Making the Case for Educational Impact in Articulation Therapy

Over the past nearly 40 years I've heard a lot of conversation around articulation therapy and "educational impact."  To this day the discussion continues to center around whether students who exhibit what may be considered mild speech sound disorders (SSD) like a lisp, are eligible for services because their difficulties don't impact academics. For instance, these children are not writing "thun" instead of "sun." Historically then, articulation therapy in the school setting may not be provided. The notion of not providing services because there is no "impact" on academics narrowly restricts the definition of educational impact. Personally, I consider any speech sound disorder as just that, a speech sound disorder, and have come to consider educational impact as a euphemism for “keeping caseloads low” and ignoring basic communication even as it relates to CCSS.  This distresses me. I am passionate about what we do and I don't like when we allow bureaucracy or misinterpretation to interfere with our responsibility. I'm taking a grave risk of overwhelming you, dear reader, and I understand the concerns around massive caseloads and staggering special education numbers, I'm sharing, nonetheless.

1. When I graduated in 1983, I had to have certification to work in the schools in NJ. My certification was as a Speech Correctionist! Working on SSD was a huge part of our job, whether mild or severe.
2. From 1985-87, when working as an itinerant SLP for Essex County Educational Services Commission, servicing the nonpublic schools, we ONLY worked on articulation.
3. The criteria and interpretation for educational impact varies from state to state.
4. Educational impact is subjective and too narrowly defined.
5. Educational impact should include things like: calls attention to the student, socially isolates them, causes peers to comment or tease, interferes with establishing peer relationships, and causes embarrassment or frustration to the child. 
6. Untreated speech sound disorders have the potential to impact individuals across the life span in terms of social stigma and economics as it relates to employment. 
7. The following was included in a letter to Stan Dublinske, the ASHA Director of School Services in 1980, from the Department of Health, Education, and Welfare and explores the problem with the term educational impact: "The broad issue raised in your inquiry is whether the definition of "speech impaired" in the regulations implementing the Education of the Handicapped Act, Part B (as amended by P.L. 94-142) is interpreted to mean that children with communicative disorders who have no other handicapping condition are ineligible for services as "handicapped children" unless educational assessments indicate concomitant problems in academic achievement. An interpretation is needed because "educational performance" is not specifically defined in the Part B regulations. However, the standard for determining whether a child fits into any of the categories of handicaps listed in the Act and regulations is that the impairment "adversely affects a child's educational performance." Under Section 602(1) of the Act, a child with one of the listed impairments must need special education to be a "handicapped child". For children who need a "related service" but no other. special education services, the Part B regulations in section 121a.14(a)(2) allow a State to consider that service as "special. education", bringing those children within the scope of the Act. . I agree that an interpretation which denies needed services to speech impaired children who have no problem in academic performance is unreasonably restrictive in effect and inconsistent with the intent of the Act and regulations." 
8. In an article written in 2002 for ASHA's Perspectives for School Based Issues, Stan Dublinske wrote, "It was ASHA's position that local education agencies requiring such educational assessments and denying services to children with obvious speech or language impairments because they did not have a concomitant problem in academic achievement were using a very narrow definition of "educational performance." In various discussions with staff in the now Office of Special Education Programs (OSEP), ASHA explained that "educational performance" included performance in communication. At that time there was a big push to ensure that all school children acquire "basic skills." ASHA made the point that mastery of "effective oral communication" was a basic skill. As a result, a speech or language impairment necessarily adversely affects educational performance. Therefore, children needing speech-language pathology services should not be denied services just because they do not show discrepancies in age/grade performance in academic subject-matter areas."
9. Students can receive articulation therapy if a school does due diligence via a multi-tiered system of support.

Enter Response to Intervention, (now merged with Positive Behavior Intervention and Supports; PBIS) and called a Multi-Tiered System of Support (MTSS).  MTSS is a three-tiered framework offering support for ALL learners, advanced and struggling alike. Tier 1 supports the entire child and is appropriate for all students and aligns with core standards. Tier 2 offers support for students who need supplemental services beyond what can be provided within the context of core instruction. It is specifically focused on an area of need and is more short-term. Tier 3 addresses unique needs and individualized support and typically is done via special education.

I provide therapy for mild SSD through tier 2. Students are offered articulation therapy with an emphasis on home and school collaboration for approximately 12 weeks. Speech sessions are only 15 minutes long two times per week and involve quick, motivating drills with 100 repetitions (phew). Parents are asked to come in for a brief meeting so I can explain their role and how they can help their child while supporting what I do at school. I do give students homework and ask that it is practiced four times per week for only 5-10 minutes.  If students are making progress and practicing with an adult partner at home, but haven't begun carryover, I will continue to a point I feel generalization can occur organically. 

This is my bottom line; any judgment of educational impact must factor in the whole child including social-emotional and the core standards of speaking and listening. In addition, the implications on future employment and social stigma cannot be ignored. As highly trained professionals it is on us to provide articulation therapy while fostering collaboration with parents to support our therapy. Speech therapy for mild SSD can be so rewarding as the outcomes are often favorable. I once received a note from a middle school student depicting me soaring through the air with my cape flowing behind me as I said, "Ssssssssss!" It was a thank you note. I knew what correcting that lisp meant to that child and I was pleased to do it.

Enough IS Enough

Next week I start my 36th year as an SLP. THIRTY-SIXTH YEAR! Somehow I thought it was 37, but I guess it just feels that way. :) I am fairly happy with where my journey has taken me. I've grown both professionally and personally, but haven't quite reached that point of complete satisfaction. I still compare myself to young SLPs with their cute Teachers Pay Teachers stores. I still compare myself to the seasoned ASHA SLPs with their positions and professional clout. I compare, I compare, I compare. ENOUGH!

