Want to Work in Acute Care Pediatrics? 5 Traits for Success

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It’s hard to believe I’ve been an SLP for 38 years! For most of that time, I’ve worked in an acute-care pediatric setting. I’m employed at the Florida Hospital for Children in Orlando, where I provide pediatric/neonatal swallowing and feeding services for multiple acute-care services, including neonatal intensive care, pediatric intensive care, newborn nursery, general pediatrics, oncology, epilepsy, ears, nose and throat, gastrointestinal, congenital heart surgery, plastics, and extracorporeal membrane oxygenation. Thinking on my feet, but carefully considering both the evidence base and interdisciplinary perspectives, is a must every day.

Sometimes people ask me: What are you passionate about? What drives you?

I am passionate about the neonatal intensive care unit and our tiny patients. Being a part of this wonderful team and fostering the parent-infant relationship through supporting safe and successful feeding continues to fill my heart with joy after all these years. I am a lifelong learner and am passionate about creating opportunities to learn from physicians, nurses, respiratory therapists, my rehab colleagues and the families I serve.

Are you interested in working with these tiny and fragile patients? If so, here are some questions to ask yourself:

  1. Do you like to solve a puzzle? Problem-solving is essential in acute care! Critically thinking about a patient’s medical history and co-morbidities, then looking at the data and making sense of the information is key. Is the infant/child safe to feed? If so, what is the best approach? How can the child best communicate? What is interfering?
  2. Are you passionate about evidence-based practice? Physicians want to know why you are recommending what you are and what evidence there is to back it up. Sometimes the highest level of evidence is our clinical experience and wisdom. But we need to be aware of what hard evidence exists and bring it to the physicians.
  3. Do you work best in a team setting? Looking at the critically ill child works best in the context of multiple perspectives. Physician specialists, bedside nursing, respiratory therapists, dieticians and our rehab colleagues bring information that helps us make better clinical decisions. Through team interactions, we jointly problem-solve.
  4. Do change and unpredictability give you a buzz? Some days we need rollerskates! The day can change quickly with new consults, children being discharged, and changes in the patients we are treating. Being ready for change and staying focused are key to riding the wave.
  5. Are you well-grounded in normal and atypical development? This knowledge allows us to problem-solve and recognize what symptoms deserve our focus. Experience in birth-to-3 is invaluable for preparing to become a pediatric acute-care SLP.

Do the traits above sound like you? If you are thinking about moving into acute-care pediatrics, stay tuned for more to guide you on your journey!

 

Catherine S. Shaker, MS, CCC-SLP, BCS-S, works in acute care/inpatient pediatrics at Florida Hospital for Children in Orlando. She offers seminars on a variety of neonatal/pediatric swallowing/feeding topics across the country. Follow her at www.Shaker4SwallowingandFeeding.com or email her at pediatricseminars@gmail.com.

 

An SLPA Eases a School SLP’s Load

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

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

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

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

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

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

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

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

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

 

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

Call for Advocacy to Garner Government Support for Evidence-Based Treatments

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Editor’s Note: This post is another viewpoint on the Speech Pathology Australia’s recent proposal and does not necessarily reflect the views or position of ASHA. 

Evidence-based practice encompasses evidence from high-level research, expert opinion, patient needs and values, along with the context within which the treatment is conducted. In the field of stuttering, we are fortunate to have strong evidence that the Lidcombe Program is effective. If we have clear evidence that a treatment approach works, it should be made available to the people who need it.

Speech Pathology Australia has made a submission to our [Australia’s] federal government to fund stuttering treatment. I’m sure it will be the first of many submissions, which aim to bridge the evidence-practice gap. However, there appears to have been a misunderstanding about the announcement, so SPA published a clarification on its website stating that “SPA’s submission relates only to the formation of the 2015-2016 federal budget. SPA is not supporting legislation or a policy change to promote one program, service or form of treatment over any other.”

As a founder of the speechBITE evidence-based practice website, I thought long and hard about the effect EBP has on clinical practice, funding sources and, most importantly, the clinical outcomes of the people we serve. There are three key aspects to making EBP a central component of clinical decision-making:

  • Firstly, clinicians need to know about the latest treatment advances.
  • Secondly, patients and clients need to be informed about current best practice options, and be satisfied with their treatment decision.
  • Thirdly, funding agencies need to be confident that they are funding treatments that are based on strong evidence.

