Kid Confidential: Using Thematic Therapy to Write Goals

creative 

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

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

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

Goal Writing

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

Goals to Be Used With Any Thematic Activity

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

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

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

Writing Thematic Vocabulary Goals

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

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

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

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

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

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

Writing Goals to Accept Data From Other Sources

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

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

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

Help from Other Colleagues

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

Short-term Vocabulary and/or Grammar Skills:

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

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

Story Telling/Narrative Skills:

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

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

Other Long-Term Language Skills

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

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

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

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

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

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

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

Five Ways to Empower Your Client

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

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

Here are five ways that you can empower your clients:

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

 

Rebecca Eisenberg, MS, CCC-SLP, is a speech-language pathologist, author, instructor, and parent of two young children, who began her website www.gravitybread.com to create a resource for parents to help make mealtime an enriched learning experience . She discusses the benefits of reading to young children during mealtime, shares recipes with language tips and carryover activities, reviews children’s books for typical children and those with special needs as well as educational apps. She has worked for many years with both children and adults with developmental disabilities in a variety of settings including schools, day habilitation programs, home care and clinics. She can be reached at becca@gravitybread.com, or you can follow her on Facebook; on Twitter; or on Pinterest.

NIMTR: Not In My Treatment Room!

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You’ve heard of NIMBY, “not-in-my-backyard” haven’t you?  Well there’s a new acronym, NIMTR or “not-in-my-therapy-treatment-room!”  Speech-language pathologists are inundated by catalogs filled with wonderful colorful, fragrant, pliable toys as treatment materials.  We use these every day with our students, our clients in clinics, our bedside patients.  But how much do we really know about the safety and makeup of those therapy materials your shrinking budget dollars are purchasing every year?

Some interesting facts about toys.

Toys are BIG business. Just visit any mall in America or website such as Amazon.com.  Worldwide, over 80 billion dollars were spent on toys in 2009, with more than a quarter of that money consumed in the United States. The latest figures by the Toy Industry Association Inc., places the annual U.S. domestic toy market at $22 billion in 2012.  Of this, $6.63 billion covers toys and articles for infants and toddlers, puzzles and games, and arts and crafts.  I mention these specific categories because they are materials most likely to be used by SLPs working with young children in early intervention, preschool, or school settings.

So many toys … but are they safe?

The United States imports many more toys from foreign countries compared to its exports. China, Japan, Mexico, Canada and Denmark lead the way in toy imports.  Since other countries do not implement the same environmental protections in manufacturing as we do in the states, the question of safety looms large.  The Consumer Product Safety Commission (CPSC) is the main body responsible for overseeing the safety and recall of unsafe toys and products manufactured in or imported into the United States.  In 2012, the CPSC released a new risk assessment tool to help improve the screening of imported products. About 5 percent of the total number of these screenings identified children’s products.  One example: a shipment of 28,000 baby bottles imported by Dollar Tree was seized after determining they were defective and unsafe using the new risk assessment tool. You can read more about the successes of CPSC online.

The Consumer Product Safety Improvement Act of 2008 made it mandatory for all toys aimed at children under the age of 14 to meet new federal safety standards.  Some of these include testing lead content and concentration of phthalates (DEHP, DBP and BBP* in particular). Here is a video to see how CPSC works collaboratively with other government agencies to seize toy imports that are unsafe for children.

Even though we have protections, toys of questionable safety continue to enter the consumer market.  Recently DNAinfo in New York released this alarming report, which shows many toys in stores tested positive for elevated levels of toxic substances, including phthalates, which have been found to be associated with asthma, birth defects and hormone disruption, among other health problems. One item on the list, a Teenage Mutant Ninja Turtles pencil case manufactured by Innovative Design was found to contain 150 times the legal phthalate limit for toys. But alas, currently, it does not qualify as a toy under federal regulations.

What if it is not a toy?

