Marisha: Welcome to the SLP Now Podcast. This is a very special episode, it's off of the regular schedule. But we are participating in the SLP Connect POD Conference. I'm incredibly excited to have Lilliana Vazquez with us today. And so just a little bit about Liliana, we'll definitely learn more about her through the podcast, but she is a certified, licensed bilingual speech language pathologist who currently practices in Chicago, Illinois. She has extensive experience serving bilingual populations and she works predominantly with bilingual Spanish-speaking students in general education programs, blended preschool, and low-incidence programs. So lots and lots of expertise and knowledge from Liliana.
Then before we dive into all of the juicy content, we just wanted to take a quick second to share our financial disclosures. So I am Marisha Mets and I'll be interviewing Liliana and just facilitating the discussion on how to diversify our speech therapy materials and just talking about why representation and inclusivity in the speech room matters. But I am the founder of SLP Now and I do receive compensation for the sale of those memberships. Then Liliana, do you want to give us a quick recap of your financial disclosures?

Liliana: Yes. Hi, everyone. My name is Liliana Diaz-Vasquez. I am a TPT author. I have my own website, bilingualspeachie.com, and I do get paid for my resources that I provide for SLPs and teachers.

Marisha: Awesome. Then we don't have any relevant nonfinancial disclosures to share, so we get to dive right in. So, Liliana, you've been on the podcast before, so if people want to listen back to episode 54, they can hear a little bit more about your experience working with bilingual students. But in case people haven't listened in, I'm curious if you can tell us a little bit about your experience with your bilingual populations and how you ended up there and then lead us into your experience with diversifying your speech therapy materials and just a quick recap of how you ended up being an awesome resource on this topic.

