluator: An Effective New Role for the Speech-Language Pathologist  

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You’re an SLP at an elementary school who sees 42 students each week (most of them twice), attends individual education program meetings that are often scheduled back to back, reports for recess duty three times a week, and writes daily therapy notes and Medicaid reports, all while trying to squeeze in materials preparation for the next therapy unit. Now, how can you possibly find time for a two- to three-hour autism evaluation?

Sound familiar?

This was a typical week for the SLPs in the Albuquerque Public Schools until they created a new role group—”the SLP evaluator.”

APS is the 28th largest urban school district in the country, with over 90,000 students and approximately 10 percent of them receiving speech-language services in 143 different educational sites. The district employs 200 SLPs, but, due to a budget shortfall the past few years, faces challenges updating and replacing all the SLPs’ testing materials, such as the newly revised Clinical Evaluation of Language Fundamentals-5 or Oral and Written Language Scales-2. In addition, the New Mexico Public Education Department redesigned educational disabilities (such as specific language impairment, specific learning disability and autism spectrum disorder) in 2011 to standardize initial and reevaluation criteria. This required more training for those working in special education.

With these obstacles in mind, APS created a new SLP role—that of evaluator—to reduce caseloads, provide consistent eligibility criteria, and save some money in materials and training.

The evaluator group is made up of 22 SLPs (several of whom are bilingual) and is divided into one of three diagnostic centers across the city. We work side by side with educational diagnosticians, psychologists and others assessing students for all initial evaluations. We test students at the centers or at the schools, write reports and share the results with the diagnosticians, interpret test results with the parents, and attend the Educational Determination meetings at the school. We also collaborate with the SLP at the school who writes goals based on the findings of the assessments.

In addition, we conduct reevaluations when a change in eligibility is being considered, and for some schools we do all the reevaluations. Schools that have high caseloads, multiple district programs, or employ SLPs who are clinical fellows or who work part time may be designated a “Full Reevaluation” school. When a student is due for a reevaluation, we review past test results and current information and decide if the student needs another formal assessment. If one is needed, the SLP evaluator administers it. If a performance evaluation is appropriate, then the school-based SLP conducts it.

Last year, the evaluator role group performed over 1,900 evaluations; that’s 1,900 evaluations that the school- based SLPs did not have to do, which gave them the time they needed to focus on their therapy. And by using standard eligibility criteria, students in each school were correctly identified, which reduced the number of students with speech or language needs. The district was also able to save over $100,000 by not having to order the new CELF-5 for all 200 SLPs.  Now in its sixth year, the evaluator role group not only has been cost effective, but has proven to be an effective use of SLPs.

Rachel Hawkins, MA, CCC-SLP, is a speech language evaluator with the Albuquerque Public Schools.  She has worked in the public schools since 1993 in New Mexico and Colorado.  She can be reached at hawkins_r@aps.edu.  

Using Comic Strips in Speech Intervention

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For the past couple of years, I have used Carol Gray’s materials extensively during my work with adults with developmental disabilities. Creating comic strip conversations has been extremely helpful in facilitating conversation, resolving social issues between peers, taking turns in conversation and providing different social scenarios within various contexts.

Since I have worked in creating my own comic strip conversations with my clients for some time now, I decided to experiment using the comics section in the newspaper. My clients are motivated by the local newspaper for many reasons. They enjoy browsing through current events, looking at the pictures in the sports section and reading the comics.

The comics within a local paper are inexpensive (in my area it is just $1.00 for the local newspaper), easily accessible and age appropriate for older children, teenagers and adults. Therapy using comic strips has been surprisingly motivating and beneficial to my clients. I never realized how effective using the comics section could be!

I like to keep my favorite comics and laminate them for future use. I have also created a game around using the comics section. My clients take turns choosing from a pile of comic cards and then have a discussion about each particular card. When one client doesn’t understand a particular comic and why it’s funny, I have him ask his peer for assistance. As a group, we have had many extensive and interesting conversations related to the comics. Here are some speech and language goals that can be facilitated with the comics:

1. Expanding vocabulary: The comics are full of language, which make it an ideal time to discuss and define new vocabulary. It will be difficult for a client to understand a particular comic without understanding the actual definition of some of the words. For example in a recent Garfield comic, Garfield thinks “This is a perfect day to stay in bed and contemplate life’s truths.” Discuss what “life’s truths” means with your client. Defining the “contemplate” can help build vocabulary and build in conversation. Ask your client, “What do you contemplate about?”