How can funding agencies be aware of current best practice and confident in their funding decisions? As a profession we need to be proactive by giving this information to funding agencies and lobbying the government. This is precisely what SPA is doing with its proposal. I applaud SPA for taking this step and promoting evidence-based speech pathology practice at the highest level.

 

Leanne Togher, PhD, SLP, is a professor of communication disorders following traumatic brain injury at The University of Sydney and is Senior National Health and Medical Research Council Fellow of Australia. Togher is the director of the speechBITE evidence-based practice website. She is also an international affiliate of ASHA and Fellow of Speech Pathology Australia. She can be reached at Leanne.togher@sydney.edu.au.

Just Flip the Lip! The Upper Lip-tie and Feeding Challenges

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While many pediatric professionals are familiar with a tongue-tie, the illusive lip-tie hides in plain sight beneath the upper lip. Because I focus on feeding difficulties in children and an upper lip-tie can be a contributing factor if a child has trouble feeding, then I probably encounter more lip-ties than some of my colleagues. Still, I’d like to encourage my fellow SLPs to just flip the lip of every single kiddo whenever assessing the oral cavity. And document what you observe. Help increase general knowledge among professionals on different types of upper lip-ties by raising awareness of how they may impact the developmental process of feeding.

Upper lip-ties refer to the band of tissue or “frenum” that attaches the upper lip to the maxillary gingival tissue (upper gums) at midline. Although most babies should have a frenum that attaches to some degree to the maxillary arch, the degree of restriction varies. So it’s important to flip the lip of every child we evaluate in order to gain a better understanding of the spectrum of restriction – especially if you are an SLP who treats pediatric feeding.

During the feeding evaluation process, consider four things: 1) The mobility of the upper lip for breast, bottle, spoon and finger feeding; 2) How well it functions in the process of latching and maintaining the latch; 3) If the lip provides the necessary stability for efficient and effective suck-swallow-breath coordination; and 4) If the lip is an effective tool for cleaning a spoon, manipulating foods in the mouth and contributing to a mature swallow pattern.

Dentist Lawrence A. Kotlow has created an upper lip-tie classification system to better identify, describe and consider the need for treatment. The tie is classified according to where the frenum connects the lip to the gums, known as “insertion points.” Envision a child with a very big “gummy” smile and the upper gum line exposed. Divide the gums into three zones, as described in this article by Kotlow:

“The soft tissue covering the maxillary bone is divided into 3 zones. The tissue just under the nasal area (zone 1) is called the free gingival area; this tissue is movable. Zone 2 tissue is attached to the bone and has little freedom of movement… Zone 3 extends into the area between the teeth and is known as the interdental papilla. This is where the erupting central incisors will position themselves at around 6 months of age.”

Now, consider the insertion points. A Class I lip-tie inserts in Zone I and (unless extremely short and tight) does not inhibit movement of the upper lip and should not interfere with breast or bottle feeding. However, if the lip itself is retracted to the degree that a child cannot flange his upper lip for adequate latching and for maintaining suction, further consideration of this type of lip tie may be necessary. Class II lip-ties have an insertion point in Zone 2, where the tissue is attached to the bone. Kotlow describes the Class III tie as inserting in Zone 3, where “the frenum inserts between the areas where the maxillary central incisors will erupt, just short of attaching into the anterior incisor.”  A Class IV lip-tie “involves the lip-tie wrapping into the hard palate and into the anterior papilla (a small bump located just behind where the central incisor will erupt).”

How might an upper lip-tie impact the developmental process of feeding?

The impact of the upper lip-tie can vary according to its classification and, in my professional experience, the fullness of the upper lip also comes into play. But, in general, consider these key points:

Breastfeeding and Bottle Feeding

  • Breast – Inadequate latch: An infant must flange the lips to create enough suction and adequate seal around the tissue that includes the areola and not just the nipple. It is essential that babies take in enough breast tissue to activate the suckling reflex, stimulating both the touch receptors in the lips and in the posterior oral cavity in order to extract enough milk without fatiguing. When the baby suckles less tissue, painful nursing is also a result. One sign (not always present) is a callus on baby’s upper lip, directly at midline. While not always an indicator of a problem, it’s typically associated with an upper lip-tie. It’s simply a reminder to flip the lip!
  • Bottle – Inadequate Seal: Because bottles and nipple shapes are interchangeable and adaptations can be made, it’s possible to compensate for poor lip seal. However, these compensatory strategies are often introduced because all attempts at breastfeeding became too painful, too frustrating or result in poor weight gain…and the culprit all along was the upper lip-tie. It is then assumed that the baby can only bottle feed. I’ve assessed too many children held by teary-eyed mothers who reported difficulty with breast feeding – and no indication in the chart notes that the child had an upper lip-tie. But, upon oral examination, the lip-tie was indeed present and when observing the child’s feeding skills, the tie was at the very least a contributing factor. Releasing the tie resulted in improved ability to breast feed and progress with solids.
  • In addition, an inadequate latch and/or a poor lip seal may contribute to the following partial list of symptoms:
    • Gassiness; fussiness; “colicky baby”
    • Treatment for gastroesophogeal reflux disease, yet to be confirmed via testing
    • Fatigue resulting in falling asleep at the breast
    • Discomfort for both baby and mother, resulting in shorter feedings
    • Need for more frequent feedings round the clock
    • Poor coordination of suck, swallow, breathe patterns
    • Inability to take a pacifier, as recommended by the American Academy of Pediatrics and noted here.

Spoon Feeding

  1. Inability to clean the spoon with the top lip
  2. Inadequate caloric intake due to inefficiency and fatigue
  3. Tactile oral sensitivity secondary to limited stimulation of gum tissue hidden beneath the tie
  4. Lip restriction may influence swallowing patterns and cause compensatory motor movements which may lead to additional complications

Finger Feeding

  1. Inability to manipulate food with top lip for biting, chewing and swallowing
  2. Possible development of picky, hesitant or selective eating because eating certain foods are challenging
  3. Lip restriction may influence swallowing patterns and using compensatory strategies (e.g. sucking in the cheeks to propel food posteriorly to be swallowed) which may lead to additional complications

Oral Hygiene & Dental Issues

  1. Early dental decay on upper teeth where milk residue and food is often trapped
  2. Significant gap between front teeth
  3. Periodontal disease in adulthood
  4. Possible changes in dentition with certain compensatory methods to propel bolus posteriorly for swallowing, such as finger sucking.

After documenting what we observe during the evaluation, clear communication with parents and other professionals will help to determine next steps. In feeding therapy, our role is to provide information for involved parents and professionals (this may include pediatricians, lactation consultants, otolaryngologists, gastroenterologists, oral surgeons and/or pediatric dentists). Our primary role is to determine, document and communicate to what degree the restricted top lip is influencing a child’s difficulty feeding.

For detailed information and additional photos, please read Kotlow’s article, Diagnosing and Understanding the Maxillary Lip-tie as it Relates to Breastfeeding, published in the Journal of Human Lactation in May 2013.

In a future post for ASHA, we’ll discuss tongue-ties (ankyloglossia) and the impact on feeding. Upper-lip ties are frequently associated with tongue-ties, so please remember to look for both during oral examinations.

Have you had an experience with an upper lip-tie impacting the feeding progress of one of your clients? If so, please tell us in the comments below.

 

Melanie Potock, MA, CCC-SLPtreats children birth to teens who have difficulty eating.  She is the co-author of Raising a Healthy, Happy Eater: A Parent’s Handbook – A Stage by Stage Guide to Setting Your Child on the Path to Adventurous Eating (Oct. 2015), the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is offered for ASHA CEUs.  She can be reached at Melanie@mymunchbug.com

 

Using Menus as a Treatment Tool

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Are you looking for a free and functional therapy tool? How about a take-out menu? Menus are practical, full of language concepts and can be used for a variety of speech and language goals. Many young adults on my caseload have limited literacy skills and often find themselves dependent on others to order for them in dining situations. If they can’t read the menu accurately they won’t know all of their choices unless someone reads it to them.

What’s more functional than being able to read a menu and make a choice for themselves? Some menus have pictures, but most do not. Even menus with images and words are tricky if you’re not familiar with all of the dishes.

When using a menu as a treatment tool, I ask my clients, “What are your favorite places to eat?” Many times they don’t know names of restaurants, but can describe the type of food they prefer (e.g. Mexican, pizza, Italian). This is also an ideal opportunity to connect with family members by getting details about restaurants they visit and food they order.

When I ask a client, “How do you know what to order?” many of them respond by saying: “I just get the pizza/chicken/hamburger,” or: “My parents order for me,” or: “I ask the waitress for the food I want.” All of these answers work when dining out, but none give clients the ability to .take charge of their preferences.

