Sunday, October 23, 2016

Working as a Team: Supporting Rehabilitative Assistants

The Frenzied SLPs are back this month with posts about working as a team, and we are truly a team, working together to bring you materials, ideas, and inspiration. Teamwork takes many forms with many different people and I am very excited to hear the different perspectives that will be shared! Thank you to Sparklle SLP, Kelly of Speech2U, and Lisette of Speech Sprouts for once again keeping the Frenzied SLP team organized!  

It seems counter intuitive sometimes. Special education is founded on a multidisciplinary teamwork model and yet it how it unfolds in schools is often the complete opposite. The reasons are many: lack of team time, huge caseloads, minimal/no administrative support, paperwork burdens, pride, you name it. Despite this, the fact remains, effective programs have effective teams, who know how to work together and respect each member's unique talents and contributions.

A frequently overlooked member of highly effective special education teams is the paraprofessional also known as a rehabilitative assistant. These bastions of support and patience are integral for SLPs and OTs. Rehab. assistants spend all day with our most highly involved students supporting them in the classroom, supporting hygiene needs, helping with transitions, lunchtime, and offsetting behavioral difficulties. In order for the work rehab. assistants do, to be eligible for medicaid reimbursement in our state, they must be supervised by a "licensed practitioner of the healing arts." It must also be very clear that the work they do with our students NOT be academic in nature. In fact, when I post those sessions I sign that "I certify that activities being billed under rehabilitative assistance for the above student(s) (...) on the dates specified (...), for which I am knowledgeable of the service provision, and provide weekly consultation to the aide, are not classroom instruction or academic tutoring, but are therapeutic in nature and are necessary for the maximum reduction of each student’s physical/mental disabilities." 

For many years the rehab. assistants, case managers, and special education administrators in our district balked at this supervisory piece. SLPs were even told that there aren't any "medicaid police." Well, we know that is not the case and I for one, finally decided I had worked too hard to earn my degree, Cs and license to lose it to egos. I now insist on weekly consultation where the rehab. assistant and I discuss how they can support student goals in the classroom. In order to document consult times I created a log sheet that allows for entering the date of the consult, comments, and initials. Having written proof certainly eases my anxiety around signing off on rehab. assistant support in the classroom. You can get it here for free! 

This takes care of the consult documentation, but the larger issue is how to utilize rehab. assistants in the most effective way possible. During my initial conversations with rehab. assistants, it became abundantly clear that the majority of support being offered to our students was academic. This was a huge concern. As a result, I enlisted the support of one of our paraprofessionals extraordinaire in order to create a planner for rehab. assistants. I am really happy with the result! So now during our consult time rehab. assistants share concerns, ask questions, and describe how students are functioning in the classroom and are able to keep it all organized between meetings. In this way, I am able to provide suggestions, strategies, and supports for students. The Paraprofessional Paperwork Planner has forms for notes, communication, a to-do sheet, strategy form, a calendar, planning sheet, glossary of common SLP and OT terms, and more. The best part? It contains several editable pages! You can find this planner here in my TpT store, Doyle Speech Works 

It appears that the rehab. assistants I supervise are receptive to this more structured consult and are appreciative of the planner. I am hoping this allows us to truly support our students in the most effective way possible using common language and consistent supports.

How do you team? Link up with the Frenzied SLPs and share your successes or struggles. We are after all, a team!

Monday, October 10, 2016

Music and Speech-Language Therapy

When I was a much younger SLP, it seems there was more of an emphasis on developing auditory skills with our students. There was a wealth of materials on auditory discrimination skills and discriminating environmental sounds. We spent time teaching students HOW to listen and follow verbal directions explicitly, encouraging eye contact and subvocalization. My articulation therapy training in the early eighties included spending considerable time teaching students to listen for target sounds in my speech, in isolation, syllables, words, then in their own speech (Mysak's Developmental Feedback). We then would work on auditory comparing student productions with therapist productions. Who remembers the games Dig for Gold and Old Itch? Discovery Toys had a great game What's That Sound whereby students listened to sounds on a cassette tape and covered a lotto board in order to identify the sound. I still have all those games and have actually started using them again. It seems our little ones are really having a difficult time sitting still and attending and listening! Hmmmm, I wonder why? I could hypothesize on the myriad reasons (excessive television and electronic media time, little family discourse, etc.), but the bottom line is we are seeing students who struggle with verbal directions, auditory skills, social listening and more.