And that’s a good point: Sometimes SLPs use materials in their practice that are not toys. Like the pencil case mentioned above or what about commonly used rubber tubing that a speech-language pathologist may use during treatment for oral exercises?  Would such rubber tubing be considered a toy, a medical device, or something else?  Who oversees the safety of products such as these?

Two organizations responsible for developing standards of safety are the International Organization for Standardization (ISO) in Switzerland and the American Society for Testing and Materials International  based in Pennsylvania.  Both provide standards to industries that produce just about everything, from iron bolts to bathmats.  Each provides standards for purchase to companies, who in turn use the standards to manufacture and distribute their product to specification.  I contacted both these organizations to find what standards exist for the rubber tubing example.  As of this writing, no responses to my request have been received.

What is an SLP to do?

So what can you do to ensure that the materials you use with your students and clients are safe?  Here are a few suggestions:

  1. If you are purchasing from a distributor online, check their website for more information. For example, SuperDuper Publications places a Product Safety statement on their website and invites customers to email them for more information.  Companies who openly provide statements such as these make it easier for the consumer to trust the safety of their purchases.  If you cannot find information on product safety or product testing, email the company and ask for it.
  2. Check the CPSC’s website for toy and product recalls. You can find the latest recalls, search for recalls by product name or by country of manufacture, and also report an unsafe product.
  3. Read the manual! Electronics such as iPads and tablets come with a manual that will often provide the ISO or ASTM Int’l standard used to insure safety and will list potential hazards.
  4. Contact the manufacturer of the product and ask for the MSDS – materials safety data sheet.  This would be a good choice if the product you have or consider purchasing lacks a manual or an information sheet on standards testing.  You also can look up a product by name and manufacturer on the MSDS website. On this site a search for “rubber tube” gave me 34 hits.  While searches can be daunting and time consuming, the insurance of safety provides peace of mind to you and the clients on your caseload.
  5. Avoid buying inexpensive toys or materials from questionable sources such as street vendors.

Informed SLPs can now approach their materials purchases with a new savvy.  Next time you are tempted to buy inexpensive therapy materials composed of questionable ingredients, just say “NIMTR”!!!!

 

Anastasia Antoniadis is with the Tuscarora (PA) Intermediate Unit and works as a state consultant for Early Intervention Technical Assistance through the Pennsylvania Training and Technical Assistance Network. She earned a Master of Arts degree in speech pathology from City College of the City University of New York and a Master’s degree in public health from Temple University. She was a practicing pediatric SLP for 14 years before becoming an early childhood consultant for Pennsylvania’s early intervention system. Her public health studies have been in the area of environmental health and data mapping using geographic information system technology.  You can follow her on Twitter @SLPS4HlthySchools.

How 2013 Taught Me To Be a Better SLP

2013

We have successfully completed another year owning a private practice in a location that is densely populated with speech language pathologists. And by “we” I mean myself and my husband. We are implementing a business plan that he poured sweat and tears over (everything just short of the blood…) and the doors to our business still remain open.

Given the multitude of stresses that come from running and owning a business, I have learned to measure my success in ways that seems contrary to the ordinary. Here’s what I have learned and how I measured my success as a speech-language pathologist in the year 2013.

1. Being a parent is hard work and I cannot fully grasp and understand that just yet. No matter what a family’s situation is, the energy, effort, resources, skills, brainpower, love, patience, problem solving, planning, and determination it takes to be a parent and caretaker of a child with special needs is really immeasurable. As an SLP I can listen, sympathize, show compassion, and provide resources, but I am not in their place at the present time. Although I am trained to be a support for these families and I respond with new ideas, I am lacking a component of what it really means to live what they are living. Coming to this realization and maintaining awareness of it is huge for me.