Liliana: Yes. Thank you so much once again for having me back on here. It's such a pleasure. Yeah, for those of you guys that are listening and don't know who I am, as I said, my name is Liliana Diaz-Vasquez and I am a school-based speech language pathologist. I have been working with the bilingual population for the last... I think now going on seven years as a bilingual SLP in the public school system. I was born and raised in Chicago. I'm first generation Mexican American and I speak English and Spanish fluently. Most of the students that I currently work with are predominantly Spanish speakers although I do also work with students who both speak English and Spanish and I work full-time in a predominantly Latinx community in Chicago.
Yeah. And I've been working with my students that are enrolled in blended preschool programs and our low-incidence programs. Overall, I feel like it's been quite a journey from when I first started, started this path of providing resources and just talking about bilingualism. It's always been a passion of mine since I was in school. It's a population that I knew I wanted to work with and I'm deeply invested in just all of the research and best practices for working with diverse populations. But yeah, I'm really just... How would I say? Just happy where I am right now overall. Today, just talking about diversity and diversifying our speech therapy materials is definitely a topic that sits really near to my heart.
It's a topic that I can greatly relate to growing up as a first generation Mexican American living on the south side of Chicago and attending the public school system from kindergarten to high school. I'm so glad to be sharing my experiences with you and the listeners, as well as my current self, reflections about my own personal journey through the education system. I attended an elementary school that had a large Latinx student population and I was very fortunate to have diverse teachers who were black, Latinx, white, Asian, and Arabic all throughout elementary school and high school. That factor alone, not many can say they grew up with that, so I'm very thankful for the wonderful teachers I had growing up.
But if you were to ask me to recall stories or literature or lessons where I saw my own culture reflected upon or where I saw a mirror image of my own cultural identity being Latina, being Mexican, I can't really tell you or give you an example of a book that deeply resonated with who I am because all of the stories I ever read in school were about white protagonists or characters. I think back to the stories I read in school, such as The Giver, Harry Potter, The Adventures of Huckleberry Finn, The Outsiders, these were all primarily white characters. Now, I don't think that at the time when I was younger that it bothered me much because I was simply reading what I was being assigned and I didn't question it because you couldn't of course.
I grew up with that mentality with what your teacher assigns you just have to do. But I will say now that I reflect upon the literature that I read, I definitely feel like I missed out on a lot of opportunities to learn about my own culture in the school setting and I feel like I could have learned about Mexico's rich cultural history a lot sooner. I'm very grateful for my parents because they have always taught me to be proud of who I am and they have shared and taught me all about these traditions. But if I didn't have that, then I would have never learned about who I am and where my family comes from. Not all students are fortunate to have families that are invested in embracing their own cultural practices, teachings, identities, for whatever the reason may be.
Those are the students on our caseload that we really need to think about. Now, we may ask, "Why is that? Why are students of color not learning about their own culture in school?" Well, perhaps one of the reasons is because most books don't include people of color as the main character in the story. Current statistics from the Cooperative Children's Book Center, or CCBC, at the University of Wisconsin, Madison, show that the percentages of children's books depicting main characters from diverse backgrounds are lower than the number of books with main characters who are animals. And the CCBC, they collect data on books by and about people of color, and their data shows that 11% of main characters in children's books are black or African.
1% are native American, 5% are Latinx, 8% are Asian or Asian American, 0.05% are Pacific Islander, 41% are white, and about 30% are about animals or other characters. Additionally, 3% of books have a main character with a disability and 3% have a main character who identify as LGTBQ. Now, just let those statistics sink in for a while. It's really mind boggling. If you're interested, you can view these statistics and how they attain them on their website at ccbc.education.wisc.edu. But as you can see, almost half of the books are about white characters and 30% are about animals. So what can we do to improve the situation? Well, we can definitely choose to include more diverse books in our therapy materials as SLPs and for several main reasons.
Before I explain why we need to diversify our speech therapy materials, we need to talk about why representation in books matters. So, plain and simple, representation matters because the world is so diverse. Our case loads are so diverse. So why wouldn't we demonstrate diversity in our materials as well? All children have the right to be seen in the stories we are providing to them. And in this diverse world that we live in, every child should have the right to be able to pick up a book and find themselves in the story. I want to quote the famous Rudine Sims Bishop who is a professor of education at the Ohio State University. She's also a literary scholar and has taught courses on children's literature.
She's also won several awards and has conducted research and has advocated about the representation of black people in children's literature. She wrote an article called, Mirrors, Windows, and Sliding Glass Doors, which is often cited because of its strong advocacy for the inclusion of diverse voices in literature for children. I want to just quickly read an excerpt from the article because her words are so powerful. "When children cannot find themselves reflected in the books they read or when the images they see are distorted, negative, or laughable, they learn a powerful lesson about how they are devalued in the society of which they are a part of. Our classrooms needs to be places where all children from all cultures that make up the salad bowl of American society can find their mirrors."
"Children from dominant social groups have always found their mirrors in books, but they too have suffered the lack of availability of books about others. They need the books as windows into reality, not just on imaginary worlds. They need books that will help them understand the multicultural nature of the world they live in and their place as a member of just one group as well as their connections to other humans." Now, this article is incredible because everything Rudine Sims Bishop discusses is 100% true. You can find the article online by searching the title, Mirrors, Windows, and Sliding Glass Doors. I definitely recommend reading it. Diverse books can help our students understand those who are different and help them reflect upon their own experiences.
Our students who are marginalized should be able to see themselves in the story books so they too can relate to the story. And we need to be able to allow our students to feel included in society and create positive views of themselves and positive views about what they can achieve. I would also like to point out that it is important that SLPs and teachers are not only choosing to use diverse books when they have a diverse caseload, white children or dominant groups within our schools also should be exposed to diverse books and materials. I'll give you an example at my school. I primarily work with Latinx students who most are Mexican, although some of my students are Puerto Rican or Guatemalan. But I can definitely say that Mexicans are the dominant group at the school.
Although a lot of my materials include teachings about the Mexican culture, I also like to include books and materials from other cultures as well. My students also need to learn that there are other interesting and beautiful cultures that exist besides the dominant group or besides the bubble that they are familiar with. So reading books that represent different abilities, cultures, beliefs, and skin colors help us change our attitudes towards these differences, and it can help us understand those who are different than us and their experiences. If we only read about characters that reflect our own image or reality, then we are more likely to believe that our own experience is more important or more valid than those that are unfamiliar to us.
So we need to be able to have new perspectives that reflect the reality of the communities that we live in, which leads me to my next reason why we need to diversify our therapy materials. We need to be able to reflect the reality of our communities. The reality in the school that I work at is that many of my students come from immigrant families who migrated to the United States. And several of my students have experienced the hardships of deportation of a family member or fearing that their family member will get deported or having limited access to resources because of the fear of deportation. Diverse children's books can definitely be used as a resource to help with these tough topics.
Books like these might provide hope, might help bring comfort, might help bring awareness, or just overall, it's these books that our students need, really need. This is just one mirror example, the topic of immigration. However, we can find other books that demonstrate other real struggles and challenges that exist in our communities such as books about equality, books about divorced parents, about gender identity, or books about loss. There is just so much more to our communities than just a perfect square and our students need to see that and learn about that. I'll definitely give some titles or examples of books a little later on, or books on these specific topics. But just moving on to another reason why we need to diversify our speech materials is so that we can create an environment of inclusivity.
So as I mentioned earlier on from the statistics from the CCBC, only 3% of books have a main character with a disability, or as I like to say, a difference. As SLPs, we work with a wide range of communication disorders and people who have a wide range of disabilities, so we should definitely be using materials that reflect those differences so our students can feel like they too can be the hero in a story. I'll give you an example of an inservice I did with a special education teacher at my school. The special education teacher and I wanted to do an inservice for our student body. We decided that we would focus on educating the gen ed students about autism and also tie it into AAC because most of our students with autism used communication devices.
We had the teachers bring the students into the library, since at the time we didn't have an auditorium, and we showed an episode of Arthur, called When Carl Met George. The episode is about one of Arthur's friends, named George. In the episode, George makes a new friend named Carl who was very interested in trains. Then George later finds out that Carl has Asperger's syndrome and sees the world a lot differently than most people. Just overall, it's really great episode because I really feel like the show explained autism in such an easy and understandable way for children of all ages to understand. And overall, the students at my school really enjoyed it and we were able to talk about what autism is and also discuss communication disorders that often coexist with autism.
And we had several of our students from our low-incidence program talk about their AAC devices to the students. It was definitely a therapy lesson that I remember which had the most impact on my students. They were just so eager and so excited to show off their devices and for once were really included in the lesson. And that is creating an environment of inclusivity. During the lesson, I was also able to tie in my students' goals. Most of my students were working on expressing a variety of communicated functions on their devices, and they definitely were able to do that. So SLPs can be inclusive in their lessons and still tie it in to their students' speech therapy goals. Our students need to experience a sense of belonging and feel that they are valued.
After the lesson, I definitely felt like it reduced the amount of staring from the gen ed students whenever my students would use their device in the hallway or whenever they were experiencing sensory difficulties in the hallway. It allowed the gen ed students to learn about the differences that exists amongst their peers. And teaching our students to be inclusive can also help reduce possible bullying in the schools. Think about our speech students who have communication disorders such as stuttering or delays or use communication devices, teachers in SLPs need to bring more awareness to these differences so that our students don't get bullied and so students can learn to understand one another. We have to establish the positive atmospheres or climates in our schools.
We can do that through the materials and lessons we are teaching, which brings me to my next point why we need to diversify our therapy materials. We need to create a positive learning environment. As I mentioned earlier, I work with primarily Latinx students who are the dominant group at the school. Most of my students speak Spanish. As most of you know, there is a wide range of different dialects that exist within the Spanish language. I love incorporating books where my students can learn new ways to say a word in Spanish and it really makes them accept that there are many differences amongst the languages that we speak as well. One of my colleagues just recently told me about a book called Rafi and Rosi by Lulu Delacre which uses rich Puerto Rican vocabulary throughout the book.
So this is a book that I would definitely want to use with my students. But by using a diverse therapy materials, our students can learn about different variations of languages. These variations also exist in English and perhaps we can find books that have rich vocabulary where our students can learn many ways or different ways to say a word. Aside from learning about different language variations, we can teach our students about just overall the rich history and traditions that are important to a cultural group. So definitely keep those points in mind, the points that I mentioned; strive to create a positive learning environment, and overall inclusivity, and representation.

Marisha: What an amazing overview. Thank you so much for breaking that down in terms of the benefits of using those materials. I love how you gave a couple examples of what that actually looked like in your therapy and in your settings. That was really cool and helpful.

Liliana: Thank you.

Marisha: So now that we're all on board on using more diverse therapy materials and we've got lots of rationale behind that, how would you go about... because you shared some suggestions for materials. What factors would you consider when selecting those materials? Where do you look? Where do you start? Any tips or suggestions that you're willing to share?

Liliana: Yeah. There's definitely a lot of considerations that SLPs or teachers should definitely think about prior to selecting or buying materials. So I'm going to outline some questions that you can ask yourself prior to choosing materials. These aren't in any specific order, but these are definitely questions that you should ask yourself. So the first one being, definitely ask yourself, who wrote it? Is the author of the book or the therapy material from the culture that is being depicted? Definitely know about the community you work in, really strive to educate yourself about what kind of community you are in, what does that population look like? Avoid books with negative attitudes towards a group, any books with heavy, negative bias, or books that express stereotypes.
Ask yourself, is the book accurate or is the material accurate? Are the events that are talked about, are those accurate? Does it align correctly to the historical events that you are teaching or talking about? Also make sure that the material that you are selecting is age appropriate with age appropriate vocabulary. Then lastly, I would also make sure that the vocabulary in the book aligns with the culture or the group being represented. I'll give you an example. As I said earlier, I work with a lot of students who are Mexican. Now just imagine reading a book that is talking about the Mexican culture and traditions but using vocabulary that doesn't necessarily represent that group. So just make sure that the vocabulary also in the book is accurate as well.