I am reading Brené Brown's Daring Greatly and she purports that much of society's problems are rooted in the "fear of being ordinary." Our social media feeds are clogged with posts of people living seemingly extraordinary lives. I know when I see posts I think, "What am I doing wrong? Why doesn't my life look so spectacular?" Brown digs deeper and describes a "culture of scarcity." In our culture of scarcity we never have enough and sadly when comparing ourselves to the perfectionism social media and media in general underscores, we never will.


As I read, I thought about how I could combat this as I approach a new school year. It occurred to me a series of daily affirmations about what I have that is enough might be a great place to start. Now, this doesn't mean I stop here, I can always do more, but where I am today is good enough for today. Tomorrow will bring something else, another change, a growth moment. So without further ado...
As an SLP:

• I am good enough
• I am successful enough
• I am competent enough
• I am talented enough
• I am creative enough
• I am compassionate enough
• I am smart enough
• I am professional enough
• I am thorough enough
• I am empathetic enough
• I am clever enough
• I am valued enough
• I am well read enough
• I write well enough
• I am organized enough
• I have enough
• I do enough
• I am enough

As a human:

• I am thin enough
• I am funny enough
• I am pretty enough
• My house is good enough
• My husband is good enough
• My children are good enough
• My car is good enough
• My bank account is full enough
• My clothes are good enough
• I am fit enough
• I run fast enough
• I have enough
• I am extraordinary enough
• I am enough

I am enough for me and the handful of people who know, accept, and love me for me. You are enough. So let's stop comparing and start this year doing what we do best. Let's live and be content. WE ARE ENOUGH.

A Little Help with /r/

I have most definitely dropped the ball on my poor blog. I feel a little guilty, but I've been told guilt is only productive for about ten minutes. I should be over it by the time I'm finished writing. :)

I was working with a student today whose profile is fairly complex. We were working on /r/ using the "ka-la" technique. While we had the "ka" piece down the "la" was proving more of a challenge. I think this is because we previously worked on /l/ and curling the tongue way back is counter intuitive, given all our work on tongue placement for /l/. We have tried play-dough, used a mirror, flashlights, flossers, and the jumbo mighty mouth by Super Duper Publications. It was tough.  This student needed some feedback that just wasn't happening.  I pulled out the mini mouth finger puppet also from Super Duper Publications. I asked the student to simultaneously move the mini puppet tongue while producing the "ka-la."  Wonder of wonders it worked. My student could see and feel what the tongue should be doing for this method!

Now, how to maintain the connection for home practice? I whipped out some red felt, a red pipe cleaner, and my trusty glue gun. Voilà! After trimming off the annoying glue threads and trimming around the felt a bit, we made sure it worked well with a few trials (it did!).  My student was super excited and now has a puppet to practice with at home.  Phew! Whatever it takes, right?

A Message for Full-Time SLP-Moms

While it may seem like I've abandoned this blog, I haven't! I have a multitude of paper scraps with notes, thoughts and ideas stowed and tucked in a multitude of places. I just took a break. The past twenty years have been spent as a working Mom.  I'm still trying to settle into my empty nest life and I haven't yet found my rhythm nor my place, so today I wanted to share a memory I had as I scrubbed floors.

Many years ago we had friends over for dinner, friends I truly love. It had been a long week and I spent my Saturday cleaning and cooking a turkey dinner. A veritable Thanksgiving feast. As we were tucking into pumpkin pie and coffee, the conversation shifted to parenting. It was then my friend looked at me and said, "Well, you're not a full-time mom."  Six words uttered that have been etched in my memory and heart. My response was simple and to the point, "Make no mistake, I am a full-time Mom."

Often when I worked late on an evaluation, those words echoed. When I had to rush my children out of the house for an early morning meeting, those words echoed. When my husband would bring a pizza to school and we would eat in my speech room, those words echoed.  I have long since forgiven the cavalier attitude that I presume accompanied those words, yet even today those words echoed, forgiven, not forgotten.

Yes, I was and am a full-time SLP, working for both the salary and the benefits that provide dental and health care coverage to my family and now college educations (as well as the love of the job).  I also fondly remember helping with bake sales, waiting for my little ballerina to finish dance class, being the den leader for cub scouts, teaching religious education, kindling a spirit of volunteerism at walks for cancer and life, driving to track meets, cross country meets, lacrosse games, editing college applications, baking bread and washing floors and dirty clothes. I was a full-time Mom, after all, and that was what I did.

I know mom-guilt is real but, I share this to remind all working moms who feel even the slightest tinge of guilt to release it.  I've heard it said that guilt is productive for all of ten minutes, after that it becomes destructive. We work, in large part, to provide for our families, nevertheless we are also models of success, perseverance, love and dedication. Working moms shine in ways that can't be quantified. Be gentle with your professional self and be gentle with your personal self. It was good for me to remember not to take either of my selves too seriously, nor to separate them!

Years have passed since that eventful dinner party. Our kids are both seeking adventures on their own and I have quite a bit more time on my hands. Despite this one thing remains, I am to this day a full-time Mom and I am pleased to say, "In my heart, I always will be."

Today is the day before Thanksgiving and before I begin my cleaning and cooking frenzy (and shopping for a new food processor as mine broke two days ago!), I want to share an email I received from a colleague and dear friend. She retired in 2016 after having enjoyed a storied and fulfilling career, and has kept active with a variety of volunteer activities that draw on her extensive special education background.