2. Baby steps are crucial–for everyone.
 I have learned that so often I attempt to “conquer” a child’s speech or language delay in just one day. My expectations are high and I want the family to see the benefits of my services. But I am not a magician and they need to realize this. And we are working with a human being, not a PowerPoint presentation that we can edit with the click of a mouse. Coming in with realistic expectations and using daily, small stepping stones to increase a child’s skills is what is most beneficial. One of the mothers I work with often repeats this back to me as we summarize sessions with her child (who has many needs). “Baby steps, baby steps,” she says. Yes, so unbelievably true.

3. I need to squish, trample, and eliminate my need for a box. I naturally go through life with a black or white mentality. If something is not one way then of course that would make it be _____ (the opposite of the initial way). I come from a long line of black and white thinkers. Nope. Nada. Not the case. Just because one child was one way, does not mean that child X will be that way as well when they get to point B. Follow? Although I try, I realize that so often I don’t factor in the child’s overall personality into my daily interactions with him or her. I’m not talking about a child’s behaviors. I’m talking about their likes, loves, and dislikes. When I was a kid I loved watches, Hello Kitty, big red soft robes, Where’s Spot? books, music, and bear hugs. This was what allowed me to flourish as a child and I need to help other families do the same with their unique kiddos.

4. You never know when someone is listening…… On occasion I feel myself turning red with frustration at my inability to “get through” to a family (thus the need for lessons 2 and 3). However, on several different instances this year a parent or caregiver summarized the very basis of what we were working on in therapy. Whoops. I love when my husband teaches me that I am not always right he was listening but it may be even more humbling when a family that I work with shares in the same lesson.

5. There is never a limited supply of resources to work with and it’s OK not to reinvent the wheel sometimes. When I’m planning for my sessions I will at times squeeze in another sheet of laminated pictures, more books, or have ready more toys within arm’s reach. Four out of five times I don’t even need these items as I survey the house and begin using whatever toy the child had already been playing with. But I have found that the magic number of three materials in a session usually does it. Why? No scientific basis for it really. A book, one toy, and a small sensory item (bubbles, play dough, etc) usually do the “trick” (whatever that is). This makes me slow down. (Yes, let’s once again go back to number 2.) It gives us enough time to play together and enough time to engage in coaching the family. The reason why there are so many cute, easily adaptable pre-made lesson plans out there is because the crafty people that make them are good at it. Really good at it. And they take pleasure in knowing that people like me are occasionally using their lessons for materials in therapy. We’ve all got our skills and using time efficiently to make materials is not one of mine. That’s what my great, far-reaching community is for.

So given all of the above lessons, how have I measured my success as a therapist this past year? Simply by the fact that I have learned. I have grown. And it only looks like there will be more of that to come in the New Year. While my feet are beginning to be planted in my current practice, the certainty of this stability does not always ring true. But my ability to continuously learn in my profession? Always there without fail. I cannot wait to continue the relationships with the families I am already working with and establish trust in new relationships to come.

Meredith Mitchell, MSP, CCC-SLP, is a pediatric speech-language pathologist who owns a private practice in North Carolina.  She maintains a blog for families on her website and also maintains a separate blog for speech therapists focusing on early intervention.  She can be reached at meredith@sterlingtherapync.com.

 

Collaboration Corner: “Out of my Mind” Speaks Volumes

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This year, I worked with a fifth grade class who was reading “Out of my Mind” by Sharon Draper. The story is about a nonspeaking 11- year-old girl with cerebral palsy. Her classmates, teachers, and even  her doctors underestimate her abilities. Little do they know she has a photographic memory. One day after months of fighting with insurance, Melody (the protagonist) is given the gift of voice through an AAC device; the drama unfolds from there.

The teachers read a little of this book every day to the class, but wanted the students to get a better understanding of Melody’s struggles. They asked me to come in and show students various kinds of AAC devices.

This was the perfect launching point for a lesson on inclusion and AAC. This was one of the most effective ways I’ve worked with teachers and students regarding the challenges AAC users face everyday.

