Marisha

Building Relationships with Students: Anxiety and Other Mental Health Needs

September 30, 2021 by Marisha Leave a Comment

This is a guest blog post by Monica, a school-based SLP, all about how to build relationships with students while taking into consideration anxiety and other mental health needs!

When our students have anxiety or other mental health needs, we can collaborate with the school psychologist or counselor on goals. We can ask them about how to best support our students.

Another option is to work with the classroom teacher! The SLP is often the best person to collaborate with the classroom teacher if the student doesn’t have academic support services. Being able to suggest accommodations in the classroom could improve a student’s quality of life at school.

Examples of Accommodations

– To be able to present alone and not in front of the class for a student that stutters.
– To be able to ask a teacher to explain directions on a test if they are unclear without fear of being told no.
– To have a discrete signal with the teacher to communicate that they need help.
– To be referred to a peer mentor for classes they are struggling with.
– To have graphic organizers to help them plan assignments.

Push-In Lesson Ideas

– Talk about different styles of communication with neurotypical and neurodivergent students, also known as the double empathy problem (Mitchell et al., 2021).
– Talk about recognizing feelings and dysregulation in your body and have students try out different coping mechanisms to see what works for them.
– Talk about different ways to self-advocate when you are not feeling regulated. (Working in the classroom is also a great way to model for teachers and collaborate without adding it to your workload.)

My favorite Instagram account for school counseling resources and information is WholeHearted School Counseling.

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Rachel Dorsey is an autistic SLP that is also one of my favorite accounts. She has a lot of amazing posts on working with autistic clients. I love this post on not labeling autistic student’s emotions:

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A post shared by Rachel Dorsey (@rdorseyslp)

References

Mitchell, P., Sheppard, E., & Cassidy, S. (2021). Autism and the double empathy problem: Implications for development and mental health. British Journal of Developmental Psychology, 39(1), 1–18.

How to Use Neurodiversity-Affirming Practices to Build Relationships with Students

September 30, 2021 by Marisha Leave a Comment

This is a guest blog post by Monica, a school-based SLP, all about how to use neurodiversity-affirming practices to build relationships with students!

If you’ve ever wondered how to build a relationship during speech sessions, I’m here to help! I’ve been using neurodiversity-affirming practices for a long time and am constantly shifting and changing. I’ll outline my approach and share what I’ve learned from autistic adults and other essential voices in the disability community. There will also be a lot of links to resources.

As a person of color and a neurodivergent SLP, my therapy approach has always been different. With more people talking about the neurodiversity-affirming movement, I have words to label what I’ve been doing. I have a neurodiversity-affirming, trauma-informed, and culturally responsive approach. It’s a mouthful, but I think it works wonders! I acknowledge that it is a unique time, where there are a lot of shifts happening in society which can be really overwhelming! Providing support communicates to our students that they are welcome as they are, and we will provide the tools to help them succeed. We’ll dig into some basic principles with some real-life examples, and by the end, I’m hoping that you’ll feel comfortable enough to incorporate some of them into your own practice.

First things first, a straightforward way to define a neurodiversity-affirming approach is to think of it as modifying the environment and providing supports, instead of expecting children to change themselves.

Ross Greene (2019) states that children do well when they can and that behind every challenging behavior is an unsolved problem or lagging skill.

In the article Collaborative & Proactive Solutions (CPS): A Review of Research Findings in Families, Schools, and Treatment Facilities, the CPS model is outlined, and a checklist of “lagging skills” to lead discussions for “unsolved problems” is included (Green and Winkler, 2019). In this list are executive functioning needs, sensory/motor difficulties, difficulties with transitions, and mental health needs–just to name a few. This article would be great when discussing making changes with other team members and administration.

This website by AutisticSLT (Emily Lees) in the UK is a fantastic resource on a neurodiversity-affirming approach.

We owe it to our students to learn about self-regulation skills and how to modify environments to help them succeed. By providing support to our students, we build trust and a relationship with them by communicating that we see their struggles and will help shape their environment, rather than putting the burden on them to change. I’ll go over a couple of different support areas for you to individualize for your students, keep in mind that this is not an exhaustive list.

If you want to learn more, check out these blog posts:

– How to Support Sensory Needs

– How to Support Executive Functioning

– How to Support Anxiety and Other Mental Health Needs

– How to Incorporate Trauma-Informed Practices

– How to Be Culturally Responsive

References

Greene, R., & Winkler, J. (2019). Collaborative & Proactive Solutions (CPS): A Review of Research Findings in Families, Schools, and Treatment Facilities. Clinical Child and Family Psychology Review, 22(4).

Building Relationships with Students: How to Be Culturally Responsive

September 30, 2021 by Marisha Leave a Comment

This is a guest blog post by Monica, a school-based SLP, all about how to be culturally responsive and why it matters!

Representation matters!

An easy way to keep that trust going with students is to have them feel like they are included and represented.

The account Books for Diversity on Instagram is an easy way to find culturally diverse books.

