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

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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.

Get Some Book Drive Know-How

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In low-income neighborhoods, one book for every 300 children? In middle-socioeconomic status neighborhoods, 13 or more books for every child? I read this jarring statistic and had an epiphany. As a university professor, mother of a school-aged child, and part-time itinerant public school speech-language pathologist, I wondered if there was a way I could help effect change for the low-SES children in my own area?

SLPs all over the United States battle with the problem of students who present with cognitive, linguistic, and executive functioning deficits related to being from low-SES backgrounds. Sometimes these students have genuine, underlying language impairments and qualify for language interventions, but many times they are typically-developing language learners whose language deficits stem from their low-SES status and its accompanying disadvantages. As experienced SLPs, we all know that low literacy skills can have lasting and serious consequences. A shocking statistic indicates that in states such as California and West Virginia, prison cells are built based in part upon the number of third grade students who are reading below grade level. What could I do to help?

I decided to attack the problem of a lack of books for children in low-income homes. I started collecting new and gently-used children’s books in fall of 2008 for a graduate student’s thesis. We collected several hundred books, which she used, and then she graduated from our program. In April of 2009, my beloved mother, Beverly Roseberry, died of a heart attack. Mom had been a general education and Sunday school teacher. In the Philippines, where I grew up (my parents were missionaries), my mom always had books for my sisters and me despite the fact that we were quite poor. On one island we lived on, my mom even started a library for the Filipino children. She loved books, and made sure that my sisters and I did, too! I decided to keep the children’s book collection going in my mom’s memory. Today we have collected and donated more than 43,000 books to local children in under-resourced areas. There are 21 area agencies and organizations receiving our books as well as three elementary schools.

 

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Third grade students at Whitney Elementary School receive books to keep and read during the summer.

It can be discouraging for SLPs who work with at-risk, low-SES children to address the seemingly insurmountable obstacles that these children face. One of these obstacles is the lack of access to age-appropriate reading materials. How can the average SLP gather children’s books to distribute to low-SES children to keep as their own? Here are some tips for being successful:

  1. Have a large, attractive, marked box in a central location that is easy for people to get to
  2. Make the collection time-limited (e.g., 1-2 months)
  3. Have a short flier explaining why books are being collected and who they will be shared with. On the flier, have a contact person with contact information (like an email).
  4. If possible, donate the books locally to groups of children that your audience of donors cares about. For example, the books collected by the Orangevale Rotary go to the Orangevale Food Bank. Books collected by moms in Davis go to Head Starts in Davis. People are most enthusiastic if books stay local and connected to them somehow.
  5. Be sure to pick up the books on a regular basis. Don’t let that box overflow and make a mess!
  6. Challenge your group to collect a certain number (e.g., 100-500 books). People love a numerical goal.
  7. Keep reminding people—announcing the book drive one time will not be sufficient.
  8. At the end of the book drive, celebrate with a treat! Share information about where the books went. If possible, share pictures of children who have received the books.

I have had several undergraduate students in our program gather between 300-800 books just by asking their friends. Members of service organizations such as the Rotary often like to take on a project such as a book drive. Churches are another great source. My own church, Bayside, has donated more than 5,000 beautiful books!

Most of all, remember: people love to donate books for a good cause. I have found that many, many people have children’s books sitting around in their homes gathering dust; however, the people are so sentimentally attached to the books that they cannot just give them to a faceless organization. Having a person specifically attached to the book drive—a face to identify with—helps people become more willing to part with books that hold precious memories. If you are the “face” of your book drive, most people will be very generous in their donations.

A book drive has several major advantages: 1) low-income children benefit greatly from having their own books, and their literacy skills improve; 2) your friends get to clean out those closets, and 3) you get the joy of seeing children own their own books—for many, these are the very first books they have ever owned. Collecting and donating children’s books is something I will do for the rest of my life, and I have been privileged to have tremendous support from my students, church, family, and friends. Good luck!

