Saturday, May 31, 2014

Soapbox Saturday: Collaboration-is it an Urban Legend or Real Threat

Did you know that my friend's friend's cousin's brother went to a local fast food chicken restaurant and when he went to bite into his chicken leg there was a tail sticking out of it?

That is one of my favorite urban legends.  It's so gross to think that you would accidentally eat a cooked rat.  I'm fascinated by these.  One of the spookiest that I remember was the one about the college roommate who was heading out to the library.  She forgot her book so she ran back in the room but didn't turn on the light.  After she finished studying, she came back to find that the police were at her dorm.  Her roommate had been murdered.  Written on the wall in her blood were the words: "Aren't you glad that you didn't turn on the light?"

That will probably win the award for the most gruesome Speech therapy blog intro.  I find Urban legends fascinating.  Another favorite story of mine is the one about a woman who always cuts off both ends of a roast when she is cooking it.  Someone asks her  why she does that and she responds that her mother always did that.  She asks her mother and she responds that that's how her grandmother fixed it.  They ask the grandmother and she tells them that she had to cut off both ends of the roast because her pan was too small.

Did you hear the one about the friend of a cousin of an aunt of a family who worked for a principal's nephew?  His speech pathologist told them that they might need more speech therapy.  The parents went to court and sued the school district and now they have to pay for private speech therapy and to do that they had to lay off 15 speech teachers.

I'm not really saying that this is an urban myth-but I'm also wondering how many lawsuits were filed where the district had to pay for private speech therapy because of a recommendation for more services.  It's probably not a good idea to recommend additional services in the school.  Instead, you could ask if they receive outpatient services.  If the parents ask what that is, you could say that some parents are able to receive additional services through their medical insurance.  When parents are requesting things that aren't possible in the schools, you could also mention that some parents choose to receive additional services which are billed to their medical insurance.  

I work at a clinic as well as within the schools.  Most of my clients or students do better when they are able to access both therapies.  We learn about the importance of collaboration in graduate school.  But when we get out into the "real world," we sometimes find that collaboration (or at least referrals) is discouraged.

I think students do better when they have access to both services for several reasons.  They are able to practice (typically in a group setting) at their school with their peers.  The school speech language pathologist has access to the teachers and can help to incorporate generalization of these skills with indirect services over an entire school day.  Private therapy is typically conducted in one on one settings.  The student receives intensive services and can achieve multiple repetitions of a target.  One on one can be especially effective for middle to high school students who tend to have "attitude" within a group setting.  The private therapist is generally able to coordinate on a weekly basis with the child's family working on carryover to the home environment.  The student benefits by practicing his or her skills in more than one setting with more than one professional which helps to increase the likelihood of carryover of skills to all environments.

Awhile ago I put on my school speech language pathologist hat to talk about how unhelpful it is when private therapists try to make a million recommendations for how you should do your job.  Today, I'm going to put on my clinic hat.

Here is what is most frustrating.  People don't know that there is an option to access speech therapy through their medical insurance.  It saddens me when I have a client come in at 16 whose parents didn't realize that they could access additional services.  Coming in at a close second is insurance plans who deny coverage for speech therapy or articulation therapy.  Or the plans who only cover services until age 5.

Students who no longer meet educational criteria for speech and language services may still benefit from one on one private speech therapy.  Students who haven't yet qualified for articulation services may be able to access habilative therapy sooner.

Doctors are thought to be the main referral sources for outpatient services but they often hesitate to recommend additional services.  In general, they do not understand how school coverage works.  I've had doctors who've refused to sign orders because they wanted the parents to access school services for a patient who wouldn't qualify for school services for two more years.

Schools sometimes seem to be the missing link in getting children access to all of their community resources.  The school speech and language pathologist is probably going to have some type of contact with most children who need or would benefit from speech and language services.  One of the bigger challenges for private clinics is how to get the information to families that there are additional community resources for speech and language intervention.  Many families will choose not to access these services for a variety of reasons-including insurance coverage, financial cost or an inability to devote the extra time to outpatient therapy.  I don't think I expect that every student should get private therapy nor do I think that every student needs private therapy.  But I just wish that each family knew that private therapy exists.  That's where I could really use the help of my School Speech Language Pathologist friends.

