Marisha

#125: How to Start Using Smarter Scheduling for School-Based SLPs

June 28, 2022 by Marisha Leave a Comment

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This Week’s Episode: How to Start Using Smarter Scheduling for School-Based SLPs

This month, I’ve had the pleasure of speaking with BeckyAnn Harker all about service delivery, tips, and strategies to help us schedule smarter in the schools. BeckyAnn is a school-based SLP near Youngstown, Ohio, and she has 24 years of clinic and school-based experience. She is currently a doctoral student in special education at Kent State University, and she’s very interested in caseload management and vocabulary intervention. For this podseries, we will be focusing on her caseload management expertise!

So far in this pod series, we’ve discussed a brief intro to smarter scheduling for school-based SLPs, a review of different service delivery options like RTI, and last week BeckyAnn shared some tips on how to navigate scheduling and different service delivery models to better manage our own workload and also better serve our students.

This is our last podcast of the series with BeckyAnn and today we will be continuing our conversation about smarter scheduling but we will be diving into some more nitty-gritty details on how to get started.

Let’s jump on in!

Key Takeaways + Topics Covered

✓ Start small: Start by implementing 10-minute articulation drills with your students who have speech-sound goals, including those you are seeing through a multi-tiered system of supports (MTSS) or response-to-intervention (RTI).

✓ Talk with your administrators, teachers, and parents.

✓Assure all stakeholders that shorter, individual sessions are more efficient and effective, allowing students to make progress more quickly.

✓ Find out the best blocks of time when you can see each teacher’s students. You can have several teachers within one larger block for more flexibility.

✓Adjust IEP minutes in a new IEP or amend the current one. Fewer minutes will be needed to meet your goals and can help with caseload management. Write your time as minutes per month, as possible, to accommodate block scheduling and 3:1 schedule

Additional Links

Next Up in this Pod Series

6/7/22: An Intro to Smarter Scheduling for School-Based SLps
6/14/22: A Quick Review of Service Delivery Options for School-Based SLPs
6/21/22: How to Navigate Alternative Scheduling for School-Based SLPs
6/28/22: How to Start Using Smarter Scheduling for School-Based SLPs

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Thanks so much!

Transcript

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Speaker 1: This week, we are continuing our conversation with BeckyAnn about smarter scheduling in the schools and just navigating different service delivery models to better manage our own workload and also better serve our students. And so the past three episodes, BeckyAnn has shared tons and tons of tips to kind of help us rethink how we do service delivery as SLPs in the schools. And today we get to dive into some more nitty gritty details on how to get started. So , where do you think SLP should start? Like if they're listening to these episodes and they're looking at their caseload and their schedule and was like, "Oh, I'm seeing all of my students in 30 minute groups." What would you suggest to those SLPs if they're looking to make a change?

BeckyAnn: So I can imagine it would be very hard to start in the middle of the school year, but I am also okay with starting stuff in the middle of the school year. It's do what you can when you can. Right? It's overwhelming and it really takes a paradigm shift. You get so stuck in understanding your schedule. You have been working in 30 minute blocks for your entire professional life. And so I think it is hard maybe to figure out maybe a little scary to step outside of that box a bit. I think the first place you can start is with your new referrals, really looking at using RTI to seeing those kids do your interventions, especially if it's just like articulation so start there. Start with the brand new ones. And like I said, if you need to go to an evaluation because it's really significant or it's really impacting their education by all means do that, but also know that you can be doing those five minute articulation drills or 10 minute articulation drills and even for some of the kids that just have some grammar issues, you can be doing those interventions and I would start there.

BeckyAnn: Then as your IEPs come due and you're meeting for your IEPs, I really suggest trying to reduce your minutes. And I say that, and people are cringing and people are going to say, "Oh my God, my parents are going to freak out and my administration's going to freak out." And they might, and I know there are some parents even that just hold onto somehow your 90 minutes, 120 minutes, like that's golden. I have reduced minutes.

BeckyAnn: Now I'm going to say this did happen during the pandemic is when I really started making the switch. And I used COVID to my benefit because I did have to see kids individually. We were in person and remote, but for the in person, kids, I really was trying to see those kids individually, which is how I wanted to do it anyway. But the only way to do that was really to reduce minutes. But every parent that I talked to and presented this to, I told them that it makes a lot more sense that I can see your child individually for less time and get better therapy than keeping them for this magical 30 minutes in a group with other kids and not meeting their goals. And I have not had one parent complain. I haven't had one administrator complain.

Speaker 1: Yeah. And you have those beautiful research articles that show that students can make rapid progress in less time and they're missing less time in the classroom. This is to benefit the students. It's not just because we don't want to work. We want to do what's best for students.

BeckyAnn: Right.

Speaker 1: So sharing those articles, which again are linked in the show notes, I think is a really great resource to share if parents are questioning or if administrators are questioning.

BeckyAnn: And I think like we had said earlier, just simple math. I can see your kid in a group of three for 30 minutes. That's 10 minutes that your kid is going to get to talk. That's simple math. And that's not even, like I said, with the activities and all the other things, even the hi how are yous, all of that stuff that takes extra minutes, your child is getting less than 10 minutes when I see them for 30. And that means they're missing 20 extra minutes out of the classroom.

Speaker 1: Yeah, absolutely. Do you have any other tips when it comes to presenting this to administrators or teachers or parents?

BeckyAnn: So, and I think this is thinking about like that block schedule that we were talking about, you need to talk to your teachers first. And how I presented this to my teachers was that I was going to try to do some more in class therapy was really, really my goal. I try this every year. I need to be listening to podcasts and talking to people about how to really do good in class intervention because I feel like I don't do a good job of that. I try. And I presented all my teachers this. So if I come in during your language arts block and I am there during these times and this way I can help, if you need help, I can be there and do therapy within the classroom or I can pull them out. And they're like, "Oh yeah, yeah, sure." And so they were really open to me just coming in and they'd feel comfortable with me just popping in. And sometimes it just means I'm standing in the back of the room watching what's happening, but sometimes I'm also helping and sometimes I'm taking the kids.

BeckyAnn: So getting the teachers on board from that way, just understanding that we're going to be really flexible, that we're not just going to be taking kids at this prescribed time because I can't tell you how many times I felt like I was imposing on the teacher or they just kind of look at me and go, "Okay." because they know that's their time, but they were in the middle of something. And I feel like if we can have that flexibility and we can respect their time, they will also respect ours because you might be at a time like, "I really need to see this kid. He's been absent three weeks." And whatever and I really need them. And even if they're teaching, they might be, "That's fine. That's fine. I know you do."

BeckyAnn: So to kind of make that connection with your teachers. And you may need to talk to your administrators too, especially if you're planning on reducing minutes. That might put their hairs up too and they're worried about, I don't know, lawsuits or something, but like you said, we do have the research to back that and we are trying to do what's best for the kids. So make sure you talk to them. And then along when you're talking to the teachers it's just really trying to talk to them about when their best time in the day is, and really try to work around that. I have some flexibility. This year has been great. I've been in one school three and a half days. I usually jump between schools. So there's a little less flexibility if you're only in a school building one day, but really trying to work with those teachers and find their best time and it's really to make friends and understand that you're all on the same page.

Speaker 1: And I feel like this approach would be more conducive to building those relationships because you have that flexibility to be in the classroom and to kind of adjust depending on the students needs and all of that. And yeah, I think like just being present and being visible versus popping in at the scheduled time to take the student and then them walking back by themselves, there's a lot more interaction with that and opportunity for collaboration.

BeckyAnn: And I think just understanding what the students are doing. I've been amazed sometimes now that I'm in the classroom. I'm like, "Whoa, you're really making them do that. That's amazing." Or I'll take whatever they're working on and help them with their writing assignment. Even if it's in my speech room, I may take them, pull them out and still work on those skills or use the book that they're reading and ask questions. And so I can just kind of understand what they're working on, their standards and their curriculum instead of living in my little office, my little cave. I feel like I'm kind of part of the school more and more involved with the kids' lives.

Speaker 1: And I feel like that would help with our own job satisfaction too.

BeckyAnn: I am the happiest this year that I've been, and this is where I'm in full force doing all of these things. I know.

Speaker 1: Wow. That's impressive. Because I feel like a lot of SLPs, I feel like the pulse is at an all time low. The fact that you are the happiest you've been after how many, 24 years?

BeckyAnn: And this is my 10th year in the district and yes, my numbers are a little lower this year. I still I've been around 60 to 65 all year and that's workload. So that's including my RTI kids. Right? But that's still 65 little humans that I'm working with. I do feel better. I know I shouldn't say that out loud because there are a lot of people that are like, "This is the worst year of my life." And I feel bad for them, but maybe, maybe doing some of these things and trying to take control of your own schedule. You can only control what you can control. And these are some of the things that I could do within the parameters of this school day. And I am the happiest I've been.

Speaker 1: Yeah. And I love that you're sharing that. It's not meant to be like, "I'm happiest and you're not."

BeckyAnn: Right.

Speaker 1: It gives hope. It's like, "Okay, so there's this SLP who's implementing trying some strategies to help with her scheduling and her caseload management and she's the happiest she's been." Even if you are that SLP who is at the lowest, there's hope there. There's a way to make it better. And maybe even to make it the best it's ever been, which is, I don't know. I think that's incredible. Cause you said something about three and a half days. Are you seeing that many students in three and a half days?

BeckyAnn: I also am at the high school. The high school I can't do the fancy scheduling, but they're already kind of fancy scheduled. Right? I see kids during their period that I can see them. But even then I keep them for often half of the period. They used to split the period up, like around the lunch times it would be split. And I don't know, I just kind of got into that habit. So I think if I see you for about half the time, but sometimes it's less, usually it's more, it's just whatever the kid needs for that day.

Speaker 1: Yeah. I love that. And I think the overarching trend is just what's best for our kids.

BeckyAnn: Right.

Speaker 1: How can we get them best possible services?

BeckyAnn: Get them dismissed if we can.

Speaker 1: Yeah. Get them back into the classroom. That's the ultimate goal. That's where we want them to be.

BeckyAnn: That's right.

Speaker 1: Okay. So let's just do a quick recap of the different strategies that we touched on during this episode. So you mentioned starting small. So if you get a new student, if you're new to RTI, maybe diving into that a little bit and doing some quick artic with those potential students. As renewals come up, we can look at shifting our service delivery times and working with them. If there's that kiddo, who's still on your caseload and just needing to wrap up his R we can try the strategy of 10 minute articulation drills. You shared so many wonderful strategies about getting administrators, teachers and parents on board. I won't recap all of that. You can listen back if you want that. And we talked about sharing that evidence to show that students can make rapid progress with those shorter sessions. Yeah. I think that's like a good recap of the strategies. There's a lot that goes into that communication piece. So I have one more question, Becky.

BeckyAnn: Mm-hmm (affirmative).

Speaker 1: Is this something that your whole district has started to adopt or are you kind of the...

BeckyAnn: Pioneer?

Speaker 1: Yeah. The pioneer for making these types of changes.

BeckyAnn: So I have talked about it with my colleagues. I don't know that they're doing this yet. RTI, I think a little more, I've been kind of spouting about that for a few years. So I think that they're definitely trying to do RTI a little bit more. I'm not sure about the scheduling, but I will have them come listen to this. And if they can hear all the wonderful things that they should be doing instead of just from me, it'll be on a podcast. So maybe it gives it more credence. I don't know.

Speaker 1: It's so official. After the [asher 00:12:25] leader and the SLP podcast. Come on.

BeckyAnn: Right.

Speaker 1: No, I love that. I think that can give SLPs hope too. You're able to implement this without having a massive district overhaul and policy change. There are other SLPs could be the pioneers in their are districts to start implementing this.

BeckyAnn: Do what's right for you really. That's what it comes down to. This is what has worked for me. And maybe not all of it will work for everybody else. And every state is different. Every school district is different. Every special ed director is different and administrators, but do what you can. Take control of what you can take control of. And so if you can reduce the minutes so that you don't have to see that kid more, but know that you're going to see them better. I think that's going to be the key and we're trying to make progress and you might be able to show, "Well, look, I've been able to get this many kids off my schedule." Which is also our plan, right, to manage our own workloads.

Speaker 1: And it benefits them because they should be in the classroom.

BeckyAnn: Correct.

Speaker 1: That's a win, win, win. Yeah. I love that. I am super excited for SLPs to hear all of these amazing tips and strategies. Is there anything else that you'd like to share Becky on as we wrap things up?

BeckyAnn: I'd like people to be able to try this. I don't know how I'd be able to get some feedback to see if it works for people or if it doesn't work, but try it. Maybe you too can have a good year after these terrible pandemic years and whatnot.

Speaker 1: Yeah. I would love that. That is my goal. And what I set out to do, because I've been in the just locking myself in my therapy room, shedding some tears, all of that. I don't want other people to experience that. So that's why I started sharing different resources and tips and it sounds like you're doing the exact same thing, BeckyAnn, so very, very grateful. And hopefully this inspires a couple SLPs and hopefully they can have their best years ever too. Thank you for your time.

BeckyAnn: Well, thank you so much for allowing me to do this, to share. This is great.

Speaker 1: Thanks for listening to the SLP Now podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episode sent directly to you. See you next time.

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#124: How to Navigate Alternative Scheduling for School-Based SLPs

June 21, 2022 by Marisha Leave a Comment

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This Week’s Episode: How to Navigate Alternative Scheduling for School-Based SLPs

So far in this pod series, we’ve discussed a brief intro to smarter scheduling for school-based SLPs, a review of different service delivery options like RTI, and today BeckyAnn will share some of her tips on how to navigate scheduling.

Key Takeaways + Topics Covered

✓ 3:1 model of scheduling: 3 weeks of direct service and 1 week of indirect.
That 1 week of indirect service gives BeckyAnn the flexibility of missing one session per week.

✓Block scheduling: This is a school-wide schedule of alternating subjects for Math, English, etc. For BeckyAnn it is scheduling blocks of time for each teacher, and not scheduled by the student.

🗓 What does Block Scheduling look like? 🗓

✓ Could be during a Language Arts block, or during stations, or an intervention time block

✓ I started by telling the teachers I wanted to be able to work with them/around them during that block. If they are in the middle of something when I get there, I will push in to help my students within the classroom. Otherwise, I will pull them out.

✓ My schedule looks like-colored blocks of time.
9:00-9:45 – I am with one teacher, and I have 3 students there.
9:45- 10:50 – I am with a different teacher and his 4 students.
During their half-hour intervention time, I have 2 teachers scheduled, each with one student with articulation needs.
I usually see them individually, but sometimes I will see them together. It’s flexible!

Tips to implement

✨ Schedule the teachers and not the student. The block will be longer if that teacher has more students in their class.
✨ Be flexible!
✨ Maybe there are classes that have similar schedules and only one kid each- you can put them together in a block. Maybe one class is in the middle of something today- you can take the other student first.

Additional Links

ASHA Leader: BeckyAnn Harker Can We Break From 30-Minute Group Sessions in Schools?
ASHA Leader: Jennifer Taps RTI Services for Children With Mild Articulation Needs: Four Years of Data
SPEEDY SPEECH: Efficient Service Delivery for Articulation Errors (Kuhn, 2006)
Laurel Bruce A Team Approach to Response to Intervention for Speech Sound Errors in the School Setting
Plant et al., (2019) Treatment Efficiency.
BeckyAnn’s Minutes Log Example
Minutes Log Template

Next Up in this Pod Series

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Transcript

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Speaker 1: Hello there and welcome to the SLP Now podcast, where we share practical therapy, tips, and ideas for busy speech language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode.

Speaker 1: Welcome back to our series on smarter scheduling, all about service delivery with BeckyAnn. Today, we're diving into one of the big questions, which is how to navigate scheduling. BeckyAnn, I'm just going to let you take it away, but I'd love to just focus on what tips you might have to navigate scheduling when using this alternative scheduling approach.

BeckyAnn: Well, I think I want to start first by talking a little bit about the three-to-one model. I use it, but don't use it. We plan our minutes per month... when we're making our IEPs, we have to put our minutes per month... and we do have that idea of the three-to-one model, where you have three weeks of direct service and one week of indirect. I have never had an entire week of indirect service. But what I do have is some flexibility of when I see my students. You might have your best plan, all your students are scheduled, but then you'll have an IEP meeting that might take over. And then now you can't see those kids. So I can see them sometime later.

BeckyAnn: I like to see my kids, especially the articulation, and even most of my students actually, I actually do try to see twice a week. But I have some flexibility. So if something comes up... We had state testing this week, for example. We had an assembly this week, and I can't see my kids, but I'm not stressed about it because I still have the next week that I can see those kids. So it's this week buffer. I don't use it as one whole week of indirect services, but I use it as a buffer to make up those minutes. That already, I guess, from looking at monthly minutes, that reduces those minutes a little bit to give us some flexibility.