I love this ASHA post, “Why Use Literary Interventions for Diverse Populations” by Phuong Palafox (2018), as well as her Instagram for information about cultural responsiveness.

In her post, Phuong talks about “three ways to incorporate literacy to support the diverse needs of your students and clients”. They are: connect to experience, represent diverse narratives, and value home language. It’s a great way to build rapport and trust when your students’ culture is respected and included in your sessions.

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A post shared by Phuong Lien Palafox, CCC-SLP (@phuonglienpalafox)

I also love JRC the SLP and her anti-racism work.

Want more information on diversifying your therapy materials? Check out this SLP Now podcast with Liliana from The Bilingual Speechie.

Nina and Scott from Stuttering Therapy Resources also have so much great information on how stuttering is verbal diversity. They also talk about different paradigm shifts around thinking about stuttering in another way.

Here’s a great post about how we should use the word “stuttering” and drop the word “fluency”, as fluency should not be the end goal of therapy.

Keep in mind that it took me years to include all of this in my sessions! It may take some time if you choose to adopt any of these in your sessions and some shifts in thinking, but they are some of the most significant changes that you can make in your therapy room.

Planning Evidence-Based Treatment Plans in Speech Therapy

September 28, 2021 by Marisha Leave a Comment

This is a guest post by Holly, a school-based SLP, all about planning evidence-based interventions for speech-language therapy.

Planning Evidence-Based Treatment Plans in Speech Therapy

During my first year as a school-based SLP, I was just trying to keep my head above water. I was taking my therapy sessions day-by-day, treading IEP deadlines, and trying not to drown in paperwork. I felt like I was managing, but I imagine I was really just treading water.

With spur-of-the-moment therapy plans, it seemed like I was starting from scratch every day. Plus, if I’m being honest, seeking out EBP- aligned intervention wasn’t a high priority. I just graduated — surely my training was fresh and comprehensive enough to help me serve my caseload of elementary through high school students, right? It turned out, I had a lot of digging to do… which led me to find resources from SLP Now!

If you’ve been tuning into these blog posts and podcasts for a while, you’ve probably heard the SLP Now team talk about the power of planning (here’s a flashback to our Therapy Planning Bootcamp) and the merits of evidence-based intervention (here’s our current podcast series on EBP). That’s because these habits and processes are ways we can #WorkSmarterNotHarder.

No surprise here: the things we think we don’t have time for often end up being the things that save us the most time.

When we reframe evidence-based practice as a process that is embedded into our clinical decision-making (rather than a stack of dusty journal articles you’ve been meaning to get to), it makes a lot of sense to use a plan in therapy.

In this EBP process, once we’ve asked our clinical question and gathered/assessed the evidence, we can develop a plan that goes hand-in-hand with our clinical decisions (source: ASHA, accessed 2021).

Based on this framework, I’ll be outlining the workflow that I use for decision making and planning. Once I have gathered evidence-based approaches for treatment, there are some things I do in order to connect the dots between the evidence and actionable therapy plans. With some of these tips and tools, I hope you’ll notice a difference in your work and your students’ communication outcomes!

Step 1: Compile your sources for decision-making.

What kind of internal/external evidence and family values will you reference when planning your therapy sessions?

Here are just a few examples of how I might gather my sources:

Types of Sources
Student assessment data
Family questionnaires
Student interviews
Journal articles
Therapy ideas on the web
ASHAPractice Portal
SLP Now Research Summaries

Organization Ideas
Physical folders for each student or binders for each therapy approach
Digital storage for documents or links (e.g., bookmark lists, Google Drive folders, Trello boards)
Family contact log (the SLP Now notes section is great for this!)

All of this information helps guide your treatment decisions by mapping out the rationale, benefits, and potential harms — plus it can also be shared with members of your IEP team or administration.

Step 2: Decide on your approach and methods of measuring communication objectives.

How are you going to implement and adapt a therapy approach for a student or group?

This is where I typically map out how an IEP goal will be targeted and monitored in the context of my therapy activities.

The SLP Now Paperwork Binder (included in the SLP Now Membership) is a gold-mine of resources — definitely check out the treatment plans across communication domains! Or check out our free treatment plan template to get you started!

Step 3: Outline your logistics.

Once the big picture is formed, it’s time to figure out the practical details.

This can include the topic/theme of activities, therapy planner for a given week or month, teaching visuals, therapy materials, and data-taking tools. There may also be other things to consider: school protocols, location of services, feasibility of implementation, therapy routines, etc. Lastly, it’s up to us to evaluate the effectiveness of our approach as we deliver services. This step of evidence-based practice is what sets us apart as clinicians!

Here’s an example of how I might use this workflow in my role as a school-based SLP.

Step 1: Compile Sources

I work with an autistic student in third grade (you’ll see identity-first language in this example — of course, use whatever terminology your student/family prefers). This student loves outer space, uses grammar/syntax effectively, and has strengths in vocabulary. The student exhibits some signs of hyperlexia and loves reading books aloud, but has trouble with comprehension. As a result, summarizing stories can be challenging. In conversation, their speech pattern is consistent with cluttering (quick rate of speech, collapsing of syllables/words, excessive revisions), plus they are having trouble navigating social situations with peers.