Here are 10 speech and language goals I target when using menus in treatment:

  1. Literacy: Work on learning to read menu-related key words like appetizer, salads, sandwiches, chicken or fish. Create a bingo game with new words, so your client becomes fluent. Review the same menu over several sessions so your client familiarizes themselves with it.
  2. Categorization: What food group is broccoli in? How about chicken? I like to work on this goal of food groups with a game called Healthy Helpings My Plate Game. Try grouping foods by cost depending on your client’s budget or by healthy versus not healthy foods.
  3. Requesting: Practice requesting by asking your client to tell you what they would want from that particular menu, such as: “I want the sesame chicken with brown rice.”
  4. Pragmatics: Work on role playing by pretending you are the waitress and your client is the customer. Reverse roles and practice greetings, turn-taking, being polite, and more.
  5. Describing/Commenting: Review different foods and ask your client to describe specific For example, “What is the difference between thin crust pizza and thick crust pizza?” or, “Describe what crispy chicken tastes like.” If your clients can describe their preferences in detail, the better they’ll get at ordering.
  6. Answering “wh” questions: As you review the menu, ask “wh” questions like: “What is your favorite item on the menu?”, “Why do you like chicken nuggets?”,
  7. Expanding vocabulary: Using varied menus exposes clients to new and unfamiliar vocabulary. I even learn new terms when reading a menu from a restaurant I’ve never visited. (Recently I participated in a cooking class and learned several new words.) Review new vocabulary and discuss its meaning. An ideal way for your consumer to comprehend food-related words is to show your client an image. Using Google Images is an easy way to do this.
  8. Money Concepts: Work on the language of money concepts with your consumer. Present a budget and figure out what they can order within it. Ask “What happens if you go over budget?” or other money-related questions.
  9. Problem Solving: Discuss possible situations that your client might have to solve using a menu. For example, what happens if they run out of your favorite item? What do you do if you have an allergy? What do you tell the waitress if you don’t like your food?
  10. Sequencing: Discuss the order of how you’re going to order food and drink items. For example, you normally order drinks first, appetizers next, entrée and then dessert. Reviewing the menu can be carried over to other activities related to sequencing.

Rebecca Eisenberg, MS, CCC-SLP, is a speech-language pathologist, author, instructor, and parent of two young children, who began her website www.gravitybread.com to create a resource for parents to help make mealtime an enriched learning experience. She has worked for many years with both children and adults with developmental disabilities in a variety of settings including schools, day habilitation programs, home care and clinics. She can be reached at becca@gravitybread.com, or you can follow her on Facebook; on Twitter; or on Pinterest.

Smart PHONeNATION: How My Device Revolutionized My Voice Rehabilitation Practice

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My smartphone has literally revolutionized the way I give sessions. And I don’t mean literally Rachel Zoe style. I use my phone practically every session! Now I hear those of you who are seasoned professionals. You are unfamiliar, maybe apprehensive about technology like this. “It’s too difficult,” you say, “I’m not generation text message-thumb.” I hope this piece encourages you to give it a try.

Age knows no bounds when you apply technology, because most everyone can benefit from these innovations. I’ll echo a recent ASHA post on SLP hats and inquire the same about the many jobs of your smartphone:

  • Stop-watch. I have one less item to worry about if I use my phone for timing maximum vowel prolongations, S/Z ratios and structured session tasks. Your phone timer also tracks session length. We all have those clients who love (I mean REALLY love) to talk, which is good when you advance to structured conversational tasks, but sometimes they carry on too long. Use your phone timer if you feel it’s appropriate for signaling a wrap-up.
  • Recording device. I record my acoustic measures when I analyze cepstral peak prominence and fundamental frequency, but during therapy—where the hard work begins—I employ my voice memo app. I also teach patients how to use their own voice memo programs, which is important for home practice. Follow-through is such a different game now, because most patients have recording options on their phones. You can record session highlights for easy patient access on his or her own device, versus cassette-taping the session.
  • Biofeedback. It’s great if you have a state-of-the-art Computerized Speech Lab setup. If you don’t, your smartphone has an app for that. (Ha! You were waiting for that phrase, weren’t you?) Bla | Bla | Bla works as a visual sound meter. As you get louder, the faces change. It doesn’t replace the software that helps you stay within a target pitch range, but can provide biofeedback for intensity tasks. I use smartphone video recorders to improve self-awareness for laryngeal and upper body tension. Instant review of these videos may help your patient meet goals sooner.
  • Piano. For Joseph Stemple’s Vocal Function Exercises, I use my MiniPiano app for pitch matching on Warm-up and Power. For the small group of clients with NO musical inclination, just do you best to find a mid-range pitch for VFE’s, but for your type-A’s (you know who they are), the option to have perfect pitch right at your fingertips wastes no time.
  • Anatomy. I used to lug around literally (Ha, Rachel again!) thousands of copies of anatomy drawings for patients. The copies usually ended up in the trash. The Dysphagia app has been my most effective tool for explaining the anatomy of a swallow, vocal folds as well as reflux. It has nice color videos demonstrating disordered and normal swallows and dramatically enhances patient education. Plus, the video action makes a more lasting impression.
  • Alarm. Ever get a patient who doesn’t practice? (You can always tell.) With a smartphone, you can name each alarm and set them to go off at certain times. The patient can deliberately practice diaphragmatic breathing and single syllable target words every hour on the hour! We’re going for making new muscle memory here, so it’s key to entice the patient to practice mindfully and not just be on autopilot. It’s beneficial for whole body exercise to take place for short periods throughout the day, so why not phonation training? And it keeps patients accountable.

Embracing the technology out there doesn’t mean you need to de-humanize sessions. The relationships you build with your clients are special. Their progress depends on how comfortable they feel in the room. Don’t spend the entire session glued to your phone, but strive to find a good balance where you use it when you think it will make a difference.

We SLP’s and AuD’s are in the people business and let’s not forget we’re professional voice users ourselves. Voice therapy techniques used to be difficult to maintain out of the treatment room. Now our clients have a fighting chance to recreate that buzzy forward-focused sound every time they glance at their smartphone between Facebook updates and Yahoo news articles.

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She provides voice, swallowing and speech therapy in her own private practice, a tempo Voice Center, LLC. She also lectures on the singing voice to area choirs and students. She belongs to ASHA’s Special Interest Group 3-Voice and Voice Disorders. She keeps a blog on her website at www.atempovoicecenter.com. Follow her on Twitter @atempovoice or like her on Facebook at www.facebook.com/atempovoicecenter.

The Complementary Role of Therapist and Mother

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I was a speech language pathologist for seven years before I became a mother. I love our field and the chances I get to bring positive change to the lives of children and their families. As a parent, being an SLP helps me be more attuned to my children’s developmental milestones.

My professional skills also allow me to provide my children rich language input, particularly because they are growing up in a bilingual home. I consciously employed language strategies such as narration, expansions and recasts in our everyday interactions. So now, when my 6-year-old daughter says, “Mommy, I made an observation about rainbows today,” or when my 4 1/2-year-old son says, “Alvin was being irresponsible” when talking about Alvin the Chipmunk’s many mischievous behaviors, it affirms that, yes, purposeful, engaging play builds language! Yes, consistent book sharing experiences build vocabulary! Yes, attentive caregiving builds confidence in children!

As a mother, I’ve also stopped judging embarrassing tantrums, senseless meltdowns and stubborn non-compliance at the worse times. How easy it is to judge without experience. My recently learned lesson is aptly summarized by a mom whose son has autism. In her witty and honest blog, Carrie Cariello states, “I don’t want to focus so much on the what and when and where and how that I forget about the who.”

This reality is tested in my own life with my son, who began to stutter at around age three. As an SLP, I always try to convey to parents that what children are communicating is far more important than how they communicate it, and that who they are inside is far more valuable than any outward challenges. In other words, we seek to value and see the person, not the disorder. What an easy thing to say when it’s not your child.

A few months ago, I remember approaching our van in a Wal-Mart parking lot one afternoon feeling teary, overwhelmed, and helpless after hearing my son significantly struggle to communicate fluently. I looked at his sweet face with despair and thought, what if he doesn’t outgrow this? And in that moment, I realized the truth of what I’ve “preached” to parents for many years…the who is what matters.

If the stuttering persists, my son is still the same cuddly, sensitive, funny, smart, and active little boy I love. He’s still a gift I am privileged to enjoy every day. He’s still the one who follows me around the house and says for no apparent reason at the most random times, “Mama, I love you so much!” And even if he continues to stutter, he’ll know he’s loved, he’s special and that what he has to say is important to us.