Speaker 1: Just to confirm, you're writing your minutes per month?

BeckyAnn: We write them per month.

Speaker 1: Okay, awesome.

BeckyAnn: So that's one thing that I think, depending on what program your district uses, sometimes they make you put in two times per week, one time per week. I'm not sure how to get around that because I don't have to. We have frequency. So we have minutes per whatever. So you can say per week, per month. You could do per quarter if you really wanted to be fancy schmancy or give yourself a little extra time, or maybe those kids are weaning off of services. So maybe you do only need to see them 60 minutes a quarter just to check in. So yes, we were able to do that.

BeckyAnn: The other thing that I have started doing... And I am really happy with this, and this has been what drove me to write the article for the ASHA Leader... is my version of block scheduling. So block scheduling, it's out there. There have been several articles that talk about block scheduling. And it has more to do with how schools will block their schedules. So they might do a 90-minute language, arts block and a 45-minute social studies block. My own daughter's middle school did that, but it was on this rotating basis. It was an hour and a half of one subject one day and then an hour and a half of another one another day. That would've driven me crazy.

BeckyAnn: But how I do it is I look at my schedule and I don't schedule my kids. I schedule the teachers. You do that anyway. You may have a classroom that has three students in it, but you might make that 30-minute group with those three students. Instead, I am going to maybe schedule that teacher in this 45-minute block where I know that that teacher should be available. But like I said, sometimes they're not. So you'll walk in and they're in the middle of a lesson. And so you have to be flexible. You can go do it, see a different teacher, or you can stay and help or just see what they're doing. But I will schedule these teachers in blocks.

BeckyAnn: And so I know that at this time, maybe right before lunch, this teacher is a really good time for that teacher. So I will know maybe on Mondays and Thursdays, I can go into that classroom and I can pick any number of those kids. And sometimes I'll put them in groups, and sometimes I don't put them in groups, but I know I've got this 45-minute block where I can see that teacher's students, if that makes sense.

Speaker 1: That totally makes sense. And that's perfect because if you schedule by students and Johnny is scheduled for Monday, but he's absent on Monday, then he just doesn't get services that week. But if you're in that teacher's classroom two days, you're like, "Oh, I miss Johnny on Monday. I'll see him on Thursday."

BeckyAnn: Right. I do that all the time.

Speaker 1: No, I love that because you started talking about what it looks like during those blocks of time. But could you dive into a little bit more detail? What happens in those blocks?

BeckyAnn: So I do run around the school a tiny little bit because sometimes I will come. I have a teacher block maybe from say, I don't know, 9:30 to 10:15. And so I will go into that classroom. And I usually have in mind the student that I want to take, or sometimes students, maybe I've got this activity that I think would be really good for these two students, but not that one because that one has to work on articulation, but these two are doing some listen comprehension. I've got this great story. So I will go into the classroom, and I lurk in the doorway a little bit. And I will ask the teachers because I want to be respectful to the teachers and what they're trying to teach at that time, and I don't want to just pull them out in the middle of their lesson.

BeckyAnn: So I'll listen or I'll just tell them, "Just finish what you're doing." And then as soon as they're done talking and I'll say, "Well, can I take these two students now?" And I always ask. I might take those two students back to my room to do that story activity that I wanted to do. And then whenever we are done because we have read the story and we've answered all the questions that I wanted to answer or did the activity that I wanted to do, if that took 20 minutes or 35 minutes, that's what it takes. And then I will walk them back to class and maybe take the other student, and we'll drill some articulation for 10 minutes. And that might be in the room just around the corner. There's an empty space. I'll just work with them there. I couldn't even work with them in the class. I just really don't working on articulation drills. I think it's uncomfortable for the students. There's a lot of other nosy students who are paying attention to what you're doing. So I usually do pull them out then.

BeckyAnn: Sometimes I'm in there for the whole time because they're doing this really great writing activity that's really language-heavy. Or of course, a lot of our students will struggle with that as well. So I do look a little bit like a tutor in those moments, and I will leave that day thinking this is a great activity, and then I have no good data to put on my sheets because we didn't actually work on their language goals. But honestly, we are there as related service. So as long as I have a balance, I will for sure get to their goals the next time. But it's all about being flexible.

Speaker 1: Yeah. And I think for our language students, if they have those grammar goals, vocabulary, I feel like with a good language-rich activity, I mean, that's prime therapy content right there. And it's so relevant to what they're working on. Being able to scaffold and support that skill in the context of something they're actually doing is just... It's so powerful. I think that's really awesome.

BeckyAnn: It's what we're supposed to be doing. But then-

Speaker 1: Right?

BeckyAnn: Right. But then sometimes, because we've written our goals a little separate from that, so it doesn't always match. But in the end, we are doing what's best for the student at that time, and we are there to support their education. So if we have to take a step back and help them because this was what they're working on in class, then I think that that is okay.

Speaker 1: Yeah. No, I love that. Just to recap, you're shifting to a three-to-one schedule, it sounds like, so you're shooting for a certain number of minutes every week, and you plan out those minutes just to give yourself a little bit of buffer in case there are those extenuating circumstances, which there always are.

BeckyAnn: Correct.

Speaker 1: And then you use a block scheduling approach. So you'll schedule sounds like usually 45 hour-long blocks.

BeckyAnn: So it depends because if there's only one student in that block and it's in our classroom and he is in articulation again, so within this half an hour, I might take one kid from this class and one kid from this class. So I made a little block for only 30 minutes with those two teachers. In one class, I had seven kids, which was a lot. Well, and actually what I did, I didn't block in two and a half solid hours there, but I broke that up over the week. I'm in that classroom four times a week, and it may only be for half an hour, just to get that one kid that I didn't get on Monday, and maybe I can pick them up on Tuesday and then their second time. So I can mix and match the kids based on what I'm doing or what they're doing.

Speaker 1: I bet most often, there's not that many students in one class where you're in the classroom four times throughout the week. But does that get hard to track how many services the student has received? Because I feel like once you get a hold of the schedule, it's probably pretty easy to mentally keep track of like, "Oh yeah, I know I didn't see Johnny yet." But do you find that is tricky at all?

BeckyAnn: I have a tracking sheet that I use. And if you have a place, I will be happy to share with you. You can post this as well. I make a grid. I just use an Excel spreadsheet and I grid by five-minute increments. So maybe some kid I'm going to see 120 minutes a month. That's the most that I can fit on this page. So if you are going more than that, you might need two lines. But I see the kid for 15 minutes, and I draw a little line across three of those little squares, and I use different color ink every day or every week at least, just for myself, for my own reading purposes. But I'll cross out three of those little blocks and I'll put, "Today's date was 3:30. I saw them for 15 minutes. I saw them for 30 minutes."

BeckyAnn: So I can see I still owe this kid 25 minutes. It's the last week of the month. I owe them for 25 minutes. So I am going to try to make sure I have a longer activity that day. So it is a lot of flexible thinking, flexible scheduling. And it does sound like a lot, I guess, as I say it out loud, but I felt like I was doing this all the time anyway. Even back in that 30 minutes, my brain hurt from just trying to keep track of who I had to see when and where and who. But within those blocks of kids, I'm like, I know I get to see them sometime this week. And if you get to the end of the month because of the assemblies and everything else, maybe you have to go to that classroom on a day that wasn't originally scheduled. But you know that that's the time slot that that teacher's available. So you're more likely to be able to work with them.

Speaker 1: Yeah. And I think that it's a lot less scheduling Tetris because those blocks will stay the same and you're just focusing on, "Okay, how can I like get these students seen?" versus trying to manipulate your whole schedule and all of that. So yeah, that makes a lot of sense to me.

Speaker 1: And then in the article, I'll link to the article in the show notes too, but you had a beautiful graphic of what your block schedule looks like for those of us who are more visual learners. You can find an example of that in the article as well. Okay. Awesome. I love the scheduling tips, thinking about a three-to-one model, planning minutes per month or quarter. One of my districts used to do minutes per year, which is uber, uber flexible. Using this approach, it might be easier to work by month just to make sure you're on track.

BeckyAnn: Yeah. I can't even figure out how many minutes. Those are more minutes that I could probably deal with at a time. It would be nice for flexibility, though.

Speaker 1: Yeah. And then the block scheduling approach, that all sounds awesome. And so next week, we will chat about just some tips to get started and starting to navigate this process. So we hope to see you again.

Speaker 1: Thanks for listening to the SLP Now podcast. If you enjoyed this episode, please share with your SLP friends, and don't forget to subscribe to the podcast to get the latest episode sent directly to you. See you next time.

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123: A Quick Review of Service Delivery Options for School-Based SLPs

June 14, 2022 by Marisha Leave a Comment

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This Week’s Episode: Service Delivery Options for School-Based SLPs

In last week’s episode, BeckyAnn and I discussed a brief intro to smarter scheduling for school-based SLPs and today we are going to be reviewing different service delivery options. We ended our discussion last week chatting about RTI or response to intervention. BeckyAnn will tell us a little bit more about what RTI is and what that could look like.

Let’s get to it!

Key Takeaways + Topics Covered

Shift to adopt RTI
✓ If SLPs do RTI it can save 6-10 hours of paperwork

Shift service time
✓About the quality of the minutes, you have with the kids. Not the amount of time.
✓ Students don’t miss as much class.

Articulation
✨ Shifting service time! Speedy Speech or 5-minute artic drills (Kuhn, 2006)
✨ 150 repetitions in 15-20 minute INDIVIDUAL sessions- remediated in 6 hours of tx. (Bruce et al., 2018)
✨ For those who needed an IEP (more severe), remediated in 53 hours, less than the district average of 83 hours which is 3 years! (Bruce et al., 2018)

Grammar
✨ Plante et al. (2019) found no difference b/w 15 and 30 minutes if 24 exemplars were used.
✨ The number of repetitions matters when remediating speech sounds and other errors and is more important than the number of minutes spent in a session.

Shift service setting (e.g., in classroom)
✓ The student doesn’t lose as much time in the classroom

Shift group size
✓ You can be flexible

Additional Links

Next Up in this Pod Series

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Speaker 1:BeckyAnn

Hello there and welcome to the SLP Now podcast, where we share practical therapy tips and ideas for busy speech language pathologists. Grab your favorite beverage and sit back as we dive into this episode. Welcome back to the podcast. We are going to continue the service delivery discussion with BeckyAnn Harker. If you missed our episode last week, definitely head to the previous episode so that you can get caught up on our discussion. And today we are going to be reviewing different service delivery options. So we ended our discussion last week, chatting about RTI or response to intervention, BeckyAnn, can you tell us a little bit more about what RTI is and what that could look like?

BeckyAnn Harker: Sure. So most schools should be doing RTI or response to intervention as part of their academic and behavioral interventions with PBIS, positive behavior interventions and support. And I know in my district, we were told we had to follow RTI, we had to follow the process, but nobody ever told us what that meant or how we fit into that because we don't fit in quite the same way. There's no tutors doing the interventions for us. And so I've been really trying to figure out how to make this work in my head. I actually end up doing the interventions, the teacher has some concerns about a kid or in kindergarten we screen all of these children. And so we are often the first ones to find some issues, but I will do some interventions on my own and then sometimes those kids have bigger issues and so they get academic testing and then we will also follow along with that, do our testing. Or I just will make the decision, I guess, to go to further testing if we need to.

BeckyAnn Harker: But honestly, the kids that just have some speech sound errors, I will just see them usually individually, sometimes in very small groups to just drill some sounds, some things I had found, because I've done some research looking into RTI for speech pathologists and there are some things that have come up like the amount of paperwork that it actually saves us if we do RTI. Someone had said six to 10 hours of paperwork that it would save us. Now think about, even if that's five kids that you have in RTI, that could be 50 hours of paperwork through the whole ETR process, IEP process, progress reports, all of the stuff that goes with that. So just saving that many hours sounds really good to me.

BeckyAnn Harker: So that's a big push for me. And the other thing that we had talked about in the last episode is just that these kids may not actually meet the qualifications for therapy yet they still need it. And so this is a way that it eases my mind. Yes, it does happen sometimes that if things get really, really busy, we're doing state testing this week, for example, and I have been helping to do state testing. The kids in RTI are probably not going to be the first ones I make sure I see this week, but it's okay. It's okay because they're getting help throughout and as I have said, nobody's ever died from not having one week of speech therapy. They'll probably be okay for the week.

Speaker 1: Yeah. I love the idea of using five minute sessions to work on articulation for our RTI students. Can you tell us a little bit more about what that would look like?

BeckyAnn Harker: Yes. And so I'm also a big fan of this five minute artic drill. So it's been called speedy speech. It's been called five minute artic drills. It's been called all kinds of things and for the articulation kids, especially... So really in five minutes I usually do 10, I'm not going to lie. I feel guilty, five minutes just doesn't seem like enough. And kids still will come and talk to you and so we waste a few minutes of chit chat and making friends, but then you can just drill sounds. And if you can get 50, 100 repetitions within 10 minutes, then send them back to class. It's no longer than a bathroom break. They're not missing a ton of class. I call it drill and kill and go back to class and you see improvements that way. You're not having to juggle between those groups of those other kids with other language needs perhaps.

BeckyAnn Harker: so within that five or 10 minutes, you can really get the kid to meet their goals a lot faster. There's some statistics too on how the five minutes drills can save... One study had them remediated their sounds in six hours of therapy. So that's kind of the RTI, don't put them on your caseload and have an ETR and an IEP and all these minutes you have to do, if you can actually fix it in six hours. And another study, even with kids who were more severe and they were put on an IEP and they had more sound issues. It still took less time. It took like 53 hours over time to remediate those sounds versus their district average of 83 hours, which is three years that you're having a kid on an IEP to work on sounds. It's kind of a long time in my opinion.

Speaker 1: Yeah. So that's 30 hours saved, that's like getting those kids off of your caseload, back into the classroom, back into least restrictive environment a year sooner.

BeckyAnn Harker: Correct.

Speaker 1: That's incredible.

BeckyAnn Harker: Right. But we should be doing this. That's what I think.

Speaker 1: Yeah. And we'll share the citations for those articles in the show notes. I think that particular article was from Bruce et al. 2018.

BeckyAnn Harker: That was, yes.

Speaker 1: Okay. So that was an example for articulation where the RTI students who had those shorter individual sessions remediated much more quickly. And then for the students who were more severe and needed that IEP, we saved 30 hours of treatment time using that approach. Have you seen studies outside of articulation? Does this apply to other areas?

BeckyAnn Harker: So Plant et al. in 2019 also found that there's no difference between 15 and 30 minutes of therapy. This was for grammar when they're working on morpho-syntax, they did 24 exemplars. So they practiced 24 times, they were able to... Or 24 different words and they were able to do the exact same amount of good in half the time. So I don't know why we have this magic number of 30 minutes. It's in our head, it's in our psyche. I think it comes from the medical model. And if you think about it, if you're going to take your kid to a clinic to be seen, you're not going to just sit there for 10 minutes and then turn around and go home and do that every week.

BeckyAnn Harker: So that 30 minute, doctors seem to block in 30 minutes. I think some people will bill in 30 minute increments. And so I don't know, that's just gotten into our psyche, but if you can do it in half the time, if you can treat grammar in 15 minutes, if you can treat articulation in five or 10 minutes, then I am all on board with that.

Speaker 1: So it sounds like the takeaway is that with the grammar study, if we got those exemplars, it doesn't matter if it's in 15 versus 30 minutes, just like the number of targets that matters, not the amount of time.

BeckyAnn Harker: Correct. And how I schedule my life right now is I'm thinking more about getting the activity done, the amount of repetitions done. So that could take a half an hour. I'm not going to say I never see kids for a half an hour. Sometimes it does. Sometimes it takes longer depending on what the activity is and what we're doing, but it should be about the quality and not the quantity. I hate watching that clock.

Speaker 1: Yeah, like what can we do to fill in these extra minutes?

BeckyAnn Harker: Right. What if you're done in 20 minutes, you're like, I still got 10 minutes to go. And now you're just wasting time or you start another activity, which then isn't done in time. So it's all about the quality of the minutes that you do have with those kids.

Speaker 1: Yeah. And I think that one of the benefits that I saw to using these shorter sessions, I love what you said about the students don't have to miss as much class. It doesn't have as much of an impact. And we don't need a lot of fluff when we're doing these shorter sessions. A student can attend for five to 10 minutes without needing extra reinforcers and a ton of behavior management. They can focus for that amount of time and we can just get super high quality therapy with lots and lots of repetitions and little to no fluff.