Celeste Roseberry-McKibbin, Ph.D., CCC-SLP, is a professor in Sacramento State University’s Department of Speech Pathology and Audiology and also works directly with students ages 3-18  as a speech-language pathologist in the San Juan Unified School District and has writes a blog about her book drive. She can be reached at sacbookdrive@gmail.com.

Summertime Prep for the School Cafeteria

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Summer!  Ten luxurious weeks of spitting watermelon seeds, munching on veggies straight from the garden and crafting the perfect s’more over the campfire.  As an SLP who focuses on feeding challenges in children, summer food skills are foremost in my mind this time of year.  However, once a week in the summer, my little clients and their families will focus on preparing to eat in the school cafeteria.  Before you know it, it will be mid-August and those little munch bugs will joining their friends at elementary school, or perhaps all-day kindergarten. For kids who are about to go to their very first day of school, it also means their very first day in a school cafeteria, and that can be quite overwhelming, especially for a child in feeding therapy.

Many kids are truly scared of the school cafeteria. In fact, one little boy I worked  with called it “the Café-FEARia.” Imagine a 5-yea- old, on his first day of school, as he tries to negotiate a sea of kids filing into the school lunchroom, attempting to locate his lunch box among 20 others piled into a giant bin and ultimately squeeze into a tiny place to sit at the assigned table. Now, unlatch that brand spankin’ new lunchbox (how does that latch work, anyway?) and peer inside … the clock is ticking … your little munch bug now typically has 20 minutes left to eat, clean up and get back in line with his class; not the most relaxing lunch for any kid.

 

Introduce Weekly Lunchbox Dinners

Feeding therapy is more than just learning the mechanics of biting, chewing and swallowing.  Generalizing skills to multiple environments is essential.  For kids transitioning to school lunch, introduce once a week “lunch box dinners” where the entire family pretends to eat in the school cafeteria.  At the entrance to the kitchen or dining area, one parent stashes a large bin, just like the kids will find at school.  Each member of the family has their own distinct lunchbox thrown into the bin, along with a few “old” random empty lunchboxes so kids can practice digging down to the bottom to find their own.

 

Once everyone is seated at the table, the child can practice the fine motor skills of unzipping zippers, unfastening Velcro® flaps and opening up containers.  Choose a lunchbox that is easy to open and holds all the food in one container.  It saves precious time!  My favorites are Easy Lunchboxes® and Yumbox® , both simple to open and perfect for cutting the food into bite sized pieces.  I call it “grab and gab” food.  Speaking of “gab,” many of my feeding clients also are working on pragmatic skills with their peers, especially when they are in unfamiliar situations.  As an SLP, I teach the parents to practice this little script: “I’ve got ____ in my lunch!”  In all my years of sitting in school lunchrooms and listening to young kids, it’s ALWAYS the first thing they say to each other.  It’s their traditional conversation starter, usually accompanied by them proudly holding up the celebrity food – the star of the lunchbox. I can attest that I hear just as many kids enthusiastically say “I have fruit today!” as “I have (fill in any junk food here) today!”  Try for  the veggies … it’s really okay … it’s just as cool to have vegetables cut up into stars or other fun shapes so they can announce, “I have CUCUMBER STARS today!”  Better yet, get the kids involved packing the lunches and creating fun shapes so they can exclaim “I made carrot triangles for lunch!”  FunBites® are child safe tools for doing just that.  They may not eat them that day, but they will be comfortable with carrots in their lunchbox, and that’s the first step to trying a new food in a new environment.

 

Once the meal is over, everyone latches their lunchbox and puts it back in the bin, just like at school.  The final piece of advice I offer to families is this: The most important word in the phrase family dinner is “family.”  Enjoy this time!  Happy Summer everyone!

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 kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is approved by ASHA and includes both her book and CD.  She can be reached at Melanie@mymunchbug.com.