This student and their family are on board with a neurodiversity-affirming approach; based on our conversations, we will shift away from teaching social skills and masking, and move towards perspective taking, problem solving, and self-advocacy skills.

Sources: Family/student interview, baseline progress monitoring data and student ratings, ASHA Practice Portal page on Fluency Disorders and Spoken Language Disorders, the Therapist Neurodiversity Collective education page, “Systematic Individualized Narrative Language Intervention on the Personal Narratives of Children With Autism” (Peterson et al., 2014), and SLP Now’s Narrative Research Summary (Included in the SLP Now Membership).

Step 2: Decide on Approach/ Methods

I’ll use treatment plan templates from the SLP Now Paperwork Binder, especially the pages related to Stuttering, Language, and Autism/Social Communication.

For the cluttering treatment approach, I’ve decided to explicitly teach strategies related to self-monitoring (rate, clarity of speech) and communication repair. For this goal, I’ll use student self-ratings to measure their awareness and speech satisfaction in structured conversation.

When using narratives to target story grammar elements, the student will focus on problems/actions/consequences and internal responses of characters throughout the story. I’ll measure the student’s progress by taking data on the student’s ability to retell a story with visual support, including these elements.

Per decision making with the IEP team (Brandel, 2020), the student will receive 45 minutes of direct therapy per week (a 30 minute small group session primarily using Literacy-Based Therapy, plus a 15 minute individual session to work on cluttering awareness and strategies).

Step 3: Outline Logistics

Topic/theme: My third graders are learning about the solar system in science, which pairs well with my student’s space interests! My library has a copy of “Mousetranaut” that I’ll be using in therapy.

Therapy activity planner (week/month at a glance): I love using the SLP Now One Page Literacy-Based Therapy Planner worksheet in order to set up plans based on a theme or book for multiple weeks at a time. If you’re using another approach, you can create your own outline for assessing, teaching and practicing skills.

Prep your teaching visuals: I have a set of materials for supporting student narratives, including story grammar icons. For recognizing characters’ thoughts and feelings, SLP Now’s Perspective Taking Bundles are great to keep on hand. I also have a set of visuals to use as reminders for cluttering strategies. It can be helpful for my students when I keep these teaching tools consistent, even as my themes change throughout the year!

Gather materials: I’ll get a copy of the book and add Mousetronaut-themed materials to “My Materials” in SLP Now (book guide, book activity, no print activity, and smart deck). Think about how you’ll organize physical materials while you’re actively using them (here are more tips on Speech Room Organization!)

Set up your data collection tools: I take data on pen and paper, then plug it into my SLP Now planner to keep track of student progress over time. I also have a self-monitoring scale that the student can use throughout our activities.

Provide intervention → evaluate & adjust as needed: I’ll adjust the plan and task complexity to account for the student engagement/progress. I’ll also follow up the student’s teacher and family members to measure how these skills are carrying over beyond our sessions.

That’s a run-down of how I embed the process of evidence-based practice into my therapy plans! I normally think through Steps 1 & 2 near the beginning of the year, then I update Step 3 as we progress through different therapy activities/themes. It takes time up front, but using a long-term plan ends up saving so much time and stress compared to reinventing the wheel every morning.

What does your therapy planning look like? We’d love to hear what tools and strategies you use to set yourself up for success! Feel free to drop any questions you have below, too ⬇️

References

American Speech-Language-Hearing Association. (n.d.). EBP Process – Step 4: Make your clinical decision. Retrieved September 2021, from https://www.asha.org/research/ebp/make-your-clinical-decision/.

Brandel, J. (2020). SLP Service Delivery Decisions: How Are They Made?. Communication Disorders Quarterly, 1525740120951185.

Johnson, C. (2008). Evidence-based practice in 5 simple steps. Journal of Manipulative & Physiological Therapeutics, 31(3), 169-170.

Petersen, D. B., Brown, C. L., Ukrainetz, T. A., Wise, C., Spencer, T. D., & Zebre, J. (2014). Systematic individualized narrative language intervention on the personal narratives of children with autism. Language, Speech, and Hearing Services in Schools, 45(1), 67-86.

Ukrainetz, T. A., & Gillam, R. B. (2009). The expressive elaboration of imaginative narratives by children with specific language impairment.

#097: How We Approach Client Perspectives

September 28, 2021 by Marisha Leave a Comment

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This Week’s Episode: How We Approach Client Perspectives:

This month is coming to an end and so is our podcast series on EBP. Today we will be finishing up by discussing the last part of the EBP Triangle: Client Perspectives.

Why are client perspectives important?

✨ Because lived experience matters.✨

Since starting the podcast, I’ve spoken with so many SLPs who have landed in a speciality or area of expertise because of their experience living with a condition.

Stephen Groner is a great example of this — his personal struggles with fluency as a child led him to develop a very real understanding of how stuttering can impact your life on a social or emotional level.