Marisha: Perfect. What would be a good way to find out if something is accurate? Do you have any tips in navigating that?

Liliana: Well, definitely doing, once again, a search or just studying or knowing, like I said, the community that you are working in and overall what exactly are you trying to teach or what exactly is the lesson that you are trying to cover. I would do some research prior to, like I said, buying the books or the material and just learn about, let's say, just for an example, say you're doing something on Black History Month and you just want to do research to really educate yourself prior to picking any materials so that you know what to talk about or what exactly you're going to be teaching.

Marisha: Perfect. Then I think one strategy to help narrow down the texts that we're choosing or whatever content is to look at who the author is. So I know on Amazon a lot of times it gives you a little bio of the author, or doing a Google search. That's definitely not a foolproof method, but I think if the author is from that culture, there's a much bigger, larger chance that that's going to be accurate.

Liliana: Yeah. Like I said earlier, these are definitely the questions that should be going on in your head as you are picking materials. And yeah, who wrote it is definitely important. You want the information just to be depicted accurately.

Marisha: And I know there's a lot of booklets and things out there in terms of recommendations made by people from different cultures. So that might be a good way to jumpstart that search as well.

Liliana: Yeah. Like I said, I'll definitely give some examples of some of my favorite materials that I like using as well as some... I have a list that I could talk about.

Marisha: Well, let's do it.

Liliana: Okay. There's several books that I have in my collection and I know that it's so easy to fall into the popular speech therapy books that are often talked about or used in therapy. I, myself, I'm guilty of using those books as well. And these are books like; There Was an Old Lady Who Swallowed a Fly, If You Give a Mouse a Cookie, et cetera. And don't get me wrong, those are great books that allow SLPs to target a variety of goals, but you can also do that with diverse books as well. So I'm going to give you some of my top recommendations of multicultural/diverse books that I frequently use in therapy as well as some speech therapy goal areas that you can target with these books. For those listening, don't worry about having to write these down really quickly.
I also have these recommendations on my website at bilingualspeachie.com as well as the goal areas that I'm going to mention. So I have these separated by category. So the first category that I have is multicultural books. I really, really like the book called, The Day You Begin by Jacqueline Woodson. This book is about feeling different or feeling like an outsider but accepting who you are and where you come from. It has a really great message. For this specific book, some goal areas that you can target are learning to describe the characters in the story. You can definitely do comparing and contrasting, answering questions from the story, describing emotions, understanding perspective of others, sequencing the events from the story, using helping verbs, and I'm using conjunction such as because with this book title.
So definitely one of my favorites. Another one that also falls under this category of just multicultural books is one called, We're Different, We're the Same by Bobbi Jane Kates. This one is super cute. This book features Sesame Street characters and overall how people show how we are all just different but have overall many likenesses or lots of similarities. The book just overall just demonstrates that our differences is what makes us beautiful. So once again, it really has a really great message. And goal areas for this book, you can definitely work on descriptive words, adjectives, once again discussing emotions because it has lots of pictures of people's faces.
So you definitely target emotions, labeling verbs, comparing and contrasting, building mean length of utterance through picture description because it has lots of pictures in it, answering WH-questions, like, who has the orange nose? Because once again it has a Sesame Street character. So you can really work on those WH-questions through the pictures it has or even following directions, such as, point to the girl that is running. So lots and lots of goals for that book. For the next one, it's same thing under the same category. This one's called Different and the Same by by Adijah and Atiya Brabham. Hopefully I'm saying that correctly. This book is about twin sisters who explore their individuality and celebrate their sameness.
The book also demonstrates different activities that make each one unique, and by activities, I'm talking about all sorts of verbs you could target with this one. I know in the story one girl likes painting, the other girl likes drawing. So definitely labeling verbs for this book, using adjectives once again, adverbs, definitely pronouns such as they, or she, comparing and contrasting, once again building mean length of utterance, answering questions like, who likes to sing? Who likes to paint? And using conjunctions, like, she likes to sing, and, she likes to draw. So another good book with lots of goals that you can work on for language.
The next category are books about the black culture. So these are books that I have on my shelf as well. The first one is called Black Is a Rainbow Color by Angela joy. This is a powerful book about a child who reflects on the meaning of being black and ties it to her culture and her history. It's also about normalizing the word black and just being proud overall of your identity. I love this book too to really discuss metaphors. In the back of the book, there are poems and you can definitely work on writing goals and just overall discussing just literary goals, figurative language, using adjectives once again. It has lots of great vocabulary such as words like freedom, community, culture, things that you can work on in therapy and also really great pictures, so you can work on picture description as well.
Another book that also falls under this category, it's called Mariama - Different But Just the Same by Jerónimo Cornelles. This book is about a girl from Africa that moves to a new country where she does not know the language and is unfamiliar with the culture. It's a beautiful story about identity and the process of integration and solidarity. Goals that you can work on with this book as well is sequencing the events of the story because it really is this long narrative of where this little girl started. So you can definitely work on, first she did this, then she did that. So sequencing, recalling and describing details from the story, making comparisons, and then also defining and using new vocabulary. The black has a glossary of a variety of vocabulary words that are used throughout the book. So that one's also a good one.
Hair Love is another one. This book, it's called Hair Love by Matthew A. Cherry. This book centers around the relationship between a black father and his daughter and it tells a story of how the father must do his daughter's hair for the first time. It's also about embracing and loving your natural hair. So I love this book and this one is super cute as well. The goal areas that you can work on with this one is same thing; sequencing events of the story, recalling, describing details. This book also has a glossary in the back of vocabulary words, so you can work on vocabulary. Also describing character emotions throughout the story and perspectives and answering questions as well.
Then another book too that also is under this category, Parker Looks Up by Parker Curry and Jessica Curry. This book is about a little girl who goes to a museum and comes face to face with a portrait of First Lady Michelle Obama. The little girl sees the possibility and promise and the hopes and dreams of herself in the painting of Michelle Obama. It's a super symbolic book. I highly recommend this one as well. With this one, it has lots and lots of pictures. So once again, these language areas that you can really work on, like pronouns, adjectives, perspective taking, WH-questions. It's also a really good book for that as well.
Now, moving on to a new category. These are books about the Muslim religion. This book is called Under My Hijab by Hena Khan. This book celebrates the many Muslim women and girls who wear hijabs and provides an introduction to what a hijab is. The goal areas for this one is definitely talking about clothing, labeling, describing clothing, recalling and describing details from the story, comparing and contrasting, once again those WH-questions, and sequencing as well because it's also a story that has a lot of sequential order to it. So lots of goal areas for that one as well. This one is one of my favorite, The Proudest Blue: A Story of Hijab and Family by... and I'm probably going to say this name wrong, but Ibtihaj Muhammad.
This is a very powerful book about a girl name of Faizah and her first day of school. And her older sister, Asiya, it's her first day of school. Not everyone at school wears hijabs and they don't see it as beautiful and the character in the story overall goes through these emotions of being hurt and confused and her sister helps her throughout the book and stuff. So this one also, I really, really like this book. You can definitely also cover labeling, describing clothing, those emotions, comparing and contrasting, adjectives. It's also a great, great book. Then moving onto a new category, books about divorce. I really think that these types of books are important as well. As I mentioned earlier, our communities are not a perfect square.
So books like these can be so helpful to our students and so meaningful to our students. This is one of my favorites as well. It's called Monday, Wednesday, and Every Other Weekend by Karen Stanton. This book is about dealing with the many changes that come with having divorced parents. It's about a boy who lives with his mother and father on different days of the week. Also has really great illustrations as well. So picture descriptions, a big one for this one. You can work on labeling the days of the week, recalling the details from the story. You can also use complex sentences with prepositions, because in the story, they start off a lot of the sentences with like, "On Monday, on Thursday, on Wednesday." So you could do that as well.
Then another book that's in a new category, these are books about autism, because as I had mentioned earlier, it's important to also be inclusive about the students that we are working with. This one's called, Too Sticky! Sensory Issues with Autism by Jen Milia. This book is about a child who has autism and is dealing with sensory challenges and then she ends up receiving help from her family and her teacher through accommodations and encouragement in order to participate in this sensory activity where they are making like slime. It was like slime, which is difficult for her. I like this book because you could definitely work on following directions and sequencing once again because there's a slime activity included at the end of the book and it comes with instructions on how to make slime.
So you can definitely tie it in to a hands-on activity when you're reading the story. And you can definitely work on problem solving and talk about expected behaviors versus unexpected and character perspective with this one. So that one's really great. Then books about gender. This book title is called, Pink Is for Boys by Robb Pearlman. This is a great book that helps rethink and reframe the stereotypical blue-pink gender by emphasizing that boys can like the color pink as well. This one you can also work on following directions. You can tell your student, "Point to the pink ball. Point to the the blue car." You can also work on adjectives by color and labeling verbs as well for this book as well.
Then the second one under the same category is called What Riley Wore by Elana K. Arnold. This book is about a gender creative character named Riley who loves to wear whatever clothes feels right for the day. Then at the playground within the story, the character is confronted by a kid who asks Riley if Riley is a boy or a girl. In the book, the author doesn't really assign a gender pronoun to the character, because overall, the book is about normalizing gender expressions that people have and about being confidently non-binary. So with this book, the character wears a lot of different clothing and just costumes. So you could work on labeling and describing clothing as well, adjectives because the character has different colored socks with different patterns, labeling body parts because the character puts on different hats on his head and on his body, and prepositions.
You can work on, "Glasses on Riley's face," or, "Children in the sandbox." So those are other goals that you could target. Then lastly, this category, books about the Latinx culture. The first one is called, Where Are You From? By Yamile Saied Méndez. Also these books that are in this category do come in Spanish as well in case you are looking for Spanish books. This book is about a girl that is constantly getting asked where she is from and she seeks advice from her grandfather who provides her with a very rich explanation. The story is overall about just self-acceptance and cultural identity. Really, really great for vocabulary. There's so many rich vocabulary words in this book. Picture descriptions illustrations are really beautiful as well, and answering WH-questions from the story.
Then I'll give maybe one more just because of time. This one, let's see. There's another book under this category called Alma and How She Got Her Name by Juana Martinez-Neal. This book is about a little girl named Alma Sofia Esperanza José Pura Candela who believes she has too many names, but throughout the book, she learns that the history that she carries with her name is beautiful and to overall be proud of her name. In this one, you can work on conjunctions, like in the story, her grandmother loved books and poetry. You can work on picture descriptions, pronouns, recalling and describing details from the story as well. So, I mean, I could keep going, Marisha. There's so many books, but for time's sake, I'll end it here.