Common Core Suggestions from One Speechie to Another

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As classroom teachers change their teaching to base objectives around Common Core State Standards, we, as speech-language pathologists, must consider the standards as well. It affects us in our identification of language disorders, goal writing, and session objectives.
It is important to consider the CCSS when identifying students through the Response to Intervention (RTI) process. It is important to collaborate with classroom teachers to understand where the students are struggling and which standards they are unable to achieve. Regardless of the RTI tier or level of support the student in question is receiving, we must  determine strategies to help these students acquire these standards necessary for age and grade.
There are a variety of speech and language difficulties that can affect a student’s ability to acquire the CCSS. Some examples of these include:

  • If they cannot use or respond to questions, it will impact their ability to “Understand and use question words (interrogatives) (e.g., who, what, where, when, why, how).”
  • If they have weaknesses in vocabulary, it will impact their ability to “Describe people, places, things, and events with relevant details, expressing ideas and feelings clearly.”
  • If they display difficulties comprehending grammatical concepts, it will impact their ability to “Demonstrate command of the conventions of standard English grammar and usage when writing or speaking.”

You should consider what standards are expected for the grade of the student in question and where the student is functioning when developing goals.

So how can you incorporate CCSS philosophies during speech and language sessions? First get a handle on what students are expected to know and understand. This will assist with carryover of skills from the speech room into the classroom and beyond. Here are some ideas to consider:

  • You can have students go on scavenger hunts to help them learn to identify text features of nonfiction texts.
  • Have students practice using higher level thinking: predict, question, visualize, analyze, and make connections.
  • Model for students what to do/think before, during, and after reading by using thought bubbles on a Popsicle stick to help illustrate what one should think and say at each of those phases.
  • Use a KWL chart (know, want to know, learned) when teaching new vocabulary/concepts. Use carrier phrases to teach students how to express key story elements:
  1. “The main characters are…”
  2. “The important events are…”
  3. “The author is…”
  4. “One fact I learned is…”
  • Use thinking notes on Post-Its while reading a story to teach students to generate their own questions while reading.
  • Use a variety of genres when incorporating literacy activities (fables, short stories, poems, plays, biographies, articles, etc.).

For the most part, the CCSS correlate with our typical speech and language goals and objectives. One difference is the expectations for students per grade. Another difference is the language students are expected to recognize, comprehend, and use in the classroom. If classroom teachers are expected to use the vocabulary in the classroom, it is important for our students to hear that same vocabulary in the speech room as well. For students with vocabulary weaknesses, they may need extra assistance in learning this vocabulary and terminology. Some important vocabulary words and concepts that we, as Speech-Language Pathologists should incorporate into our sessions and make sure our students understand include:

  • Evidence
  • Central idea
  • Point of view
  • Plot
  • Audience
  • Analyze
  • Dialogue
  • Theme

Whether you are identifying students that could benefit from speech and language services, developing goals, or creating treatment plans,you as an SLP working with school-aged students need to consider the CCSS. It will help advocate how a student will benefit from speech and language services as well as justify for those that are ready to graduate. It also will help make speech and language sessions more academically relevant and easier to promote generalization into the classroom.

“Miss Speechie” is a licensed speech-language pathologist working in a public elementary school in New York State. She is the author of the blog, Speech Time Fun. She enjoys creating and sharing materials, resources, ideas for speech-language pathologists. 

Collaboration Corner: Time to Reflect and Give Thanks

 

 

blog may 16“Though our experience of knowing is individual, knowledge is not.”

(Wenger, E., McDermott, R., & Snyder, W. [2002]. Cultivating communities of practice. Boston, MA: Harvard Business School Press. p. 10)

This time of year is frenzied; closing up the school year, planning for next year. I have students moving up to middle school, and little ones coming up from preschool. When my brain and emotions start to wonder, I make a conscience effort to slow down. Stop. Reflect.

I thought this would be the perfect venue to pay thanks to the professionals whose collaborative efforts made my days a little lighter this year.