Lastly, I realize more fully now how much effort it actually takes to make needed changes in the home in order to help our children when they struggle with communication. For my son, it forces us to slow down transitions, to give him needed thinking time as well as curb our tendency to interrupt his talking time, especially when his sweet and chatty sister frequently attempts to cut into his sentences. It means coaching my husband on altering his pace, reducing interruptions and valuing the message.

So when we as professionals make recommendations for environmental changes in the home or in communication styles, we must be very patient and really clear on what that actually looks like, because at the end of the day, the who is what matters.

 

Ana Paula G. Mumy, MS, CCC-SLP,  is a trilingual speech-language pathologist who provides school-based and private services.  The author of various continuing education eCourses, leveled storybooks and instructional therapy materials for speech/language intervention, Ana Paula also offers free resources for SLPs, educators, and parents on her website The Speech Stop. You can contact her at apmumy@gmail.com.

 

 

Of Language Barriers, Culture Gaps and e-Bridges

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It certainly isn’t news that our country is becoming increasingly diverse. What may surprise us is that some of the biggest growth is happening in non-border, less-urbanized states. California, Texas and Florida continue to have the most residents who were born in another country. However, Alabama, Arkansas, Delaware, North Carolina and Tennessee all saw more than a 70% increase in foreign-born residents between 2000 and 2012.

This means that ASHA members probably find themselves with more and more English-language learners on their caseloads. These audiologists and SLPs likely also live in areas where there may not be many resources for serving ELL students. Our Code of Ethics states that we should provide culturally and linguistically appropriate services. ASHA also acknowledges that the ideal situation for ELL clients is to work with a bilingual service provider with specific language and clinical skills.

Telepractice offers an elegant solution for connecting colleagues with these competencies to our clients that need them.

The versatility of telepractice makes it useful in different settings. A school district might use several Spanish-speaking telepractitioners to manage its entire ELL caseload. A rural health clinic may create a limited agreement with a bilingual audiologist for follow-up care of a patient who communicates in a less-commonly spoken language.

Telepractice can be used for more than intervention. We can assess patients—even formally—through telepractice. Formal assessment via telepractice is getting easier because many well-known tests are now digitized. Even when a certified professional is not available through telepractice, an onsite team can use technology to connect with interpreters and cultural brokers to help provide appropriate services.

Telepractice licensing, however, remains a hurdle for taking advantage of remote services or becoming a telepractitioner. Most states don’t currently have regulations on telepractice for our professions. ASHA and local associations, however, advocate for states to formulate and adapt guidelines permitting telepractice.

In the meantime, associations advise telepractitioners to verify requirements and policies, as well as hold all appropriate credentials, both in the state where we reside and where the client receives services. This applies also to special credentialing for bilingual telepractitioners.

ASHA doesn’t certify bilingual service providers, but it provides guidelines for those who represent themselves as such. For example, we are ethically-bound to ensure that we speak or sign another language with native or near-native proficiency, and possess various clinical competencies.

To my knowledge, only Illinois and New York have a type of credential for bilingual practitioners, and these are specific to professionals working in schools. However, because policy changes frequently (and is difficult to track), SLPs and audiologists should verify any bilingual-specific requirements in states where they might practice before providing services.

Telepractice holds a lot of promise for serving clients with diverse needs. Even when there is some red tape to figure out, using technology to build bridges to communities that may not have many resources is one of my most rewarding professional experiences!

 

Nate Cornish, M.S., CCC-SLP is a bilingual (English/Spanish) SLP and clinical director for VocoVision and Bilingual Therapies.  He is the professional development manager for SIG 18: Telepractice, a member of ASHA’s Multicultural Issues Board, and a past president and vice-president of the Hispanic Caucus.  Cornish provides clinical support to monolingual and bilingual telepractitioners around the country.  He also organizes and presents at various continuing education events, including an annual symposium on bilingualism.  Contact him at nate.cornish@vocovision.com.

Noise Control: 11 Tips for Helping a Child With Autism

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Editor’s note: This is an excerpt of a blog post written by Karen Wang for Friendship Circle. Her full post can be read here

When my son was a toddler, he had a panic attack every time our washing machine clicked loudly to change cycles. He developed a phobia of all types of bells. He covered his ears and cried in crowds. But he became calm, even joyful, every single time we went for a walk in the woods, visited the library or entered any kind of religious environment: his stiff, tight muscles would relax instantly in my arms.

