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

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

 

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

 

How to Navigate the Profession One Binder at a Time

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

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

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

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

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

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

Kid Confidential: Using Thematic Instruction in Speech Therapy

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

Harnessing Learning Styles

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

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

How to Put the ‘Super’ in Supervisor

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

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

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

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

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

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

Kid Confidential: Teaching Parents the Power of Play

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I don’t know if it is just my experience or if you too have found this to be a problem, but I have noticed the more I work with very young children, the more I realize parents do not actually know how to play with their children.  I know this is a trend I am finding to be true more and more often, however, I am still shocked when I see it.

Play is such an integral part of a child’s development as it affects all areas of growth including, but not limited to, social skills, communication development, cognition, problem solving and reasoning skills, and imaginative thinking.  Therefore, for those of us SLPs who are working with infant, toddler and preschool-age populations it is not just enough to model play or target language development, we must teach parents how to play.  You know the saying “If you give a man a fish, he eats for a day.  If you teach a man to fish, he eats for a lifetime.”  Well I believe this to be similar–we need to teach parents how to play so their children can continue to develop during the time we are not present as service providers and throughout their childhood.

I have noticed that sometimes even involved parents who are willing to participate in book reading and speech and language drill type activities, are still not always comfortable participating in play.  Involved parents want to know what they can do to help.  The problem is they don’t fully understand the importance of play or how their child’s thinking skills change and grow via play.

So what do I do about this?  How do I try to teach parents how to play?  Here are a few techniques I have used:

  1.  Parent education:  The first thing I do is teach parents why play is so important and how learning takes place.  I explain to parents why we need to incorporate play into our therapy and why their child needs to participate in play with them when I am not present. I also explain the types of play their child is currently exhibiting versus what types of play they should be exhibiting at their age (you can find more details on ages and stages of play here).  This truly helps parents fully understand their child’s current level of functioning and why focusing on play skills is so important to communication development.
  2. Never make assumptions:  When I was fresh out of graduate school I made assumptions that parents knew and understood child development.  But the truth is we cannot assume that parents have had the same experiences as we have had.  Even if we are working with parents of a large family, this does not mean they know or fully understand how to play with their children.  I have learned after making many mistakes to never make assumptions about what parents do or do not already know.  Rather than treating parents as if they are in need of education, I will say something like “I would be remiss if I did not explain/show you how to…”.  Other times, I will say something like “I’m sure you already know this but I need to explain that…”.  Again, these are just two ways to help share my knowledge with parents while not treating them as if they are uneducated or making the assumption that they know more than they do.
  3. Model and explain play:  I then create play scenarios at whatever level of play the child is functioning currently while attempting to expand the play and improve language and problem solving skills.  I carefully explain what I am looking for in a child’s play and how I am changing the play slightly in order to achieve those goals.
  4. Give the parents a turn:  It is imperative that I make sure parents have a turn taking over the play interaction.  I want to empower parents and make them feel as if they can play with their child when I am not there.  However, the only way to do that is to make sure they have an opportunity to practice these skills while I’m still there to assist.  If help is needed, I will guide the interactions while continually reducing support throughout the session.
  5. Videotaping for success:  Videotaping parent/child play interactions can be an invaluable way to educate and empower parents.  I like to videotape portions of interactions so parents can refer back to the videos as needed.  When parents see how they have taken suggestions and turned them into positive interactions with their child, they begin to anticipate and invest their time into participating in play more often with their child.
  6. Follow up weekly:  The key to making this technique work is to make sure I follow up with parents and hold them accountable for their child’s play week to week.  I encourage parents to take videos on their smart phones and save them for our next session.  This way I can see the growth in their child and continue to provide assistance as needed.