Her endeavors provided her with a new base of comparison: new contexts, new teams, and new protocols often highlight how truly fortunate we were in previous employment settings, despite not always realizing that what we had was awesome. She wrote:

"Over the past months in my work with S---, I have come to realize even more what a phenomenal team you are. I have encountered some children whose educational programs are good, certainly, but some that are lackluster and even neglectful and borderline non-compliant with N---.

These are some of the things you all do that I really appreciate:
You contact outside evaluators and medical professionals to make sure you are addressing the needs of the child appropriately, that you're not missing anything, that you gather as much information about the etiology and strategies of each individual child - this takes open-mindedness and awareness that there is always more to learn. It also acknowledges that you are there to help the child learn and grow.

You try your hardest to write IEPs that are meaningful, and then you follow through. Testing, FBAs, consultations, documentation- you do it in a timely manner, and you do it well.

You engage parents in the process, and are respectful about it. You keep in contact with them, you listen to them, and you help them learn about and understand their children. Even if you don't agree with them, you try hard to make sure they know you are all in this together on behalf of the children.

You treat the children with respect. We have all had students that might be harder to appreciate- but you never let the child know.

You are creative and resourceful, with the goal of making learning fun, accessible, and challenging.

I know that some school districts have significant financial limitations. But S--- doesn't have gobs of money either. That never stops any of you.

Thank you."

In the spirit of gratefulness, I would encourage us all to find a moment to tell a colleague what they mean to you, both professionally and perhaps personally. In an age when we are quick to ruminate on what frustrates, annoys, and divides us, words of support and affirmation are more needed than ever before. 

I appreciate and value YOU, for whatever it is you do and for taking the time to read this blog.

Happy Thanksgiving!

Progress Monitoring Resources for Speech-Language Therapy

About a two months ago (hard to believe) I was considering some new goals for a middle school student. I was feeling at a loss in terms of what I could use to monitor present levels. I have some tools that are quite effective, (my freebies are here and here) but I wanted to progress monitor his word finding skills and what I created just didn't cut the muster. I also have some progress monitoring tools I purchased and truth be told, I'm not thrilled with them.  So what to use?

I remembered some books that I used to use ALL. THE. TIME. When new materials become available my tried and true resources get relegated to the back of the cabinet. How sad! As I considered what I had available, I pulled out these materials that are perfect for progress monitoring all manner of targets. Here are a few I will be using now: HELP: Handbook of Exercises for Language Processing, Language Remediation and Expansion: 100 Skill Building Reference Lists, and BESST: Book of Exercises for Successful Semantics Teaching.Why purchase something new, when I already have great resources? These books contain wonderful lists for many, many language goal areas.

There are other sources like these that I think would be extremely useful when progress monitoring including this from Academic Communication Associates, Word Retrieval Activities for Children and these beauties from Thinking Publications.  I haven't used these in years and actually had to retrieve the Warm-up and Working Out books from my attic (did you notice I inventory all my materials?). I believe I bought the Warm-up books when I was I member of the mail order Speech Pathology Book Club! Who remembers that one?

It occurred to me as I was searching for what I thought I needed, that I need search no further than my therapy cupboards. I don't need anything newfangled, I don't need to buy anything else. I need to actually use what I have, because you know what? It's good stuff!

How about you? What do you already have that you can breathe new life into? 

Helping Students Who Are Orally Defensive in Speech Therapy

I was working with a group of students last week and I wanted to help them grasp proper tongue placement for /s/. I pulled out the mirrors, tongue depressors, and toothettes when all of a sudden one second grader flipped out. With his hand covering his mouth he pushed himself away from the table and expressed with terror in his voice, "I don't like things in my mouth!" Okay," I responded, "no worries we don't have to use these." He remained fearful even with reassurance that I wouldn't come anywhere near him with the toothette. His peers on the other hand, were eager to use the cherry flavored tongue depressors. That session was lost for him and yet I still needed to help him understand tongue placement. I have a Super Duper Jumbo mighty Mouth Hand Puppet, but I wanted him to have a more personalized experience.

In the car on my way home (where all my ideas/thoughts happen) I decided that in order to have him develop comfort with his own mouth, he had to make one and not just a paper mouth, but a mouth where he could move the tongue. I've seen mouth craftivities with mini marshmallow teeth, but I wanted this one to be used more than once. I also didn't want to spend too much money as lately I've been a little too spendy. I ordered 1/4 inch white pom poms to be used as teeth and found pink baby socks at Walmart. I bought the 0-6 month size. I made a mouth template from card stock that the students traced on pink paper with a small rectangle where the sock tongue would be glued. Unfortunately, the pom poms didn't arrive in time, so we used crumpled tissue paper for teeth. I wish I had thought of that before I bought the pom poms!  I struggled stapling the tongue in when it occurred to me to use hot glue. I also trimmed about two inches of the sock cuff off, so there wasn't excess sock.

My little ones placed their fingers in the sock and moved it all around their mouths. They used tongue depressors and toothettes to touch all around the teeth and tongue. My colleague from our PK had a great idea to add some texture to the alveolar ridge I had drawn on. I think I'll outline it with white glue and sprinkle sand, glitter or salt on top. I'd like them to understand that the alveolar ridge is bumpy.

Years ago, I worked with twins one of whom was very orally defensive. His parents were at their wits end, because he was having considerable dental problems, yet they couldn't get him to the dentist. We are fortunate to have a dental program in our school whereby a dental hygienist comes and cleans students' teeth.  They asked for help so I ordered some dental tools. Never fear, they were never placed in the student's mouth, they were simply to desensitize him to the tools. He used them on the Jumbo Mighty Mouth and used the mirror tool to look in my mouth. It worked like a charm.