Next week I'm going to talk a little bit more about how collaboration benefits both school and outpatient therapy clinics and also how we can make that collaboration successful.

I'd love to hear your thoughts (good or bad) on this topic!  You can comment below.  If you thought this was particularly interesting or relevant, please think about sharing this post with others by using the social media buttons below.

Friday, May 30, 2014

What's New at Speech2u: April/May edition

Once a month, I take some time to share what I've been working on.  I completely forgot to post last month, so I'm catching you up on the last two months of products. 

Nothing Minimal about these Pairs: Fronting/Backing:
This is the third product my minimal pairs products. This one focuses on fronting/backing.  It includes 55 different minimal pair sets, sentences containing minimal pair sets, rebus stories and memory homework sheets. 

I Want My Hat Back: 
This was my first book companion.  I wrote about this book last month HERE.
Intelligibility Checklist: 
I love to use checklists during assessments.  This is a checklist I made up years ago to describe what is impacting my student's intelligibility.
Silly Name Quizzes:
I love those silly quizzes you find on Facebook (ex. What's your pirate name?)  I figured my clients would like them too.  Here is the vocalic and prevocalic /r/ version.  I'm hoping to have additional versions posted by the end of next month.

Easter Conversational Starters & WH questions:
I really like these products to check generalization for WH questions as well as a fun way to address articulation carryover during sessions.

Next month I'm thinking a lot of narratives and sequencing.  Check in often for activities, products and posts about sequencing!

Enter to win your choice of one of my new products below!

a Rafflecopter giveaway

Monday, May 26, 2014

Mama-on-Days: My Summer Bucket List and a FREEBIE

This is it.  It's our last summer before the big K-KINDERGARTEN.  I'll probably blink and he will be graduating from high school.  I'm alternating between being excited AND trying to figure out how old I would be, if I tried for just one more, when that child graduated.

The Biscuit is at the age where he is just starting to get a little self conscious about things he says.  But he still has some hilarious ideas.  Yesterday I asked him what he wanted to be when he grew up.  He says, "Oh.  I'm going to be a spy.  Or an artist.  Maybe I could be a spy who draws people."  I asked him what he had to do to become a spy.  He told me he thinks he needs to practice being a spy. It seems that if he can hide for 10 minutes without anyone finding him-then he's an automatically in the spy agency.

I know this summer is going to go fast-so I thought I'd write out are summer "bucket" list.  I know my analogy is a little off-but I think I can make it work by thinking of all the fun things I want to do before "summer" kicks the bucket.  

Here's a few things that I have so far:

  1. Run through the sprinkler.
  2. Start keeping cash on hand so that I can buy ice cream bars from the ice cream truck I hear roaming our neighborhood.
  3. Go on a nature scavenger hunt.  Try to catch a frog.  I'm still cool if I wear gloves when we do this, right?  
  4. Pick fresh berries, come home and make a pie.  
  5. Sit on the burlap sacks and ride the big yellow slide at the State Fair-twice.  Intellectually, I understand that the laws of physics will not allow me to fly out into space when going down slides but my brain is still pretty worried that it's a possibility.  
  6. Make a fire in our fire bowl that has been sitting in our back yard unused for years.  Make S'mores.  Sing campfire songs.  We are surrounded by neighbors-so maybe we should reconsider the campfire songs.  
  7. Go to the beach for the whole day.  Try to build the world's biggest sand castle.  Let the biscuit try to bury me.  
  8. Go to our local amusement park.  Ride the rides.  Try to win a giant stuffed animal. 
As I was writing this, I thought it might be fun to use this activity with my clients.  What do they want or wish to do in the summer.  So I made this (very literal) summer bucket list.  

You can grab it for FREE by clicking on the image or clicking HERE.