Parents are always looking for the “right” ways to play.  So I give them a few tips:

  1. Show some emotion:  I explain that parents need to make sure their face, voice and entire body is showing the emotion they want to exude.  So when parents look their child in the eye, smile wholeheartedly and say, “I’m excited to be playing with you today!” or “This is really fun!”, I know they understand the importance of emotional in play.
  2. Play when you can:  Parents often times shut down if they think I am asking them to play for hours a day with their child which ultimately results in no play from them at all.  Instead I ask them to try to play for one or two 15 minute increments a day.  For parents who work full-time and have several children, I have found this to be a more realistic expectation and request from them.  Also encouraging them to involve their other children in play is a stress reliever for some parents as children are great models for each other and many times siblings are vying for their parent’s attention.  Incorporating siblings in play, seems to help provide the much needed parental attention while teaching the whole family how to interact with a child who may have delays.
  3. Turn off the TV and turn on some music:  Parents believe their children do not watch much television however when I ask if parents like to leave the television on for background noise I tend to get more “yes” answers than “no”.  So I encourage parents to get rid of the visual distractions like television and if they must have some background noise, play some child friendly music instead.
  4. Change out toys the child has available to them:  I have noticed even with my own child that when I periodically change out toys available, I see very different types of play.  This can keep a child’s play dynamic and guard against stagnation.
  5. Mix and match toys:  Mixing and matching toys that would not typically go together encourages growth in a child’s imaginative play.  I have seen some amazing pretend play when I brought random toys to therapy for my clients.
  6. Use nondescript toys/objects:  Some of the best pretend play I’ve observed comes from objects that don’t seem to look like anything in particular.  Have you ever placed a few boxes and a bucket of blocks in the middle of a room and watched preschoolers play?  It’s amazing the “thinks they can think”.  The more nondescript the object, the more creativity goes into the play.Parents always ask me if they are “doing it right,”  if they are playing the right way with their child.  My response is always the same “If your child is smiling, laughing or fully engaged with you, then you are doing it right.”

Do you spend time teaching parents about the power of play?  If so, how do you go about it?

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.

How To Become a Telepractitioner—Without Going Private

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Working in schools for 23 years was very rewarding for me, but in 2012, I found myself looking for a different avenue for delivering speech-language pathology services. Simply, I was ready for a change.

Therapy sessions seemed to have become more condensed, requiring me to work with groups rather than specific students, which was not always beneficial for them. Incorporating technology into therapy sessions seemed to help my students maintain focus, motivating them to work. Whether I used technology to help students practice articulation drills, writing organization or social skills, they enjoyed it.

Could I find a job opportunity that would allow me to bring together my interests in working from home and using technology to provide speech-language services? The answer seemed to be “telepractice,” also known as “teletherapy.”

I knew leaving my position in the schools would be a bit intimidating. Questions began swirling through my mind: What were the “pros” and the “cons” of leaving my current position? Would it be worth leaving the schools to work from home? Did I want to provide treatment as an employee of a company or as a private provider?

I’ve always wanted to work from home; being able to transport my children to and from school and spending time with them afterward was a major motivator. I’ve also longed for scheduling flexibility that working from home would allow (the ability to throw in a load of laundry between sessions or plan in the evening without needing to drive back to work). But would I miss the staff camaraderie? What about students’ hugs? Would I feel isolated? Since I began providing telepractice treatment, the answer to each of these potential drawbacks has been “no.” To me, the “pros” have far outweighed the “cons.”

I researched telepractice some more on the ASHA website, which reviews studies pointing to teletherapy’s efficacy, and joined ASHA Special Interest Group 18, Telepractice. I later attended a teletherapy training in Maine that tasks that would ordinarily take 60 minutes to complete when providing “onsite” speech/language therapy could be accomplished during approximately 35 minutes of teletherapy!

Next, I considered providing teletherapy as a private practitioner, but I balked at the additional marketing and operational work that would require, even though I knew it would mean being my own boss and making my own schedule.

After careful consideration, I decided to accept an offer to become a teletherapist with a company I knew delivered quality training and treatment. At my company’s direction, I attended American Telemedicine Association-accredited training provided by Michael Towey.