Marisha: First of all, you were so incredibly amazing. That was so helpful. I feel like given your... just how the hour has gone so far, giving the rationale, giving us some tools that we can use to make decisions and select really great materials, and then you took it one step further and just put together this amazing list for us to start with. Then the speech therapy goal areas, that is so incredibly practical and helpful. I love it. I will put the link to your blog post in the show notes so if anyone is having trouble finding that link. It is absolutely amazing. It's pretty much an outline of all of the tips Liliana gave today and then it gives all of the links to the books and the goal areas. It's a phenomenal resource. I'm so excited.

Liliana: Yeah. I mean, these are really great books that I really think every SLP should have in their library of books. Just one thing I want to mention. Topics like race, culture, gender, can often come up as we are working with our students and especially if you're going to be using diverse materials. As I mentioned before, it's really important to create exposure to these conversations for our students in order to guide their learning towards being really loving and caring human beings. I know at times these conversations will come up and I just wanted to provide an outline of what are some considerations that SLP should just keep in mind when reading these books to their students.
Far and foremost, definitely listen... as you're reading these stories, listen respectfully and consider your student's point of view as you're talking about these books. Keep in mind that students can sometimes indirectly give us insight as to what is going on at home or in their life. Respect their opinions. Ask yourself, why does your student feel the way he or she does? Try to provide guidance as needed. And if your student is experiencing something that should be addressed immediately, then reach out to the correct professional such as a social worker, admin, or whoever you may need. Also don't make assumptions and take the time to educate yourself or learn more about your students' cultural beliefs and practices before you assume a certain book or speech materials appropriate.
Whether you are working in student groups or not, don't expect any individual to speak on behalf of their gender, ethnic group, class, status, or the groups that we perceive them to be a part of. The student may not feel comfortable doing so, or more importantly, we cannot allow ourselves to assume that he or she is part of a certain group. So it's kind of going back to doing your research, educating yourself about the community that you are working with or the students that you are working with. Overall, if you want to establish rapport, which is key to really getting to know your students and their families, then I suggest that you do that from the very beginning of the school year. I know now we're in that back-to-school season.
I created a letter in Spanish and English that SLPs can send home to their students' families. It's like a questionnaire that respectfully you can provide to families so that they can provide you with information about the students and their family. So that's something too that you can do ahead of time to really do that research and just educate yourself about the students that you're working with. That ties in with establishing communication ahead of time and really just getting to know your students. So as I mentioned, sending home a get to know you activity where the student and family can complete is something I recommend. Communicate with parents ahead of time and just overall plan ahead.
Plan a framework, discussion questions, and overall, lead with your goals. I would say that foremost, it's important that we are also tying these conversations to our students' speech and language goals and leading with our goals because ultimately we are also trying to help our students express their ideas and point of view. So leading with your students' goals can help ensure that you are on topic and that you are guiding the conversation in a way that will be meaningful and useful to the student. But if an SLP is looking for... just SLPs listening for more tips on just managing these conversations in the speech therapy room, I highly recommend checking out Indiana University's website.
They have a page called Managing Classroom Discussions and they provide really great tips on preparing for these conversations. So I could send you the link, Marisha, so that you could share with the listeners. Then also, the actual leader also has a great article by Phuong Palafox, who is also bilingual SLP. She discusses why literary interventions for diverse populations are important. The article is called, Why Use Literary Interventions for Diverse Populations? She also discusses some great tips on how you can support your diverse populations by building rapport as well in case SLPs are interested in just learning more. But yeah, these are great books. I really recommend looking into them.
Also keep in mind you could find free books online as well. So some resources that I really recommend looking into; there is a website called diversebooks.org. It's a nonprofit organization that advocates for diversity in children's literature. They have such great resources and just tons of websites on there just linked in on where you can find books like these online. Since I know a lot of us are doing remote learning, so you can find these books online for sure. Another website that I frequently use is called International Children's Digital Library. That one has so many books in different languages. They have... I don't even know, like over 50, 60 different languages. And all of these books, you can just search by the language that you are looking for as well.
Then there's also Children's Book Council. So that is cbcdiversity.com. Also has really great book recommendations. Lastly, Diverse BookFinder. So that one is pretty cool. It's called diversebookfinder.org/books. You can just type in exactly what you are looking for in the search engine on this website and it will populate a list of books that you can use in therapy. So I love these websites. I would definitely bookmark them. If the listeners are listening in, bookmark them in your computer, they're really great references.