I'm fairly certain it's going to take repeated exposure "playing" with these mouths before this particular student becomes more at ease. It may never happen, in fact, but at least he will have  a greater awareness of his tongue in his mouth and will be less anxious when I pull out tongue depressors for use with his peers.

One last picture. I was able to find some white pom poms in my big ole bucket of pom poms, so one student glued them on his mouth as teeth. I actually think I like the look of the crumpled tissue paper better, plus there was no drying time because we used glue sticks.

Any other suggestions? How do you help your students with oral defensiveness? I am open to any and all suggestions!

Star Wars, Stuttering, and Stereotypes

June 18, 1977 was the day before my sixteenth birthday. Three weeks earlier, on May 25th, the movie phenomena, Star Wars was released and we decided to go see it for my birthday. We developed a strategy in order to save time on serpentine lines that coiled around buildings, half of us holding a place on the ticket holders line while half waited to purchase tickets on the ticket buyers line. Once the tickets were purchased we would reconvene on the ticket holders line. Our intent was to watch the 9:00 p.m. show. That show sold out before we got our tickets and we remained on line finally getting tickets for the midnight show. When I left that theater, I was sixteen and a Star Wars fan for life.

I love Star Wars, although, I love some episodes more than others. The Empire Strikes Back was my least favorite. I also find their adherence to a plot format tiresome. This post, however, is not a movie review, per se, so I'll spare you the particulars of my opinion on the Star Wars dynasty, because love an episode or hate an episode, I'll go see every single one and I'll watch them again and again. This post is more of an observation from The Last Jedi and the introduction of one of the most villainous Star Wars characters, I think has been developed.

Enter Benicio Del Toro's code breaker, DJ. DJ, it appears, is an enigma. One initially wonders whether he is a rakish, yet ultimately heroic character, like Han Solo or Lando Calrissian. At the conclusion of the movie, it would appear not. He is amoral, sidling up to, not necessarily the highest bidder, but the party that will ultimately allow him success in his machinations. DJ is really someone who we might know or meet. He could be our neighbor, a coworker, or a guy on the bus. He is self-serving and arrogant AND he stutters.

In The Star Wars saga, one is immersed in a world that exists long, long ago in a galaxy far, far away and a plot and characters who become friends and foes. While it is pure fiction, the writing and character portrayals draw on our biases and cultural mores and those are woven throughout the story and create a powerful subtext. Our personal experiences and background knowledge are fused with a story. Hence my struggle with Benicio Del Toro's DJ. A deplorable, disreputable, opportunistic mercenary who is portrayed with a stutter.

I broached this matter with my SLP friends and one shared a more optimistic view, Del Toro's portrayal offered the notion that stuttering is "universal," literally. I would agree if the characters Finn or Poe stuttered, but no, it was the villain. I would assert, that yes, stuttering is universal and so is the shame that has been assigned to it. Art imitates life and DJ's speech sent a clear and powerful message, that stuttering is a dark flaw attributed to villainous characters. I would have hoped that in 2017, with all we know about stuttering, that greater sensitivity would be offered when developing the persona of a character. Movie makers and actors alike do bear a level of responsibility when creating works that reach billions in perpetuity. Now when I see DJ on the screen, I will forever be struck by his loathsome behavior and the disregard with which the actor chose to portray his speech.

Yes, art does imitate life, yet I truly believe there needs to be greater awareness and sensitivity in how actors portray their characters. Del Toro's DJ would still be abhorrent without stuttering and an entire segment of our society wouldn't be, once again, having to explain "stuttering is what we do, not who we are."

When Students Feel Sad

Recently I experienced a deep sadness with someone I care about. It wasn't my sadness, but hers.  To see tears and self-doubt, a turning inside out was so incredibly difficult. I felt a strong feeling of helplessness when wanting to remove all the hurt from her heart. Of course, that is neither realistic nor helpful. Encountering and coping with sadness is crucial and I contend that the desire to not feel is why so many Americans are on antidepressants, but that's a different issue entirely. Sadness, hurt, grief are difficult emotions, yet passing through them gives us fortitude. Passing through them allows us to see our power within and the beauty in the world. While I wanted to tear the sadness from my loved one, I knew she had to navigate it herself, had to experience it, to find her moxie. The sadness is temporary, the lessons learned, lifelong.

As SLPs we often have students who are dealing with sadness, whether it is the loss of a parent,
being shunned by "friends," or family/economic concerns. We may find ourselves in positions to help assuage that sadness. As I shared my loved one's sadness I thought about my responsibility to my students' sadness over the years and I've learned a thing or two.

Be sensitive to my own emotional responses. 

When hearing of a student's trauma, my first response is, well,  to respond emotionally. I feel anger, sadness, disbelief, anxiety. I have to remember to keep my own emotions in check. If not, I could foment my student's response and that is not helpful. I need to be present, to be a compassionate listener. 

Practice the "art of the pause."

When confronted with a child's distress (or any difficult matter) I have adopted what I call the "art of the pause." I need to remind myself to stop and assess the stage and take in the circumstances. Pausing allows the rational mind to get footing and prevents responses that may be regretted later.

Be mindful of trust.

The fact that a friend, colleague, parent, or child has confided in me can be a source of comfort and a source of anxiety. Having information that has been shared in confidence can be burdensome. It is a blessing that the child trusts you with their secret, but it also presents challenges if I am called to seek help for the child. I am always forthright with students and tell them I may not be able to keep their confidence. Often these children find it difficult to trust adults, the last thing I want to do is give them more reason to doubt. Expressing at the outset, that the information may need to be passed on, gives a child the power to share or not share. It establishes an honest relationship.

I don't need to solve the problem. 