I hope you enjoyed this post.  If you did, I'd love for you to share it with your friends by clicking on the Pinterest or Facebook pages listed below!

Monday, May 19, 2014

Speachy Feedback

Nicole over at her awesome new website, is hosting the last Speachy feedback party for this school year.

I love getting feedback on my products.  It really helps me to figure out things that are working and not working and guides my decisions regarding new products.

This month we are picking feedback from a freebie as well as feedback from a paid product.  One of the many reasons why TPT creators make freebies is to get feedback.  (There are lots of other reasons including feeling grateful to followers, wanting to share your knowledge and expertise, giving back to your profession and wanting to acquire new followers.)  I love freebie feedback because I know it takes the extra effort to either review the product once you've downloaded it or to REMEMBER to go back and leave feedback.

The Speech Space took time to leave feedback on my newest flip-flap freebie for Better Hearing and Speech month.  I love that she gave me some specific feedback.  Plus I love finding new blogs so was excited to check out the site.  There are some fun therapy ideas on there.

Shannon S. is the winner for my paid product.  This came at a really great time for me as I'd just gotten some intense criticism related to my choice of themes.  I was so thankful to receive such specific feedback related to my product.  Zombies aren't for everyone.  But a lot of my clients really related to them.

Shannon S and Speech Place please email me your choice of any product (excluding bundles).  Thank you again to everyone who takes the time to leave feedback!  You are amazing!

Head on over to to see all of the other great feedback-or to link up!

Thursday, May 15, 2014

The Eye contact debate

Should you encourage eye contact for children on the autism spectrum?

 When I first started working as a speech language pathologist, it was common to see goals such as "Johnny will sustain eye contact for 5 minutes" or "Johnny will maintain eye contact for 90% of a conversation."  This is a great goal if your annual IEP is written to encourage Johnny to be a creepy stalker. Try this, go to the grocery store and initiate a conversation with sustained eye contact. How long did you last? I'd be surprised if you made it longer than 30 seconds.

Individuals with Autism have reported that eye contact is painful. Others have said that if they are looking at you they can't listen. I've thought about some of my kids on the autism spectrum as one channel processors. For instance, if they are looking at the something very visually appealing, they may not respond to our verbal overtures. They may attend to smaller details but have difficulty synthesizing everything they see and hear to come up with the whole picture.

Last year I wrote a similar post about eye contact.  Since then, I've started to prompt my clients in a new way when they are speaking. I cue them to use a START/STOP approach with their eyes on the listener or speaker.

We try to START our verbal communication by using visually checking in with the speaker.  If they need to look away while they are speaking, they are able to do that in order to compose their thoughts.  When they are done with their thought-they need to visually check in again. We talk about how we need to make sure that the person understood us so we look at their face and decide if we need to reword what we said.  In general this has worked pretty well.  My clients are able to check in to make sure the listener is ready to receive their message and then again at the end to see if the listener has understood the message.  We talk about making judgments or inferences to decide how the other person feels about what we said.  Sometimes, we need to work on how long they should talk-conversations are not monologues.

We use the same START/STOP approach when we are listening.  We try to check in visually when we first hear someone talking to us to let the speaker now we are listening.  We use "whole body listening" strategies for them to know we are still paying attention.  We check in again when they are done speaking to let them know that we understood them.  You can download your copy of GO/STOP rules by clicking the above picture.

Do you work with eye contact with children on the Autism Spectrum?  What are your favorite tricks?  I hope you enjoyed this post.  If you did, please consider sharing it with others on Pinterest or Twitter by clicking the links below.

Monday, May 12, 2014

Mama-on-days: The curse of being a "time optimist"

Did I ever tell you that I gave my son a standardized assessment once?  Just to check out his scores.  I'm happy to report that he was around 113 or so.  Not in the gifted range, just average for language skills.  There is a question on one subtest which asked what you would say to a teacher sitting at their desk when you walk in.  He responded with, "Oh, I'm sorry, we're just running a little late today."
That's the story of my life.  I'm a perpetual late arriver.  Which means I'm living in a constant state of anxiety.  I don't want to be late.  I want to be early.  But time after time, I fail.