Marisha: That is so incredibly helpful and I will definitely find a way to share all of these amazing links, because I just started pulling them up and they are so incredibly helpful and definitely tools that I'll be using. So thank you for sharing.

Liliana: No problem.

Marisha: Then, was there anything else that you were hoping to share or any huge takeaways?

Liliana: Just the huge takeaway is like as I said. I think the points that I mentioned earlier on why we need to diversify our materials is so key. As I mentioned, we need to be able to create these positive learning environments for our students, we need to be inclusive, and we need to start really providing that representation in the speech therapy room. As I gave those examples, as I said, the popular speech therapy books, we all use them, they're great, but you could do so much more for our students by covering these type of materials, as the books I mentioned, in your speech therapy room. You'll be surprised at the different conversations that you can have with your students and just so many things that you can learn about your students to really establish that rapport, that trust.
I've done it before with my students and I absolutely love having these conversations with them. As I mentioned before, I wish I had that when I was younger, growing up in the school setting. I wish I could have read a book about Mexican American, Latina, but unfortunately I didn't. I really wish I had and now I want to do that in my therapy room with my students so that they can really, really relate to the stories that we're providing to them.

Marisha: Yeah, absolutely. The cool thing is that it benefits all students, because learning about different cultures and just all the different topics we talked about, that's going to help all of our students just increase their awareness of everything that's out there, which is really cool.

Liliana: Yeah. Like I said earlier, you shouldn't just provide or use diverse books with diverse populations. Everyone benefits from these. So I hope whoever's listening out there, take that into mind, consideration, and just start thinking more about the way you're providing services and really make it meaningful for our students.

Marisha: Yeah. The cool thing is too, we might be thinking like, "Oh man, I already have a full library of books. I don't have money or a budget to purchase new once." I haven't checked your book lists, but a lot of books are available on YouTube or through the library. So there's so many way... You don't need money, you don't need anything fancy, you can make this happen without a huge investment. And just do what you normally do with books, but just add new ones to the list.

Liliana: YouTube and Epic, the Epic app, you'll be surprised as to what book titles you can find on on Epic and on YouTube, like the full story, the full version. So definitely take advantage of those resources.

Marisha: Yeah. It's amazing. It makes it so much more accessible. You don't have to spend hundreds of dollars building a library because a lot of them are available for free, which is amazing.

Liliana: Exactly.

Marisha: Okay. Well, I think that brings us to the end of this amazing conversation. Thank you so much for sharing all of your knowledge and expertise with us. Then just to wrap up, do you want to let people know where they can find out more about you and what you do?

Liliana: Yeah. So as I mentioned earlier, you could find the list of books that I mentioned on bilingualspeechie.com as well as the goal areas that I talked about and some of the important points that I talked about today as well. Otherwise, you can always find me on Instagram, bilingualspeechie, and also on Teachers Pay Teachers as well if you're looking for known resources in Spanish and English as well.

Marisha: Awesome. Thank you so much and I will see you next time.

Liliana: Thank you.

Marisha: Hey there. And welcome to the SLP Now Podcast. I am so incredibly excited to have Liliana with us here today. We are going to be talking about all things bilingual therapy. It is definitely going to be a crash course. We were just talking about this before we started recording. And all of the questions that I have for her, like each individual line, could be a massive course. Liliana has done a ton of work to kind of distill the most relevant details, and give us just a good starting point. But, this is definitely, like I said, crash course.
But, a little bit about Liliana before we dive in. She is a certified, licensed bilingual speech language pathologist currently practicing in Chicago, Illinois. She obtained her bachelor's degree in communication disorders in 2012 and her master's degree in speech language pathology at St. Xavier University in 2014. She has extensive experience serving with the bilingual population, which is why she's here today. She currently works full-time in a public school setting as a lead bilingual SLP for her district. She also works part-time in early intervention with bilingual families. She runs an amazing SLP blog geared towards providing bilingual resources for SLPs and parents. She also creates bilingual resources and activities on her Teachers Pay Teachers store. So without further ado, welcome, Liliana.

Liliana: Hi. Thank you so much for having me here. It's a pleasure chatting with you today.

Marisha: I am so grateful you are willing to share your time with us. I've been getting a lot of questions from the SLP Now Podcast listeners about bilingual therapy, so I am super excited that you get to share your wisdom with us here.

Liliana: Oh, thank you. I'm glad to be able to answer any question that you have today.

Marisha: Before we dive into all of the nitty-gritty details, I'm really curious about kind of what led you to specialize in bilingual therapy and how you got to where you are today.