Another of my knee jerk reactions, is to try and solve the problem. This is frequently not possible and leads to my own place of paralysis and frustration.  I need to be cognizant of my role. My student doesn't necessarily need me to solve the problem. It serves us both better if I can be a sympathetic and compassionate source of support.

Make a realistic assessment of my role. 

Do I need to take action to help my student? There may be instances where steps are needed to help a child. Be realistic and cautious when discerning how to proceed. I always assess whether this is a place I should be involved and if not, who can I enlist to help the student?

Recognize the need for help.

Some situations require a larger team. If I think more professional help is needed, whether it's administration, a psychologist, or law enforcement, seek it. Being cautious not to betray a child's trust, get counsel from others if necessary. In the end, the child may feel more supported knowing there is a constellation of others who can help.

Be wary of judging. 

Being present for a child during times of sadness takes an emotional toll, as we know. Said toll leaves us wide open for passing judgment on those who caused the sadness. When my loved one was hurt, I most definitely passed judgment. I was angry and wanted to go to bat for her. That would have been a mistake. I always need to understand, I can only guess what the motivation of the other person might have been. It serves all involved well, if I try to remain nonjudgmental.

Self-Care

I have learned a lot about myself and my empathy can lead to considerable anxiety. I need to do whatever it takes to keep myself grounded when helping others cope. For me, I stay active. I have been known to clean for hours. I mean really clean, deep clean. It seems a metaphor for what I am feeling. Exercise is key and includes real sweat inducing exercise to yoga. Journaling is extraordinarily helpful in putting things in perspective. It is both cathartic and healing. Art, in whatever form is a wonderful distraction. Lastly, and for me the most helpful, prayer. Prayer for myself, that I will be a source of comfort, prayer for the child that she may find healing, and prayer for the source of the child's angst. My greatest prayer is that we all trust in God's providence.

It is so hard to see others in pain, but we can be a source of comfort and healing for all involved. It has always helped me and the one I seek to comfort if I remain observant to my own understanding of what healthy compassion looks like and how to exercise it.

I am Not Superpowered!

I can't explain it. I have had a very, very busy year with no less than six evaluations pending at a time and I have been coping quite well. Two weeks ago...BAM! Leading up to my proverbial "hitting of the wall," we had been coordinating a two-day NHSLHA Spring Conference and rehearsals for our middle school play began. I am assistant directing this year. Adding a little lemon juice to the paper cut I had progress reports and IEPs to address. This was all magnified by a system of meeting scheduling that is inefficient and panic inducing. Case managers submit requests for meetings to the secretary, who then begins sending a barrage of emails to the required meeting attendees asking if the date is good. This means I may get a permission to test and a meeting request within days of each other. Naturally, I don't have the testing done or the written evaluation and already a meeting is being scheduled. I can get four of those at a pop! I can't think about a meeting when I haven't even had the privilege of evaluating a student. I quite literally had a panic attack, twice. My breathing became shallow, I was dizzy, and the tears just came.

I saw a friend who suggested I go to our principal for help. She was very supportive and suggested I take two days and get as much testing done as I could. She also offered administrative days whereby I could do my progress reports from home and type my evaluations. I declined the administrative days as I have no problem going to work. I happily accepted the time to test. I spent Wednesday testing and felt relieved. Thursday morning, lying in bed, another unproductive emotion reared its ugly head; guilt. Guilt over not seeing students for therapy, guilt over being given the time I needed to do the work I have been given. Guilt, guilt, guilt. I immediately began sabotaging myself ("I'll see my regularly scheduled students. I'll test in between groups.") UGH! I ignored my guilt, however, and I did test.

I was chatting with some SLPs extraordinaire and the subject of retirement came up. We were sharing how many years we have left to work. I like to think I can do everything I could do when I was twenty-two. I question why I can't run as fast and long, why I can't run up those steps or why I can't kick my heels up (I'm sure the extra twenty-five pounds I'm hauling doesn't help). I am putting forth the same effort and work ethic as I did when I was younger. I haven't given up any responsibilities, but I am tired. My fatigue joins forces with my anxiety, which, for me, has been a lifelong reality. A perfect storm for panic and a feeling of drowning. Understand this: I love what I do. I love my friends. I love the schedule. There is so much that is wonderful about it, but the workload can get the best of me.

My friends had some wonderful suggestions ranging from prayer, to exercise, to Vitamin D. I understand how to relieve stress, but how do I keep it at bay? I'm a thinker. That can have benefits and downfalls. I started to wonder why as SLPs we are so susceptible to stress? I wondered if I bring any of it on myself? That's when it occurred to me; I have a water cup that reads, "I'm an SLP. What's your superpower?" I loved the sentiment, it gave what I do some sort of value, but it also sets the bar really, really high. The notion that I am superpowered also caused me to compare myself to the other "supers." I had to maintain a level of performance that resulted in near burnout. The bottom line is, I don't have superpowers. I am but a mere mortal, who as one SLP pointed out, has roughly five full-time jobs.

My thinking has led me to this:

• While I would like to don a cape and mask and save all my students, their families, my colleagues, and administrators, I am not superpowered. There I said it.
• Every speech therapy session does not have to have a book companion, game, mixed group activity, or the latest and greatest material. Sometimes a little positive reinforcement after a target is produced is all my students need and want.
• I read fewer blogs. I am pretty good at my job. I've been doing it for 34 years and I have to trust that what I have been doing has merit. I don't need to compare myself to everyone else.
• Perfection cannot be my hallmark of success. I realized my standards are VERY high! Incidentally, my standards are how I measure everything and everyone; not fair!
• I love interpreting testing data. I love digging through test results and parsing out an accurate diagnosis. I love to research different aspects of communication disorders. I don't have to write a fifteen page evaluation, each and every time! Again, my standards are exhausting me.