BeckyAnn Harker: Right, I will bring a blank worksheet that has little pictures, whatever on it. And in the session we're choosing our targets, we're practicing, we're saying them in words and sentence and I will be writing those words down. So then they have homework within that 10 minutes. It's individualized for them, for what they needed, what they were working on. And they're kind of watching, sometimes I'll have the kids write it and so they have the homework to take home with them from what they were just practicing with me.

Speaker 1: Wow. Double whamy. I love it.

BeckyAnn Harker: Yeah.

Speaker 1: Make their homework during the super short session.

BeckyAnn Harker: Yes. Be efficient.

Speaker 1: Yeah. I love it. So what does this look like in terms of the logistics? So next week, we'll chat more about how to navigate scheduling, but if the sessions are so short, do you go to the speech room? What does your setting look like? Are you in the classroom, in the hallway? Can you just paint the picture of the basics?

BeckyAnn Harker: Sure. it's flexible. So I guess my theme, I just try to be flexible, flexible in my group size, flexible in the amount of minutes that I spend, flexible in what I do. So we will be talking about how I do block scheduling. So I kind of block by teacher and then I will go to that classroom. So during that time, if they're in the middle of an activity, I'm not going to pull a kid. How many times do you go to the classroom, even though they know that their time is at 10:30, but they're hardcore in the middle of a language lesson or a math lesson, but it's your time and so you take them and pull them from that. So I don't do that. I try to find a time within that block.

BeckyAnn Harker: So I'll go to the classroom, if they are in the middle of a project or a thing, I will stand there and I will help. I'll help my students. Sometimes it's a little bit of a waste of time because I'm... Kind of, I'm just listening and seeing what the teacher's doing, but I also know what's going on in that classroom. So then I can reinforce that if I end up pulling the students out, but sometimes I work right there. Sometimes we'll go in the hallway. I'm fortunate to have a couple of work rooms. So I have my office, but there's also a workroom on the other end of the hallway, the other wing. So I'll just pull a kid in there and practice for 10 minutes and then send them back. So it's kind of all of the above.

Speaker 1: Yeah. That's perfect. I love it. Thank you so much for helping us picture what that would look like a little bit more. And I think that's a really good overview of some of the different service delivery options that we might have available to us. And when we're getting strategic and helping students make more rapid progress and giving ourselves less paperwork. And so in the next episode, we'll dive into one of the biggest questions I think that we get is how do we actually navigate scheduling with this? Thanks for listening to the SLP Now podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episode sent directly to you. See you next time.

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#122: An Intro to Smarter Scheduling for School-Based SLPs

June 7, 2022 by Marisha Leave a Comment

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This Week’s Episode: An Intro on How to Schedule Smarter for School-Based SLPs

This month, we are diving into all things service delivery and tips and strategies to help us schedule smarter in the schools.

I am so happy to be having this conversation with BeckyAnn Harker. She is a school-based SLP near Youngstown, Ohio, and she has 24 years of clinic and school-based experience. She is currently a doctoral student in special education at Kent State University, and she’s very interested in caseload management and vocabulary intervention. For this podseries we will be focusing on her caseload management expertise!

I am just super excited to dive into this conversation. So let’s get to it!

Key Takeaways

Why BeckyAnn Changed her Service Delivery Method

✓ 100+ kids on caseload and felt like running through the motions
✓ Needed a new way to manage a caseload in the double digits
✓ RTI or Responsive to Intervention was the start of that solution

Why 30-minute group sessions aren’t best for the student

✓ Mixed Groups – Needs don’t get met
✓ Behavior management
✓ Activities take extra time

Why 30-minute group sessions aren’t best for our workload

✓The student is on our caseload longer
✓Causes extra stress, rigid groups, no flex for meetings
✓Extra paperwork

Additional Links

ASHA Leader: BeckyAnn Harker Can We Break From 30-Minute Group Sessions in Schools?

Next Up in this Pod Series

6/7/22: An Intro to Smarter Scheduling for School-Based SLPs
6/14/22: A Quick Review of Service Delivery Options for School-Based SLPs
6/21/22: How to Navigate Alternative Scheduling for School-Based SLPs
6/28/22: How to Start Using Smarter Scheduling for School-Based SLPs

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Transcript

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Speaker 1: Hello there, and welcome to the SLP Now Podcast, where we share practical therapy, tips and ideas for busy speech language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode.

Speaker 1: Hello there and welcome to the SLP Now Podcast. This month, we are diving into all things service delivery and tips and strategies to help us schedule smarter in the schools. And I am so excited to be having this conversation with BeckyAnn Harker. She is a school-based SLP near Youngstown, Ohio, and she has 24 years of clinic and school-based experience. She is currently a doctoral student in special education at Kent State University, and she's very interested in caseload management and vocabulary intervention. So today we'll be focusing all on caseload management. I found out about BeckyAnne in the ASHA Leader, so we'll link to that article as well. But I am just super excited to dive into this conversation. So hello, BeckyAnn.

BeckyAnn Harker: Hello. Thank you for having me here.

Speaker 1: Yeah. Thank you so much for taking the time to share your wisdom and expertise. Yeah, I'm really excited. And so I'm curious, can you tell us a little bit more about your story? How did you end up pursuing a doctoral degree and what got you to focus on caseload management?

BeckyAnn Harker: So my doctoral degree is probably mostly going to focus on vocabulary, which is not what we're talking about today, but that's okay. I work as a speech language pathologist, as you said, and I'm in the schools. I have worked in clinics and I've been in the school district a couple different times. I worked in Indiana many, many moons ago where I had 100 kids on my caseload and it was ridiculous. It was stressful. I would get to the end of the day and I would have no idea what I did that day. It was terrible. And I kept thinking then that something has to be better. There has to be some other way, but we were very locked into this 30 minutes, two times a week with 100 kids. It was insane and unreasonable as far as I was concerned.

BeckyAnn Harker: But since then I've worked back in the clinic and then I'm back in the schools. And I have often felt, and I think living in both of those worlds, that working in the school, you really cannot be the best therapist that you are. I have felt with all of the constraints, the time constraints, all the IEPs, all the minutes, all the kids that you have, I cannot do my best work there like I did in the clinic, where you have those children, one on one, you get to work with the families. I want to make it better. I want to make a difference.

BeckyAnn Harker: And so I ended up going back to school and it's in special education, mostly because that's the world I live in right now. And it's special ed law that we have to work under. And so I'd like to make things better just for kids all around, all of the kids, but especially my kids, and working on caseload management is just something that I've been trying to do forever just for myself. And so I feel like I've come up with maybe something that works. And so I thought maybe I would share that. And that's why I wrote that little article in the ASHA Leader. I was just trying to share some ideas.

Speaker 1: Wow. I love that story. And just sharing that was really special, so thank you. And I'm right there with you. I also had a caseload in the triple digits and yeah, it's really hard to operate at the top of our license when we're working within those constraints, you're absolutely right. And I'm so excited to see what you do with this.

Speaker 1: So let's start chatting a little bit about the ideas that you've had so far to start addressing this and start improving caseload management strategies in the schools. I think it makes sense to just chat about what the standard is at this point. So you mentioned that most of us are seeing our students, 30 minutes once a week, maybe twice a week, in groups. It gets pretty obvious that that would be difficult with a caseload of 100 students because our groups would get very, very large. Let's dig into some of the cons of using that approach.

BeckyAnn Harker: I am just not a fan of the group approach, and I'm not saying that I never see kids in groups, because I will sometimes. But the model I used to work from, was you would go to a classroom, that classroom might have three students that are mine. I will take those three students. One has articulation errors. One has language errors. One's working on all of the different things, right? And so I felt that by the end of my 30 minutes, sometimes those kids maybe practiced six times. And maybe that was me, but I just felt very ineffective. There were so many things that having the mixed group, even in that amount of time, you just couldn't get to all of them. One kid needed a little more time to work on his goal. And then the other one maybe did their sound and like two seconds, that's great, but the other one just took longer.

BeckyAnn Harker: So that was a problem. Behavior management becomes a problem, because now you've got three or four kids that you're trying to work with. And one, they get squirrly, they have to wait. They don't like to wait for that one. And then also you need some kind of game or activity. So then you think within that 30 minutes, even if you have three kids in that 30 minutes, that's 10 minutes per kid and you need to explain the game, make sure they're taking turns correctly, deal with it when somebody loses a turn or whatever happens. And then at the end, if you really gave that kid five good minutes of your time, that's probably stretching it. So I was very frustrated by that.

BeckyAnn Harker: And so some of the things I had looked into... So RTI was really where I started was trying to harness RTI. I saw Jennifer Taps speak at a conference one time. She's kind of the big RTI guru, so shout out to her. But I really liked the thought of that, you're still seeing students. And I think we have to be careful because there is a chance too, you could just do RTI and not give kids services if they really need them, and I am not saying to do that. Obviously, if a kid needs services, they need services. But think of your articulation caseload and how many of them are the R sound? How many of them are maybe just one or two articulation sounds, that when you really look at it and you weigh all the options, all the criteria to qualify for services, is it really a disability? Is it really impacting their academics or their education? And sometimes it does. And then for sure, those kids might need an IEP.

BeckyAnn Harker: But I still feel like this is our job to help these kids because we also don't want these kids graduating from high school with R sounds that are not correct, if we can help it. So RTI is one way that these kids are not on our caseload, but they're on our workload. And so there's that whole workload caseload thing that we're supposed to all be doing. But from what I have read, I think 70% of us are not doing that, really looking at our workload, instead of our caseload. So those kids count as your workload, but really that will get your numbers down, and then you don't have all of the extra paperwork that goes with writing IEPs and ETRs and those dreaded progress reports, so that's kind of where I had started.

Speaker 1: Yeah. So just to recap, if we're seeing more students, in RTI, we have less of that paperwork up front and throughout the whole process. It's possible that some of these students, I've done this before, where I was getting a bunch of referrals, so I was trying to move through things quickly and I qualified some students and there's one student in particular that stands out to me. We started therapy and he just blew through his goals so quickly and its like this could've absolutely been an RTI student. And yet, I spent all of this time on the paperwork, it's going to take more paperwork and more time out of the classroom to get him out, and in the meantime, he has a special education label. That's not benefiting anyone.

BeckyAnn Harker: I've seen that happen, even with some language kids too. You see those kids sometimes once, to get your testing done. And then you're like, "Well, he didn't score so well," and then you qualify them. And then, a few months into this, you're like, "Yeah, this was really not a language disorder." And then you kind of have this kid, at least until the end of the IEP and maybe longer. So I believe in trying to utilize... Our schools have this system set up, we should be using it, in my opinion.

Speaker 1: Yeah. And there's absolutely ways to do that. When I saw that happening, I was like, "Wait, no, that was a huge red light." And so I started looking into RTI more and we worked on building the team at the school where they had to document different interventions. We don't have enough time to dive into all of that in this chat, that might be a really fun follow up. But there's absolutely things that we can do so that it benefits our workload and caseload management, but then also it's better for our students. So yeah, I love it.

Speaker 1: So to wrap up this initial discussion, because we talked about how we typically schedule students, why that's not best, necessarily. And then, we also touched on why it's not best for our workload because of the paperwork. Is there anything else that you would add there in terms of how that impacts our workload, when we're using that approach?

BeckyAnn Harker: The RTI approach?

Speaker 1: When we're doing the traditional 30 minutes once a week in groups.

BeckyAnn Harker: So I think the other thing is just about scheduling and I know, this has just happened, right? So you have back to back, 30 minute sessions all day long, it looks great on paper that you can get all these kids seen. And then how many IEP meetings do we have, that we then have to cancel those kids? And then you're scrambling for minutes and you're scrambling for time and schools don't run as smoothly as it looks like on paper. So I think just trying to come up with some other ways to handle our schedule, to handle the minutes that we see our kids, RTI is certainly one way, but there's other ways too, because we're still left with a whole bunch of kids on our caseload. I try to come up with some other ways to manage the time that I have with those kids.

Speaker 1: Perfect. So I think this is the perfect introduction to what we're going to be spending the next several weeks talking about. So stay tuned for next week's episode, where we dive into a review of the different service delivery options and what it could look like to actually start navigating this. Thanks for listening to the SLP Now Podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episode sent directly to you. See you next time.

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#121: A Crash Course in Sensory Strategies for the SLP: The Optimal Learning Zone

May 24, 2022 by Marisha Leave a Comment

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This Week’s Episode: How to Find the Optimal Learning Zone

This month I have had the pleasure of chatting with Jessie Ginsburg. Jessie is the founder of Pediatric Therapy Playhouse, a multidisciplinary clinic in Los Angeles. She has shared so many good tips on a topic that she is so passionate about: Sensory Strategies for SLPs.

Jessie set us up with the importance of why SLPs should understand sensory processing in the speech room. Then we dove into the importance of the SLP’s role in sensory processing in the speech room and how we can help regulate our students and make them comfortable with us. Last week we discussed the different levels of arousals.

Today our crash course in sensory strategies for SLPs comes to an end. As we wrap up, Jessie will talk to us about the optimal learning zone and then we will recap our month’s discussion.

In Jessie’s recap, everything comes together nicely and we hope that some of these tips inspire you to implement sensory strategies in your therapy sessions.

Let’s dive in!

Key Takeaways + Topics Covered

Strategies for bringing your clients into their optimal learning zone (37m)

✓Identify the child’s level of arousal
✓ Identify your own level of arousal
✓ Co-regulation is important – put out your own energy (the opposite of where your student is)

Touch – tickling is more alerting than rubbing back softly
Vestibular – moving slowly/rhythmically (calm) vs. spinning
Auditory – sing hello (quietly/slow if high arousal with deep hug, sing fun and loud and silly with spaghetti arms)
Lights – sensitivity to light can cause dysregulation

Additional Links

Jessie Ginsburg on Instagram: @jessieginsburg.slp
STAR institute (sensory-related trainings)
Jessie’s Sensory Certificate Program

Next Up in this Pod Series

5/3/22: A Crash Course in Sensory Strategies for the SLP: The Why
5/10/22: A Crash Course in Sensory Strategies for the SLP: Our Role
5/17/22: A Crash Course in Sensory Strategies for the SLP: Levels of Arousal
5/24/22: Crash Course in Sensory Strategies for the SLP: The Optimal Learning Zone

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Transcript

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Speaker 1: Hello there and welcome to the SLP Now Podcast, where we share practical therapy, tips and ideas for busy speech language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode. So let's dive into some strategies that we can use to bring our clients into the optimal learning zone. And I assume it'll be a combination of noticing their level of arousal and reacting accordingly. But you're the expert here. So what do we think about when we start looking into strategies?

Speaker 2: I think that some of the most important things to think about are of course, like you said, identifying the child's level of arousal and where they are. And the step after that is identifying your own level of arousal. Because as we know, co-regulation is so important. We always expect the kids are going to be able to self-regulate. Like, "You go take care of that problem on your own and come back when you're calm." The world doesn't work like that. We need people to help us regulate.

Speaker 2: So when we come into a session and we are already stressed, or we already have a high level of arousal, and we're overwhelmed, we cannot regulate a child when we are not regulated. This is true in all situations. It could just be at parenting. If you're a parent you've been there, where you're so frustrated with your kids and you know that you need to go take a breath before you go and you talk to them any further because you need to regulate yourself.

Speaker 2: So if we have a kid who comes in with a high level of arousal, we're overwhelmed and anxious and our level of arousal is high, we really need to get ourselves in check, figure out what you can do. And for me, I think what works best is just figuring out how to take the pressure off. Because I think a lot of our heightened anxiety, I guess you could say, comes from putting a lot of pressure on ourselves to have the perfect session or do the perfect thing, or have all the answers or get everything done we wanted to get done. So I think for me, if there's times where I'm really stressed in a session, I just have to tell myself, "My goal here and getting back to what we talked about initially is how can I connect with this kid? How can I get this kid see-saw balanced?" And once you really put that in the forefront of your mind and as your primary goal in therapy, I think that helps us regulate. At least that's something that would help me.

Speaker 1: Yeah. I love that as a strategy to help us regulate, because I think that's so true that if we're stressed and if we're dysregulated, we won't be able to help our students regulate.

Speaker 2: Yeah. And energy's contagious. It's like... I don't know, are you into sports?

Speaker 1: My fiance is, so I guess I am, by proxy, a little bit.

Speaker 2: Yeah. Okay. So I am not at all. I'll go to games so that I can get a soft pretzel. That's my level of enthusiasm.

Speaker 1: Yes. I love it.

Speaker 2: But it's like, you might go to a basketball game or a football game and the home team scores and everyone's on their feet cheering and all of a sudden I'm up cheering too. And I'm like, "Yeah, we got this." And it's not even that I care. It's just, energy's contagious. So when we go into those situations with that high level of energy, we end up there as well. And the opposite's true too. Like if you walk into work on a Monday morning and your coworkers are sitting around just like miserable talking about how horrible their weekend was, pretty soon you're going to feel pretty bad too. So I think just keeping in mind that the approach is very counterintuitive so that when we do have a kid who comes in with a high level of arousal, our job is to really calm them versus having a kid who comes in with a low level of arousal, our job is to give them more alerting input.