Creating a Plan to Deal With Sounds
All of these observations gave me food for thought as I developed a plan to help him cope with his sensitivity to sound. Over the years his ability to tolerate noise has steadily increased, and barking dogs are his only remaining noise-related phobia.

Here are eleven ways to help a highly sensitive person learn how to cope with and enjoy everyday noisy situations.

1. Know the types of sensitivity
There are several different types of noise sensitivity, and there are different treatments for each type. Consult with an audiologist to pinpoint which type of sensitivity is affecting your quality of life. There are five common types of sensitivities, but keep in mind that a person may be affected by more than one issue. For example, my son has hyperacusis in addition to phobias of specific sounds.

2. Provide relief
Headphones and earplugs offer instant comfort and relief. Noise-canceling headphones are the most effective, because they replace irritating environmental noise by producing calming white noise. However, most audiologists, physicians, therapists and educators recommend against frequent use of headphones and earplugs, because a person can quickly become dependent on them.

3. Identify safe environments
One of the first steps that I took for my son was to make a list of his “safe” places and increase his participation there.

4. Allow control over some types of noise
At its heart, anxiety is a fear of being unable to control reactions and situations. When my son had a phobia of bells, I gave him several different types of bells to handle and experiment with at home. When we saw bells at customer service desks or in other public places, I allowed him to ring the bell. He gradually became comfortable with the sounds, and he even began identifying speaker systems, alarm systems and other sources of sounds everywhere we went.

5. Allow distractions
When my husband and I took a Lamaze childbirth class many years ago, we learned about the power of distraction in pain management. By giving a person something like an iPad to focus on or an unusual privilege such as bringing along a favorite toy from home, it becomes possible to direct attention away from the offending noise.

6. Gradually increase exposure and proximity
The cure for a fear of snakes does not involve throwing a person into a snake pit. Similarly, relief from noise sensitivity requires a gradual desensitization and not a sudden exposure. Start by observing something from afar and take a step closer with each opportunity.

7. Alternate noisy and quiet
I discovered that my son’s tolerance for noise increased the most when I scheduled frequent quiet breaks. After a morning out doing errands, we enjoyed a quiet lunch at home. After a playgroup with 7 other children, we made time to snuggle on the sofa. When we felt brave enough to visit a large theme park, we booked a hotel inside the park so that we could retreat as often as necessary. We always take a break before the noise upsets him, so that he will want to return for more fun after resting.

8. Hyperacusis Retraining Therapy (Tinnitus Retraining Therapy)
Auditory Integration Therapy (AIT) is sometimes suggested to people with noise sensitivity, but there is very little peer-reviewed research published on the topic of AIT, and the existing research has generally not been favorable. However, there is plenty of medical research on Tinnitus Retraining Therapy (TRT), which involves listening to broadband pink noise to habituate a person to ringing in the ears. Pink noise contains all audible frequencies, but with more power in the lower frequencies than in the higher frequencies. Most people report that pink noise sounds “flat.” Because of this, it helps to rebuild tolerance to sound.

9. Cognitive-behavioral therapy
Physicians widely recommend cognitive-behavioral therapy for phobias and anxiety because it teaches a person to self-manage emotions and coping skills. The goal of the therapy is to reframe a person’s thought processes about the cause for anxiety in order to increase quality of life.

10.Consider supplements
Many people with tinnitus or hyperacusis are deficient in magnesium or other minerals. Consult with a physician to determine if nutritional supplements may be able to help.

11. Avoid food additives
Certain food additives, especially those in the salicylate family, are associated with noise sensitivity. In fact, medical literature refers to salicylate as a “tinnitus inducer.” Special diets, such as the Feingold Diet or a diverse whole foods diet, eliminate those additives and may help reduce sensitivity. Consult with a physician or dietitian before making any major dietary changes.

Karen Wang is a regular blogger for Friendship Circle, a nonprofit organization that supports people with special needs and their families.  Karen is also a contributing author to the anthology “My Baby Rides the Short Bus: The Unabashedly Human Experience of Raising Kids With Disabilities”

Heidi’s Top Blogs

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Editor’s Note: In her daily work at PediaStaff, Heidi is Editor-in-Chief of the popular PediaStaff Blog for pediatric and school based therapist, and also created the PediaStaff’s Pinterest Site  for therapists and parents of special needs children.  The company’s continuing work to educate, share resources with, and support the special needs community has been featured on Parents.com, and Love That Max, (an award-winning special needs blog).   In addition, PediaStaff was profiled by the well-regarded social media blog, The Realtime Report, for their innovative work.