That experience is part of why he’s so effective in his work today!

But we don’t always share the same conditions as our students, and pathology isn’t the only experience that influences the client perspective; it’s just one example.

Linguistic diversity is another example of something to consider when it comes to client perspectives, so we spent some time discussing that — and if you want to learn more (specifically as linguistic diversity relates to narratives) check out this episode from last month.

Effective therapy is about so much more than laying out the material and following a plan.

Taking client perspectives into consideration allows us to get a full picture of what’s really going on with our students so that we can use our clinical judgment and meet them where they’re at.

We want to set our students up for success, and this helps us do that! 🚀

Of course, client perspectives is also about more than just the student — especially if they’re too young to provide meaningful information during an intake.

Figuring out what kind of support is available outside of the speech room is so important because if there isn’t buy-in from the student, their family, or teacher…well, you probably won’t see much progress.

Okay! There’s so much more that I could tell you about, but this is an email not a novella. 😂

If you’d like to catch up on this month’s podcast series, you can do so by visiting these links below:

A Quick Review of the EBP Triangle
Evidence (Internal & External)
Clinical Expertise

Let’s get to it!

Evidence-Based Practice Triangle (EBP):

Important Take-Aways

– Get to know your student
– Take an inventory of your student’s thoughts and feelings
– Are there any cultural differences?
– Get client and family buy-in
– Send the family a language use questionnaire (linked below)
– Find out who the client’s main caregivers are
– Use the ASHA Evidence Maps
– Reflect on your internal evidence, is it working?
– Reflect on your external evidence, do you need to make adjustments?
– Pair it all up with what works best for your client and boom, you’ve got yourselves EBP with a pretty bow on top! 🎁

Links Mentioned

– ASHA: Evidence Maps
– Podcast: Considerations for Linguistic Diversity When Assessing Narratives
– Cornell University: The Multilingual Language Use Questionnaire
– Adventures in Speech Pathology

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Thanks so much!

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: Hello there and welcome to the SLP Now podcast. I'm your host Marisha. And this month we have Monica Lynn joining us to talk about all things evidence-based practice. So in episode 95, we did a review of the EBP triangle, just some of our initial thoughts. And then for the rest of the month, we are going to be diving into the different parts of the triangle. So without further ado, let's dive into this week's episode.

Marisha: Now, let's tackle all things client perspectives, at least as much as we can. Where should we start when we're thinking about client perspectives?

Monica Lynn: You know what I think the ASHA Evidence Maps is probably the best place to start just because I've got a whole tab for it. A lot of times there might only be one or two, but it doesn't have to just be from the client perspective tab, I feel like sometimes just in the regular tab. For example, if you go to the cultural and linguistic diversity one for external evidence and clinical judgment, that's it, just thinking about the cultural linguistic diversity is taking the client's background into account. So you're already kind of doing it. So the one that I looked at is the use of dynamic assessment. So even doing that, doing a dynamic assessment, you're taking into account that your student is bilingual in being able to do that.

Monica Lynn: So then there was a meta analysis right there. It says that is a great way for diagnostic accuracy for that. That's a great way to be able to take that into account, that client perspective ones. There was one on telepractice and outcomes for speech-sound disorders. We definitely had our fair share of telepractice this year, but this one study listed under client perspectives said that all studies included high levels of participant satisfaction with tele-health delivered speech and language interventions. This is for the study, I am sure that those of us that weren't able to do telepractice in the way that it was meant to be might have some differing opinions, but at least you would have kind of some place to go from in general that it is possible for this type of service delivery model to be successful. And then there was one on fluency and stuttering and the lived experience of stuttering.

Monica Lynn: And this one was like implications for rehab. So this was for adults, I believe, but just like how we're listening to autistic adults to learn from adults who stutter like SLP [inaudible 00:03:08]. But this study included five themes of lived experience of adults who stutter. So like avoidance is used to manage stuttering that stuttering unfavorably impacts employment experiences. It shapes your self identity. What kind of negative reactions there are. So some of these things that might even be like social, emotional things that we need to keep in mind even for when we have them when they're children, because that can shape the therapy that they have and their perspective about it can shape their thoughts about themselves, their self identity, their self-esteem, and then that can bleed into so many areas of their life that if we didn't consider those things, when we're doing therapy as children, that it might affect the way that they are as adults.

Monica Lynn: And those are kind of like important things to think about and part of the EBP triangle where it really might be just taking like an inventory of their thoughts and feelings about something. Like I know in my sessions we're always talking about how we feel about things and doing a lot of self regulation type stuff. And I think the lesson probably is, don't be scared to do it during your session. Therapy does not have to just be like, "Here's our material, here's our plan," black and white. We can include a lot of this stuff to be a whole picture of the student, just to make sure that we're having the best outcome that we could.

Marisha: Yeah, absolutely. It's interesting too, because last month when we were talking about narratives, we were talking about linguistic diversity. So I feel like our whole last episode last month was talking about how this could be implemented with narratives.