Speaker 2: And this could be done, like we've talked about, through the energy that we're putting out ourselves, but it can also be done through sensory activities. So just some really easy, I guess you could say rule of thumb for those of you who want to learn more about integrating sensory strategies, in general, when we're thinking about different sensory systems and we want to figure out, can this activity be calming or can it be alerting? You can think about the level of intensity of the sensation. So if we're looking at tactile input, which is touch, something that's going to be alerting is going to be a more intense tactile input. So whether that means like textures that are sticky or rough, or just have a higher degree of stimulation just by nature, or it could be something like tickling is going to be a more intense type of tactile input than rubbing someone's back softly.

Speaker 2: And you could really start to go through all of the different sensory system to think about, "How could I use this type of input in a calming way versus how can I use it in an alerting way?" So if we're looking at vestibular input and we're trying to use movement, if we are moving a child slowly and rhythmically, that is going to be a more calming and less intense type of vestibular movement than spinning the child with auditory input.

Speaker 2: If we are singing Hello, that's my favorite time to start working on either calming or learning input is just from the second the kid gets in the room, we've got the Hello song, that's the perfect time. So if we have a kid who's high arousal, we might sing the Hello song really quietly. We might even whisper it. We might sing it really slow and rhythmically while giving a child big, deep calming hugs or something like that, or squeezes on their arms.

Speaker 2: Versus if we have a kid who comes in, who has really low arousal, we might sing the song really fun and loud and silly. And I don't know if you know what spaghetti arms are, but that's like my go-to or you take the child's hands and you kind of give them a shake, like little spaghetti noodles. I think that's one of the easiest, but also trickiest things about sensory is that all the activities we do, they could almost all be done in a calming or in alerting way just by how they're done.

Speaker 1: Yeah. That makes a lot of sense. And do you ever do anything with lights or have you found that to be a helpful strategy?

Speaker 2: Absolutely. The funny thing about lights... I don't know funny is the right word, interesting thing I guess is that, if kids have sensitivity to light, that could be something that is causing them to be dysregulated, that is something that you may not even and have realized. They might come into the room and the lights might be so bright, but it's not something that you've even thought about. And it may not be something that they even realize is so dysregulating for them either. So they can't tell you.

Speaker 2: But in our office, we've got these magnetic light covers and it's like a cloth that you can put on top of the lights to soften them, which we really love. But we also will often turn off the lights completely in order to help kids calm. Or if kids really love lights and they love that visual input, then really using a lot of toys or activities that have lights in them. So it could be the opposite as well.

Speaker 1: It's such a cool way to think about this, because like you said, any activity can be modified. Like I love the example that you gave with a Hello song. We can easily modify that. And I feel like after practicing this a little bit over time, I'm sure you just automatically you start to make those adjustments without even thinking about it.

Speaker 2: Definitely. It's something that, I think with anything else... Like I've had a business coach tell me, "You can't always work in your business. You always have to make time to work on your business." Have you heard that?

Speaker 1: Mm-hmm (affirmative) Yep.

Speaker 2: So it's the same thing as our therapy. It's like, we're always in the weeds of our therapy, but if we don't sit back and take time to really work on our therapy, then the, in our therapy part is never going to be easier or better. One of my favorite things, which I know probably most of us hate to do is videotape my sessions because that's where I get to see things that I would've never noticed. I love to watch them back and there's things that you will see when you video yourself that you just did not realize when you were in the moment. So being able to go back, review that, look at a child's sensory profile, go through each of the sensory system, make a plan for things you can try. And it's fun.

Speaker 1: Yeah, absolutely. And I think with video, modeling can be... it's a little different. Like I've used that with some social groups and just like letting them see themselves on video, they're like, "Oh, I do that?" And it's just like a huge light bulb moment and it changes a lot of things. But I feel like I've had that exact same experience, like seeing myself on video and even just seeing the session through a different lens because there's so much going on in this session. We might miss the little cues that clue us into, "Oh, maybe they are sensitive to lights and that's what's causing that dysregulation." There's those types of things that we start to see that we might otherwise miss.

Speaker 2: Yeah. And it's so funny, for those of us who work in early intervention, I think that that strategy is really common. Ask parents at least to take videos of themselves at home. I know in certain programs like [inaudible 00:10:23], it takes two to talk. That's a really big piece of it. It's funny because we go and we make these requests from parents and then many of us shy away from doing that ourselves.

Speaker 1: Yeah, definitely. If you're not used to doing it is a little bit being your own observer, I guess, getting an observation from an admin or something.

Speaker 2: And you know what's funny is I look back on videos where in the past long time ago I would've taken videos and if it wasn't demonstrating exactly what I wanted to demonstrate, I wouldn't even keep the video. I would just go, "Oh, I'll try next session to get that." But now going and presenting and trying to train SLPs, I'm like, "I wish I had all of those epic fail videos. Those are so valuable. There's so much to teach from them." In fact, I have a video I use when I present of me as an SLPA, just like the most embarrassing video of all time. I'm making a fool out of myself and just not able to get this little guy engaged at all. But I feel like it's those videos that are the ones that we truly learn from.

Speaker 1: Yeah, no, that's so powerful. I love that.

Speaker 2: Yeah. There's a lot to learn always.

Speaker 1: And we'll never be done learning. It'll be a lifelong journey.

Speaker 2: Mm-hmm (affirmative).

Speaker 1: Let's do a quick recap of kind of where we went through this little series. So we started off talking about why SLPs need to understand sensory processing. And I love how you shared about The Whole-Brain Child. That book as a resource and the downstairs and upstairs brain and kind of setting the stage for helping our students feel safe and secure. And just taking the pressure off and helping them get regulated so that we can engage in all of the cool language stuff and all of that. So is there anything that you would add there or highlight?

Speaker 2: Yeah, I think that's the most important thing at the end is that really getting them in a place where they're regulated and just being able to explain that to parents and teachers and everyone that we're working with.

Speaker 1: Yeah. So that little summary kind of loops really nicely into the SLP's role because we can always make a referral to OT if we're seeing a student who is dysregulated, but if we have tools that allow student to access this session and participate and really engage with us, then I don't see why I would not do that. I feel like that's just a pretty clear reason. So yeah, I think that helped me to wrap my head around the SLP's role and you shared some really great resources that we can use to learn more. But I'm super excited about your sensory certificate program. I feel like that's such a cool way to guide SLPs into where we need to go for that.

Speaker 2: Yeah. I honestly had no idea if it was going to be a need for people. And I was just blown away by how many people wanted to learn more. And I felt like that's really what validated the idea for me is all these people coming out from literally all over the world we've had people trained in this program now. And it's really cool because it's so much greater than just how can we make a difference in our sessions and how can we better engage and help our kids learn language?

Speaker 2: This is so much more about how can we very slowly but greater changes in how therapists are doing therapy all over the world so that our autistic kids are not only getting the best services, but getting access to all these resources about how they can feel comfortable in their own body and know what their needs and how to get their needs met and be able to advocate for themselves and trying to open the world to more neurodiversity affirming therapy approaches.

Speaker 1: Yeah. There's a much bigger context than just participating in whatever book activity we have planned for the day. Yeah, I think that's super empowering and really exciting to get to be a part of.

Speaker 2: Yeah. Yeah. There's a lot I think we can all do to do our part. Spread the word.

Speaker 1: Thanks for listening to the SLP Now Podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episode sent directly to you. See you next time.

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#120: A Crash Course in Sensory Strategies for the SLP: Levels of Arousal

May 17, 2022 by Marisha Leave a Comment

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This Week’s Episode: Understanding the different Levels of Arousal

This month I have had the pleasure of chatting with Jessie Ginsburg. Jessie is the founder of Pediatric Therapy Playhouse, a multidisciplinary clinic in Los Angeles. She’s also contributed in a bunch of publications. You’ve probably seen her in the ASHA Leader.

So far in the series: Crash Course in Sensory Strategies for the SLP, Jessie has set us up with a strong foundation on why it is important for SLPs to understand sensory processing.

Last week we chatted about the SLP’s role in implementing sensory processing in the speech room and how it is OK to decrease demands and focus on regulation.

I’m really excited to continue to conversation with Jessie. This week we discuss the different levels of arousal and how to find a balance so that the student can become regulated and feel safe and regulated.

Let’s jump in!

Key Takeaways + Topics Covered

✓ Sensory Preferences Assessment is a good place to start, but not the end all, be all
✓ Often refer to OT if a student is dysregulated but SLPs can work on this too!

How SLPs can work on dysregulation in the speech room

✓ Look at the Level of Arousal – many kids are not at the optimal level (needed for language)
✓ Figure out where the student is at
– Are they high energy?
– Are they passive, low affect, slow?
✓ Come in with the opposite level of arousal and create that balance

Additional Links

The Whole Brain Child by Daniel J. Siegle and Tina Payne Bryson
Jessie Ginsburg on Instagram: @jessieginsburg.slp
STAR institute (sensory-related trainings)
Jessie’s Sensory Certificate Program

Next Up in this Pod Series

Subscribe & Review on iTunes

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Transcript

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Marisha : Hello there, and welcome to the SLP now podcast, where we share practical therapy tips and ideas for busy speech language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode.

Marisha : Hey there, it's Marisha, and today we are continuing our series on sensory strategies, with Jesse Ginsburg. In episode 118, we talked about the why, and 119 talks about the SLP's role in sensory strategies. Episode 120 talks about levels of arousal, and episode 121 talks about the optimal learning zone. If you're listening a little bit later in the series, definitely head back to 118 to get a really nice foundation, before we dive into the other areas. If you want to access the resources for any of these episodes, you can go to SLPnow.com/, and add in the number of the episode. SLPnow.com/118, or /119, and that's the easiest way to access those resources. Without further ado, let's get back to the content.

Marisha : You talk a lot about levels of arousal. Can you walk us through a little bit of a framework that SLPs might be able to use, as maybe a little bit of a crash course?

Jesse Ginsburg: Absolutely. This is one of those things that I learned very early on. I learned this when I was an SLP assistant, and it completely transformed the way that I looked at kids. As I went through grad school and internships, I could not believe this was not something that was really taught to SLPs. I think what happens is, a couple things. One is that, when people want to start integrating sensory strategies, they're like, "I know what I'll do: a sensory preferences assessment! That will solve all my problems, and I'm going to get all the information I need." Which, don't get me wrong, I love a good sensory preferences assessment. That is definitely part of my program and what I teach. It's not the end all be all. Knowing what a kid likes or dislikes is not the end all be all.

Jesse Ginsburg: The other thing is that, there are such limited resources, we feel like there are at least. When we have a kid who comes into our session dysregulated, the only thing we can think of to do is refer to OT. "Send him to OT, and then he'll get his OT 30, 60 minutes a week, and then he'll be regulated all the other 23 hours of the day," which we know is not the case. There have to be ways that we could work on this ourselves, too. One of the ways that I started to learn to look at kids, which I had learned through co-treating with OTs many years ago, was to look at the child's level of arousal. What we see a lot with our autistic kids, because research shows between 69% and 95% of autistic adults have sensory differences, that means that we need to be really competent in understanding it and what we can do.

Jesse Ginsburg: This means that our kids are a lot more likely to not be in this optimal level of arousal, which we've talked about is where kids really need to be in order to process language and learn in the most efficient way possible. What's really common is, we might see kids who either have a low level of arousal, or a high level of arousal. I like to say, think of Tigger and Eeyore. Eeyore is passive, low affect, low energy. Eeyore has a baseline low level of arousal, versus Tigger. Tigger is constantly on the move, high energy. He has more of a baseline high level of arousal. It's really common that we'll see kids who have a baseline that is either a lower or a higher level of arousal.

Jesse Ginsburg: Our job is to figure out where that kid is, and just by describing the Tigger and Eeyore, you and anyone listening could probably think of some kids right off the bat that they see. In the ASHA article that I just wrote, this last November is when it came out. I talked about this true story, and I feel like we all have stories like this, but I have this little girl I used to see Thursdays at 4:30 PM, and it was the last kid of my day. I would always sit there, waiting for her to barge through the door. We have an electronic check-in, but they never got to do that, because she would zip right into the clinic. She would get into my food leftovers on my desk, start taking bites of things that I've had out since lunch, or coffee, whatever it is. Climb my bookshelf. She was always looking to get this pink kinetic sand, which is the biggest nightmare in the world to clean.

Jesse Ginsburg: That was always her goal, was to get to the top shelf of the bookshelf, where I keep the pink kinetic sand. It was this session where you can imagine this little girl has such a high level of arousal, and she would come into sessions, and I would immediately be dysregulated. It's hard and stressful to keep up with a kid who has such a high level of arousal, or it can be. I put so much pressure on myself, I was like, "The only way I'll engage her is if I out-fun her. I have to be more fun. I have to have more energy. That's the only way I'm going to get her to engage with me."

Jesse Ginsburg: I learned the hard way that, that was the complete opposite of what I should have been doing. What we want to do, in reality, when a kid has a high level arousal, we want to come in and be more of a calming source for them, so that we could bring them down to a more optimal level. It's very counterintuitive to come in with the opposite level of energy than the kids we see. The same thing goes for kids who have low level arousal. If they come in and they're calm, we tend to feed off their energy, and we calm down and chill out too. In reality, they really need some more alerting, exciting, high energy type of inputs, to bring them up into their more optimal level of arousal.

Marisha : Yeah, that makes a lot of sense. Have you had any examples where maybe it's not as obvious if they're at the high or low levels, or is it always pretty easy to tell else?

Jesse Ginsburg: Kids can definitely have a mixed level of arousal. I get that question a lot. I find that kids have a baseline, to tend to be toward one or the other. I think the biggest thing that might trip people up is that they might picture a kid who is low arousal just sitting there, like a bump on a log, when that is how a kid with low arousal will always present. Will they sometimes? Sure. For other kids, they might have a low level of arousal, but they're still moving around a lot, but it's more of a wandering, slow, aimless type of moving, from what I normally see with my kids, rather than this high energy, going between activities really quickly, moving really quickly.

Marisha : Yeah, that makes sense. The lower level is, we'll probably still see movement, not a bump on a log, like you said, but it's more slow and aimless. Whereas, the high energy will be moving through activities really quickly.

Jesse Ginsburg: Yeah. If you think of our lowest level of arousal, which we all go through different levels of arousal throughout the day, is usually when we wake up. We're sleeping, that's us completely zoned out, versus the highest level arousal we would be in is more of this fight or flight type of response. We tend to be a lot more anxious when we're at the top, really high level of arousal.

Marisha : Thanks for listening to the SLP now podcast. If you enjoyed this episode, please share with your SLP friends, and don't forget to subscribe to the podcast to get the latest episode sent directly to you. See you next time.

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#119: A Crash Course in Sensory Strategies for the SLP: Our Role

May 10, 2022 by Marisha Leave a Comment

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This Week’s Episode: The SLP’s role in Implementing Sensory Strategies

Last week Jessie set us up with the importance of why SLPs should understand sensory processing in the speech room and I’m excited to continue the conversation!

Today we will discuss the SLP’s role in sensory strategies as this is typically reserved more for OTs.

Let’s dive in and get to the good stuff, shall we?!

Key Takeaways + Topics Covered

✓ The SLP’s energy plays a big role in helping regulate the student
✓ Sensory integration is meant to make long-term changes in the sensory system
✓ Different than using strategies to make sessions more effective
✓ Use a Seesaw as an example. It can tip (signs of dysregulation)

🌟 Decrease demands and focus on regulating 🌟

Additional Links

Jessie Ginsburg on Instagram: @jessieginsburg.slp
STAR institute (sensory-related trainings)
Jessie’s Sensory Certificate Program

Next Up in this Pod Series

Subscribe & Review on iTunes

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Transcript

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Marisha: Hello there and welcome to the SLP Now Podcast, where we share practical therapy tips and ideas for busy speech language pathologists. Grab your favorite beverage. And sit back as we dive into this week's episode.

Marisha: Hey, there it's Marisha. And today we are continuing our series on sensory strategies with Jessie Ginsburg. So in episode 118, we talked about the why. And then 119 talks about the SLPs role in sensory strategies. Episode 120 talks about levels of arousal and episode 121 talks about the optimal learning zone. So if you're listening in a little bit later in the series, definitely head back to 118 to get a really nice foundation before we dive into the other areas. And if you want to access the resources for any of these episodes, you can go to slpnow.com/ and then just add in the number of the episode. So slpnow.com/118 or slash 119, and that's the easiest way to access those resources. So without further ado, let's get back to the content. What would you say to SLPs who went to grad school and started working in a school, they didn't sign up for the program at USC, like how do you think that changes things? What do you think our role would be? And then maybe how can that role change as we do additional learning?