I'm late to my strength class at the gym.
I'm late to work.
I'm late for son's Christmas pageants
I'm late for church
I'm late for my spa appointments
I'm late for dinner with friends.

Ironically, I ran for Secretary at my school in 5th grade.  My dad helped me write the speech.  I think it went something like this, "Hi, My name is Kelly ***** and I'm running for school secretary.  I am organized and punctual."

Thanks Dad for the wishful thinking.  I remember getting in trouble in 2nd or 3rd grade because I forgot to meet my parents at the ski lodge.  I grew up in the 80s with particularly permissive parents who had no problem dropping their young daughter off at the ski slopes for the day.  It wasn't as bad as when they sent me and my brother on a tour bus from San Diego to Knott's Berry Farms because they wanted to go golfing.

*Big sigh*  So now you know.  I sometimes feel like I am letting the whole profession down.  The Speech language pathologists I know are organized.  They are timely.  They write up lesson plans.  They wear fabulous outfits to work.  I'm like their embarrassing second cousin.

So I thought it was interesting when I read this article in the Experience Life Magazine called: On-Time Arrival by Jon Spayde.  He's writing about the chronically tardy and the book, Time Management from the Inside out by Julie Morgenstern.   It's the first time that I heard about time optimism vs. time realism.  So now I can tell you that I clearly suffer from time optimism.  I want things to take less time than they actually do.  I might do a google map to see how long it takes to get to a restaurant.  But I don't factor in traffic, the time it takes to get into the car, dealing with a 5 year old etc.  I want to be their earlier so I just think that it will happen.  So I'm thinking this is a book that I need to get.  And one of my summer challenges will be to get back to that little 5th grade girl who claimed that she was punctual.  The first step is to start timing yourself.  How long does it actually take to do the things that you want to do.  Are you or someone you know perpetually late?  What strategies have you used?  Thanks for stopping by to read this post.  If you liked it, please consider sharing this post by clicking on the Pinterest or Twitter buttons below.

Saturday, May 10, 2014

Soapbox Saturday: What if we have the wrong answer to our problem?

Years ago when I started as a speech language pathologist, there was a big push for us to service children with reading disorders.  Around that same time, it seemed that our scope of practice was getting so big as to be impossible to reach every child.  For awhile, it seemed like we were expected to treat everyone-and there were a lot of discussions about what we should and should not do.

A quick disclaimer:  I live in a state that has one of the strictest criteria for initially qualifying children for speech and language services.  Students need to be 2 standard deviations below the mean on 2 separate language measures in order to receive services within the school.  Once students have qualified initially though, we can continue to service them by demonstrating continued need.  I actually didn't realize that we were so strict until I joined some of the SLP Facebook groups.  I was a little shocked.  I find that a lot of therapists in my state don't realize that a lot of these students would qualify in other states for speech and language services.  The schools here can't service them-but does that mean that they wouldn't make progress or shouldn't receive services within a medical model?  

Many districts have adopted a primary service provider model within birth to three programs.  In most cases, an early intervention teacher is going out to the house but can access information from the Speech Language Pathologist at any time.  I've seen a few nonverbal clients coming in at around 3 years of age who qualify for 15 minutes per month with the speech language pathologist.  I get the idea of having one main person who is in contact with the family.  But are we saying that we don't have anything special to offer these children at an age when it benefits them the most?  Is the early childhood teacher trained to prompt and change cue levels in the same way as a Speech language pathologist is?  

Some students on the Autism Spectrum are being serviced by the Autism Specialist and do not receive speech and language services.  Communication as well as social interaction is one of the MAIN areas of concern for individuals on the Autism Spectrum.  I'm pretty sure communication is part of our scope of practice.  Don't we have specialized knowledge of typical communication development that is not taught in applied behavioral analysis programs?  