• When I am given help, I need to accept it. It does me no good to cry, seek and receive help, and not accept it. I need to do so without guilt. I've heard it said, guilt is productive for all of ten minutes, then it becomes destructive.
• This one may be the hardest for me...EXERCISE. Getting my heart rate up for twenty minutes four times per week is as effective as medication for me. One week I set a goal to run fourteen miles. I did it and I felt awesome, and then, I stopped! 
• I need to remember not to tick off my to-do list over and over in my head or aloud. Each time I recite what I have to do it triggers my anxiety all over. In fact, I don't even know how many students are on my caseload. I decided not to count. It doesn't help me.

Since last week, I feel better. I am setting realistic goals and as I tackle the work my anxiety gets checked. I am doing simple and effective therapy. I am still writing fifteen page evaluations, but one thing at a time. At least I have a handle on my emotions and repeating, "this too shall pass. I always get it done," has been helpful. I would love to hear how you handle your job. If you have no anxiety associated with work, PLEASE share! I can use all the advice I can get!!

Teamwork: The Blessings and Challenges

As professionals, members of families and communities we frequently engage in activities that require group dynamics. Whether you are coming together to raise funds for a new playground or church or to put on a production or event, you are working with individuals with their own experiences and backgrounds. Those experiences invariably shape their thinking, feelings and actions and can have an impact on the group as a whole. Their experiences may spur the group onward reaching for more and encouraging members to strive for results. Their experiences may be grounded in doubt and therefore detract the group from taking risks. Their experiences may be more pragmatic and result in taking very measured steps to the end. Whatever their background, their experiences will add a distinct flavor to the group dynamic, for better or worse.

Because we really have no way of knowing what the experiences, thoughts, and feelings of our group's members are, I have been thinking about how crucial it is for us be be mindful of our intellectual and emotional health when tasked with group activities. I arrived here because, I know the blessings and challenges that come from group work. Moreover, I am struck by how often, I know I don't always consider these same challenges and blessings when I am working to help my students learn to work in a group.

The question then becomes, "how do we remain positive, motivated and encouraged" and "how do we impart these strategies to the students we work with?" First of all, there will be times in most of our lives when we are part of a group that has a common goal. This group may be professionally based, community based, church based or even family based. What has recently occurred to me, is that because you share a common goal, you may believe you have a common vision. That may not be the case. Goals and visions aren't necessarily one and the same. Merriam-Webster defines a goal as "the end toward which effort is directed" and vision as "a thought, concept, or object formed by the imagination." Personally, I think this is where I run aground; goal versus vision! This distinction is huge and has the potential to prevent much discord. When working in a group or when helping our older students learn HOW to work in a group, it may be important to clarify the difference between a goal and a vision and encourage the group to refine their collective notion of each. When, as a group, your goals and visions are aligned, it becomes easier to recognize where problems are seated.

Second point; remember when working in a group, you are in fact part of a group. That means that the group is the driving change and decision making body. So while you may have grand ideas and visions, if they aren't shared, they most likely won't be accepted. That can be very discouraging. It is in those moments that often we are faced with making a decision about whether we have a good fit with the group. I am not suggesting giving up. I am suggesting either yielding to the majority or perhaps finding/forming a group that is more in line with your goals and visions. In some groups, the discomfort associated with change is more than the discomfort associated with stagnation. Those groups might not change and if that is what the group wants, then that should be what the group gets. Find your group!

Third point: you may feel like an island, believing you are the only one with a vision of growth and success. That may not be so. As a wise friend said to me once, "As long as there is at least one other person in the trenches with you; that's the mover and shaker you need. Two can turn into four, and four can turn into eight, and so on." The takeaway here is, find an ally. I don't mean someone to collude with. I mean someone who complements your vision and can help you express it effectively.

Working in groups is one of the most wonderfully difficult, challenging blessings we can engage in. It is a life skill that if not learned, can result in family, school or employment struggles. Group dynamics bring about dichotomous relationships; the discouragement of roadblocks with the elation of success; the sadness of isolation with the joy of unity; frustration of negativity with the thrill of positivity. In life, there is value in experiencing and learning to cope with all.

Supporting One Another: The Power of Encouragement

This post has been on my mind since July. I have hemmed and hawed about writing it, and then thought, "It's time." I've been contemplating what support looks like in our profession. As speech-language pathologists we are 100% behind our students. We go the extra mile, we devote our time, energy and talents to helping our students/clients achieve. We spend our own hard earned cash. We create, remediate and advocate! All this for our students and clients. We would never consider suggesting our students can't or shouldn't try something new or hard. We would never suggest they not try something innovative or daring. Would we? I think not.

This summer while at ASHA Connect I was enjoying some social time with friends, old and new. We were a mixed group, ranging in age from 30s to 50s. Some of us worked in the schools, some in SNFs, some in private practice and some who even are COOs of health care organizations. Our common thread, speech-language pathology.  The conversation moved to our college days, as some of our group were reunited with college professors while at ASHA Connect. One would think the reunions were happy, not so.  I was shocked to hear from these accomplished and successful individuals that while they were in undergraduate or graduate school they were DISCOURAGED from continuing in the field, despite high marks. One was told she wasn't a "good representation of the profession." Another was told her voice was "too harsh." I recall a professor in graduate school posing to our class, "How many of you might pursue a PH.D? None I presume, you are not good graduate students." I felt flattened.  I was a great student with a 3.87 G.P.A., a graduate assistant in the department, and I was looking forward to a long and successful career. Clearly, however, I was NOT Ph.D. material. I have carried that with me my whole career.