Regarding equipment, I recommend using:

• A laptop with at least a 15” screen and built-in webcam (or you can use an external webcam).
• A headset with attached microphone or external speakers with an external microphone (I prefer a headset because the microphone is always close to the students’ mouths).
• A document camera for use during therapy. You can find most of this equipment on Amazon.

The software I use is a HIPPA-compliant, video-conferencing platform provided by my employer. It is important to consider security and compliance when selecting a Web-conferencing platform (Skype, for instance, is not compliant). Some telepractice companies require that you purchase your own equipment as well as their telepractice software. Be sure to consider that in your research.

For materials, I have found different online resources to draw from: SLP blogs (such as ChapelHillSnippets.com), eNewsletters, and ASHAsphere. I often use my own materials via a document camera. Once I received the necessary equipment and became comfortable with it, I worked on reviewing each student’s IEP, listing goals/objectives for each, and documenting IEP/re-evaluation due dates. Training a paraprofessional was the next step because I needed someone to: chaperone students coming to and leaving from therapy, be a behavior manager as needed, serve as a technology problem-solver, help as a student-response “confirmer,” and be a “skill-carryover” assistant when possible.

Connecting with students via teletherapy has a different “feel” when compared to onsite therapy. While working in the schools, students would draw pictures for me, hug me, and stop in my speech room to see how my day was going. Obviously hugs aren’t available over the Internet, but I have found that there are other ways to connect with students.

Frequently, when students first join the session, their faces light up, and I’ll hear, “Good morning, Mrs. Sippl! What are we doing today?” If my students earn a few minutes of free-choice time at the end of a therapy session, frequently they will ask to draw or color online. Once they’re done, they’ll explain that the drawing is for me and that I need to print it out to hang on my wall. As you can see, the “connection” with students is not lost. It is just different.

Based on my own telepractice experiences, my sense is that students are able to accomplish more in less time compared with face-to-face therapy. Teletherapy has its own rewards, and students find ways to show you how important you are to them. Once, as I was working with a Kindergarten student, she looked at me and exclaimed, “Hi, Mrs. Sippl! I’m so excited to see you today! I love you!”

Tracy Sippl, MS, CCC-SLP, is a Seymour, Wis.-based speech-language pathologist and tele-therapist with Cumberland Therapy Services. She is an affiliate of ASHA Special Interest Group 18, Telepractice. 

Planning a Play-Based Therapy Session

momanddoll

The big laminate-top kidney tables that many of us have in our school-based “speech rooms” are a great place to run through flashcards, worksheets, read and map stories, answer questions, and teach brand new skills. However, unlike infant–toddler SLPs, for whom playing on the floor is standard, school-based SLPs often overlook opportunities for such play-based therapy.

With play-based therapy, you can really capture a child’s attention and make memories that will extend beyond the therapy session. These memorable moments support learning and retention, and are essential when treatment sessions are infrequent.

Play is flexible, non-literal, episodic and process-oriented. During play, the child is actively engaged and intrinsically motivated. True play has no extrinsic goals, but we sacrifice some of that to ensure that target skills are practiced. When designing play-based lessons, the less you deviate from true play, the better. Here’s how:

Required targets

The first step of planning a play-based therapy session is to select targets to teach. Next, you’ll identify a way to require those targets during play. Start with the lesson, not with the toy or game! You may think in terms of how to give access to something the child wants following skill demonstration. This “something” can be toys, food, parts of a whole (for example, puzzle piece, song phrase, portion of a motor sequence), social interaction, or a funny or amusing consequence. You’ll also have suggested targets that are encouraged but not required. This is because requiring target demonstration at too high a frequency quickly turns the play session into drill-based “work” and begins to peel away the benefits of playful learning.