Jessie Ginsburg: Yeah, definitely. I think that with sensory processing it's like any other training that you would do post grad school. Most of us don't get a course on feeding therapy. Most of us have to go out after school and seek those additional courses and trainings in order to feel like it's ethical for us to work on that. So the training that I did through USC was called [inaudible 00:02:05] sensory integration and sensory integration is meant to create long term changes in the sensory system. That is separate than the idea of using sensory strategies.

Jessie Ginsburg: Our goal as SLPs is how can we use sensory strategies in our session just to change the child's level of arousal, trying to get them into a regulated state so that we can have more effective sessions. So I think that it's up to us to go out there and do these trainings, which I've tried to make a lot more accessible to SLP. Recently, I did a free sensory intensive that was four days long, teaching a lot about getting started with sensory. Yeah. Like you mentioned, I've written for ASHA about how we can start integrating sensory into our treatment. So there's definitely a lot to learn, but there's a lot that we could do and get started with really quickly.

Marisha: Yeah. That absolutely makes sense. And you gave some examples when you were sharing more of your story and it's totally fine if we repeat some of those examples, but can you illustrate a little bit about what that could look like in a typical session?

Jessie Ginsburg: Yeah. I'll give you an analogy that I use with parents and when I train therapists of this, I call it the sensory seesaw. But if you picture a seesaw and in my head, I just picture like a line with a triangle underneath it, right? Very basic, like seesaw is how I would draw it for parents in sessions. And I explained to them that a balanced seesaw represents a regulated child. This is when the child is in what I call their optimal learning zone. They are regulated, their body is ready to learn. And when we can get them in that optimal learning zone, that's where we want them to be in our sessions in order to get the most out of the session. So if you picture a tipped seesaw that would represent a dysregulated child. So when we see that our kids seesaws are tipping, so if we start to see little signs of dysregulation in our session, what is our goal in that moment?

Jessie Ginsburg: Is it to continue on with the activity at hand and continue to put demands on the child and let the seesaw tip further and further and further down, or is it to decrease demands, focus more on regulating and get the child back to a balanced state? And to me the answer is obvious that it is our job to bring the child back to this balance state of regulation. But I think if we always kind of have that visual in our minds of the seesaw. And where is the child in our session? Is the seesaw balance? And if not, what can we do to get him back there? And I've presented a lot with Jake Greenspan who's the son of Dr. Stanley Greenspan who created floor time.

Jessie Ginsburg: So we've talked a lot about kind of integrating floor time strategies. But something that he's mentioned before that really resonated with me is that for some kids, and the way I put this into my seesaw analogy is like, imagine the triangle and the seesaw wasn't in the middle. Imagine it was like to the left. And that means that maybe you can have a negative experience on one side, which tips a seesaw over so far, but it's not just going to take one positive experience to bring that seesaw back to center. It might take five, six positive experiences to bring that seesaw back to center.

Jessie Ginsburg: So I think that we can think about that in terms of the demands that we're putting on kids, is that when we do see that a child is dysregulated, it doesn't just mean that we could do one thing that they're going to enjoy to bring them back to center. It really might take a lot more positive experiences than that. So that's why the idea of like, how can we try to keep this child seesaw balance as much as possible when we see signs of it tipping, bring it back to center instead of letting it tip over all the way.

Marisha: Yeah. And I love that visual of the triangle and the seesaw moving because that can help put it into perspective a little bit. And even if that triangle is right in the middle, it might still take more than one positive experience too.

Jessie Ginsburg: Yeah, definitely. And I think like if we take the pressure off of ourselves to get whatever task done that we've got laid out for the session, and instead, how can we keep that seesaw balanced? Like what could we do in this session? How can we balance our demand so that we could keep this kid regulated, keep that seesaw balanced? Your therapy is going to look completely different if that becomes the focus of your session.

Marisha: Yeah. So if an SLP is interested in learning more and like really being able to feel more confident in their role with these strategies, what are some resources that you would recommend?

Jessie Ginsburg: There's a lot of resources that are not meant for SLPs. So there's a lot of trainings online. There's an Institute called the STAR Institute, which has all sensory related trainings. And then obviously there's these way longer, more expensive programs like the one that I went through at USC. But that's honestly like where my sensory certificate program came about was from this realization that I needed and SLPs needed these resources and they didn't exist for us.

Jessie Ginsburg: When I went through all of these courses, I learned so much, but a huge amount of it was completely irrelevant to me as an SLP. When I was in my courses, I was writing handwriting goals. Like it was not stuff related to what I was doing in speech. I had to actually go through all of that coursework and pull out the things that were related to what I was doing and then try to draw the connections. So I do still think the resources are really limited, which is why I ended up creating a program to teach SLPs about it, but also started doing a lot of free training for those who couldn't commit to the full program.

Marisha: Yeah. No, that's super helpful in knowing where we can potentially look. And I think that your Instagram account is also a great place to kind of start dabbling a little bit. The program is another amazing resource, if you are super ready to dive in.

Jessie Ginsburg: Yeah.

Marisha: Thanks for listening to the SLP Now Podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episodes sent directly to you. See you next time.

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#118: A Crash Course in Sensory Strategies for the SLP: The Why

May 3, 2022 by Marisha Leave a Comment

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This Week’s Episode: Why SLPs Need to Understand Sensory Processing

I am so incredibly excited to have Jessie Ginsburg joining us today. We are in for such a treat. Jessie is the founder of Pediatric Therapy Playhouse, a multidisciplinary clinic in Los Angeles. She’s also contributed in a bunch of other publications. You’ve probably seen her in the ASHA Leader.

I brought Jessie on today and I’ve asked her to share some really amazing tips that I’ve been able to use and implement with my caseload.

Today is a crash course in sensory strategies for the SLP and we’ll break it into four segments for this month’s podcast series.

We’re going to start off this week’s episode by chatting about why SLPs need to understand sensory processing. I’m really excited for you to hear a little bit about Jessie’s story, because I think she has a really amazing journey and I’m excited to share that with other SLPs.

Let’s get to it!

Key Takeaways + Topics Covered

✓ Transform your session with the unconventional by taking into consideration your child’s sensory needs
✓ Saw transformations when co-treat with OT (sensory strategies)
✓ Jessie got her Sensory Integrations Certificate USC which is typically only for OTs with graduate degrees – but she was able to sneak in and now she has a passion to teach SLPs to implement strategies

The Whole Brain Child by Daniel J. Siegle and Tina Payne Bryson
>> When our brain gets dysregulated it’s like a seesaw isn’t balanced
>> downstairs brain – automatic responses
>> upstairs brain – language
>> When we are dysregulated some kids get trapped downstairs
>>How do we help our kids feel safe and secure and regulated? Keep the pressure off of the activity at hand and all of these other skills can come out.

Additional Links

The Whole Brain Child by Daniel J. Siegle and Tina Payne Bryson
Jessie Ginsburg on Instagram: @jessieginsburg.slp
Jessie’s Sensory Certificate Program

Next Up in this Pod Series

Subscribe & Review on iTunes

Are you subscribed to the podcast? If you’re not, subscribe today to get the latest episodes sent directly to you! Click here to make your listening experience auto-magic and as easy as possible.

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Transcript

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Speaker 1: Hello there and welcome to the SLP Now Podcast, where we share practical therapy tips and ideas for busy speech language pathologists. Grab your favorite beverage, and sit back as we dive into this week's episode. Hello there, and to the SLP Now Podcast. I am so incredibly excited to have Jesse Ginsburg joining us today. We are in for such a treat. Jesse is the founder of Pediatric Therapy Playhouse, a multidisciplinary clinic in Los Angeles. She's also contributed in a bunch of publications. You've probably seen her in the ASHA Leader. She's done tons of different presentations and she also has an amazing series of courses now, right Jessie?

Jessie: Actually the first one was discontinued so that we could focus on the recent one.

Speaker 1: Oh, awesome. So maybe if we have a little bit of time, we can dive into that, but I brought Jessie on today... If you don't follow her on Instagram already, you definitely should. But she shares some really amazing tips that I've been able to use and implement with my caseload. And so I was like, "We just have to share this with more SLPs." Today is a crash course in sensory strategies for the SLP and we'll break it into four segments. So we're going to start off just by chatting about why SLPs need to understand sensory processing. And I'm really excited to hear a little bit of your story, Jessie, because I think you have had a really amazing journey and I'm excited to share that with other SLPs.

Jessie: Thank you so much for having me. I'm so excited. And I know I was telling you this before we started recording, but I'm just so impressed. And I feel like you were just one of the first to get out there and do an SLP podcast and it's lasted for so long. It's so awesome to see you continue to do it.

Speaker 1: It's been a lot of fun. I love nerding out and getting to talk to really cool people like you, so it's just much fun for me as it is for the SLPs who listen.

Jessie: Yeah, definitely. And I know we've talked a lot recently because I think... Did you come to one of my free sensory intensives?

Speaker 1: Yeah. I signed up for one of your courses.

Jessie: The sensory course?

Speaker 1: It's the ASD from the inside out. I don't know if that's the one that you discontinued.

Jessie: Oh yeah, that was beforehand. Oh, how cool. Okay. I didn't even know that, but I really have gotten into the sensory world because I've just have seen such a need for SLPs to better understand this topic. And it's funny when we talk about how we get started in our journey, like you were mentioning, and I don't know if you feel like this too, where it's like one coincidence in your life has led to the next and all of a sudden you wake up and here you are.

Speaker 1: 1000%. I can totally relate to that. I've never phrased it like that, though. I love that. Just the coincidence, and then you wake up and...

Jessie: It's funny because I was just listening to a podcast last week and they said, "You're just one decision away from changing your entire life." And I thought it's so funny, but ironic how you don't know what those decisions are in the moment, it's something that you come to find years later when you look back on your life. Do you watch The Office?

Speaker 1: I've watched a little bit of it. It's been a while though.

Jessie: This was reminding me of one of the characters, Andy, the name in real life is Ed, I think. He was in The Hangover, the one who lost his tooth in The Hangover, but there was this reel that was going around Instagram recently that was a very popular audio and my partner, Chris pointed it out to me. I didn't know it was from The Office, but the phrase of the audio was, "I wish there was a way to know you were in the good old days before you've actually left them." That was good, but it kind of same thing. It's like you don't really realize in your life, these defining moments that are always happening to you until you look back and then all of a sudden you're where you are and you come to appreciate, and it's usually the tough times too, that are those defining moments.

Speaker 1: Yeah, absolutely.

Jessie: So when I graduated college, I, like many people had no idea what I wanted to do with my life. I wasn't convinced yet that I wanted to go into speech, but I had enough hours to get my SLPA license, my assistant license, because at the time it was just having a matter of observation hours and you could apply for your license. It was a lot different then. So I went and I'm looking for jobs all over Los Angeles, sending out my resume, getting almost zero interviews. But I got one at this multidisciplinary clinic and they brought me in for the interview. They were giving me a tour of the clinic and they said, "Here's our gym where we do OT. Here are the rooms we do speech. Here are the rooms we do floor time therapy. And if you work here, you will also be doing, in addition to speech, you'll be doing floor time therapy. You know what that is, right?" And I just smiled and nodded then I accepted the job on the spot because it was my only offer out there. I wasn't going to waste that opportunity.

Jessie: And then I get home and I Google 'what is floor time therapy?' Never heard of it. That is really one of those moments where if I had never taken that job and never jumped into floor time, there's no way I would be where I am today, doing what I'm doing today. Because for those of you listening, who aren't familiar with floor time, it's a really common therapy for autistic kids and all kids really. But it's just about supporting kids socially and emotionally, and really not only helping them regulate and develop engagement and language, but really helping them learn how to think for themselves, unlike other therapies where it's very prompt dependent. Floor time is all about helping kids to really think for themselves without relying on other people, to be prompting them all the time. That job was just a huge learning experience for me.

Jessie: And there's this little boy that I worked with and I still am in contact with his mom, but he was a three year old boy. He was not speaking. He would come into the clinic, just run through the clinic, run in everyone's therapy rooms. Everyone knew this kid because this was a kid that would just run in, pop in on anyone's therapy to go in, grab a toy out of their room. He was just very, very busy. And I saw him for floor time therapy. And I should mention that our sessions were three hours long. Have you ever heard of such a thing?

Speaker 1: That is a very long session.

Jessie: So it was a long session with this boy that I felt completely incompetent in treating. And then what the clinic would do is they would choose kids that they wanted to see and show footage to all the supervisors in the clinic. There were maybe 15 supervisors. So they said, "Hey, Jessie, we really want to see a clip from this kid's session." And I said, "Are you sure? Because I don't know if this is the best choice of a child." I mean, this was absolutely the hardest kid I was working with. I ended up filming and getting this incredible clip of him jumping off the little therapy table into my arms. And he was so engaged and he was having so much fun and we were just so connected. It was this beautiful moment looking back on and watching it.

Jessie: And I was so excited to submit it to them. I was like, "Oh my gosh, no one's seen him like this. This is going to be so cool to show them." And this is me as a completely insecure clinician. It's not like I thought I was great. I was not good at my job, I will tell you. So I was so excited to show them this clip and they watch it. And then the feedback was, "Well, why do you let him jump off the table? That's not safe." And I was just so heartbroken by that. I was so excited to share that. And then to get that kind of feedback, I was like, "Wow, it was missed. That beautiful moment we shared was missed." But that was just one of those kids where I look back and I realized that was when I realized how much you could transform your sessions when you are doing things that are just totally unconventional and you are really taking into consideration a child sensory needs.

Speaker 1: Wow. That's so powerful. And I love that quote, transforming your sessions with the unconventional. I totally butchered that quote, but why the concept? I love that.

Jessie: You just never know what's going to work. And I think that we put so much pressure on ourselves to produce results and get through activities when the bottom line, and the most important thing that we could do is really build a connection with our kids because that is what's going to make the biggest difference for them, not just in our sessions, but in their lives.

Speaker 1: So building those connections is what will make that difference?

Jessie: Yeah. So I can get into a little bit more about sensory regulation and why.

Speaker 1: Yeah, let's do it.

Jessie: So I just became just so... I guess you could say obsessed with sensory after that do job. I mean, that was what I wrote my grad school essay when I was applying to school. That's what I wrote my essay on because I saw such a change in my autistic kids when we started to do co treats with the OTs and I was learning these sensory strategies. So I just really dove in and did as much research and training as I could. And I went through the full sensory integration certificate program through University of Southern California, which is typically only for OTs who have their graduate degrees, but they let a few SLPs and other professionals sneak into their classes. And I knew I had to do that for myself and for the kids that I was working with. So now what I love to do is really teach other SLPs how they can integrate sensory strategies into their sessions so that they can have more effective sessions.

Jessie: The book, The Whole-Brain Child, if you've read it or any of your listeners, is so incredible at describing this, but we wonder why sensory regulation, why is it that when kids are dysregulated, they're not getting the most out of the session or we're not getting the most out of them. And what's really fascinating is what happens in our brain when we're dysregulated. And in that book, they described it really simply, which is a really cool analogy to be able to explain to parents or other professionals you're working with where they say, "Imagine that there's the upstairs and the downstairs brain and there's different structures in each of them." So it is physically an upstairs and downstairs as well in the actual brain. But basically the downstairs brain is responsible for these automatic reflexive responses. And basically your survival, so breathing, fight or flight, all of these automatic responses happen in our downstairs brain, whereas in the upstairs brain, that's where all of our logical thought and language comes into play.

Jessie: So what happens is that when we are dysregulated, it's almost like they say a baby gate being shut between the downstairs and the upstairs brain. And we get trapped in the downstairs and we cannot even get up there to access those upstairs skills. So when we think about a kid coming into our session, completely dysregulated, that child is in their downstairs brain. That child does not even have access to their language at that point. So how could we possibly expect that kid to sit down at a table and do some structured language activity when their body is not in a regulated state? Their body is not in a place where they're ready to learn in that moment.

Speaker 1: Wow. That is a really powerful analogy. That would be so helpful to share with parents.

Jessie: Yeah. Because I think that it's just so easy to put pressure on ourselves. I'm a parent, I have three tiny little children at home and you wonder like, "What is wrong with me? Why aren't they listening to me? What am I doing wrong?" But there's so many times when the answer is so simple, which is how can we help our kids feel safe and secure and regulated? Because once they do, that's when the magic happens, that's when all of these other skills are going to be able to come out.

Speaker 1: I love that. That's so powerful. How do we help our kids feel safe and regulated so that the other skills can come out? So good.