Fast forward to today's internet driven world. We have SLP blogs and TeachersPayTeachers. We have Twitter, Snapchat, Facebook and Instagram. We have SLP glitterati and followers. Just the term followers makes me cringe! And yet, we all have the same goals, to help those who need it. For some reason a strata has emerged that breaks my heart. Sellers versus buyers. Posters versus likers. Names versus followers. Groups versus individuals. Who's in versus who's not.

Our field is fueled by advocacy and support and yet, it seems we have forgotten how to support each other. It isn't always outright, sometimes it's more subtle, like ignoring the efforts of groups/individuals viewed as rivals. Rivals for what? Followers? Likes? Sales? While at ASHA this summer I was flat out, face to face ignored by a "friend" who only chooses to speak to me when others aren't around! Of course, I know my value. I was initially hurt by the dismissal, then quickly realized it had nothing to do with me. On the contrary.

I may not be a big TpT seller (by choice, I have decided to focus on my practice and create when I have a need) but I have a lifetime of experience. I did therapy before lesson plans could be downloaded for $5.00. I was creating goals for diverse populations before goal banks. I was writing evaluations by hand before spellcheck. I was using ditto masters and thermofax machines before some SLPs were born. My hope for this community is that at some point we all realize the contributions we can offer to each other. Not just those in our niche.

My hope is that collectively SLPs learn to view each other as assets, not rivals. That we move forward as a group with each person sharing their vision, so that collectively we support those who need our support. Support doesn't necessarily mean advice, either. It may just mean encouragement. It means a professor encouraging the graduate student who needs to take a risk or make a change. It means offering encouragement to the person who thinks they can't to, "Yes, start a blog." It means encouraging a creative SLP to author products. It means encouraging the seller who just posted a picture of her new creation by commenting. It means encouraging the author who is successful and not begrudging them their success. It means so many things that are kind and loving and inclusive.

Imagine then a field where we all use growth mindset thinking and encourage each other to work hard and strive to be the best version of ourselves we can be.  How would that then trickle down into our own lives, our interactions with our families, colleagues and students? It may just be a dream, but it's a good one and it IS POSSIBLE. "Therefore encourage one another and build one another up, just as you are doing." 1 Thessalonians 5:11

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!

An InLinkz Link-up

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.

From Those to Whom Much has Been Given

My Teachers Pay Teachers Store is sort of a snoozer, in large part because it is my red-headed stepchild. Doyle Speech Works, the store has 52 products, some of them lovely little gems, but they are not big sellers. I am not a big materials creator nor am I a stellar marketer. I create things I think my students will enjoy and if the mood hits me, dot my copyright I's and cross my copyright T's and upload them. I don't earn a substantial income from my halfhearted endeavors. I marvel at those who have made Teachers Pay Teachers a successful business, however I choose to spend my time doing other things. This spring I reevaluated my commitment to TpT and decided to un-clutter my life and eliminate thoughts, things and activities that add an element of stress, so I stopped creating altogether.

Fast forward to the weekend of September 10, 2016, when Mother Teresa was canonized. Here is a woman, who amid swirling controversy and negative publicity, devoted herself to helping others. Here is a woman who despite experiencing what is called the "dark night of the soul," (a feeling of spiritual emptiness) still sought God. I am humbled by her selflessness and the selflessness of countless others who give of their time, treasure, and talent.

I used to be one of those people. When my children were younger, I spent a considerable amount of time and energy in volunteerism. I taught faith formation, helped raise money for and build a playground, began a women's retreat (now going on its 16th year), raised money for Bibles for middle school students, and did walks and runs for everything pushing my little ones in a double stroller as I did them.  As my children got older they volunteered on their own and I did less. My volunteerism of late has been paltry. I donate money to causes, but I DO very little.

As I reflected on the life of this diminutive nun with a Texas-sized heart, this verse from Luke echoed in my mind: "From everyone to whom much has been given, much will be required" (12:48). That means me. I have so much to be grateful for, so much. I need to dig back into my heart and find that altruistic nature I once nurtured.

To begin, I have decided to donate any monies earned in my Teachers Pay Teachers store through December 31, 2016. If I don't earn much I will supplement the amount, so as to provide a donation that is helpful. My goal is to help 3 different charities, one per month. I have selected the Captain Douglas DiCenzo Camp Fund, the Jim Kelly Memorial Fund for the PRHS Music and Theater Department, and CADY. The Camp Fund provides children, who would otherwise be unable to attend, an opportunity to go to summer camp. Jim Kelly is a recent graduate of our high school and a dear friend to my children and many others. Sadly, Jim is no longer with us, but his music and theater legacy will live on with this memorial fund and I will do what ever I can to sustain it. CADY is a nonprofit organization dedicated to promoting alcohol and drug-free youth in our community and beyond.

I have to spend more time discerning where to give my time and talent. I have some thoughts and will fill you in when I have made a decision. I would like to enlist my husband to work with me as we move forward in our lives. It will be nice to work together.

You never know this might motivate me to create more materials! Meanwhile, take a gander at my store. If there is something that piques your interest, buy it! I hope it makes you happy to know all proceeds will go to to those who need it. Praise God, I don't!

Thoughts from the Back Porch: Summer Post 1

School officially ended for me on June 16th and let me tell you, I was ready! I love what I do, really, I do, but this year was quite challenging. I completed a TON of evaluations, IEPs and assorted other paperwork. It seems I was scheduled for a meeting before school nearly every day! Consider the math; an extra 30 minutes every morning times 180 days amounts to 90 additional hours per school year!  If I was to be more conservative and cut that down to three mornings a week (atypical), that is 90 minutes per week times 36 weeks (180 days ÷ 5 weekdays= 36 weeks) yields 3,240 minutes converted to a whopping 54 additional hours! Add to that the 1-2 hours added to the end of the day to catch up on lesson planning, writing those evals, and anything else that needs completing! It seems the expectation to silently consent to extra, extra, extra has become our new normal.