2. Abstract Language/Humor: The comics are excellent in discussing abstract language and humor. In many comic strips, there are often multiple meanings of words. In a recent comic, the discussion between the characters was about “trail mix.” To one character trail mix was the snack, to the other character trail mix was a bunch of items that you picked up along a trail in the woods (e.g. dirt, sand, rocks). This comic began a conversation about the multiple meanings of words and how they had a miscommunication. Discuss the humor in the comic and why it may be funny to the reader. This can be a tricky exercise for many clients especially with autism, but it can be extremely useful as well. Helping a client recognize humor can help build friendships and improve conversational skills.

3. Taking Turns in Conversation: Between characters, there are natural turns in conversation. This can be a great model for conversation. As a carry-over activity continue the comic with an extra blank comic strips. This can help your clients create their own conversations.

4. Improving Literacy/Punctuation: Having your client read the comics can help improve literacy and reading comprehension. Point out different punctuation markers within the comic such as exclamation marks, periods, question marks, etc. Also, discuss the difference between the characters thinking a particular thought versus actually speaking it.

5. Interpreting Facial Expressions and Feelings/Emotions: In many comic strips the characters have extreme emotions. In other comics, the feeling and emotions of a character can be a little tricky due to the high levels of sarcasm. Read the specific comic strip together, discuss the language and then ask your client how the character is most likely feeling.

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.

 

Three Easy Ways to Collaborate with Teachers

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Like many of you, as a school speech-language pathologist, I left graduate school ready and excited to jump into classrooms. I realized the benefits of reaching my students in their own environment and so I set out to reach them there by “educating” teachers on speech and language. And then… reality hit. With all the added responsibilities, how do I go about adding one more task to my ever-growing list and collaborate with teachers?

Are you like me? Often, school SLPs feel lost when it comes to reaching their students in the classroom. Typically, we fall into one of two camps. Either we feel the need to completely take over the classroom lesson to “teach” the teacher something about language or we become too afraid of looking like a “know-it-all” and so do not offer any suggestions. Neither of these offers a solution. Here are three easy ways to collaborate with teachers that provide a balance between the two:

1. Provide a monthly newsletter. This is one of the easiest ways to stay in touch with teachers. If you have monthly themes, give them an idea of what you’re working on. Provide a “vocabulary word of the month,” a tip on how to serve students in their classrooms, a good resource or website, or even a practice sheet stapled to your newsletter for teachers to provide to students. Teachers will appreciate the time you took to reach out to them and will also gain information on both their students and how we service them.

2. Give a student snapshot to your teachers. This is most beneficial at the start of the school year. Unfortunately, with all of our responsibilities, important information is often not communicated and students’ services often suffer as a result. Relay any accommodations on students’ Individual Education Program (IEP) that the teacher is responsible for providing in the classroom and make sure they understand what each one means. It is also helpful to provide an overview of the goals you are working on with their students. For example, a simple statement such as “During Johnny’s speech and language session, he is working on increasing his vocabulary and reading comprehension,” would give the teacher an idea of what he works on with you.

3. Hop into the classroom during independent reading. Many classrooms now schedule a chunk of time devoted to practicing independent reading and writing skills. My district uses a structure for this called “The Daily 5” created by Gail Boushey and Joan Moser. When I walk into a classroom during Daily 5, I can immediately sit with students and listen to reading, ask questions about what they are reading, teach vocabulary and assess and monitor articulation skills while reading. What does this type of intervention mean for us as SLPs? We can easily monitor and work on skills within the classroom setting all while requiring minimal if any planning time. This type of intervention also sets the tone for easily working with the teacher on their turf without taking over the entire classroom.