So here it goes (in no particular order):

Thanks to my colleagues, the inclusion facilitators,and  special educators who made sure communication goals were an integral part of each student’s IEP, and owned by all staff. Thanks for making me feel a part of your teams, even if I was traveling between buildings.

Thanks to my colleagues, the general education teachers who shared materials gave me curriculum to reinforce key concepts, and implemented language-based strategies that helped not just one child, but an entire classroom with narrative language development. There are many more examples that I could give, but suffice it to say, the art of teaching is alive and well.

Thanks to my BCBA colleagues, who understood how our disciplines can (and should) overlap in all areas of behavior, communication, academics, and even eating.

Thanks to my colleague, an English Language Learner teacher. She helped me support a language-impaired child who moved in late in the year and didn’t speak a word of English. We tag-teamed and figured out the difference between fundamental language skill deficits (word retrieval, vocabulary), and the typical obstacles expected for acquiring English. She outlined a plan and approach sensitive to the family unit and culture, which was invaluable in my decisions around goal-writing and intervention.

Thanks to my colleagues, the paraprofessionals, who sat in on all of their students’ speech and language sessions, translated my words into Spanish,  asked questions, made visuals and PECS books, programmed devices, and worked hard to make sure generalization could happen.

Thanks to my colleagues, the social workers and psychologists, who helped me understand keenly the role of emotional stability, learning readiness, and effects upon communication.

Thanks to my colleagues, the teachers for the visually impaired, who helped me set up a communication book made completely of tactile symbols, and engaged in healthy dialogue on cognition, cortical vision impairment and communication.

Thanks to my OT and PT friends, kindred spirits of the related services world who understand the value of co-treatments and interdisciplinary input for kids with complex medical and physical needs.

Thanks to my SLP colleagues who helped me keep a sense of humor in a way that only another SLP working in a public school can understand.

Finally, thanks to the administrators who continue to believe in inclusion, and supported my time this year in each of their buildings. Leadership doesn’t happen in a bubble, and has transformative affects upon the school culture and inclusion.

So thanks. Happy spring…..fewer than 40 days to go!

 

 

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

Kid Confidential: Teaching Our Kids About “Tricky People”

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We’ve all heard of “stranger danger” and have probably taught our own children about the concept.  Don’t go anywhere or get into a car with anyone you don’t know.  As speech-language pathologists we may have even discussed this as part of our safety topics along with fire safety, learning about law enforcement and teaching our students how to dial 911.  We may even talk about “stranger danger” when we are targeting problem solving and reasoning skills for those students with social communication or cognitive delays.   But is “stranger danger” the best way to teach our children to be aware of adults, teenagers, or even same age peers that may hurt them?  According to the American Psychological Association’s web article, titled “Child Sexual Abuse: What Parents Should Know,” 30% of predators of sexual abuse are family members, while it is estimated that an additional 60% of predators are non-family members but are known to the child (i.e. family friends, caregivers, neighbors, etc.).  Considering 90% of all child sexual abuse cases occur by someone the child knows, is “stranger danger” really accurate?  I’m not so sure anymore.

I recently became aware of Safely Every After, Inc, a company devoted to child safety that focuses on teaching children and adults ways to identify the “tricky people” in our lives because many times “tricky people” are not strangers at all.  Pattie Fitzgerald, owner of Safely Every After, Inc., has been advocating for child safety for more than 10 years and has a number of wonderful free resources on her website including prevention tips, red flags for parents/adults, safety rules for children, internet safety rules and cyberbullying guidelines.  Pattie educates children of all ages as young as 3 years of age.  For preschool age children (3-5 years), she has written a book titled, No Trespassing-This is MY Body!, which discusses what “thumbs up” and “thumbs down” touch is and that children are the “boss of their own bodies.”  She also presents her information to schools and offers workshops for children grades K-4 (Kidz-Power) and grades 5-8 (Play it Safe!).  Additional workshops for kids and adults such as Internet Safety and Social Media and Protect the Children You Teach geared toward educators and school staff are also available.  If you think your school could benefit from a presentation by Pattie, feel free to refer your administrator to her website for more information.