Jessie: In our speech sessions really taking the pressure off of, I think the activity at hand and focusing more on how can we get our kids feeling safe, how can we get them secure? How can we get them to trust us? How can we get them to connect with us? And if you put that at the forefront of your goals in therapy, you will see changes. That's just the fact. You will see greater changes over time, then when you come in with a plan and you've got to get a bunch of structured activities going.

Jessie: And there was this little boy I started seeing recently, undiagnosed autism and he's three. And I inherited him from someone else, from another SLP. And the first session, I just had these high expectations. It's like, "I'm going to do this, this and this." I read his goals. I assumed he was at a certain place in his language. And I had this whole plan in my head. I was frustrated the whole session because I wasn't getting what I wanted to get out of the session. And I took a step back and I completely changed my approach. And I just started following his lead, modeling language because he was a gestalt language processor. And the best thing that I could do when I realized that was really model language for him. And I really just started focusing on building a relationship with him.

Jessie: And it hasn't even been that long, but now he comes to the office, he gives me the biggest smile. When he sees me, gives me a big hug, we cuddle. I love this kid so much. I mean, he could be my own child. That's how much I feel like I connect with him. And those are the types of connections that we have to have when we really want to make the big difference in our kids lives.

Speaker 1: Yeah, absolutely. I definitely think you've convinced me of why we need to understand sensory processing, because like you said, it can just have such a big impact on our students. And I think it helps us feel... decrease our own frustration. Is there anything else that you would add to that recap?

Jessie: You're hitting all the main points here. One of the biggest questions I get from people is, "Why can we do this as SLPs? Why can we work on sensory regulation, or is that not within our scope?" Those types of questions. When you explain it like this with... when a kid is not regulated, they can't access their language. They can't learn. We know that it is within our scope to get them to a place where they're calm and they're attentive. And funny enough, I've had people ask me or tell me, I guess I should say, "You aren't trained in this. You shouldn't be working on this." And I was enrolled at the time in the sensory integration courses through USC. And when I say this program, this is not like a SOS feeding two day, three day intensive course. This was, I want to say a year and a half of classes, grad school level classes, assignments, quizzes, exams, the whole deal.

Jessie: So I remember asking my professor and she said, "You are here, you are learning these strategies and you're trained and you are 100% able to go out there and say, 'I am sensory integration trained.'" So for me, that was really, really validating.

Speaker 1: I think that makes a lot of sense. Sensory processing can definitely play a role, and a very pivotal role in the work that we do with our students. Thanks for listening to the SLP Now Podcast. If you enjoyed this episode, please share with your SLP friends. And don't forget to subscribe to the podcast to get the latest episodes sent directly to you. See you next time.

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#117: How to Use Dynamic Assessment When Evaluating Culturally & Linguistically Diverse Students

April 26, 2022 by Marisha 1 Comment

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This Week’s Episode: How to Use Dynamic Assessment When Evaluating Culturally & Linguistically Diverse Students

This month I had the pleasure of chatting with Kallie Knight (@kknighttherapy), a school-based SLP, regarding evaluations for culturally and linguistically diverse students.

So far this month we discuss why different types of evaluations are important and different things to consider when evaluating CLD students, tips on how to take good language samples for these students, and last week we talked about non-word repetition and how it is a non-biased form of evaluation for CLD students.

This week we get to talk about the juiciest part, dynamic assessments, and how important it is when you contrast it with norm-referenced tests.

Kallie’s reel shares a real-life example of what happens when you take the time to do a little more research in your evaluation process. Be curious and ask questions.

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A post shared by 𝐊𝐚𝐥𝐥𝐢𝐞 𝐊𝐧𝐢𝐠𝐡𝐭 | 𝐌𝐒, 𝐂𝐂𝐂-𝐒𝐋𝐏 | Bilingual SLP (@kknighttherapy)

Key Takeaways + Topics Covered

Why Use Dynamic Assessment?

> DA contrasts with norm-referenced test (static measure, you get it right it’s right, you get it wrong it’s wrong, it doesn’t matter what their experience is)

> Construct validity (are we measuring what we want to measure)

How to use Dynamic Assessments

>DA is the complete opposite of norm-referenced/static tests–it’s DYNAMIC

1.test 2.teach 3.retest

>>mediated learning experience

>>check the student’s “modifiability” (how well do they respond to instruction)

>>was it difficult to teach? or was it easy to teach?

>> vocabulary is experience-based (e.g., ice cream sandwich)

Additional Links

Kallie Knight: @kknighttherapy
ASHA Leaders Project: Non-Word Repetition Module
SLP Now Membership
Bilinguistics
Gathercole et al 1994

In this Pod Series

4/5/22: Evaluations for Culturally & Linguistically Diverse Students: The Why
4/12/22: How to Use Language Samples When Evaluating Culturally & Linguistically Diverse Students
4/19/22: How to Use Non-Word Repetition Tasks When Evaluating Culturally & Linguistically Diverse Students
4/26/22: How to Use Dynamic Assessment When Evaluating Culturally & Linguistically Diverse Students

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Transcript

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Speaker 1: Hello there and welcome to the SLP Now Podcast, where we share practical therapy tips and ideas for busy speech language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode. Now we get to into maybe the juiciest most fun part dynamic assessment. For SLP who aren't familiar with dynamic assessment, do you want to give us a quick overview of what it is?

Kallie: Yes. And I think understanding not only what it is, but how important it is when you contrast it with norm-referenced tests, which is what we usually use. And if you listen to that first episode in this series, you'll hear a little bit about that. But I'm going to compare first, a couple things that I didn't say in that first intro series so that I can compare it to dynamic assessment and show you why it's so gold, just gold. So with norm-referenced tests, thereKallie's static measures.

I'm giving it to the kid and that's it. If you get it right, you get it right. If you get it wrong, you get it wrong. Doesn't matter if you don't even understand the language. Doesn't matter if for example, if you've never seen a wagon and it's a vocabulary test and they're like, "What's this?" And you're like, "A chair with wheels? No, wrong. It's a wagon." And it's like, well, I've never seen a wagon before, but it doesn't matter. Like it's static. It's just right, wrong, right, wrong. So that static test is not taking into account any of these biases.

Kallie: It's just, what have you experienced in your life up to this point? And that is what I'm testing. And when we look at construct validity, which is another psychometric principle that we're just saying, "Are you measuring what you want to measure? And are you doing it effectively?" Even logically, you're going to say, "No." And so these are some of the things that we have with those kinds of measures. But when we look at things like dynamic assessment, dynamic assessment is different because it is the complete opposite of static assessment. It is dynamic.

Kallie: There are quite a few different teaching protocols, but the one that most frequently used takes a test teach retest procedure. So you do test them just like you would in a norm-referenced test, but instead of stopping there, you do a little teaching. They call it an mediated learning experience, but you give them a little bit of instruction. You check there what they call modifiability in the research you see how well they respond to that instruction. And at the same time you're also paying attention as an examiner. Like, "Am I pulling my hair out trying to teach this to this kid, or is it fairly easy? Are they transferring the things that I'm teaching them."

Kallie: And then at the end you do a post test and then you see essentially, how did they perform after that mediated learning experience? And so obviously even if you're looking at the construct and idea of a dynamic assessment, it aligns better construct validity wise with what you're measuring. I want to measure a language disorder, which really is a language learning, or language acquisition disorder. And what is a dynamic assessment measuring language learning or the ability to learn, or respond to intervention in a short amount of time.

Speaker 1: Yeah. Perfect. And I think it's pretty clear why that's important, but how could that give us different results for culturally and linguistically diverse students?

Kallie: That in my head, I feel like that's like, duh, but at the same time, I was like, but it's not. So let's use the example of, so vocabulary is so experience based, regardless of whether where you come from, if you have not experienced or heard a vocabulary word, you're not going to know it and you shouldn't just magically know it because it developmentally pops into your head. So say you would take a norm-referenced test. What is this? It's a wagon. You didn't know what it was. Well, what if you did something like, oh, you ever seen a wagon, something like that. Talk about the features of a wagon.

Kallie: "This is called a wagon. You pull it," and then you might wait a little bit and then pull it back up and be like, "We just learned about this thing. What was this?" And they'll be like, "Oh," and they might be able to not know the exact word, but they'll be like, "It was the thing and you pull it and it's a toy, it's a wagon." So that would show, oh, with a tiny, tiny bit of instruction. It's like, "Oh, I got this." And I think that's the important thing about dynamic assessment too, is like with a norm-referenced test, the purpose of a norm-referenced test is just to say, is it typical, or is it a disorder? It does not tell you difference, or disorder.

Kallie: The difference there with a dynamic assessment is we're saying, if I give you that experience that you probably didn't come to the table with, can you suddenly do this task? And that helps you delineate, is it a difference, or a disorder? Because if you're giving that instruction and they're still having a really hard time with it's probably a disorder. If you're giving them that context, or that instruction that they've never received and they respond to it readily, it was likely an exposure issue.

Speaker 1: Perfect. This is a little off topic, but I'm an English language learner too. And when you were talking about the wagon example, it reminded me of, I was at a friend's house and the mom asked me if I wanted an ice cream sandwich and that was not something that was in my vocabulary. So I tried to infer and I was like, ice cream with bread does not sound good. But I saw her give the other kids an ice cream sandwich, and then I learned it and it was just like, I hadn't had that where I was from. So if they don't have exposure to it, how can we expect it to just magically pop up in their head?

Speaker 1: A lot of kids, if it is a difference than just having that little bit of exposure, and then I'm remembering some experiences, I've made mistakes, I've qualified kids that probably didn't need to be qualified. I did the evaluation, they got the scores they needed to, to qualify, but then we'd start treatment. And they'd just like zoom through everything. And maybe I'm the most epic therapist, but it probably more likely was that I didn't incorporate that to dynamic assessment.

Speaker 1: And yeah, maybe they'll zoom through therapy quickly because it is a difference, but in terms of our caseload, why you do that? And then also in terms of the student, that has an impact on them. It'll take at least some time for them to be exited and then return to the general education classroom. So I think this is a really, really awesome tool to include in our evaluations to make sure that, that doesn't happen.

Kallie: And to your point, just because I'm all about being real. I have also qualified people that same way because on the day, or days that they came in for their evaluation, the data that I got in that snapshot did align with what I would call a disorder. However, you only get so much time with them, oftentimes, especially in an initial evaluation. And so guess what? Everyone's going to make mistakes because you can only operate off of the information you have.

Kallie: So I always tell people like, don't beat yourself up. Even if you did everything right, there are going to be when we realize, wow, they do respond to instruction and they do it readily and guess what? They probably didn't have a disorder, but I didn't know that given the data I had and I did a good evaluation. So just to your point, I just want people to know even well seasoned clinicians probably make a mistake every now and then, because you just don't know how a kid is going to perform on a given day. So just to your point.

Speaker 1: Yeah. And I think we're constantly learning and growing so we can look back and maybe the student just happened to be sick those few days. And that's just when we pulled them and I know my language isn't as great when I'm sick. Yeah. So there's things that we can try and take away. Like maybe we don't really have control over, like the student's health, we definitely don't have control over and we are really same free time. So maybe that's not a situation that we could have changed.

Speaker 1: And I think like trying to pull from other resources as well, like looking at classroom data and the parent report, teacher report and all of that will help remediate that. But we can look at those examples and we don't have to beat ourselves up, but we can say, "Is there anything I could have done?" And sometimes there isn't anything and sometimes they're like, "Oh, maybe I could have pulled a little bit more, or tried a different schedule," but always learning opportunities. But we also have to just know that we're doing our best.

Kallie: Exactly.

Speaker 1: Give ourselves some grace. Okay. So because you mentioned using dynamic assessment in conjunction with a norm-referenced test, what does that look like for you?

Kallie: So I'm going to give a little bit of a backup real quick so I can compare two things. Dynamic assessment in and of itself is like a teaching procedure. It's a set of principles. It's not like I'm going to Google dynamic assessment and there's going to be one procedure and I'm going to print it out. And it's going to walk me through what I need to say and do, no. Dynamic assessment is just a procedure for evaluating. So that being understood, you can apply that anywhere.

Kallie: And I can tell you for example, how you can apply that to a norm-referenced test, but there are other dynamic assessments that clinicians have realized, you know what? While some people do like to just take the principals and go, lots of us, SLPs, just want to be told what to do. So they've made protocols that are more broken down and systematic and say, this is what you say, and this is what you do. So we've got those two classes where you can either take the principles and apply it anywhere for example, to a norm-referenced test, or any therapeutic opportunity, or you can access a dynamic assessment that has more structure.

Kallie: And we can talk about both, but I'll talk about the norm-referenced test example first, just because you asked about it. So for example, I really don't like the self at all and its psychometrics are very poor, but sometimes I just have to use it because that's what I have access to. And so I'm going to give another vocabulary example, maybe like the wagon, or you could do this for syntax too, but say I was doing like, I was just doing a bilingual evaluation the other day and we were doing the word class, I think, where you give them four words and you say, which two of these words go together?

Kallie: This kid, you got to a certain point and it was like, he didn't know any of the words. He heard one of them that sounded similar to something he knew. And so he'd do his best guess. And of course he got it wrong and it's probably words that other kids his age probably were familiar with. But I was like, "I don't know that this is a straight disorder. This could totally just be language experience." And so I would straight up ask him, I score the standardized test exactly per standardization. However, I do go back to test items and I'll be like, "Okay, we're going to do some instruction. Are there any of these four words that you don't know what they are?"

Kallie: And usually two or three of them he'd be like, "I don't know what those are. I have never heard those in my life." And then you just give a little bit of instruction on what each of those words mean, and then you can reask it. And then he was always like, "Oh, my goodness, oh, it's these two." But he would've never known because he'd never heard the words before. And another plug this isn't just for kids who are culturally and linguistically diverse. This is just a shortcoming of all norm-referenced tests. It's just somehow in your life, you have never accessed to no certain vocabulary been experienced to it. Every vocabulary static test is going to be biased in that way.

Kallie: But that's just an example of showing how a little bit of instruction resulted in immediate aha like, "Oh, I know what the answer is, it's this." Whereas likely I've done the same thing with a kid who has a more severe disorder and it's just like headlights, or deer in the headlights, or they try to guess to were, or sometimes they can't even remember the words to give back to you. So that's just an example of, you can go back to test items and you can do a little bit of instruction and then retest. So it's again, you're just stopping in a test item and doing test, which is giving it to them, teach a little bit of something and then retest them and see if it was easy for them to just get it, or if it's like, "I'm still not getting this at all."

Speaker 1: Yeah. Perfect. And then do you typically do the teach and retest in the same moment, or do you space them out?

Kallie: Truthfully in this probably isn't perfect for standardization purposes, but I usually will stop in the moment and do it just because it's natural. And since the standardized score isn't going to be valid for me anyway, if I'm breaking standardization ever so slightly to give these little teaching experiences, in my clinical opinion, the benefits outweigh any damage that, that could do. So I do stop and it's so quick. All you have to do is be like, "Are there any of these words you don't know?" And most of the time they're like, "Yeah. I have never heard of those." And then you instruct.

Kallie: And then what I do is I have a column and, if I've done a repetition and I'll put a little R, or I'll put dynamic assessment, DA and then I'll put plus or minus. With the short dynamic assessment, did they get it? So when I'm done with my norm-referenced test, when I'm writing it up, I report everything I say, "Interpret with caution." And then really I have a lot of information where it just says, "In nine out of 11 opportunities, dynamic assessment was employed and in nine out of 11 opportunities, it resulted in immediate accurate response." And so when you look at things like that, it's like, well, it's very likely that this was an exposure issue and not a disorder.

Kallie: And things like that, like I said, it only takes an extra 30 seconds to two minutes per item that you want to do it on and you get a lot of extra information. And the benefit on top of that especially as a school-based SLP is A, I can see if they have a disorder or not. And B, I see what accommodations and support they need to be successful. So I already know what recommendations I'm going to write.

Speaker 1: Yeah. That's perfect. I love the example with a vocabulary and with a norm-referenced test, do you ever do dynamic assessment with the language sample trying to teach a grammatical construct? I feel like that might be a little harder to generalize in the moment, but-

Kallie: I mean, it depends. I feel like things and like I said, it tends to be kids who speak Spanish that I'm evaluating. So I can always go back to a language sample later. Like I'll mark in the norm-referenced test that they missed this so that I can be sure watching it in a language sample to see. So I do have that added benefit, but something else that you could do even in a syntactic portion in the self, for example, irregular past tense verbs, I promise that the vast majority of kids are not going to tell you your irregular past tense verbs, or irregular plurals, or something like that.