Here’s all I used:

  • A PECS book;
  • Two iPads with two different communication apps;
  • An alphabet board;
  • Low-tech battery operated voice output device;
  • A sheet with a picture of two “thought bubbles” and two hearts (see below);
  • Index cards with written scenarios; and
  • A sheet of emotion cartoons.

First, the class gathered together, and I gave them an overview of how people might communicate. Most understood body language, words, and some mentioned sign language. Then I brought out the different systems. Their eyes lit up. Then they started to make connections to other children in the building who used these systems. They were hooked.

Next, the children broke up into groups of four or five. Each table had two AAC systems. Within each group, students paired off. One student had a “speaker” card, and the other a “listener” card. Speaker cards had clues like, “you can’t speak, but you can point and read. You really want to tell your friend about the movie you saw last night.” The partner’s card (“listener”) read, “Your friend can’t speak, but she can point and read. She really wants to tell you something, find out what it is.”

I wish I had taken a video. The interactions were amazing, and the students really dove into the activity. Each group got a turn with a different kind of system. A nice, unexpected experience: Teachers went by and facilitated interactions with tips like being closer to the speaker, or waiting and not interrupting.

Finally, I collected the devices. Each group received a copy of a words related to emotions and a worksheet, which they worked on individually. This gave them a chance to reflect.

On the worksheet were only two fill-in the blanks on top:

When-I-was-the-speaker

On the bottom were two more:

When-I-was-the-listener

And then the teaching part happened! Here were some of the responses:

  • I was thinking, why can’t he understand me!!! I was outraged!
  • This is so hard! I felt like giving up.
  • I don’t have enough words. I felt like oh, well, never mind.
  • I wanted to help you, I’m sad and frustrated for you
  • I can’t understand you, I felt impatient.
  • Keep trying! I felt helpless.
  • I can’t spell, this takes too long! I felt annoyed.

I kept copies of every single sheet, I’m not exactly sure what I’m going to do with them, though I’m fighting the urge to wallpaper my office with them.

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

 

 

 

 

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

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

 

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

 

How to Navigate the Profession One Binder at a Time

Binders

 

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

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

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

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

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

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

Kid Confidential: Using Thematic Instruction in Speech Therapy

pirate

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

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

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

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

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

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

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

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

 

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

Taming the Wild Editor: How to Get Published in The ASHA Leader

lion

All around the world, wherever their presence is tolerated, editors are notoriously cranky and unreasonable. Some are so ill-tempered, they’re like wild animals. Can you blame them? They would rather be writers to begin with. Instead, these stunted authors toil in bumpy office chairs, sip stale coffee, and cultivate eye strain and stooped shoulders … while they pore over a seemingly endless pageant of manuscripts. Their profession is based almost exclusively on spotting others’ errors—in short, being insufferable curmudgeons. And this wretched life stamps its mark all over a person’s demeanor.

Right about now, you may be thinking: Thank goodness I’m not an editor. Most reasonable readers would agree and share your relief.

But here’s the bad news: If you’re a prospective author for The ASHA Leader, editors not unlike the ones we described above will decide whether your carefully crafted proposal is accepted or rejected. Like hungry (and angry) lions locked in a cage too long without Starbucks coffee, these ferocious editors seek out any signs of weakness in your proposal … and pounce. Call it instinct.

On the other hand, nothing is as soothing to these savage editorial beasts—nothing shines so bright a ray of light into their cluttered lives—as a well-crafted, compelling story proposal. Editors feel satisfied when they find an error, but finding a storyteller fills them with joy. It’s like catnip for editor lions.

So how can a prospective author brighten a downtrodden editor’s life? How can you find a path to safety—and publication—through the famished, circling lions? We’re about to arm you with the chair, whip and confidence you’ll need to tame a pack of wild editors.

In the Leader’s general guidelines, we ask prospective writers to submit a proposal form before they spend time completing an entire manuscript. This is designed to save everyone some time, rather than writing an entire story that may not be suitable for the Leader, or for its upcoming content. And the proposal form includes a checkbox for authors to affirm that they’ve read the Leader’s writer’s guidelines.