I prefer not to carp and would like to be part of a positive work environment, so I went through the proper channels and was effectively shut down. I suggested the flexible service delivery model, dedicated meeting days, etc. I was told, "nothing is going to change." How should I respond to such stonewalling? What do I say while trying to maintain professionalism and grace under fire? Speech-language pathology, and in larger part education, can be such a joy, and yet, it is often disappointing to be part of a bureaucracy. I crave the respect that is afforded to other professions. I often feel cornered into behaving like a petulant child ("Well, I guess I just won't be available before school any longer!")

The above scenario illustrates what I would consider thinking from a fixed perspective. I am reading Mindset by Carol Dwerk, Ph.D. and LOVE IT. I began reading it at the suggestion of Jennifer Hatfield, MHS, CCC-SLP of Therapy and Learning Services, Inc. (who is helping us with executive functioning as a family. More about that in a future post.) This is what I have gleaned so far; I spent a good part of my life in a fixed mindset, not accepting challenges for fear of failure, thinking I lacked innate abilities, seeking validation from others, etc. At some point that all changed. I remember a very distinct turning point. I was at bootcamp and I shared that I had decided to run a half marathon. Someone asked me "Why?" I responded, "I don't know why. I just think I can." That to me exemplifies a shift toward growth mindset thinking.

You might be wondering, what does this have to do with WORK? In as much as I have approached my personal life of late with a growth mindset, I truly believe much of my work life has been viewed through the lens of a fixed mindset or at the very least a "mixed" mindset. This past school year I saw much of my situation as untenable, never changing, out of my control, and that resulted in considerable anxiety. As I reflect on the stresses that come with my position, I am thinking, much of it was created by my thinking. Yes, we are often asked to complete tasks with herculean strength, but what if I can view these tasks as an opportunity for growth? No...what if I CHOOSE to view these tasks as an opportunity for growth?  I, more than likely, won't feel that crushing sensation in my chest.

I am very fortunate. I get to spend my summer recharging my batteries, passing many restful hours on my back porch. I read.  I look at my flowers. I watch the butterflies and hummingbirds. I ignore the begging chickens and I think.

This provides a wonderful opportunity to reevaluate the previous school year. What worked? What didn't? This school year has allowed me to see that when the pressure mounts, I struggle to maintain a healthy balance, I get cranky and "fixed." As part of my growth mindset practice this summer, I am setting goals: attainable, realistic goals that allow me to capitalize on my momentum. For instance, last week my goals were to run 11 miles (not all at once), transplant some deeply entrenched perennials, bake and read three chapters of Mindset. CHECK!! I found having clear expectations of what I wanted to accomplish helped me stay the course.

My approach toward the stresses of my job can be growth oriented too, just as it is for my personal life. In fact, it really should be. So as I look at my math computation above I can reframe my thinking from "I have added anywhere from 54-90 additional hours of work to my job," to "We haven't found a solution to the meeting debacle...yet, but we will!"

Speechy and Teachers Pay Teachers Appreciation Sale

It's May! Better Hearing and Speech Month, Teacher Appreciation Day, AND a Teachers Pay Teachers sale!!  Add to that the frenzy of IEPs, progress reports and evaluation reviews.  Busy, busy days, so to help our friends, the Frenzied SLPs are hosting a linky highlighting a couple of our own products and some products in our carts.

My Editable Vocabulary Playing Card Decks consists of standard playing cards for middle and high school vocabulary development including:

Two 52-card decks addressing:
Synonyms
Antonyms
Word in sentence
Definition 
Part of speech sound
Multiple meaning
Association
Category
Taste
Smell
Texture
Sound
Location
Parts
Size, Shape, Color

This product has an added bonus of  52 editable cards so you can add your own option of deck.
These decks can be used while playing any traditional card game. Print the desired deck and pair with vocabulary specific to your students needs. My students LOVE these decks, they are fun, functional, and versatile!

My Spring in New England Nonfiction Text Passages for Middle School contains 6 nonfiction passages relating to springtime in New England. When I made this product I had my middle school students in mind and wanted to expose them to material that was relevant to our region. I think it is appropriate for high school speech-language students as well. Each passage is followed by several comprehension questions calling for higher-order thinking and context clues. Also included are vocabulary matching worksheets for each topic.

Topics include: Vernal pools
Peepers
Black flies (blech)
Ice out
Mud season
Frost heaves
Download includes:
4 SCOPE editing strategy cue cards
6 Passages
6 Vocabulary-definition matching pages
1 Vocabulary organizer page

Now, what am I buying?  Decisions, decisions! My wish list (I am ashamed to admit) is TEN pages long and has close to 200 items. Crazy. However, there are couple of items I have been waiting for sale day for.

The first is Little Red's Reading Comprehension Passages Bundle. This bundle looks amazing and should keep my students well supplied with informational text materials with 160 reading passages and corresponding comprehension questions. I can think of so many uses in language therapy for these passages!

The second product I am really looking forward to snagging is Panda Speech's Language Blocks. I have the articulation version and my students truly enjoy them.  This bad boy is chock full of language targets including vocabulary, following directions, grammar and so much more.

I hope this short list of my fave products is helpful. We would love to know what products you have to offer as well as what you may be purchasing, so link up and show us your cart!

An InLinkz Link-up