So who are “tricky people”?  According to Pattie, here are just a few red flags that you are with a “tricky person”:

  1. This person continually tries to arrange for “alone time” with children;
  2. He/she befriends one particular child and lavishes gifts upon him/her;
  3. He/she frequently offers to babysit or “help out” for free;
  4. He/she insists on being physical with a child especially when the child seems uneasy or has asked the person to stop; and
  5. He/she blurs boundaries of physical touch or uses inappropriate words to comment on a child’s looks or body.

Tricky people can be a stranger or someone the child knows.  A tricky person can be a friend of the child’s parent or a family member.  Tricky people are everywhere and we need to listen to our instincts when we get that “uh-oh” feeling.  These are the things Pattie and her crew at Safely Every After, Inc., advocate teaching children and adults.

Granted, as SLPs in schools, clinics, and private practice, we may not be permitted to discuss the topics of touch with our students depending on parental preference.  However, we can discuss and teach general safety rules.  For example, the second rule on Pattie’s “Super-Ten Safe-Smart Rules for Kids and Grownups” is that a child must know his/her name, address, phone number, and parents’ cell phone numbers in case of an emergency.  We as SLPs do work on having our students answer biographical information questions so this rule works perfectly within our therapy goals.  A few more examples of rules that would go nicely with targeting problem solving and reasoning skills are rules three, four, and five that state “Safe grownups don’t ask kids for help.  They go to other adults for assistance,” or “I never go anywhere or take anything from someone I don’t know no matter what they say,” and “I always check first and get permission before I go anywhere, change my plans, or take something even if it’s from someone I know.”  There are several other safety rules that can be discussed when targeting reasoning and problem-solving skills in a safe way and I encourage you to read all about them on Pattie’s website.

So why, during ASHA’s Better Speech and Hearing Month, am I discussing the topic of child safety?  Well, who better to modify and explain child safety rules to our communication-delayed children, than SLPs?  Who better to determine if our children have the capacity to communicate when and how they have been hurt? Who better than the programmers of our non-verbal students’ AAC devices, to make sure there is language available for our students to express when they are hurting?   Who better, than us, to prepare our students for safety over the summer months?  In fact, we, as SLPs, may be the first adults to successfully broach the topic of safety with our students as we can modify and adapt information to the child’s level of comprehension.  So my question is, who better than us?

Disclaimer:  I am not, nor have I ever received payment or any form of compensation from Pattie Fitzgerald or Safely Ever After,Inc. for writing this blog article.  My purpose for writing this article is purely for educational purposes to share the knowledge I have recently learned and found on this website.  Use this information at your discretion.

 

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.

Believe It Or Not: The Common Core Standards Can Make Your Job Easier

shutterstock_15584677The Common Core State Standards have changed my life.  I know that’s a bold statement to make, but armed with simple resources and the confidence that I really am integrating the curriculum and assessing academic impact, working as a school based speech-language pathologist is suddenly more fulfilling. And yes, we are talking about the same Common Core State Standards. While some teachers seem to be quivering in their boots about the prospects of implementing the Standards, I think speech-language pathologists should be rejoicing.

Now I’m not going to tell you about the oodles of research that went into developing them (for history on Common Core State Standards, go to the CCSS website and look under ELA Appendices A), nor will I lecture about why you should use them (let someone else do that). I’m here to show you why they changed my practice from a speech-language lens and how it has not only improved my treatment but strengthened my clinical skills too.