Example: “Sleepy Sue,” target = /s/-initial words. Let the student choose dolls for each of you. Make your doll’s name “Sue.” Explain that Sue has a pesky tendency to fall asleep (*insert snoring*). When she dozes off, the child’s job is to wake her up by saying, “Sue! …Sue!” You assist with correct articulation, then commence with doll play until Sue falls asleep again. In a short period of play, the word “Sue” will be required many times, but you may also model things Sue and her dolly friends like to do, like sew, sing, or sit—targets that will be suggested but not required.

Memorable episode

The more episodic and story-like your play-based session is, the better. This is because associated events scaffold memories. Later that day, if a child can’t tell mom “what I did in speech today,” you aren’t reaping the benefit of repeated recall. Consider the “Sleepy Sue” example above—the more related the activities that Sue and her doll friends do, the better. It’s too easy to *think* you’re using playful learning, when in reality you’ve set up a nonassociative work–reward–work–reward structure (as with many games).

Memorable targets

In addition to the play episode being memorable, it’s perhaps even more important that the targets be memorable. I’ve used “Sleepy Sue” with a five-year-old who called me out the next session because I accidentally called Sue, “Sam.”And that was great! But a lot of kids wouldn’t remember that target, just like they won’t likely remember many of the target words in a series of flashcards. So I’ve also had “Sleepy Sue” do a cooking episode.

Example: “Sue Makes Soup,”target = /s/-initial words. Sue loves to cook, and the student can help Sue by choosing the ingredients for her soup. The child can add salsa, sausage, seeds, soy sauce, syrup, sour cream, and such. Of these targets, some can be the real thing! And how much fun is it to put real salt or real seeds in the soup bowl? “Salt” and “seeds” can be your required targets, and you hold the shakers until the student needs them. The student may even take some of the “targets” home to show dad. The other words may be required or suggested targets, depending on the student.

Play-based learning can be done with children of any age. What would play-based learning look like for a fifth grader? Start by considering how fifth graders play with one another (for example, talking about their favorite TV show), and design from there. Play-based learning is also excellent for students with autism—check out this article and this one. Whatever the child’s age or skills, always ask yourself—“Could we be playing with this?”


Meredith Poore Harold, PhD, CCC-SLP,
is a speech–language pathologist and independent scholar in Kansas City, Missouri. She works primarily with infant-toddler and elementary-aged children, and provides resources for parents and clinicians at www.meredithharold.com.

Kid Confidential: My Top 10 Reasons for Attending the ASHA Schools Conference

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I know I typically write about some topic related to child development but I thought I would take a detour this month and write about my first experience participating in the ASHA schools conference.  The reason I think this is important is because so many SLPs out there are school-based or work primarily with pediatrics and my experience at the schools conference this year was a very good one full of great insight into various topics, issues and research on child development.

First, let me say that I get no financial or non-financial benefits for writing this article.  So that being said, rest assured this blog post is coming solely from my personal experience and opinions.

This year was the first year in my long career as a speech-language pathologist (yes, you heard that correctly) that I was able to attend the ASHA Schools Conference.  Although I had wanted to go for some time now, between marriage, my husband’s multiple deployments and motherhood, I just couldn’t find the time or financial means to attend before this year.  However, with that said, I had such a wonderful educational experience that I do regret missing out on conferences of previous years and I knew I needed to share with you that it truly is worth saving your quarters, dimes, nickels and pennies over the next year to ensure you can attend.

In an effort not to take myself too seriously and to make this fun for you, I will, like some famous evening talk show host I will not name, give you….(drum roll please)….

 

My TOP 10 Reasons for attending the ASHA Schools Conference:

10.  Location, Location, Location:  Every year it is at a new location in the United States and it’s a nice reason to go check out some parts of the country you might not otherwise ever see.