I hope this next school year finds you rested and ready to try new ideas. Reaching out to teachers often feels like one more to-do, and can fall to the bottom of our priorities. By making a goal each year of trying just one new idea, it can seem less overwhelming. I guarantee it: by reaching out to our students in their environment, we will be making a huge impact on their lives.

Nicole Allison, MA, CCC-SLP, has a passion for creating materials that benefit the school SLP, especially when it comes to data collection and the Common Core State Standards. She currently works in a public school as the only SLP (yes, that’s right, all 13 grades and loving them) and is the author of the blog Allison’s Speech Peeps (speechpeeps.com). She also serves on The Ohio School Speech Pathology Educational Audiology Coalition as secretary. Her and her husband recently had a baby and are loving parenthood. She can be reached at nrallison@gmail.com.

What School SLPs Want to Know

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If you want to know what the real talk is at an ASHA Schools Conference, you need to pull up a chair at the lunch tables. That’s where you’ll hear chatter about the most top-of-mind topics for the speech-language pathologists and audiologists who attend.

So it was that this roving blogger sat down to share a sandwich and some conversation with this year’s attendees. Here’s what a sampling of them report are the most burning issues that brought them to Schools 2014 in Steel City: Pittsburgh.

Brianne Young, SLP, Renfrew, Pennsylvania
I want to know how we’ll use the Common Core State Standards. We’re switching to the Common Core totally but we haven’t yet transitioned the speech-language piece of it 100 percent. We started adapting the reading and language standards last year, and nobody’s sure how this will all work. I also want to know more about incorporating Common Core with RTI.

Amy Shaver, SLP, Hamden, Connecticut
As a former stay-at-home mom just getting back into it—I just got hired fulltime by a school for next year—I want to learn more about iPad apps for speech. The technology has changed so dramatically and rapidly in eight years. It’s kind of an odd place to be because as a mom, technology can seem like a big negative. I’m always limiting my kids’ screen time. So it’s an interesting shift to think of it as an educational tool.

Sabrina Hosmer, SLP, Manchester Public Schools, Connecticut
As a bilingual evaluator, I’m here to find out how other SLPs have made systemic changes to their school districts. In our district we have problems of overidentification of speech-language disorders among bilingual children. The children are tested in English, and they’re not supposed to be, but we don’t have enough bilingual SLPs to do appropriate assessments or to serve the bilingual kids who really do have speech-language disorders.

India Parson, SLP, Prince Georges County, Maryland
What’s on my mind? The Common Core—how do we use the literacy standards with children with severe disabilities? And what’s going to happen with tying them to performance evaluations of SLPs, which they’re doing with teachers and are talking about doing with us? The other issue is the shortage of bilingual therapists. We have a big problem of overidentification of disabilities in the bilingual population. We need folks making better diagnostic decisions up front.

Christine Bainbridge, SLP, Ithaca, New York
What’s burning for me is wanting to learn more about central auditory processing disorder—what is the research evidence base on CAPD, how does it truly change children’s functioning in the classroom, and how do we intervene with it in an evidence-based way?

Audrey Webb, SLP, Charlotte, North Carolina
I’m just coming into the K-12 schools this year after working as a preschool SLP for many years, so what’s going on with the Common Core will be big. Of course, a lot of that’s up in the air now because our state legislature just repealed it, but we’ll still be using it for the time being. I’m also big on RTI. I’m a fan of it, and always interested in ways to get teachers on board with it.

Mary Pat McCarthy, SLP, Clarion, Pennsylvania
My reason for going to Schools every year is always to see what the current buzz is. It’s no one thing I want to know. It’s everything, really. I know if I go, I’ll get what I need for the coming school year. This year I’m especially interested in hearing about working with teachers on improving our work on phonology and articulation with kids. But this conference is always a great professional recharge during the summer.

 

Bridget Murray Law is managing editor of  The ASHA Leader.

SLPs in the Home: What’s Pot Got to Do with It?