Sometimes, as therapists, we can find it hard to know what a child should be able to do when all we see are students with delays, disorders and disabilities. What is grade level, age appropriate and just plain old typical can become confusing when you don’t have a set of norms to compare to. With the added pressure on school-based SLPs to be curriculum- related and demonstrate academic impact, it has been a personal relief for me to simply look up a standard and think, “so that is what my student is expected to do.” Even if you aren’t based in a school but work with school-age clients, the Common Core State Standards can still guide your treatment decisions.

The Common Core State Standards can look overwhelming, but the English Language Arts curriculum is probably the most useful for speech-language pathologists. It focuses on reading, writing, listening and speaking and language. What may seem cumbersome at first will soon become ingrained and you will start to see just how our profession and scope of practice is present in almost every learning outcome. A very simple idea of how different areas of speech-language pathology relate to the curriculum is demonstrated below.

Reading: Focuses on the reading continuum from foundational skills to fluency and integration of knowledge. Areas include phonological awareness, answering key details, identifying main ideas, description, comparing and contrasting, sequencing and retelling.

Writing: Focuses on written compositions of a variety of genres (for example, narratives, explanatory and arguments). Areas include sequencing, linking words, description and comprehension.

Speaking and Listening: Focuses on oral and receptive and expressive language skills. Areas include syntax, pragmatics, narrative skills and comprehension.

Language: Focuses on grammatical conventions and vocabulary. Areas include vocabulary acquisition, syntax, morphology and higher-level language skills such as multiple meaning words.

Most SLPs already know just how much of learning is dependent on language and communication skills. So I encourage you to think outside the box and use the Common Core State Standards in a number of different ways:

  • Refer to them to write grade level Individualized Education Program goals.
  • Use the horizontal/vertical progressions (below) to help with step up/downs in treatment.
  • Use the standards to help guide informal assessments. Take a language sample and compare to the standards’ Language section or do some classroom observations to understand academic impact.
  • If teachers are still unsure of your role and scope, why not do an in-service and use the standards as a reference. This could help with collaboration, response-to-intervention and moving toward working in the classroom.

You can go straight to the Common Core State Standards site and view the English Language Arts Standards, but keep your eye out for ways other states present the standards. Maine breaks down them down into vertical progressions (view writing, language, speaking and listening) so you can see how each skill develops each year, while Arizona provides the standards in a horizontal progression.

Download the free Common Core State Standards app. I love the ease of swiping through the standards, as it is much faster than flipping through papers. Finally, ASHA’s Common Core State Standards: A Resource for SLPs also includes great information and resources for speech-language pathologists. Be sure to click on “Resources and References” to access articles, blogs and useful sites.

Remember, the Common Core Standards are coming to a school district to you soon, so why not start getting familiar with them now?

 

Rebecca Visintin, CCC-SLP,  is an Australian-trained, school-based speech-language pathologist  in Washington state. She has worked in the Australian outback and Samoa and provides information for SLPs working abroad and free therapy resources on her site Adventures in Speech Pathology.

 

On the Brink of Kindergarten: Placement of Bilingual Students

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As a preschool-based speech-language pathologist in New York City, I get a number of bilingual children on my caseload every year. Many of them are sequential bilingual learners, with English being their second language (L2). It is also not uncommon for these sequential bilinguals to first begin to acquire their L2 here at the preschool. Speech-language and overall cognitive functioning of these children varies greatly, often a function of how much exposure to English they had to prior to preschool. During the Turning Five meetings, these students’ overall speech-language progress becomes especially salient.

At these meetings, I find that for some of our bilingual students, particularly the sequential bilinguals, the kindergarten setting recommended by the evaluation team tends to be smaller (for example, a classroom size of 12). This type of educational environment is often recommended for children with severe delays and disorders such as autism spectrum disorders, learning disability and childhood apraxia of speech.

During one of these meetings, a graduating student I will call Andy was described as extremely slow to progress and retain information. All team members agreed he requires a lot of support to comprehend basic in-context commands in therapy sessions and the classroom, and presents with minimal use of words. However, we also know that he is from a home where the primary language is not English. In addition, the student only joined the program at the age of 4, not at 3, which would probably have made a big difference. The speech-language evaluation in the child’s file indicates a severe delay in English (I bet I would be severely delayed in a language to which I had minimal or no exposure) but no mention of the skills present in L1. Communication with the family has been limited due to a language barrier.