9.  It’s Some Work and Some Play:  Presentations are over by 3:30 on Friday and Saturday so you have the choice to stay for round table discussions or poster presentations but if you choose not to participate, the rest of the evening is yours to spend sight-seeing.  Sunday, the conference is over by lunch time so you have the rest of the day to grab your camera and officially play tourist.  I was able to head on over to enjoy the beach while the sun was going down one evening, walked about the harbor tourist shops on a Sunday afternoon and strolled along the palm tree lined streets and bike paths with my family.  It was some fun, work, and some super fun play!!!

8.  A Family Affair: I decided to bring along my husband and 3-year-old son on this trip.  They were able to spend some quality Daddy time while I was enjoying the conference and we had some nice family time in the evenings.  It was a win-win situation for me, still having some time to enjoy my summer with my family.

7.  It’s Like Looking in a Mirror:  Have you ever seen a convergence of 1000+ pediatric SLPs on one convention center?  We are all dressed in our khakis and flip flops with our bag of notepads, binders, tablets, pens and pencils slung over our shoulders.  It really is like looking in a mirror and seeing thousands of ourselves out there.  After registration, I was walking back to my hotel room and waiting at the crosswalk were two women who looked like … well me.  So I asked them “Are you SLPs?” and one woman turned around and said “Yes, but that’s a heck of a pick-up line don’t you think?” Ha!  So true!

6.  Feed Them and They will Come:  Yes you guessed it, your registration fee includes (or at least this year included) breakfast each morning, lunch for Friday and Saturday, and snacks.  The food was very healthy and delicious too.  No too shabby!

5.  It’s About What You WANT to Know:  The feel of the schools conference is not about who you know, what researcher you like or who’s work you just finished peer reviewing.  It’s about what you WANT to know.  “What session are you going to next?” was a question I heard often that weekend from strangers who became new found friends because they happened to sit next to each other in a session.  It’s all about what we have come there to learn and what we can share with each other when our sessions are done.  The exchange of educational information for the pure purpose of learning!  Ah, does it get better than that?

4.  The Social Network:  What I love about school SLPs is that although we love our technology, we also love our old school email (strange that email is actually old school now, don’t you think?).  Of the speech pathologists I talked to and exchanged information with, there weren’t any future “tweets” planned or Facebook private messages offered.  It was more of “Shoot me an email when you get back to ____ and we’ll talk.”  So yes, we are able to build our network of SLPs in a way that works for us.  And let’s face it, what SLP can really stick to 140 characters?  Limiting our ability to “talk” is really the worst nightmare for an SLP, don’t you think?!

3.   It’s Not What You Say, It’s HOW You Say It:  The presenters chosen for this conference (I can only speak to the 5 presentations I partook) were down to earth, engaging, interactive and some of them were very, very humorous!  David Hammer, an SLP who presented on CAS, introduced himself by saying he’s NOT an expert but a specialist because he believes he is always learning.  This is one example of how things said really change the dynamic of the session.  Luckily, he was not the exception.  All of the presenters I encountered and talked to were there because they wanted to share their passion for their field with us.

2.  Use Our Time Wisely:  Each presentation was FILLED with useful information, techniques, strategies and therapy activities we can use on a daily basis for a variety of different deficits and disorders.  I was very happy to see that my money and my time was NOT wasted on theory or upcoming research while only spending the last 15 minutes on therapy as many times happens at conferences.  Rather, after every presentation I left with the feeling that I had new tools in my toolbox ready to try in therapy with my clients.

And my number 1 reason for attending the ASHA schools conference is…

1.  It Only Takes a SPARK:  The number one reason I recommend going to the ASHA Schools Conference is because it helps flame the fire and passion we have inside of us for our field.  It only takes a spark, but once our fire gets going, we are hard to stop!

So those are my top 10 reasons for attending the ASHA Schools Conference.  Did you go this year?  What are your impressions?

I have already started saving for next July’s schools conference which incidentally is being held in my old stomping grounds of Pennsylvania.  I hope to see some of you in Pittsburgh next summer!

Maria Del Duca, MS, 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.