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I never thought I’d be writing an article for ASHA about marijuana, but because I live in Colorado, I’ve got the latest news on weed to pass along to my fellow SLPs. In fact, if you were sitting here with me in the privacy of my own home (and you were over 21), we could chat about it while lawfully smoking a joint, munching on an edible cannabis-laced cookie, sucking on a marijuana lollipop or even, inhaling the vapors from an e-cigarette packed with marijuana oil. That’s just a sampling of the options we have to get high in the “mile high city.” Before you shout “I’m coming over!” I should probably disclose that I’m not a marijuana user, medical or recreational. If your next thought is “But I DON’T live in Colorado (or Washington) so this doesn’t apply to me – at least professionally” please read this entire article. Colorado law is considered a “springboard for other states” to legalize marijuana soon. Plus, illegal shipping to other states, often discovered during a routine traffic violation committed by the average Joe next door, has increased significantly. According to the El Paso Intelligence Center & National Seizure System, the mini-vans and SUVs bringing home “souvenirs” from Colorado aren’t just from the states bordering the Rocky Mountains. New York, Florida, Illinois and Wisconsin were some of the most popular destinations and consequently, you may experience some unexpected safety issues if you are providing home-based care for children and adults.

In an effort to educate therapists on the new laws and our responsibility to inform our families of issues that may arise with recreational marijuana use, Jane Woodard, the executive director of Colorado Drug Endangered Children, is traveling the state providing health care professionals the necessary information to keep ourselves and the families we serve safe. SLPs are required by law to report suspected conditions that would result in neglect/safety issues or abuse of children and adults. However, many of our families are simply not aware of the safety concerns and home based therapists are often the first resource for educating those families who choose to partake in using, growing or processing recreational marijuana.

Given the various populations that we serve, here is an overview of some of the safety issues:

Infants: As a pediatric feeding therapist, just one of the populations in my care are babies who require support for breast and bottle feeding. In this Colorado culture of embracing our new freedom, mothers are commenting to me without restraint that they’re using marijuana to combat nausea during pregnancy or enjoy “a little pot now and then” while breastfeeding.Studies indicate that by age four alarming changes occur in children that have had prenatal exposure. It’s noteworthy that the studies focused on a much lower amounts of delta-9-tetrhydrocannibinol (THC: the chemical that produces the psychoactive effect) than what is present in today’s super-charged marijuana products. The children demonstrated “increased behavioral problems and decreased performance on visual perceptual tasks, language comprehension, sustained attention and memory.” Marijuana use while breastfeeding is contraindicated because the THC is excreted into breast milk and stored in fat and is suspected to impact a baby’s motor development. There are no established “pump and dump” guidelines for THC and it stays in the bloodstream for much longer than other drugs. Consider the increased risks from both second-hand smoke and third-hand smoke or the “contamination that lingers” after smoking, including an increased risk for SIDS and more. For the home-based SLP, exposure to second and third-hand smoke or residue means that I will likely carry that aroma with me to the next home. I am responsible for the safety of all of the children I treat, and many are medically fragile and/or have sensory challenges and would be impacted by these odors. Today, I am faced with difficult conversations with parents that I never imagined I would have.

Children: In four short months, from January to April 2014, Colorado’s Poison Control Center has reported 11 children who ingested edibles, one as young as five months old. Over half of those children had to be hospitalized and two were admitted to the ICU. Consider that those are the reported cases – and what goes unreported is difficult to ascertain. While the law requires that the packaging cannot be designed to appeal to kids, current practices are questionable. Some argue that edibles are packaged too much like junk food, with boxes of “Pot-tarts” similar to the popular toaster pastry, bottles of fizzy “soda-pot” and candy bars with labels that rival Mars® and Hershey’s®.  In April 2014, Karma-Candy was the marijuana candy that a father in Denver consumed just before hallucinating and killing his wife, who was on the phone with 911 dispatchers at the time. She could be heard yelling to her kids to go downstairs as she desperately tried to get help for her family.