Kallie: And so you can do a quick thing and be like, you know what? In English, we have really weird words when we call lots of kid, or what is it? Child and children that they have in the self. And they'll always say, "Childs." I'll be like, "We're weird in English. We don't just add an S, sometimes we change the whole word. It's children for a lot of kids." And they're like, "What?" Yeah. So there's one child, or lots of children and they'll be like, "Oh, okay, lots of children." And then you might talk about it and then come back a little bit later and be like, "Okay, you remember the weird word in English when we talk about a lot of different kids?" And they'll be like, "Children," or they'll just be like, "I don't know."

Kallie: So, I mean, you can do that with syntactic things too. Really the big thing with dynamic assessment is, it's working off principles of zone of proximal development. So I mean, whatever you want to do, take them with whatever task it is, take them to those zone of proximal development, see what they can do by themselves. But with you do a little bit of teaching and see if they acquire it. It really doesn't even matter what the task is.

Speaker 1: Yeah. Perfect. I love it. And we know how to teach all of these things like where you target them day in and day out. So we can just use our typical strategies, see if it helps the student and go from there.

Kallie: Exactly.

Speaker 1: I love it. I love the easy... Well, it may not be easy to implement at first, but it makes sense.

Kallie: It's one of those things where I think it's uncomfortable able to not have something structured when we're so used to having a lot of structure as SLP to take something that the principles are always consistent, but you have to use your clinical intuition and your clinical expertise to implement them. And I think that's a little bit scary to some people and can be hard to master, but once you do it just comes to you. Like you don't even think about it. And some people do it and don't even know. So you might as well just take the data on it. And that's really the information you need for your report anyway.

Speaker 1: Perfect. And I love the example that you gave of how you report that. I might just have to add that in the show notes for easy reference. I feel like that made it more structured in my head too. Like the strategy of writing down, whether you gave a repetition, or you did some dynamic assessment and how the student responded and then just reporting the score without the support, and then also adding in what worked. I think that's so helpful, if any receiving SLP would read that report, I feel like it'd be so helpful to figure out how to navigate. And even for the teachers, which strategies are helpful.

Kallie: I was going to say, I do that for all my students, whether they're culturally linguistically diverse or not, just because there are some kids where on the standardized test, there's no repetition that's allowed, but then you just think, what would happen if they just got one repetition? I was like, you don't need specialty design instruction from a speech therapist for a teacher to repeat things one time, if one repetition results in an accurate response the majority of the time. And so even for typically developing kids all do dynamic assess, well, typically developing and kids who maybe even have a disorder, but are mainstream.

Kallie: You still get the same information because I mean, now you know exactly what accommodations they need, whether they're going to be in sped or whether you're saying, "I'm not going to qualify, even though the standardized score shows lower because I know that they can still perform well given these supports that don't require specialty design instruction."

Speaker 1: Yeah. Perfect. Well, this was so incredibly helpful. Thank you, [Kallie 00:18:59] for breaking this down for us. And I hope everyone walked away with at least one new strategy, or perspective that they can use with their students. So yeah, that's a wrap. Thanks for listening to the SLP Now Podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episode sent directly to you. See you next time.

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#116: How to Use Non-Word Repetition Tasks When Evaluating Culturally & Linguistically Diverse Students

April 19, 2022 by Marisha Leave a Comment

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This Week’s Episode: How to Use Non-Word Repetition Tasks When Evaluating Culturally & Linguistically Diverse Students

This month I had the pleasure of chatting with Kallie Knight (@kknighttherapy), a school-based SLP, regarding evaluations for culturally and linguistically diverse students.

So far this month we discuss why different types of evaluations are important and different things to consider when evaluating CLD students, and tips on how to take good language samples for these students.

In today’s episode, Kallie shares tips on how to use Non-Word Rpetition takes when evaluating CLD students.

Let’s get to it!

Key Takeaways + Topics Covered

How to Use Non-Word Repetition Tasks

✓ Take a variety of non-words that are increasing in length and complexity (usually syllabic)

✓ Say it to the child and have them repeat *For consistency’s sake, record the word and play it for the student

✓ Similar to sentence recall

✓ This is a less biased approach, no linguistic bias, and measures phonological memory

✓ Don’t use Non-Word Repetition by itself as a diagnostic measure

Additional Links

Kallie Knight: @kknighttherapy
ASHA Leaders Project: Non-Word Repetition Module
SLP Now Membership
Bilinguistics
Gathercole et al 1994

Next Up in this Pod Series

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Transcript

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Speaker 1: Hello there and welcome to the SLP Now podcast, where we share practical therapy tips and ideas for busy speech language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode. Now let transition into talking about non-word repetition tasks. So, Kallie, do you want to tell us a little bit about what those are and why you use them and what that looks like?

Kallie: Yeah, so non-word repetition tasks, actually it has the best name, because it explains exactly what it is. You're taking a variety of different non-words that are increasing in length and complexity, usually syllabic complexity, and you're just literally saying it to the child and having them repeat it. And then you're marking the accuracy of their repetitions. It's similar to your sentence recall tasks, but it's non-words. And so the idea behind using non-words is that it's a less biased approach because there's not this linguistic bias. It's just kind of phonological memory, is what they think this processing deficit that they're looking at here is. And these words can be weird. It depends on the protocol you use and there are a lot of them out there. But it might start with like some bi-syllabic words and they go to three syllables and go up to six, seven, some protocols go up to eight syllables.

Kallie: And they're just weird words, like [herbokdee 00:01:28], it makes no sense. And it's just them repeating exact, like I said, it's funny. So again, it's really quick because all you have to do is tell the kid, I'm going to tell you some really silly words. I want you to repeat what I say. And then tell them the word, and then they repeat it to you. And then you mark syllabic accuracy or the sound accuracy. And then you just give all the words.

Kallie: Most protocols have about 15 to 20 words. And like I said, they range in syllabic complexity. And then they usually for each protocol have a cut off score that's like, if you have this many syllables correct, you're probably like, okay, yeah. This many syllables correct, at risk. This many syllables, not likely to have a language disorder. Because this is the one thing, I would not use a non-word repetition task by itself as a diagnostic measure. I think it is helpful because it is a less biased option and it a processing dependent task. But I just think it doesn't give you a very comprehensive view and it's not perfect in terms of accuracy. So I'll put that plug in. This is just an easy way to add another measure to that triangulation of data that I talked about in the last episode. That does a little bit of information, I'll follow up with anything that I need to fine tune.

Speaker 1: Perfect. No, that's really helpful. And then in terms of the protocols, how did you find the ones that you used?

Kallie: For research that I did in undergraduate and graduate school and for my thesis, I used a protocol from Gathercole, et al. I think it's in like 1994. That one's old, but they have a lot of newer ones. If you go on the ASHA leaders project and you type in like non-word repetition, I think they have one or two non-word repetition protocols that you can just click and print out. And they have them in English, Spanish, and I think I saw that they have a Mandarin one now.

Speaker 1: Yeah. I just pulled it up. So they have one English, two Spanish and one Mandarin. And what was the one that you said you used

Kallie: It's from Gathercole, et al. I think it's like 1994. It's kind of old. But I don't think either one is any more right or wrong. That just happens to be the protocol that I am familiar with and use, just because I've used it for a long time. But those other ones are just as good. And I think those other ones are perhaps even better because they already have the protocol and the words marked out for you. So you just need to print it out. Something that I would recommend for non-word repetition tasks, this probably doesn't make a huge, huge difference, but because they are non-words and they're weird, for like reliability sake, sometimes I will take them and I will record myself and I'll do the whole thing on recording.

Kallie: Like, I'm going to tell you some funny words. I'm going to say it first, then I want you to say it back to me. And then I'll say the first word and pause for like three seconds, and then say the second word. And I'll go through it on a recording so that every time I have to give it to a kid, I just press play. And I make sure that the productions of those words are the same every single time. Some of these non-words are so, so weird and who knows, one person could produce them different than another. And it just makes it easy to say, oh, we're doing this real quick. Play. And you can gather all of the information you need in three to five minutes.

Speaker 1: Awesome. Yeah. And I'll link to the leaders project, which has all of those non-word repetition task protocols in the show notes. But they also have, it looks like they have two little video series too, showing an SLP administering that and with different children so we can see how different children might perform on it. Which I think would be super helpful if it's not something that you've done before, just like giving a little bit of that context. Super cool. Thank you so much for sharing that. And would you explain this to parents and teachers in the same way that you explained it to us? Or would you say anything different when you're writing up the evaluation or?

Kallie: To be honest, most of the time I just report it. And I report it as being an additional measure that tends to be less biased. If I try to explain any more than that, it's going to go over their heads. So I usually put the amount that really matters for their knowledge, and then I'll write out the results and then I'll put a key that's like, their score aligns with, you know, like in the average range or in like a risk range. Because really at the end of the day, could I put more information in there? Yes. But is it going to be particularly helpful to the parent? Probably not. So for me, as much as I would love to just data dump, because you and I and other SLPs would geek out and think that's cool, a lot of times I feel like parents and other professionals are like just tell me what I need to know and no more.

Speaker 1: Yeah. That's perfect. Anything else that you'd want to share related to non-word repetition task?

Kallie: I don't think so. Non-word rep, like I said, it's a pretty easy measure. I'll just reiterate again, to each his own. You choose what your clinical decisions are. I would not use this as a standalone measure. But it is a quick, easy measure just to add to your other informal measures. And it might not align with your other informal measures. The other two or three informal measures might be like, yeah, this kid definitely has a disorder. And then this one might come out in the at risk or average range, and don't freak out. It's okay, it's a triangulate of data. You're looking at all of your different parts. Just because one area comes out more normal doesn't mean you need to go in a tizzy and be like, oh my goodness, maybe this kid doesn't have a disorder. Maybe I need to second guess myself. And I feel like with non-word repetition tasks, this happens a little bit more often than other things for me. So don't freak out if it doesn't align with every other piece of data you have.

Speaker 1: Do you have any hypotheses on why that happens?

Kallie: I don't. And I mean, if you look at why they use non-word repetition tasks, they talk about it being a processing dependent task. We're looking at something that's really more measuring, I mean, really phonological working memory, but like a cognitive skill. And a lot of people propose that these deficits in cognitive skills are also present in students with language disorders. And so, that could be why. But then that doesn't always make sense because some kids who I'm like you definitely have a language disorder, end up doing, I mean, not well. I don't think anyone who's ever had a language disorder does well, but they might not hit those cutoffs. But you could get that in any test. You could give the Self to a, not a culturally and linguistically diverse kid, like someone who it is totally normed and made for, and they could still have a disorder but somehow have scored in the average range. So I think you always just have to look, take everything, not with a grain of salt, but look at things comprehensively.

Speaker 1: Perfect. I love that analysis. I think that's super helpful. It can just be like a relative strength for the student too. Like that's something that we can leverage. Thanks for listening to the SLP Now podcast. If you enjoyed this episode, please share with your SLP friends. And don't forget to subscribe to the podcast to get the latest episode sent directly to you. See you next time.

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#115: How to Use Language Samples When Evaluating Culturally & Linguistically Diverse Students

April 12, 2022 by Marisha Leave a Comment

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This Week’s Episode: Using Language Samples When Evaluating CLD Students

This month I had the pleasure of chatting with Kallie Knight (@kknighttherapy), a school-based SLP, regarding evaluations for culturally and linguistically diverse students.

So far this month we discuss why different types of evaluations are important and different things to consider when taking data for these students. In today’s episode, we share our tips on how to use language samples (the gold standard) when evaluating CLD students.

Stay tuned for the rest of this month’s series as we discuss different types of assessments and tips for taking better evaluations for CLA students.

Let’s get to it!

Key Takeaways + Topics Covered

How to use language samples

🍏Lange samples are the gold standard for ALL evals (syntactic, morphological features)
– Be careful comparing to norms when taking a CLD language sample
– Consider other languages

🍏Collect a sample in both languages
– Bilinguistics book is a great resource!
– Negative transfer error

🍏 This also applies to speech sound disorders! phonology varies across languages

Additional Links

Kallie Knight: @kknighttherapy
ASHA Leaders Project
SLP Now Membership
Bilinguistics

Subscribe & Review in iTunes

Are you subscribed to the podcast? If you’re not, subscribe today to get the latest episodes sent directly to you! Click here to make your listening experience auto-magic and as easy as possible.

Thanks so much!

Transcript

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Speaker 1: Hello there, and welcome to the SLP Now Podcast, where we share practical therapy tips and ideas for busy speech language pathologists. Grab your favorite beverage and sit back, as we dive into this week's episode.

Speaker 1: Now, we'll dive into language samples. So, last week, Kallie shared some of the common learning opportunities that we might have, when working with culturally and linguistically diverse students. One of the things that she mentioned was using language samples. So, do you want to tell us a little bit about the role that language samples play for you when you're completing these evaluations?

Kallie: For sure. For any evaluation, regardless of whether they're culturally linguistically diverse or not, I'm going to use a language sample because that's just the gold standard. If I want to see, or at least look for different maybe, syntactic morphological function features, the best way to do it is, to hopefully get the kid talking, and get a sample and analyze it.

So obviously that's not surprising, but the thing that's a little bit different with our culturally and linguistically diverse students, is simply taking a language sample and then trying to compare it to norms or grammatical structures, syntactic structures from English only, there's a good chance that that child is going to make a lot of errors and if you don't do a comparative type analysis with their first language, you could be seeing a lot of these errors and just say, "Oh, yep. They're making these errors."

Kallie: If you want to MLU, and you length the veterans, "Oh no, it's really short." But it could just be that, for example, in English, it less developed or, again, this kid could have a disorder. But it's hard to tell because if they have a disorder, it's going to show up in both languages, which is why it's so important to do both.

Speaker 1: Perfect. And what tips would you... Because I know this is different for every district. I'm just curious, what does it look like in your district if you have a bilingual student who comes in and speaks the language that you're not familiar with, what are your tips to navigate that?

Kallie: And I'm glad that you said a student whose language you're not familiar with, because I can give you an experience from a Spanish speaking student because I speak Spanish. So for me it's a lot easier to do those evaluations because I can, with fidelity, get a language sample in both languages. I can analyze it and I'm good to go. I am confident. But I actually had a student who spoke some language that I can't remember, but from Africa and I was like, "Yeah, no, I have no idea." And so at that point... And I'll tell you what? I've done... That's been best for me because I certainly don't speak that language. And it would be really nice if you could get an interpreter or a parent or someone who does speak the language. So you can get that language sample. But sometimes you just can't, sometimes you get a language that's just really different, or really not common to your area and you can't get an interpreter, or maybe the parent isn't available.

Kallie: And if you can't get the comparative language analysis, you're not a failure. Later, we'll talk about dynamic assessment. I think that's where the gold is. Let's just say that you have a more common language, maybe Spanish or Mandarin. Usually, you can get someone who either speaks the language or who is an interpreter and they can at least help you facilitate a conversation with the student and then be able to record and transcribe it. And then once you've done that, the coordinating getting that scheduled is often the hard part, but getting it transcribed by the person isn't so hard. What is a little bit harder is the interpreter doesn't know what am I supposed to be analyzing. And so you have to know. And so there's resources like... I think Bilinguistics has a really good book where they have a lot of different languages, and they have different morphological structures, different syntactic structures across different languages.

Kallie: And you can see when you're looking in English, this is an error there might make in English or this is how it compares to their home language. And so you can look for like negative transfer errors and you can say, "Oh, it's likely that this person made an error here because of their first language, a negative transfer error." Not because they have a disorder. For a lot of languages, past tense is often present in both languages. But it may not transfer to English well. And so a lot of times there will be tense errors and for a lot of people are like, "Oh yeah, tense in agreement errors, that's hallmark of a language disorder."

Kallie: And so they'll see a lot of cultural and linguistically students have those errors, but not be able to compare and say, "Oh, but they use it appropriately in their home language." So it's likely a language acquisition, development experience error, not a disability. But it's not clean. Let me just say like it's not clean. It's a lot of gray. You're not always going to know every single time it's going to be, "Oh, that's a negative transfer error." That's that. Sometimes you just have to make your best guess.

Speaker 1: And I think that's why because a language sample typically has multiple opportunities. So we need to look for what are the patterns, and there may be one off errors. But just trying to look at the bigger picture and do the best we can. And I love that you mentioned the Bilinguistics book too as a resource to start navigating that because if you are not familiar with the language, it's very hard to figure out what those negative transfer errors might be. So we'll definitely link to that in the show notes as well. And then is there anything else that you would share in terms of language samples and navigating that?

Kallie: I think I would add on top of this. We're talking about language samples like language disorders. But it also applies speech sound disorders because phonology also varies. So I might throw that in there too, when I say language samples there's that, but you can also do a speech sample and do the same phonological analysis. And in Bilinguistics and in other places you can also compare phonological features of different languages. So I should put that plug in there. It's not just language. It also goes to speech sound disorders. And there are going to be some things in Bilinguistics, some different languages that just are not there. And don't freak out, because if you Google, you can Google phonological features or phenology of another language. It's not going to have it broken down for you where, "This is the exact error they make."