There are rumors that some districts are moving towards servicing language only students through special educators rather than Speech Language Pathologists.  Do we provide distinctly different services to address vocabulary and comprehension?  Do we have specialized training on development and do we approach vocabulary and comprehension in a different way than teachers.

Some of these changes are being made in part due to a shortage of speech language pathologists.  Some of them are being offered as solutions for high caseload sizes.  Part of it is based on the law.  School therapists can only treat students who demonstrate educational need.  School therapists cannot spend their time treating students who are not motivated to change or refuse to attend therapy.  

But I feel like the answer to high caseloads that I keep hearing is: "We need to see less students."  When I think the answer should be: "We need to hire more Speech Language Pathologists."  

Unfortunately, our current graduate programs cannot train the number of Speech language pathologists to fill the need.  And current pay structures don't provide many incentives for therapists to go back and complete their doctorate.  Even if there was a plethora of speech pathologists for hire, schools continue to be underfunded by the government making hiring additional speech language pathologists difficult if not impossible.  

Could we narrow our scope down to a point where we no longer have a job?  What options (if any)  should we provide for students who no longer qualify for services within the school district.

I don't know that there is an easy answer, but I do think we need to start thinking about how we can help our students and families access all available resources within the community.  And that's going to require a pretty big policy shift from administration.  I hope you come back next week to hear why I think collaboration and referrals could be one of the keys to reducing caseload sizes which continuing to provide services to individuals who benefit from speech and language interventions.

I'm curious-what is your caseload size?  Do you find that is manageable or not manageable?  Leave a comment below.  

Friday, May 9, 2014

Lazy Speech Therapist-End of the Year Card deck activities

Is anyone else a little bit fried by this time of the year?  It's the perfect time for super lazy speech therapy games.  They are still motivating-but require very little effort from the exhausted Speech Language Pathologist who still has 900 progress reports to write before the end of the year.  And don't even talk to her about the 10 students that suddenly need MA billing documentation completed. This is a time to conserve your energy.

Here are three super lazy games I played last week when I couldn't seem to get my bottom off of my rolling stool:

1.  Go Wild:  For this game, you need to have enough energy to open and pull out cards from a metal Super Duper can.  While it may seem like this is easy enough, remember that it is fairly easy for some of these cards to get stuck in the side of the holder.  So you might need to expend a little extra effort trying to extract a card or two.  Simply place the card deck onto the table and start saying your speech sounds.  When a student turns over a "wild" card, everyone needs to act wild and crazy for exactly 5 seconds.  Resume play immediately.

2.  Pack it or Trash it:  I developed this game a few weeks ago, when I forgot to grab a game from my materials room.  I had a Fisher Price loving family hatchback car in the room and a dollar store trash can.  Game play is simple.  You are going on a trip and have to decide if you should pack the pictured object or trash it.  Have the student put the card in the car or trash can.

3.  Talking "Tom it": Talking Tom is an app made by Out Fit 7 Ltd.  You talk and the app repeats what you say in a different sounding voice.  They have a lot of different types of apps including dinosaurs, cats and my favorite-bacteria.  For this activity, I used Super Duper's irregular verb deck.  I said the present tense sentence and the student repeated the sentence using the past tense version with the app turned on.

What are some of your favorite "super lazy" ideas for the end of the year?  I'm excited to hear them!
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Wednesday, May 7, 2014

What really happened to that rabbit?: 2 Great Books for Inferencing and Theory of Mind.

I've always loved reading.  As a child, I used to get grounded from the library.  (Probably not the most logical parenting choice, but it was the 80s.)  In junior high, I remember going up to my friend's cabin for the week.  We both packed one suitcase full of clothes and the other suitcase was full of books.  I'm not talking high quality literature.  I'm thinking it was a lot of Sweet Valley High and Fear Street books.  We each read our suitcase full of books and then switched and read the other person's books.  I'm not even sure that we went outside.