Packaging of certain products must also be in an opaque and re-sealable container, but that law only applies to the time of purchase. Plus, most edibles contain multiple servings and it’s not unusual for one cookie to serve six people. Even adults are mistakenly eating whole cookies and in April 2014, one visiting college student consequently jumped to his death from a hotel balcony after eating too much of an edible. A New York Times columnist visiting Colorado ate a whole candy bar labeled as 16 servings, and “laid in a hallucinatory state for 8 hours.” Home baked marijuana options are equally confusing. As a feeding therapist, I used to be comfortable offering foods to a child from a family’s pantry. But now, a tempting plate of brownies may be more than just a plate of brownies. By law, edibles, like any marijuana product (even plants), must be in an “enclosed, locked space.” However, it is not unusual for Colorado therapists to arrive for their home visit and find a bong, topical lotions or a half-eaten edible on the living room coffee table. Early intervention and home health care agencies are considering how to educate families on the first day of contact, during the intake process. Susan Elling, MA, CCC-SLP, who treats both children and adults in the home, notes that “It will be very important to have an open and honest conversation with a patient (and their family) regarding marijuana use as part of taking the medical history – just as we do for alcohol and smoking.”

Adults: Ms. Elling reported that “the population in need of homecare services may be more likely to use marijuana to control pain and nausea” because family members are more likely to suggest it and there will no longer be a need to obtain a medical marijuana card. Ms. Elling also notes that marijuana “affects sleep, balance, coordination, and cognition.  This may be amplifying the conditions a patient is already dealing with related to medical issues.  It can also significantly raise anxiety.  These are all factors that increase fall risk, confusion, lead to poor judgment, and can setback a patient’s recovery. It may be very difficult to determine what issues are related to the patient’s medical condition and which are related to the marijuana use.  Interventions, progress and prognosis may be affected.” Edibles in particular are a safety hazard for this population, because of the inability to self-regulate. There is no predicting how an edible will effect one person or another.

“It’s not your grandmother’s marijuana,” reported Dr. Richard Zane, who is the head of the Department of Emergency Medicine at the University of Colorado Hospital. Well-meaning family members, hoping to control their loved one’s discomfort, may not realize that the strength of today’s marijuana is significantly higher than the pot your cool grandma smoked in the 60’s. In fact, THC levels represent a 121% increase just from 1999 to 2010. Family members may not understand that the strength and effect of the drug varies from product to product. For example, compare two hits on today’s joint and an individual will ingest approximately five mg of the chemicals that produce the psychoactive and/or sedative effects compared to up to 100 mg in one packaged edible. Plus, even using the exact same method of ingestion does not guarantee the exact same dosage every time. Zane reported in this interview with Colorado Public Radio that the “drug isn’t always spread evenly through food or candy, so several people eating the same amounts can be ingesting different quantities of marijuana.”

The uncertainty of dosage and effects has Elling on guard: “I am concerned that the high potency, unpredictable effect, easy availability, and unclear dosage information of edibles may have serious consequences for homecare patients with already fragile health. It is also misleadingly considered quite “benign” and safe compared to alcohol consumption and smoking.  I feel the need to know the signs and symptoms of a marijuana overdose and know the contraindications with any other prescription or OTC drugs they may be taking and be able to educate my patients and their caregivers regarding this issue.”

Additional Safety Concerns: In the course of this short article, it’s impossible to cover all of the safety issues, including those related to growing and processing marijuana in the home. These concerns include electrical hazards from impromptu wiring (not to code); cultivation hazards such a mold and poor air quality for medically fragile patients;  increased carbon dioxide and carbon monoxide necessary for growing; chemical exposures and improper storage of pesticides and poisonous fertilizers; THC on household surfaces and airborne exposure; and exploding hash oil labs. From January to April 2014, hash oil explosions occurred on a weekly basis in Colorado, some triggered just by turning on a nearby light switch.

Consider Family Functioning: The impact on safety is the tip of the iceberg. Woodard explained that home health professionals must consider a parent’s behavior when using marijuana, the impact on a child’s behavior and family functioning overall. Difficult but often necessary questions to ask include: What steps have you taken to protect your children and family members? How do you store your marijuana and paraphernalia? What are you like when you use? Most importantly, she recommended asking yourself “Do I believe that the conditions in this home could reasonably result in harm” to anyone in this household? If so, educate the family and be mindful of mandatory reporting laws.

 

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.