 

In the past few years, the internet has exploded with speech-language resources, largely due to the ease of publishing one’s thoughts through a blog. When I wrote a piece on SLPs blogging back in 2012, most clinicians had no idea that this wealth of knowledge was out there. Today however, blogs are everywhere and they are widely known as a great place to get specialty information on virtually every topic.

Anyone who has ever blogged will tell you that regular blogging is a time-consuming commitment that demands ongoing diligence. A successful blogger needs to write insightful, informative posts at least two to three times per week. Blogging usually starts for most as a fun way to get your ideas out there. A year later, when the “newness” has worn off, contributing to your blog evolves from a “want-to” to a “have-to,” and then unfortunately often to a “Do I really need to?” task.

A good many of the blogs we featured in our first article no longer exist. Fantastic clinicians have just decided that the time it took to consistently share the excellence they practice was just too much of a drain on professional and personal time. Thankfully, a new crop of bloggers have recently come in to fill some of the gap left behind.

Others, have gone the route of making their blogs a way to supplement their income. If I am going to invest this much energy in blogging, why not sell some of my great ideas? After all, school speech surely doesn’t pay very well. The advent of Teacher Pay Teacher, has enabled many extremely creative school therapy clinicians to share their ideas and earn themselves a nice secondary income to boot.

In this article, I selected only blogs that are not offering their own products for sale. There are so many creative SLPs doing this now, that I would never be able to choose.

Here are some of my personal favorites (in alphabetical order) of those bloggers sharing all of their insights, opinions, tips and activities free of charge:

Almaden Valley Speech Therapy Blog – While I do not personally know the author of this blog, I find her posts, mostly on pronunciation, quite interesting.

ASHAsphere – You’re here. Need I say more?

Bilinguistics Blog – This blog focuses on bilingualism and issues facing clients with multicultural backgrounds. Highly recommended.

Chapel Hill Snippets – After years of giving away substantial resources—especially printable books and Boardmaker share activities—Ruth Morgan has finally bitten the bullet (her words) and opened a TpT store. While she is selling a few things now, I wanted to share her blog for the enormous collection of free resources she has amassed and still offers for your use.

Doyle Speech Works – A new blogger, Annie Doyle muses mostly on professional issues facing SLPs. Insightful, fresh and enjoyable.

Erik X. Raj – Erik is one of the most creative SLPs I have had the pleasure to meet. Funny and full of spot-on ideas to engage kids, this blog never fails to inspire.

Language Craft – Lucas Stueber is especially good at sharing ideas that inspire boys to enjoy speech-language treatment. In addition, he has some excellent profession insights. While he hasn’t been blogging often lately, the entries he posts are definitely worth a read.

Play on Words – Sherry Atemenko – is an expert on reviewing books and toys through a speech and language lens. A very valuable blog, indeed.

PrAACtical AAC – A perennial favorite, this blog specializes in augmentative and alternative communication and does a mighty fine job of it.

Speech Adventures – Mary Huston always has something interesting to say, even though the number of posts she writes has slowed down this past year. Whether she is reviewing apps, talking about commitment to the profession or just musing, her blog is definitely worth a subscription.

Speechie Freebies – This is the one primarily Teacher Pay Teacher oriented blog in this article. Every post offers something free and generally printable to use in the classroom or clinic. And while, each contributor does also sell their wares on TpT, the offerings on Speechie Freebies are always free and often substantial. If you are interested in bloggers that offer their ideas on TpT, Speechie Freebies is a fantastic way to explore them.

Speech Techie – If you’ve been to an ASHA convention in the last few years and are interested in how technology can be valuable in SLP practice, you have heard of Sean Sweeney. It’s a top-notch blog with the awards to prove it.

Happy reading!

 

Heidi Kay is one of the founding partners of PediaStaff and is the editor-in-chief of the PediaStaff Blog, which delivers the latest news, articles, research updates, therapy ideas, and resources from the world of pediatric and school-based therapy. PediaStaff is a nationwide, niche oriented company focused on the placement and staffing of pediatric therapists including speech-language pathologists.