Marisha: And I'm curious if you have any, just more general suggestions in terms of that domain.

Monica Lynn: So I think for cultural staff, during your interview with the family, asking who the caregivers are at home, who's helping with homework, do the tips and the recommendations that you're giving align with their family values or their culture. So like a lot of the common things like reading books at home that might not be a cultural practice that they do at home. So that might be really difficult for them to incorporate at home. Or for a lot of my families the grandparents or the caregivers while parents are working, so they were helping a lot with schooling and they weren't very comfortable in English. So it might've been the older brother and sister who also had to do school at the same time. So they might not be able to do any of these things at home because parents are at work.

Monica Lynn: I also had a parent who uses ASL. So it's like asking them, "You should provide whatever you want at home, what you're comfortable with in the language that you are comfortable in." So it's like, "If you want to practice this, practice it in ASL. Do it in a way that is feasible for you." And I think it's just like being flexible with that because I know a lot of the external evidence is going to say that the practice has to happen at home for generalization to happen, but real life, that may not happen. So then you might have to work with the teacher to make sure that happens in the classroom, just because of the way that your population is and just to be sensitive to that. I think another one could be, are your materials diverse?

Monica Lynn: Is your population represented in your materials? Like if your students need more support in language, are you giving your directions in a way that they can understand? All of these things together it is a lot, but I feel like after you do it a lot, it just kind of becomes routine and then you don't have to think about it so much. But in the end, this might be some of the most important stuff too, just because it makes the family feel included.

Marisha: Yeah. If we don't have the student buy-in, or the family buy-in, or teacher buy-in too, we're not going to make much progress. We could be the most experienced SLP, totally dialed in on all of the research and all of our data collection have the best system ever, if we're not taking this into consideration, we could still have students that make minimal progress.

Marisha: I'm curious too, obviously we want to get the buy-in from the student and the family and the teacher, last time we talked about the language use questionnaire to just kind of understand where they're coming from and I think that can sometimes bring things to light, but what other things could we be considering when we're having those conversations? Is there anything that we can listen for or something that we can ask?

Monica Lynn: I think generally when we're using like that questionnaire, I use a general questionnaire about what the family feels like are the student's strengths, what they're doing well with, what helps them succeed, what they think the challenges are for them. And what is one thing that you would love to see your child succeed with? And maybe like, what are things that help with that?

Monica Lynn: If they have found that repeating directions, or having a visual, or something especially if you have a new student that you're assessing, all of that could be really valuable information. And we touched on it a little bit too with the teacher that you could ask the same sort of things in the classroom. But I think that it doesn't just go for narrative, I think that it goes for everything that, do you notice that if you have it projected up on the TV... our classrooms have TVs, we're really lucky and the teachers can project it and show an example of how you're supposed to do it. Does that visual help a lot or do you have to come over to the student's desk and repeat the verbal instructions when you're closer and you know that they have their attention?

Monica Lynn: So some of those things and kind of narrowing down what type of support that that student might need and really considering that student's individual support needs, I think can help. Also, the student's social, emotional situation. So if you're doing like a multi-disciplinary team approach, did anything else come up with the other people who are doing the assessment? IF you're picking a goal for stuttering is that going to be something that you're taking the student's social, emotional situation into account? For autism, are you incorporating methods that aren't going to make the student uncomfortable? Like making sure you're not using eye contact goals or preventing them from moving their body in a way that they need to? So those might be embedded support. So in my thing, I have embedded supports for... they can sit or stand if they need to, or if they need a movement break.

Monica Lynn: So those are all some things that you can look at for supports that you need to have a successful session that aren't necessarily based in, you're not going to read like a whole article on it, or you might not have internal data for it, but it's just kind of something that you're considering about the client as you get to know them to think about the best way to support them.

Marisha: Absolutely. And I think now would be a good time to tie all the pieces together. One example that stands out to me, and this was from Dr. Strand's seminar too, I think it's important just to listen and have an open perspective as to what is important too, because that's what this boils down to. What's important to our students and parents and teachers? She's got all of her clinical experience or expertise, and she definitely knows all of the research and she knows what progression of words is the most evidence-based.

Marisha: But this student really, really wanted to learn to say his name, it was not in the protocol, it didn't make sense in terms of where the student was, but that is what he really wanted to do. So they took some time every session to work on learning his name. So she incorporated all of those different parts of the triangle, that motivation I think really contributed and the student felt seen and heard, and it all went together. So I'm curious if you have one other example to wrap this up.

Monica Lynn: I do have a specific example, but that also made me think about using a student's special interest in the session. And it's like, sometimes if they are not in the mood, they're not super regulated, we will throw everything out the window and talk about trains for half an hour. But you know what? We still get the work done and they're still making progress.

Monica Lynn: So I think that's just something to keep in mind. But for pulling it all together, I think we could talk about... like a student you have with a phonological disorder, they're not making much progress, you learned about minimal pairs that seem like the easiest. There's a little bit of rhyming in there for phonological awareness, you feel like you're doing okay, but then you look at your internal evidence and you're like, "You know what? I feel like maybe we would've made a little bit more progress now." So then you look into other treatment methods. So you were looking into external evidence. So you see that from your assessment that student had phoneme collapsed. So then you could look into multiple oppositions and from also different external evidence research articles that you want to add some more phonological awareness activities as well.