The catch, however, is that reading the guidelines typically isn’t sufficient. The Leader’s editors look for proposals that exemplify the guidelines: lively, entertaining stories that provide practical advice or enlightening information about communication sciences and disorders. Every story needs a “hook” to draw the reader in, and should be conversational enough to keep them reading. Write sentences in an active voice. Avoid technical terms, jargon and overuse of acronyms. And per the Associated Press Stylebook, don’t include parenthetical citations in the text.

In short, if an author checks the box affirming he or she has read our writer’s guidelines, we expect the proposal to demonstrate the guidelines. If it doesn’t, the author’s chances of being invited to submit a manuscript are greatly diminished.

Some have wondered whether the Leader is still a science magazine. It absolutely is. But it is not a scholarly journal. As far back as April 1962, James Jerger declared in Asha Magazine his belief that scientific writing can be readable—that it can inspire and inform while appealing to a wide audience. (The full article [PDF] is worth a read.) The Leader’s editors share Jerger’s belief. Instead of presenting concepts only to fellow clinicians, using specialized language and tangled verbiage, we see the redesigned Leader as a vehicle for clinicians to show the public and other professionals (those in CSDs’ many and varied areas) what they do—in language most readers can understand.

So what are the most important things you can do to ensure your proposal’s best chance for acceptance? The first four come straight from Jerger’s article:

  • Write short sentences. Use a new sentence for each new thought.
  • Avoid artificiality and pompous embellishment. Write it the way you would say it.
  • Use active verb construction whenever possible. Avoid the passive voice.
  • Use personal pronouns when it is natural to do so.

Most important, craft your proposal so its inspiring, informative qualities jump off the page. Use a hook. Include sample content that whets the appetite for more. Make the Leader’s editors sit up, take notice and demand to know where your story is going. At the very least, take pains to follow the writer’s guidelines in your proposal.

After all, when you’re fending off wild animals it’s usually best to throw them a bone.

Matthew Cutter is a writer/editor for The ASHA Leader.

All I Want for Christmas is My G-Tube Out!

santa baby

A Parent’s Expectations and an SLP’s Goals

As a pediatric SLP who focuses on feeding, I guide families through the process of transitioning from g-tube feedings to 100% oral feeds and ultimately, removal of the g-tube.  This year, I had the unique experience of learning more about the emotional process through the eyes of one mom who happened to be an SLP, too.  In the course of nine months of feeding therapy,  her daughter Payton has taught us both that goals and expectations aren’t always met on the SLP’s or parent’s timeline and that most importantly, the child sets the pace.  Payton’s mom graciously shared her thoughts on the process:

History: Payton was born in December 2012 at 38 weeks, 4 days and weighed 4 lbs., 13 oz..  One month  later, Payton was hospitalized due to congestion, but it soon became apparent that this was a more serious matter.  On January 9th, surgeons performed a Ladd’s procedure to repair a malrotation of the stomach and intestines, a Nissen fundoplication to control reflux and secondary aspiration, removed her appendix, repaired a hernia and placed the g-tube.

Payton-Preemie2

Melanie: When I first met you in March 2013, your family and of course, Payton, had been through so much!  What did that feel like, knowing that she needed surgery and consequently, a g-tube? 

Payton’s Mom: This was my baby; my flesh and blood. I was so mad, sad, overwhelmed, devastated, in denial, and didn’t want any of this to happen. There had to be another option, another way to make her better. My child was not going to eat through a tube and I was going to do all that I could to get that thing out as soon as I could.  I was SO mad and devastated that this had to happen to MY baby.  It felt to us that when she was in the hospital, that the goal was to “fix” her and then we were sent home (feeling totally alone and shattered) to cope with all that we needed to get her to grow and thrive.  Short and long term goals were not clearly communicated to us.  In the back of my mind I knew that this would be a long journey, but I didn’t exactly know how long or what it would entail and I wanted to know NOW! Everyone in the hospital kept telling me that Payton would do this at her own pace (“Payton’s Pace”) but I didn’t want to wait. I wanted my baby better now!