At the outset of our school year, our school district offered a series of in-services presented by fellow colleagues. I decided to attend a session on Music and Literacy offered by a dynamic and creative music teacher in our SAU, A.J. Coppola. A.J. uses a method of instruction referred to as the Kodály Method. Kodály was a Hungarian composer who was dismayed with the state of music education in Hungary. He felt there needed to be better teacher training, better music curricula, and an increase in the amount of time devoted to music instruction in schools, thus, the Kodály method was born. The framework of his method is solidly based in child development. Students are introduced to skills according to their developmental levels, first being introduced to more simple tasks and progressing to those that are more difficult as they master skills. It is a very linear and sequential method whereby skills are continually reviewed and reinforced through movement, games, and songs. It really sounds a lot like what we as speech-language pathologists do in therapy!

We know melody and rhythm is valuable in increasing fluency in patients with aphasia (Melodic Intonation Therapy) and can be very effective when working with students with ASD.  From a speech-language perceptive, music has many applications including helping students with Central Auditory Processing difficulties detect pitch and stress differences to developing social skills through song. A.J. introduced us to several books I thought would be wonderful to utilize in therapy (the Feierabend Series publishes a book each year using folk songs and the Musicmap Series uses multicultural songs in an illustrated format.)

Songs are a wonderful way to calm anxious students and establish connections. They provide the basis for rhythm, pattern, and pitch which are basics in speech-language therapy. Listening skills are foundational to communication and classroom functioning. Auditory skills, from sound discrimination to figure-ground discrimination to perception, reception, and synthesis, are skills necessary for learning. I, for one, am going to pull out my shaker eggs and maracas, Old Itch and Listening Games books and return to some SLP roots. So grab an echo mic, learn a folk song or two and SING.

Sunday, October 2, 2016

Capitalizing on Trends in Speech Therapy

As many parents do, when our children were younger we made it a point to know what they were watching on television. We sat through countless episodes of Bear in the Big Blue House, Teletubbies, Noddy and more. As they grew up, their tastes changed. We moved on to Pokemon and Avatar. Pokemon was so cheesy, I would have to hold back my laughter. Avatar,  is one of my personal favorites and I will admit to watching it alone even today! I am impressed by the clever writing and the relationships forged between the characters. To see males depicting tender emotions and hugging or crying in a cartoon is generally unheard of. We then moved on to the Disney channel and Good Luck Charlie, The Wizards of Waverly Place, and Lab Rats.  I will also admit to laughing during some of those episodes. As a result of the Pokemon craze of the early 2000s, our children have amassed a lovely collection of Pokemon figurines. Who knew that in 2016 we would see a resurgence of Pokemon? Well, I guess with all good marketing, it was bound to happen. Companies don't want to let go of a good thing.
In speech-language therapy, any SLP will tell you about the importance of capitalizing on a trend. Over the years I have made Strawberry Shortcake games, used pogs and slammers as reinforcers, and played with My Little Ponies. We will do whatever is necessary to motivate our little clients, so why not use what they know and love? Finding the right motivator for each student is a time consuming and sometimes expensive endeavor. Time is a hot commodity and creating activities around Minecraft and minions is not something I am able to do as often as I would like. Additionally, since our children are older, it is not as easy for me to know what's hip. Yes, I am getting older and sometimes feel like a caricature of someone screaming "Look out, old person coming!" 

Okay, back to speech-language therapy. In the past two years I have seen a marked increase in the number of students on my caseload with fluency disorders. In fact, that number has increased from zero to five. This isn't the classic definition of stuttering either. It's more consistent with ASD and is characterized by final part-word repetitions, phrase repetitions, and considerable fillers. Add to that the behavioral challenges associated with ASD and we have a perplexing student profile. Finding the right motivator is crucial with this population. Using both the cognitive techniques for ASD and fluency strategies has been my approach when doing stuttering therapy with these students. Enter Pokemon! When I mentioned to one student in particular that I had two large containers of Pokemon replete with Pokeballs and figurines I saw a notable shift in his demeanor. So I dusted off the bins and carted them into school. It has been an incredible success therapeutically, as a relationship builder, and as a motivator.

I was able to incorporate Pokemon into my student's therapy in this way:

  1. My student selected a Pokemon to research.
  2. I used this website for Pokemon statistics:
  3. Using a write-on die, I colored each side of the cube to correspond to a fluency strategy to practice.
  4. My student rolled the die, matched the color to the corresponding strategy written on the whiteboard and read the statistics using the strategy.
  5. Our daughter gave us permission to give away any Pokemon, so my students can purchase one by saving their "Doyle Dough" earned in therapy. Our son, on the other hand wants his container returned to the safety of our home as soon as possible.

It has been so much fun pulling these toys out of the attic. I have enjoyed seeing the happiness they have brought to a new generation. I have enjoyed how effective they have made therapy. I have enjoyed seeing how my own children are ready to pass them on or guard them dearly.  I would love to know what toys you have dusted off for speech-language therapy? I am always searching for fun, new ideas!