Monica Lynn: So then you're going to use your clinical judgment to then put that together and try this new method, which Rebecca from [inaudible 00:13:08] and speech pathology has amazing stuff for that. And put that together, [inaudible 00:13:12], the phonological awareness, switch it up with the student, that the student has low frustration during sessions. So they're going to be able to try that when they're making new sounds. So you've thought about that student's social, emotional reaction that they might have to try a different method that might be a little bit more difficult. So that client perspective comes in there. The family at home has been asking for homework and they said they will practice because the student is really unintelligible. So now you've got that client and family perspective. So now you know that they are going to do some practice at home.

Monica Lynn: With really unintelligible students, I also do what you were talking about. I'll ask families to send me like 5 or 10 words that are really important for them that they struggle with and are frustrated at home with so that we can practice, or I might even teach the classroom aid after we've gotten it pretty good. We'll have like maybe a classroom aid if there is one. Just practice that list with them a couple of times every day. So I have that [inaudible 00:14:22], and then you wrap that all together and now you've got an EBP treatment plan.

Marisha: Oh, I love it. It's like a nice little bow.

Monica Lynn: Right?

Marisha: Wrapping it all together. That is the perfect way to wrap up the series all on EBP. Thank you for sharing all of your experience and research with us, Monica. It was super helpful.

Monica Lynn: Yeah. This has been fun.

Marisha: And yeah, we'll see you all next month.

Marisha: Thanks for listening to the SLP Now podcast. This podcast is part of a course offered for continuing education through SpeechTherapyPD. So yes, you can earn ASHA CEUs for listening to this 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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7 Phonological Awareness Strategies in Speech Therapy

September 21, 2021 by Marisha 2 Comments

This is a guest blog post by Monica, a school-based spech-language pathologist, all about Phonological Awareness Activitiesin school-aged speech therapy!

What is Phonological Awareness?

Phonological awareness is “the ability to identify, process, and manipulate phonological units that compose spoken words of different complexity and size” (Milankov, Golubović, Krstić, & Golubović, 2021).

In other words, phonological awareness is the ability to break down and manipulate spoken words into different parts.

Phonological awareness includes the awareness of words, sentences, syllables, onsets (first sound in a word), rimes (sounds that follow the first sound in a word), and individual sounds in syllables and words (Harbers, 2003).

Some examples of phonological awareness are:

Rhyming: identifying words that rhyme

Counting syllables: identifying how many syllables are in a word

Alliteration: identifying words that begin with the same sound

Phonological Awareness and Phonemic Awareness: What’s the difference?

Before working on phonological awareness and phonemic awareness in your speech therapy sessions, it is important to note the difference between phonological awareness and phonemic awareness.

Picture phonological awareness as an umbrella, with phonemic awareness falling underneath of it. Phonological awareness is the ability to break down and manipulate spoken words and sentences into different parts using larger chunks (think rhyming and counting syllables), whereas phonemic awareness is the ability to manipulate smaller pieces, such as individual phonemes in spoken syllables and words (Harbers, 2003).

Some examples of phonemic awareness are:

Segmenting phonemes: “map” = /m/ + /a/ + /p/”

Substituting phonemes: “say map, what is the word if we switch /m/ with /t/?”

Isolating phonemes: “What is the first sound in map?”

Why is Phonological Awareness important?

Making the jump from research to practice can sometimes feel overwhelming. Working on phonological awareness with students who are already at risk of developing dyslexia is one that translates pretty painlessly. This post will quickly cover why we should target phonological awareness in our sessions and then discuss speech therapy ideas. The activities will focus on preschool to 1st grade, but you could easily adapt them for any age group.

If you follow Dr. Farquarson on Instagram, you know that including phonological awareness activities during speech sound sessions is a must!

The article, Exploring the Overlap Between Dyslexia and Speech Sound Production Deficits, by Cabbage et al. (2018) is a must-read on the connection between dyslexia and speech sound disorders. The article states that, “Approximately 18% of preschool-age children with isolated speech sound disorder (absent of a co-occurring language impairment) have reading difficulty in mid-elementary school” (Cabbage et al., 2018) (Lewis, Freebairn, & Taylor, 2000). “In a separate line of work, an estimated 25% of school-age children with a family history of dyslexia have a history of speech sound disorder in early childhood (Pennington & Lefly, 2001). Thus, speech sound disorder and dyslexia are highly comorbid.”

Long story short, students with speech sound disorders are at a higher risk for developing dyslexia later in life, so including phonological awareness activities is an easy way to introduce reading skills early on (Tambyraja, Farquharson & Justice 2020).

If you want to know more about phonological awareness, check out the podcast episode on Where to Start With Phonological Awareness.

What is the Phonological Awareness Hierarchy?