Melanie: We have often talked about the difference between setting goals and setting expectations.  Your journey with Payton has helped me to have a better understanding of the difference.  Goals are targets or objectives.  Expectations feel more passionate and focus on hope, anticipation and personal beliefs.

Payton’s Mom:  As an SLP, I set goals and benchmarks all the time. There is a target behavior you want your client to meet and you set reasonable, attainable steps to get there over a specific, realistic time period.

As a parent, when you have a child with any challenge, you have expectations for them that are based on your emotions, including sadness, anger, denial and/or hope.  From the beginning of our journey, I remember having the expectation that Payton would eat a normal birthday cake and drink milk from a cup on her 1st birthday. Even though Payton just had a feeding tube placed and we were not sure when she would be eating orally again, I still had this expectation.

Melanie: I remember that so well!  I asked you what I ask every parent in feeding therapy: “Tell me what you want for your child” and you answered “I want her to eat birthday cake on her first birthday” and then, you stated it clearly to me once again, just to ensure that I understood.  “She’s GOING to eat BIRTHDAY CAKE on her FIRST birthday” and you had tears in your eyes.  That was a big lesson for me – you’ve taught me so much.  Expectations are very emotional. 

Payton’s Mom: I also had other expectations: that she would be running the hallways of the hospital on the week of her first birthday and say hello to the doctors who treated her!  When I stated these expectations, I knew in the back of my mind that it was unfair to myself and especially to Payton to expect this, because if she couldn’t do it, then would I feel guilty, disappointed, angry and upset that the therapists and doctors didn’t do their job right, or that I wasn’t doing my job.  It was all based on my hope for her to be “normal” and desperately wanting all the emotions of sadness and anger to go away after this difficult journey

Melanie: Is there anything else you feel would be helpful for parents and therapists to understand?

Payton’s Mom: Most importantly, follow your instinct as a parent. I truly believe that following my instinct saved Payton’s life.  A parent should trust that feeling inside of them and advocate for their child as they know them best. The opinions of doctors and therapists should be respected as they are knowledgeable and experienced;  however as the parent you go through life with your child all day, every day and it’s important to communicate and discuss the issues  with the doctors and therapists. Come to an agreement what is reasonable and feasible for your child and family. Sometimes when doctors and therapists are not on the same timetable as you it “gets in the way” of your expectations as a parent. A lot of time is spaced between appointments and as a family, life goes on. Another lesson is to pick your team well. When you have a child who works with many different specialists, it’s important that you work well with them as a family and that your child responds positively to them. There are many options when it comes to professionals and you don’t have to work with who was assigned to you, specifically in the hospital, if you do not communicate well with them, agree with their overall philosophy, or feel that there is mutual respect in the relationship.  Lastly, I have learned to respect my child’s pace of development and progress. Getting your child the therapy they need and following through with the  recommendations from doctors and therapists is essential, but that doesn’t necessarily mean they are going to meet the goals and expectations for them on your timeline. I have tried to remind myself when things get tough/or my expectations are not met that this is “Payton’s Pace.” She is her own being who will determine what she does and when she does it.

Melanie:  Yes, she sets the pace.  So, we don’t know if she’ll get her tube out at Christmas.  What’s  most important is what a fantastic year this has been for her and for Team Payton!   Plus,  this is her birthday month!  She’ll have cake and something delicious to drink from a cup.  Probably a purple cup … because she loves purple.  Happy Birthday, Payton!

Payton-One-Year-Old2

Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating.  She is the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is  offered for ASHA CEUs and includes both her book and CD for each attendee.  She can be reached at Melanie@mymunchbug.com.