I don't have as much time for reading as I used to-and I tend to geek out on Speech Pathology books more than I should.  But I still love to pick up children's books.  I was really excited when I found the book, I want my Hat Back by Jon Klassen last fall.  Recently, I found another book, "This is Not My Hat" by Klassen.  My son, who rarely wants to read a book twice has been a little obsessed with these books too.  

Each of these books features a "surprise ending" and characters that do not act as you might expect.  They both offer opportunities to practice inferencing as the ending is not clearly spelled out.  I want my Hat Back is great for working on some Theory of Mind tasks.  

Each book his written in short clearly sentences which makes it great for working on early sentence structures and an easy book to read within a single session.  I Want My Hat book has lots of examples of question forms followed by polite acknowledgements.  This is Not My Hat uses several "Even if" statements that could be used to work on more complex sentence structures.  

I don't want to give a lot away because I think both of these books are really fun to read and experience on their own.  

I enjoyed I Want My Hat back so much that I ended up making a book companion for it.  I actually made the whole packet almost twice because I had just finished all of my directions and bonus activities and my computer timed out.  *Sigh*  I know my husband wants to help-but you know what's not particularly helpful?  Asking if I saved it.  And then talking about how you save things all the time.  Says the person who should have SAVED her document several times during the four hours she was working on it.  

I ended up with a 50 page product which is minimal color especially for end of the year budgets.  (Does anyone have an end of the year budget?)  

Have you read either of these books?  How do you use them in therapy?  Let me know by commenting below!  I love to hear other people's ideas.  If you like this post-or if you are always looking for good therapy books like I am, please consider sharing this post with others via twitter or Pinterest.  

Saturday, May 3, 2014

What's in your cart: Linky party

Jenna from Speech Room News is hosting a "What's in Your Cart" linky party for the upcoming TPT sale.

 I'm always interested in seeing what other people are buying.  I usually find some pretty awesome products!

Here's my shopping strategy for this time of the year.  I'm looking for some home programming stuff-summer homework packages or calendars are awesome!  I also stock up on a few products that require more set up.  I figure these are good to pull out and prep on a rainy summer day. 

I just bundled and renamed my Roll-a-sound products.  I found a set of 50 blank dice on Amazon for pretty cheap.  So I made up 16 mm dice template for sticker paper.    

Then I added the stickers to the dice and printed off the game boards.  

My plan is to prep these this summer so that I have a bunch of games to use in the Fall.   My "Shake It, Roll it & Say It Artic-zee bundle is 20% off the individual price and will be another 20% off for the TPT sale.  

Now for what's in my cart:  

Articulation for Reading and Conversation from Nicole Allison of Speech Peeps.   I've got a lot of students who are at the reading level with their sounds.  I thought this would be a great quick print end of the year activity for some of my students.  

Extra licenses for Mia McDaniel's Tackling Apraxia CVCV-Early Sounds Edition:  I'm lucky enough to have a volunteer that comes out.  She helped me prep this packet so I'm getting her a license so she can have her own copy.   I saw some of my coworkers eyeing it too-so I may have to pick them up a license also!  
I'm also picking up her articulation cans expansion packet-Another great rainy day activity.  My kids have loved the first version so I'm excited to add to the collection!

I've been looking for some new conversation resources for some of these kids.  Conversational Topics & Turn-Taking from Looks-Like-Language sounds intriguing.  Plus, I'm always excited to see new seller's products!

 That's what's in my cart now-I'm sure I will add to it before the sale is over.  How about you?  What are you picking up?  

Head over to The Speech Room News to see what some of my other SLP blogger friends are picking up.  If you don't have a blog, you can link up a list on Facebook. 

SLP Frenzy!

I'm really excited to be participating with some fabulous SLP bloggers and TPT sellers in another SLP frenzy.  What a great way to start Better Hearing and Speech Month!

The frenzy is held on Facebook and starts tomorrow at 8 am.  You can start on any of the pages listed up above and collect your freebies.  It's a great way to get some product samples before the big TPT sale which is May 6-7.  All of my products will be 20% off!

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