Now that we have a better idea of what phonological awareness is, let’s take a look at the phonological awareness skills based on complexity. According to Moats & Tolman (n.d.), the following is a list of phonological awareness skills, ranging from the most basic phonological awareness skills to the most advanced phonological awareness skills:

Word awareness: tracking words in sentences

Rhyme and alliteration during word play: enjoying and reciting rhymes and alliterations (not producing)

Syllable awareness: counting, tapping, blending, or segmenting words into syllables

Onset and rime manipulation: producing rhyming words

Phoneme awareness: identifying and matching the sound in words (e.g. “which picture begins with /p/?”, segmenting and producing sounds (e.g. what sound does map start with?”), blending sounds (e.g. /m/ /a/ /p/ = map), segmenting phonemes in words (e.g. map = /m/ /a/ /p/”, and manipulating phonemes by removing, adding or substituting sounds (e.g. “say stop without the /s/”).

Teaching Phonological Awareness Skills using the General Education Curriculum

I typically incorporate phonological awareness into my sessions based on the Preschool Learning Foundations (PLF) and Common Core Standards (CCS).

Here’s a quick snapshot of the PLF and CCS if you need them as a reference:

Preschool Learning Foundations:

Common Core Standards for Phonological Awareness (Kindergarten and 1st Grade)

How to Write Speech Therapy Goals for Phonological Awareness Skills & Phonological Awareness Goal Bank

Like any speech language goals we write, we want to make sure our phonological awareness goals are SMART, meaning our goals are Specific, Measurable, Attainable, Realistic, and Timely.

A great place to start to get ideas for phonological awareness goals is the SLP Now Goal Bank. There are several examples of phonological awareness goals to get inspiration from. Remember, it is important to make goals individualized yo your students!

5 Examples of Speech Therapy Goal Targets For Phonological Awareness Skills:

Listen to a word and identify the first/middle/last phoneme.

Listen to individual sounds and blend them to form a word.

Produce the individual sounds in a stimulus word (e.g. /k/ + /a/ + /t/ for”cat”).

Delete phonemes in a word to form a new word.

Phonological Awareness Skill Building Activities

Now on to the phonological awareness activities! I’m going to cover my favorite ones and how to use them during speech sessions. I weave phonological awareness into my speech therapy activities. They aren’t separate tasks that take a lot of planning or prep. It’s part of the teaching process and works well with auditory discrimination.

Manipulating Individual Syllables

I use small dry-erase boards the most for this activity since it would be a lot of prep work to print and cut out words by syllables for all of my students. They also get practice writing out the words when we use dry erase boards, which teachers love anyways! I try to get a list of sight words from teachers and pick out words that have my student’s sounds.

Write out a target word on the students’ dry erase boards at the top to leave room for them to copy it on the bottom. Draw lines between the syllables and erase syllables, so students practice manipulating words.

Here’s what it might look like if you had a student working on multisyllabic words:

SLP: I’m going to write strawberry on the top. Let’s clap that out and see how many syllables it has. Straw/ber/ry. Did you hear 3? Let’s do it again. Straw/ber/ry. Let’s draw lines between the syllables, and then I’ll have you copy it down at the bottom. We heard 3 syllables, right? So every time you say the word, it should have 3 syllables. Let’s try!

*A prompt to build self-awareness could be, “did that have 3 syllables?”. Students would be able to say yes or no and then try their words again.

SLP: If I take out the first syllable “straw,” what’s left? Ber-ry. If I take out “berry,” what’s left? Straw. If a student can’t get this, I’ll use the dry erase board and cover the syllables to match what I’m saying. Let’s make sure we get all of the syllables when we say our words.

Rhyming Words

Using minimal pairs is an easy way to work on rhyming! I usually use a small set of words (no more than 5) and ask my students if the ending sounds the same. I mix in random words that sound really silly to make it fun when we’re contrasting sounds that don’t rhyme.

Here’s what it might sound like in a session if you were working on fronting:

SLP: Let’s look at these pictures. This person is tall (gesture for tall), and this person is making a call (gesture making a call). Let’s say those words. Tall. Call. Did you hear how both of the words have “all” at the end? Let’s just say “all”. Now let’s add our /t/ sound. Tall. Let’s say “all” again. Let’s add our “c” sound. Sometimes our “c” sound is just like our /k/ sound. Call. Did you hear how they both have the same sound at the end? That means they rhyme. What if I say call/oink. Did those two rhyme? No! That has a different sound at the end.

Other Phonological Awareness Ideas

Go through the minimal pairs and ask students to jump or do some movement or gesture every time the pairs rhyme, then sit down if they don’t.

Have the words separated into onset and rime. Have your students say what you hold up so that they have a visual of the rime being the same. Write the “c” and /t/ on their own and then have /all/ on its own and then put them all together to make words and also say /all/ by itself to build awareness. This is also a great way to work on blending.

Add some fun to repetitions by varying the speed of combining and deleting the onset and rime as they repeat them. Verbal instructions for this one could be, “Let’s put this one together fast” or “Let’s put this one together super slow”.