Kallie: But usually linguists will write all about that. And because you understand what they're saying, you can usually see what errors or what rule patterns that language has, and you can still compare it. Don't be worried if you have a language and you do invest in that bilinguistics book, and then realize, "But that language isn't even in the book, what do I do now?" You can still do a good Google search and you have the knowledge to be able to look at some of those linguistics websites that just give all the linguistics knowledge on different languages.

Speaker 1: Yeah. Perfect. Just in terms of productivity and navigating... Because if this is new to an SLP, I'm sure that over time, you've gotten really efficient with all of this. But if this is new to an SLP, that's a lot of different things to think about and that analysis can take a little longer. So do you have any tips, or what does it look like for you just maybe give them a glimpse at what it could look like once this becomes a little bit more streamlined for them?

Kallie: I like this question because you could ask me, "What would it look like ideally versus what can I feasibly get done truly given your workload?" And those are going to differ significantly. What ends up working that I think gives me plenty of information. I don't sit there and probably don't get and transcribe a 150 utterances or more. Would that be ideal? Yes. Would I be able to like plug it into something like SALT and have it give me some good hard data? Yes. But more often than not, I don't even get to transcribing most of it unless it's the language that I don't know. Then I do have to spend a little bit more time.

Kallie: But if it's a language that I do know like Spanish, most of the bilingual evaluations that I do are Spanish speaking students, I can just hear most of it. And I know what to listen for in both languages. So I'm listening in real time and making notes instead of transcribing everything thing they say, but not every person can do that. So I'm going to be honest, if you can't do that, it might take more time just to transcribe a little bit so that you can see it and analyze it. But don't feel like you have to take a million long utterances. You just don't have time. You can probably do 20 or 30, if that, and you'll be okay.

Kallie: The good thing is the language sample while it is a gold standard, is not the end all be all. And you'll likely have other measures to what I like to call, create a triangulation of data. So don't feel like you have to have the best language sample ever because you're going to have other sources of data that can still help support your clinical decision.

Speaker 1: Yeah. And I think if an SLP is newer to using language samples or especially like analyzing them across languages, recording the language samples so that you can just try your best to see if you can hear it just in real time and to work on trying that skill. But then you still have the recording to go back to if you need to, for sure reference. So then that can be like a little bit of a safeguard so there's not as much pressure like, "I must get it all now."

Kallie: Yeah, because that's not realistic. Even sometimes I record it because sometimes you just don't have all your brain cells there. So...

Speaker 1: Yeah. You never know. That's perfect. So I love all of these tips for language samples. We talked about language samples being the gold standard for all evaluations because they give us some really good information about like syntactic and morphological features, all of that good stuff. But when we are working with CLD students, we want to be careful when we're comparing to other norms. And we also want to make sure that we're considering that other language and doing a little bit of a comparative analysis, and like looking for negative transfer errors, like Kallie said. Like if they don't have past tense verbs in the first language, then if they're not using them in the past in English, then that can be an example of that error. Does that sound right?

Kallie: There are just so many, it could be negative transfer or it could be in one language, they don't have a feature in English like in a lot of languages. Past tense is just past tense. But in English we have like past tense ed regular, we have irregular past tense and it's just like... It's ridiculous. So like you said, if you just look at English and try to evaluate it as is that kid's probably going to come out real poor when that may be the case if you compare it to the other language too. But it could totally not be the case.

Speaker 1: Thanks for listening to of the SLP Now Podcast. If you enjoyed this episode, please share with your SLP friends and don't forget to subscribe to the podcast to get the latest episode sent directly to you. See you next time.

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#114: Evaluations for Culturally & Linguistically Diverse Students: The Why

April 5, 2022 by Marisha Leave a Comment

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This Week’s Episode: Evaluations for CLA Students: The Why

This month I had the pleasure of chatting with Kallie Knight (@kknighttherapy), a school-based SLP from Texas, regarding evaluations for culturally and linguistically diverse students. In today’s episode, we discuss why different types of evaluations are important and different things to consider when taking data for these students.

Stay tuned for the rest of this month’s series as we discuss different types of assessments and tips for taking better evaluations for CLA students.

I’m excited to dive in. But before we do, take a look at this reel Kallie made on Instagram. It sets us up with a real-life example of the issues we can run into if we don’t take more things into account when evaluating CLA students.

View this post on Instagram

A post shared by Kallie Knight | SLP | Narrative Language Specialist (@kknighttherapy)

I hope her reel got you to start thinking about all the odds that are stacked up against this specific student. Let’s dive into the importance of gathering updated and important information about your student *before* we look at assessment results.

Common Mistakes

Not using the correct tools
Only a static language sample
Everyone comes from different cultural backgrounds, we don’t always understand everyone’s culture, in learning about other cultures we can be more aware
Not getting a parent or caretaker interview

Additional Links

Kallie Knight: @kknighttherapy
Leaders Project
SLP Now Membership

Next Up in this Pod Series

Subscribe & Review in iTunes

Are you subscribed to the podcast? If you’re not, subscribe today to get the latest episodes sent directly to you! Click here to make your listening experience auto-magic and as easy as possible.

Thanks so much!

Transcript

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Speaker 1: Hello there and welcome to the SLP Now Podcast. This month, we are diving into evaluations for culturally and linguistically diverse students. So CLD for short, and this topic was inspired by Kallie Knight. I am so excited to dive this. She's got some really awesome tips for us to navigate these evaluations. And then just a little bit about Kallie. I told you she's got an amazing Instagram account and it's such helpful and inspiring content. I love how she approaches all things SLP. And just a little bit more about her. She is a school based speech language pathologist in Texas. She is in the trenches with us. Maybe she can tell us a little bit more about her caseload. I'm really excited to hear from her. So hello Kallie.

Kallie Knight : Hi. I'm happy to be here

Speaker 1: Before we dive into all of the nitty gritty strategies and content, I thought it'd be helpful to just kind of back up a little bit and chat about why this topic even matters. And I think that will kind of align with what was in your reel on Instagram as well.

Kallie Knight : For sure. And I think understanding the why is going to guide and make everything we would do in addition or differently for these students or clients. It's all just going to make sense when you understand the why. And so, especially for these students, when we look at like a stereotypical evaluation that we would probably do, we're likely going to use a standardized norm-reference tool. Yes, you'll probably use a couple of different informal measures too, if you're able to. But one of the big things we use, whether you're in a school or clinic, lots of people use standardized testing and it's kind of just a necessary evil. Sometimes we have to do it, but what we have to realize, not only for culturally and linguistically diverse students, but even for some of our kind of mainstream, main culture students, there are a lot of issues with norm-reference test, more issues just come with our culturally and linguistically diverse populations.

Kallie Knight : So for example, if we want to go over psychometrics, like we want to go over classification accuracy, sensitivity and specificity, which basically is just how accurate is the test identifying people with disorder or not disorder correctly. And if you were to go into the manual or really look into most of these norm-reference tests, that classification accuracy is actually pretty poor. What we're really looking for to be good is about 80% across the board. And most of our norm-reference tests, even for those that the test is normed for is under 80%. So that's a little bit of a red flag.

Kallie Knight : But on top of that for a lot of our culturally and linguistically diverse students, and that could be someone who's from a different culture, from a different language all together, socioeconomic status, like culture goes far more than just you live in a different place than me. But there's a lot of bias there. There's content bias. There's obviously linguistic bias and I could go into that for forever. But these are just some of the issues that when we have these culturally and linguistically diverse students take a test that was essentially normed on and made for oranges and they're apples, we're not really getting a good comparison.

Speaker 1: Yeah. And just to bring this home a little bit, like how can that hurt our CLD students?

Kallie Knight : I mean, I think it depends who you talk to. Some people might say, well, it's not going to hurt them to be in speech therapy and maybe not. But especially from a school based perspective, when I'm looking only at eligibility or what's going to be best for a student, it's going to be the least restrictive environment. And for a student who does not have a disability, which happens to be a lot of our culturally and linguistically diverse students, that's not special education, which is where we give speech therapy. That nuance looks a little bit different, if you're not in a school setting, but I am. So a lot of what I'll talk about might kind of apply to the school setting. So at the end, they're just not getting the help they need. And just think about those other things, like when you get put into special education, I know most kids love to come to speech, but there can be other sociological factors or like feelings associated with going to special education when they don't even have a disability.

Speaker 1: Yeah, absolutely. Like, I love what you said. Like it won't hurt for them to be in speech therapy. It'll only help. But especially in a school setting, if they're seeing us, they're missing time out in the general education curriculum, which is where they're supposed to be doing their learning. And if they miss out on like a critical component of the math ... I mean, school districts now have a lot of regulations on when students can be pulled, but if they're missing out on, even if it's some other part of the curriculum, like that could lead to some other issues down the road as well.

Kallie Knight : Absolutely.

Speaker 1: Marie Ireland did a presentation at the SLP Summit. If you ever have the opportunity to hear her speak, definitely do that. And we won't go into too much detail here, but she shared like even more consequences in terms of like correlations. Like if students have IEP or the diagnosis and what that looks like long term. So there's impacts that we might not even see, that could come up down the road.

Kallie Knight : Absolutely.

Speaker 1: Okay. Awesome. And then just back channeling a little bit. So in terms of the psychometric properties, I know that some SLPs hear that and they're like, where do I look? Like, what do I look for? So I know it's different for every test, but do you have any suggestions or resources for SLPs who are trying to start looking into that?

Kallie Knight : Yes. So, I mean, obviously if you want to find where it should be, and I say should be because unfortunately not every test reports these kind of psychometric features, and in some cases that should be a red flag in and of itself, but you can find it in the test manual. They should have a section on validity and reliability, and there should be usually a section on sensitivity and specificity and it should outline it. The [ASHER 00:06:41] Leaders Project has a couple of really, really nice in depth reviews on a couple common norm-reference tests, like the PLS and the self. And they'll not only give the sensitivity and specificity, but a lot of other information with like pros and cons.

Kallie Knight : And then I can't remember who made this, but someone or some program or community, someone made a big list where they basically went through all the test manuals and made a list of this is the test. This is the classification accuracy. This is who it's normed on. This is who it's represented in the normative sample. And I can't remember who did it, but I do have access to it. So if there's a way for me to give it to you and get it out to people after this, we can do that.

Speaker 1: I think it's Virginia Department of Education. I think that's part of the research that Marie Ireland was also a part of. But we'll definitely put that in the show notes so that even if it doesn't exist, we'll find a way to have some kind of resource to get us started here.

Kallie Knight : And there's probably more than one document like that, but that makes it easier for SLPs to just grab and go. But I think sometimes it's good to be informed and know if you don't have that quick reference, that you can still find that information and the test [inaudible 00:07:56].

Speaker 1: And let's say a test has like, I don't know how many of them are out there, but let's say a test has 90% sensitivity. Because you said that 80% was the goal for that.

Kallie Knight : Right. That is what is typically considered adequate.

Speaker 1: And then even with 90%, there's 10% who meet the criterion, but may not be. So let's say a test has that 90% sensitivity, but it's normed on, what would be an example of a norm sample?

Kallie Knight : Like a lot of our normative samples have a lot, a lot of people who are monolingual English speakers. So that's one, if we're looking at linguistic diversity. There are some that have some bilingual students, but it's usually Spanish or one or two kids from other language backgrounds. And that's certainly not enough for me to give a fair comparison. Again, like the apples and oranges thing. And on top of that, you need to look at things like socioeconomic status. Like even those kind of things where you're not coming from a completely ...

Kallie Knight : Sorry if you hear my dog squeaking. If you come from a different country or obviously like, oh yeah, you have a different culture, but there's even different cultures from different parts of the United States from different socioeconomic statuses. And most of the time this is, or it should be outlined in the normative sample. And so you're able to go in and look in the test manual and be like, okay, is there a sufficient amount of kids here that represents the student I'm evaluating? And for a lot of our culturally and linguistically diverse kids, it's often no. The answer is no.

Speaker 1: Do you ever use that assessment then?

Kallie Knight : If I wasn't working in a school where it's kind of a necessary evil and they just want to see the score, I would probably skip it all together. However, because it's something I have to use, I can still give it. And when we talk maybe later about dynamic assessment, I can show you some things you can do to still get a little bit of bang from your buck if you're going to give a norm-reference test. But when you report the scores, I just say interpret with caution. And you can explain why, like there was cultural bias, there was linguistic bias and content. And if you want, you can explain some of those or you can just state that. And I often say this person also wasn't represented well in the normative sample. So just interpret with caution. And then you go into the rest of your evaluation that hopefully has a lot of informal information that contextualizes their performance. Because there's a good chance they could have done poorly on the norm-reference test and have a disorder or they could not.

Speaker 1: Perfect. I love how you laid that out. That makes some much sense. Perfect. What are some common mistakes that we might be making? I mean, we talked about some of them, so not considering the normative sample or looking at the psychometric properties of the norm-reference tests, but are there any other common mistakes that you see when evaluating CLD students?

Kallie Knight : I would say the biggest one is probably the tools we use just because people know I need to use my standardized test because that's what we use. And I don't even want to say a mistake because a lot of people just, I think don't know that is the case and that there are better things to use. Or sometimes they know that they should use something better and don't know what it is. And that's when I'm like, you know what? And then you just learn about it, and it's okay, and you don't need to worry about it or feel guilty. But we'll talk about this probably a little bit later if we're talking about informal measures. But sometimes doing things like language sampling and just kind of doing like a static language sample, but not doing any comparative analyses. Just looking at the kid's language sample and analyzing it the same way you would any other kid, a good chunk of the time you might make some errors, but we could go on for a while.

Speaker 1: Okay. Perfect. Anything else that just like general big picture that SLPs should look out for or consider?

Kallie Knight : I think something else that is important to consider is just everyone does come from different cultural backgrounds and we have to realize that sometimes we don't understand everyone's cultural nuances and what is isn't important in their lives and what experiences they haven't had. So that's, I think another one of those ignorance mistakes sometimes. Sometimes learning about other ... In learning about other cultures, we can be more aware, but I think some of the times everyone comes to the table with different experiences, different beliefs, different values. And if we haven't experienced that culture before, there's always mistakes that we can make there. But some of that is just, you have to learn as you go because you don't know what you don't know.

Speaker 1: Yeah. And what do you feel like has helped you learn more about the different cultures? Is it just experience working with different families or ...

Kallie Knight : I would say that's definitely the best way because even if you try to go online and learn about culture, it usually gives you an idea of a general macro culture. And that doesn't mean that complete aligns with that individual family's values. And so I think there is obviously some good, like maybe doing some book learning or learning on the internet about different cultures, but I think where you really learn and get good contextual practice is just learning from the families themselves. And they're usually more than happy to help you, especially when you're like, I'm just going to let you know. I don't know what backgrounds you come from. I don't know what's important to you. So you tell me what's important to me, what your life experiences are like, and I've made a lot of mistakes and I think that's where I've learned. And I think when you're okay with making mistakes and learning from them, that's probably the best thing to do.

Speaker 1: Yeah. Oh, I love that. And I think in general, people really like talking about themselves.

Kallie Knight : Yeah.

Speaker 1: Like if I were to go see a doctor or a therapist or like whatever support I'm seeking, like if they ask questions and try to get to know me, like I think I feel very seen. And I think that really helps establish that relationship. So we build the trust by like being curious and asking those questions, but we also kind of get to continue building on that.

Kallie Knight : Totally goes along with like just doing a good in depth, thorough case history. So we just touched on that, but I guess I didn't say that explicitly. That's another mistake that sometimes people make is not doing any case history at all, or parent interview or something like that. So I'm glad you touched on that.

Speaker 1: Okay, perfect. So let's wrap up just kind of the intro part of this. So we talked about some of the common learning opportunities when we're working on CLD evaluation. So we may not using the correct tools or considering the psychometric properties and norming sample of norm-reference test. We may only take a static language sample and we'll talk more about that in a future episode. And then another learning opportunity is to take time, to understand the culture and then also to do a good client history background, parent interview/all of those things. So we will talk about you alluded to this too, but if we do use a norm-reference, even if the norm population isn't representative of the student, we can use dynamic assessment too. And that's a really great tool. So we'll talk about that in the fourth episode in this series. So stay tuned for all of the good stuff, but yeah, I'm so excited.

Kallie Knight : Me too.

Speaker 1: Thanks for listening to the SLP Now Podcast. If you enjoyed this episode, please share with your SLP friends. And don't forget to subscribe to the podcast to get the latest episode sent directly to you. See you next time.

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Marisha

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