Liliana: Well, it's definitely been a long journey. I would say it really just started early on when I was trying to choose or pick a career to study, which can be a difficult task for most 18-year-olds growing up. At the time, I just remember I wanted to major in forensic sciences, but I wasn't sure. I also thought about psychology. I think my mom played a really huge role in my just decision-making and just her influence. She always urged me to pursue a career either in the medical or healthcare industry where I can utilize my Spanish-speaking skills in hopes that I can make a difference in the Latinx community.
Then, I mean, for this reason, growing up in a household where Spanish is the language predominantly spoken, that meant trips to the doctor with my grandmother or making phone calls for my dad in order to interpret for them. So, my mother always stressed kind of the importance of being able to find someone who's proficient in Spanish when going to a hospital or any type of facility. But most importantly, she often stressed that the quality of parent communication improves greatly when you have someone that relates to you on a cultural level. Then, I feel like that statement stuck with me forever.
So since the beginning, I knew I wanted to work with the Latinx population, with the bilingual population. At the time, I was actually at the University of Illinois studying psychology. I just kind of realized that that wasn't the career for me. So once I got my mom kind of urged me, she's like, "Oh, you should look into speech therapy. It sounds like a really great career." Then, I did my research and switched majors, switched schools. And like I said, from the beginning, I had let my professors know that I really wanted to kind of have a bilingual emphasis with my clinical placement. So, that's kind of how I gained experience working with the bilingual population.
Then, I guess fast forward to once I graduated and once I did all my clinical work, I was super excited to finally be on my own and start my career. I was placed in two schools in the Back of the Yard neighborhood here in Chicago where 70% of the community are Latinx, and about 70% of the student population are English language learners. So, I was really trying to find resources. I was honestly a really complete nervous wreck my first year. I was trying to learn a ton, ask a ton of questions, make materials, and just overall try not to panic just because that's when I really realized that resources and activities were very limited in Spanish. So, I started really just creating my own stuff and using my activities in therapy. Then, it just kind of took on from there. I wanted to share my activities and share my resources with other bilingual SLPs that I know are in the same boat as I am trying to find resources and activities for their specific population.

Marisha: I love that story. I feel like I just was a little bit similar in that I started with psychology, too, and eventually switched over to speech therapy, but yeah.

Liliana: I think we made a really great choice.

Marisha: I agree. I think I chose an amazing field. I love how you were able to use your Spanish and just your experience growing up to kind of create a really specialized role for yourself and having an impact in a way that ... a very unique impact. So, that's super inspiring. Thank you for sharing that.

Liliana: Aw, thank you. Thanks.

Marisha: Now, let's get into the nitty-gritty content. I think it'd be helpful to start about just talking about some common myths about bilingualism because I think that's kind of a good starting point in just making sure we're on the same page.

Liliana: Yeah, of course. I will discuss some of the most common myths that I have heard over the years while working with the bilingual population. Most of these myths I have heard from parents or professionals working in our field who may not be necessarily informed about the best current processes in regards to working with linguistically diverse and bilingual populations. And some of the myths that I will discuss have been debunked by a vast amount of research, which I will mention as well.
I would say the first biggest myth is that ... It's on the topic of language confusion. Language confusion is the idea that children are incapable of becoming bilingual without experiencing some sort of confusion. Therefore, it's often believed that exposing infants or toddlers to more than one language will cause delay. Currently, there's no research that shows that bilingualism causes language delays. We can expect children to meet the same developmental trajectory as those who are exposed to one language. This is a quote directly taken from Asch's statement on bilingualism.
Then, of course, there's research. There's a study done by Dr. Barbara T. Conboy, who's an SLP with specialty training in early language and bilingualism. She completed a research study in language differentiation in bilingual infants. Overall, her research indicated that children's cognitive systems as early as infancy can handle more than one language without confusion. So, that myth was debunked by all of the research.
Then, another myth that's often heard as well is it also goes along with the topic of language confusion. And it's that when children mix their languages, it means that they are confused. I have heard this concern from several parents of bilingual children over the years. Often, the parent will state that he or she heard his or her child say a word in one language and then started to combine words of features from the second language in the same sentence. Now the parent is concerned that their child is confused or not learning each language perfectly.
This is actually an amazing behavior that the parent is observing. It's called code mixing, which is the use of elements from two or more languages in the same utterance or conversation. Often, as children are learning both syntactical symptoms from both languages, the child may carry over features from one language while speaking. And if a child is still learning both languages, we might hear what may sound like to us as errors. However, when compared to the mainstream language, however, I like to tell parents and other professionals that these are not errors but instead interesting linguistic patterns which indicated that the child is really starting to understand and manipulate these grammatical rules from both languages.
Parents and educators should not reprimand children for code mixing because code mixing is actually pragmatically strategic and grammatically constrained, meaning that it doesn't occur randomly. We know that it's actually rule governed. And often, people code mix in a way that respects the grammatical rules of both languages, which is really, really cool. It also helps to fill lexical gaps in the child's proficiency in the target language and at times may also reflect the child's cultural and social identity. So, code mixing is perfectly normal.
Then, another big myth that I often hear, too, is speaking two languages to a child with a delay or disorder will make them worse. Therefore, during intervention and at home, the parent and clinician should expose the child to only one language. This is probably, I would think, the most commonly heard myth that I've heard in multiple settings from multiple professionals, including doctors or pediatricians who have recommended that the parent should only expose their child to one language. Often, parents of children who have autism are worried that speaking two languages might delay their child's language development or altogether just stop it.
It is intuitive to think that adding another language may impair their child language learning systems, but there's a growing body of research indicating that children with a wide range of communication disorders are capable of becoming bilingual. There have been several studies on children with Down syndrome, articulation impairments, and autism. And all of these studies have shown that bilingual children's language skills can be comparable to monolingual children with the same impairment. Overall, there's no evidence to support the idea that being bilingual will result in additional language delays for children who have language impairments. We can see this statement supported in research studies completed by Gutierrez-Clellen, Wagnus, Corkman, Pratus, Kreigo. There's several research studies that have also debunked this myth.
A very popular study that was done was done by Hambly and Fombonne in 2011 where they compared the social language abilities of three groups of children with ASD from Quebec and Ontario. In the research study, they had three groups. One was monolingual. One group was simultaneous bilingual, meaning that they acquired both languages at the same time. And another group was sequential bilinguals, meaning that the participants acquired one language first and then later the second language. The researchers examined several language aspects in the study, such as social responsiveness, initiation of and response to pointing, attention to voice, vocabulary size. And overall, they did not find differences between these bilingual groups and their monolingual peers with ASD. We can see similar results in other studies with children who speak English and Chinese.
But overall, these researchers found that children with ASD who were simultaneous bilinguals did not experience additional language development, developmental delay. The findings suggest that children who have autism or Down syndrome are definitely capable of becoming bilingual.
Then, lastly, another big myth is bilingual children will have academic difficulties and the language of intervention should be provided in the classroom language or the language of instruction, which most of the times, here in the US, is English because providing intervention in any other language would not support the student's progress in the classroom. This myth I frequently hear in the school setting, especially during IEP meetings or during any meeting where a special education team is deciding types of academic supports that the child will receive.
I have been in meetings where parents or parent advocates or other professionals will make a case for removing bilingual support or pushing for English-only instruction or intervention because English is the language of instruction. And once again, this idea that exposing the student to another language will cause the student more learning difficulties or lead to not mastering any languages is highly believed. Although this assumption may appear valid, there is no evidence to suggest that children with severe disabilities are unable to successfully become bilingual. This statement comes directly from a researcher by the name of Ohashi. In 2012, he did a research study.
But, overall, restricting language input to one language only may result in negative consequences which can impact the child who comes from a bilingual environment. We need to think that if bilingualism were too cognitively demanding for children with disabilities, it would mean that children with typically developing language skills will perform below their monolingual peers because of the increased cognitive load of bilingualism. But yet, the research, the literature does not suggest that. We have research that shows that bilingual children can have academic advantages of being bilingual, including superior problem-solving skills, multitasking skills, and increased cognitive flexibility.
A study by Barac et al. in 2014 called the Cognitive Developmental of Young Dual Language Learners found that, overall, in the area of nonverbal executive control skill such as memory, typically, bilingual children showed more advanced skills than their monolingual skills. Then, a more recent study that appeared in the Chicago Sun-Times called English Language Learners are Matching, Exceeding Other CPS Students revealed that bilingual ELL students met and sometimes surpassed monolingual students academically.
Overall, I believe that it is our ethical responsibility as professionals, as SLPs to educate others about the facts and the research currently out there. Because myths like these can have an impact on service delivery, an impact on decision-making in the special education process. We really must keep in mind that eliminating a child's home language comes with great consequence. It can result in poor language models at home, difficulty with family cohesion or communication, and prevent families from passing on their cultural values. So, we really must take this into consideration when working with diverse populations. And just ultimately, it's not our decision to make when it comes to which language the child should be exposed to.