There are many bilingual children in the New York City school system that follow Andy’s path. Hence, it should always be alarming to us, the educators, when a bilingual student in whom L1 is not English but there are no known global delays transitions into a kindergarten setting of 12. Additionally, a kindergarten special education classroom includes students with a variety of diagnoses and behaviors, with the more severely impaired students not providing a model for appropriate social skills and verbal communication.

So why do these students continue to get placed into smaller, more restrictive educational settings? Most obviously because of concern that they will not be able to function in a larger setting. But what could we be doing instead? Each child’s case would need to be studied individually. Specifically, we would need to review all the relevant cultural and linguistic background information starting at birth, such as the amount of L1 and L2 exposure in and out of home, history of speech- language delays, and the level of education in the family, to name a few. Other variables to consider are: 1) the amount of time that the bilingual student has spent in an all-English formal academic setting, 2) the presence of “problem” behaviors that significantly maintain the overall delays and reduce time the student is actually learning, and 3) the lack of sufficient, if any, L1 support (Spanish/ Bengali/Arabic) received in the school setting, including from an assigned SLP.

The latter one is of particular interest to me, as I am a bilingually certified English/Russian speech-language pathologist. However, I have little practical language skill to offer to my Arabic-, Spanish-, Bengali- or Albanian-speaking students. In such cases we, for the lack of a better word, “exercise,” our nonverbal communication skills and teach English as a second language.

Sure, an ongoing collaboration and a close relationship with the child’s family can potentially shed light on the speech-language and cognitive skills of the student. However, my experience has been that, due to communication barriers, the family yields little information that can guide me. Therefore, in most cases, I cannot reliably pinpoint speech-language deficits present in languages other than English or Russian.

This is an ongoing issue of inappropriate services to and settings for our bilingual special education students. Research is full of examples of typically developing bilingual students taking longer to learn and acquire L2 skills. This is even more consequential for children with special needs, whose speech- language and/or cognition is already delayed. Subtractive bilingualism is the term Fred Genesee and colleagues use in their book “Dual Language Development and Disorders” (2004) to describe this language-learning dilemma and the danger of “switching” our culturally diverse students to English only. According to the literature, the problem with monolingual (English-only) placements is that many of our already delayed bilingual children can’t “catch up” to their monolingual peers. Therefore, the all-English classroom setting of 12 carries a rather pessimistic long-term implication for overall academic success.

But what if every bilingual child with special needs received enough L1 support? Would that change the outcome? What if we had enough bilingual certified SLPs representing a variety of cultures and languages to help our culturally diverse students? Would the bilingual children still be placed into restrictive settings with no L1 support and with communicative interactions that offer few appropriate models? I believe that if these students received speech-language services in both the L1 and L2, they would make significantly more progress and at a much higher rate.

It would certainly further expedite their progress and make the instruction more holistic and ethical. Of course, today, more than ever, we have major problems with budget cuts that affect the number and the size of special education classrooms available to us, as well as the amount and the type of services we can offer. In fact, in recent years it has become much more difficult to qualify a child for related services even in the presence of notable deficits. Greater still is the cost of not delivering appropriate and culturally/linguistically ethical services to our bilingual children. We might be in far greater need of special education services years down the line when trying to remediate difficulties that were further compromised due to lack of appropriate language support. Just something to think about!

Natalie Romanchukevich, MS, CCC-SLP, is a bilingual Russian speech-language pathologist at the Children’s Center for Early Learning in New York City. This post is adapted from a guest post Natalie Romanchukevich wrote for Tatyana Elleseff’s blog Smart Speech Therapy. Natalie can be reached at natalieslp@gmail.com.