You could also put the pictures down and have students pick up matching rhyming pairs. You could modify this to add movement by sticking your pairs on the wall with some sticky tack and standing for parts of your session. You could make a scavenger hunt for the rhyming word after you’ve gone over all of the pairs. The ideas are endless!

Isolating Sounds

I use isolating sounds the most out of all of the phonological awareness tasks. It also really helps my deaf and hard of hearing (D/HH) students. If you have any students with initial or final consonant deletion, you’re probably already including it in your sessions. I love that it’s auditory discrimination and phonological awareness all rolled into one.

I mainly use gestures as we talk about our sounds and go through repetitions.

If a student is working on /s/ blends, I will ask them if the /s/ sound is in the front of the back. I put my hand on my heart for the “front” sound and point to my back for the “back” sound.

SLP: Our word is “spot”. Did you hear the /s/ sound in the front (hand to your heart) or in the back (point to your back)? Spot. I heard that in the front (hand to your heart). I want you to try the next word. Spill. Did you hear the /s/ sound in the front or the back? Yes! The front. What’s our back sound? Spill. It’s an /l/ sound! I will say the sound for new words and ask, “What sound did you hear in the front?” and “What sound did you hear in the back?”.

When a Student Responds Incorrectly

I ask, “Where is the /s/ sound? Front or back?”

Then I say, “You’re right! It’s in the front, try your word again.”

After enough times, if I ask “front or back,” they can correct their sound by themselves.

It works really well with initial /s/ blends and leads to less prompting pretty fast. I love that it builds self-awareness and self-correction quickly too.

Deleting and Manipulating Sounds

Here’s another activity that’s perfect for working on blends. Let’s say a student was working on /l/ blends. I use a dry erase board, or we make it a listening/auditory discrimination activity.

SLP: We’re going to work on the word “flip”. What’s the first sound we hear in “flip”? That’s right, an /f/ sound. What happens if I take the /f/ sound off? It becomes “lip”! Let’s try with some more words.

It also works well with final and initial consonant deletion.

SLP: Let’s work on the word “cat”. I’m going to write it out. If I cover up the “c” what do we have? At! Let’s try to say all the sounds by themselves “C-A-T”. If we put those all together, what does it make?

I often mix and match phonological awareness activities and put a couple of them together depending on what process we’re working on. I also adjust based on how much support my students need. Tambyraja, Farquharson & Justice (2020) highlight the unique skill and importance SLPs have in developing early reading skills with our students during speech therapy sessions. I love that I’m helping my students work on their reading skills, and it doesn’t take a lot of effort on my part.

I also love this resource from Reading Rockets. They partnered with the National Education Association and Colorín Colorado to make a guide for parents. It’s great for educators too. They have lots of activities for phonological awareness. It’s a great place to look if you want more ideas.

References

Cabbage, K. L., Farquharson, K., Iuzzini, -Seigel Jenya, Zuk, J., & Hogan, T. P. (2018). Exploring the Overlap Between Dyslexia and Speech Sound Production Deficits. Language, Speech, and Hearing Services in Schools, 49(4), 774–786.

Harbers, Heidi. (2003). Phonological Awareness and Treatment Outcomes. Perspectives on Language Learning and Education 10, 21-26.

Lewis, B. A., Freebairn, L. A., & Taylor, H. G. (2000). Academic outcomes in children with histories of speech sound disorders. Journal of Communication Disorders, 33(1), 11–30.

Pennington, B. F., & Lefly, D. L. (2001). Early Reading Development in Children at Family Risk for Dyslexia. Child Development, 72(3), 816–833.

Milankov, V., Golubović, S., Krstić, T., & Golubović, Š. (2021). Phonological Awareness as the Foundation of Reading Acquisition in Students Reading in Transparent Orthography. International journal of environmental research and public health, 18(10), 5440.

Moats, L, & Tolman, C (n.d.). The development of phonological skills. Reading Rockets. https://www.readingrockets.org/topics/developmental-milestones/articles/development-phonological-skills

Tambyraja, S. R., Farquharson, K., & Justice, L. (2020). Reading Risk in Children With Speech Sound Disorder: Prevalence, Persistence, and Predictors. Journal of Speech, Language, and Hearing Research, 63(11), 3714–3726.

#096: How We Approach Clinical Expertise

September 21, 2021 by Marisha Leave a Comment

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This Week’s Episode: How We Approach Clinical Expertise:

Monica and I are continuing to dive into all things evidence-based practice!

We kicked off the month’s series by talking about how the components of EBP have been super helpful for us, and, what we found to be the most challenging about putting it into action.

Last week we focused on the bottom part of the triangle and discussed how to approach internal and external evidence. We provided some tips and some of our favorite resources.

This week we will be talking about the second component of the triangle: Clinical Expertise. Tune in as we discuss the importance of making an honest assessment of the progress your students are making. Is this External Evidence right for my caseload? Can I tailor it to fit my students’ needs?

Remember, trust your clinical expertise. You are your best tool! 💛