Marisha: Oh my goodness. What an amazing overview. I was scrambling away taking notes. There's so much good information there.

Liliana: Thank you.

Marisha: Thank you so much.

Liliana: No, no. Thank you. I could definitely send you the research studies so that you can share with the listeners.

Marisha: No, that's amazing. So helpful. Those are all things that I've heard in meetings and everything, too. So, I think this was a really great starting point in just kind of getting all of us on the same page on where things stand with bilingual therapy. So, let's just dive into some ... And I wish we could talk about this for much longer time. But like I said, we're doing crash course today. Let's start diving into assessment. So, what are some ... Let's say we have a bilingual student on our caseload. We're convinced that we're looking at both languages or maybe even more than two languages if they are speaking more than that. But, what are some of the best practices for the assessment pieces? Where do we want to start with that?

Liliana: I will kind of outline some really important just key features about bilingual assessment. As SLPs who work with culturally and linguistically diverse populations, I would so that foremost, it is extremely important to become familiar with the student's ethnic background, educational background, student's cultural and dialectal differences prior to your evaluation. You definitely want to use your resources and do a thorough review on pragmatic differences that exist within the student's culture. Portland State University has some really great resources. That's the Portland State University website.
Just the last thing you would want to do or to make is a miss- or over-identification of the language disorder because of a cultural difference. So, definitely inform yourself about the student's dialect. For example, there are so many dialects that exist within English and/or the Spanish language, for example. And it's not safe or best practice to assume that your students speak the same dialect as you. I speak Spanish. However, my dialect of Spanish is completely different from a student living in, let's say, the northern part of Mexico. And it is completely different when compared to a student who is from Puerto Rico.
Overall, a point that I really want to stress is that we also need to acknowledge the students' linguistic differences and not judge or hold these differences as less or as the substandard when compared to the mainstream language. Overall, the SLP that is evaluating or working with diverse populations needs to practice culture humility in order to best serve these populations. But overall, we really need to be able to obtain qualitative and quantitative information from our evaluation and ensure that we are using a variety of assessment tools to help guide our decisions when assessing diverse population.
We definitely need to use multiple measures, both informal and formal, in order to really obtain the complete picture. So, you definitely want to do an in-depth family interview. Caregivers can always provide accurate information about a child's communication strengths and weakness, and just being able to understand the family's view, which can give us a lot of insight about the child's cultural values, educational status, language use, and communication deficits.
We also need to complete thorough interviews about the child's language background use. This is completely different than the regular interview. This information, the language background use, is going to help us obtain language of the student's dialect history as well as measuring the amount of exposure and usage of the student's language and the communication partners that the student communicates with on a daily basis. It really gives us a lot of good insight to the student's language preference and information about the student's acquisition of both languages.
So, tools that are very helpful for the part of the evaluation are language history questionnaires. Some assessments such as the BESA already have great questionnaires embedded within the assessment. Or you can always download a questionnaire from ... There's a website from the Cornell University that also has a good questionnaire called The Multilingual Language Use Questionnaire, which is really great. Because once again, it really breaks down all of those questions about language history.
But aside from that, too, we need to use nonstandard speech language assessments, pragmatic tests, language samples, or even criterion reference assessments if formal standardized testing is not available in the child's primary language. These tests will help determine the client's understanding and use of conventional language. And just really keep in mind that most, if not all, assessments are not always normed on the diverse population that we work with. Therefore, using scores to justify our decisions is not enough. I can't stress that enough. The most widely standardized language assessments that SLPs use are biased against most linguistically diverse students.
So even according to Dr. Kate Crowley, who is a well known SLP researcher, most bilingual students perform poorly on a standardized test, not necessarily because they have a disorder but because they do not have the same prior experiences as the mainstream American middle class experiences that form the content of most of these standardized tests. So, definitely keep that in mind. And keep in mind that it is not appropriate to translate standardized assessments to reach a standard score when you are working with these diverse populations. You simply cannot report standard score as when using assessments that are not normed for that specific language.
You start to think, "Oh, well, if I can't use standardized assessments, well, what else can I use?" One of the best tools that you can use is in-depth language sample. Honestly, it's the best tool that you can use when evaluating bilingual students. Language samples prove to be not culturally or racially bias. It's considered the gold standard for assessing children's language skills because it, honestly, is the only assessment measure that captures a speaker's typical and functional language use. This is a quote directly from Heilmann et al., 2010. Clinicians can use tools like salt and sugar to assess the students' morphology and syntax in both languages or even obtain language samples with tools such as the SLAM cards from Dr. Crowley's Leaders Project website. You could download them there. They're free. Also, just check out the website because it contains great information about working with diverse population. But, she has several tools on there that you can use and download so that you can use for your assessment.
Then, lastly, I would say that dynamic assessment can also be very useful when assessing bilingual children. And for those who are unfamiliar with dynamic assessment, it's a method of assessment which uses the test, teach, retest model. It can help us determine difference versus disorder when working with children that speak another language. Dynamic assessment really focused on the child's ability to acquire the skills after being tested and after being exposed to instruction. Children who are able to make significant changes after short-term learning or intervention sessions are very likely to have language differences in that language disorders. Overall, that's kind of my outline of things. So, just keep in mind when you are doing these assessments, language samples, interviews, dynamic assessments, criteria, and reference test.

Marisha: That is another amazing overview. I love how you structured that. It gives us some really nice action items to kind of look at and compare and see what we're currently using in our assessments, and then giving us a jumping-off point to learn a little bit more. So, that is perfect.
I second Dr. Crowley's site is amazing. I love the SLAM cards and all of the resources she has on there. So, that's a really great place to look if SLPs are wondering about language samples.

Liliana: It's a really great resource to just also learn more about dynamic assessment. Because I feel like that's one of the biggest questions that I often receive is how do you do a dynamic assessment or what are the components. So, she has great, great resources, the Leaders Project website.

Marisha: Yes. Yeah, we will definitely link to that in the show notes. Let's say we finish our assessment. We did our interviews. We looked at the language background use. We did a variety of different assessments. And we're only using norms when appropriate, which it sounds like that would be pretty rare in these situations, and we did some dynamic assessment. So, how do you go about starting with goal writing with English language learners? Do you have any rough guidelines or suggestions for getting started there?

Liliana: Yeah. Figuring out where to start in speech language interventions can be tricky, especially when working with bilingual children. Every case is different. And I will keep kind of my recommendations a little general because of this. However, one point to always note according to best practices in bilingual intervention and research by Dr. Goldstein, who is the author of the book Bilingual Language Developmental and Disorders, is that it's always easier to start with therapy goals that consist of shared features of both languages in order to develop a strong foundation and lead to overall gains in the student's language ability in the first language and in the second language.
Basically, what that would look like would be imagine you have a student who speaks, let's just say, English and Spanish. Finding shared features between both languages would be in the example of, let's say, a language goal, would be plurals, for example, because plurals exist with the final S, adding the final S to nouns, exists in both languages. So, that would be a goal that you can address. Let's say for the example of articulation. For example, if you're writing a goal for articulation, you would want to pick target sounds that are also shared amongst both languages. So once again, going to that English, Spanish example. Some shared phonemes would be the S sound, the M sound. You might want to start there when you're writing your goals.
But in addition, targeting shared features in your speech language goals will really help you avoid writing goals that are dialectal differences, which is not best practice. And once again, it's just really important to become informed about what those dialectal differences are. Write goals that consist of shared features of both languages. Then, once the student has mastered those goals, intervention can then later address the non-shared features or language-specific features as deemed appropriate.

Marisha: Awesome. Then, for SLPs who aren't as familiar with the second language, you mentioned that Portland University site ... Here, I'm trying to look back at my notes.

Liliana: Yes, yes. Portland State University.

Marisha: Portland State University. That would be a good place to go for dialectal differences or no?

Liliana: Yeah. The Portland State University website has a variety of languages under ... I believe it's the multilinguistic tab that they have on the website. They list a variety of languages. You could just click on the language that you're looking for, and it gives you an overview of pragmatic differences, just information about the culture, the language. It's very, very informative.
I know ASHA as well has a lot of good information on the website on dialectal differences for some languages. Bilinguistics has a whole book on different languages and their dialectal differences. So, I would highly recommend checking out those resources if you are working with English language learners.

Marisha: Is there an easy ... Are there similar resources to identify the shared features in both languages?

Liliana: Yes. I think, once again, Bilinguistics has the shared features within their book. I can't think of the names right now, but they do list out kind of this diagram where they show what those shared features are and which features aren't shared as well within their resources.

Marisha: Awesome. That leads me to a follow-up question, too. Of these resources that we can use, if we're not familiar with the language ... Or, yeah. So, the follow-up question there is ... So, let's say an SLP is working with a student who speaks Portuguese and she doesn't speak Portuguese. She can do that research and figure out the shared features, the dialectal differences, all of that. But, do you have any other ... I mean, ideally, the student would have a speech therapist who speaks both. But, do you have any tips or suggestions in navigating that?

Liliana: Yes. It can be challenging at times working with or communicating with families who don't speak another language that you know you know. In that specific case, sometimes you might not always find a Portuguese-speaking SLP to help that student. I would highly recommend the use of an interpreter if possible. That is best practice is to provide the student with intervention in the child's language. So, I would reach out to your admin, your school if you do come across a situation like that where you don't speak the language. Because in that case, like I said, you would really need the use of an interpreter.

Marisha: Awesome. Then, that leads me to the next question. In that case, we'd also be working with the parents. Oftentimes, if that's the primary language for the student, then that is also the case ... Or that can be the case for the parent as well. So, do you have any suggestions in providing effective communication when the primary languages don't match up?

Liliana: Yeah. Once again, like I said, it sometimes could be difficult to find those resources or even the use of an interpreter if possible. I know sometimes that's not the case, especially when you want to just be able to send home activities or explain an assignment. Overall, here, I'm going to list some tips in order to help improve communication with parents. I always ask families about their language preference for activities, meetings, and overall communication. I highly suggest that. Don't assume that because English is their second language that they aren't comfortable speaking it. If they prefer to speak in their first language, definitely try to find an interpreter. But, that's definitely a question to always ask families right from the bat is what their language preference is.
Definitely get to know the family and their culture. Once again, this is practicing cultural humility and being able to be culturally competent in order to ensure that any activities or materials you provide are just appropriate culturally and accurate. Let all the students and families know that they are welcome. A welcoming environment that celebrates students' cultures and encourages family leadership creates a strong foundation for relationships in your practice.
Then, use your resources. If a translator is not available to help you translate your materials or instructions on an assignment, you can use Google Translate. It's not perfect. But from experience, parents will tend to appreciate the effort you put into your communication a ton in case you really, really need something translated.
Then, the biggest point, I guess my biggest point of advice, is don't cut corners. It may seem very easy to leave out information or feel frustrated that you cannot get your message across with ELL families, but ELL families are legally entitled to information about their child's schooling. This includes all information about enrollment, parent conference meetings, IEP meetings, and any services that the school provides, such as speech therapy. They have the right to understand this information and have this information in a language that they can understand. ELL parents must have access to the same information as non-ELL parents.
According to the US Department of Education, schools must communicate information to limited English proficient families in the language they can understand. They must provide translation or interpretation from appropriate and competent individuals and may not rely or ask students, siblings, or friends, or untrained school staff to translate. It's just not sufficient enough for the staff to be merely bilingual.
Then, another thing to keep in mind, the IDA 2004 mandates that an interpreter facilitates the communication between individuals who do not share the same language. This includes assessments as well. Really keep in mind that sending information home in English will not always ensure that it is read and understood. I want to say ask yourself, what is your school doing to meet the needs of the current student population within the school? Does the school staff reflect the student population? I know sometimes these factors may seem out of our control, but we need to initiate these conversations with our admin at our schools in case you find yourself in a case where you have some students that need that interpretation or need that ELL support.

Marisha: Wow. So many good tips. I did have a follow-up question, too. I mean, we could talk about all of these points for hours and hours. But, I'm curious if you have any specific suggestions on getting to know the family and their culture. Can you give a couple examples of questions you might ask or just how you might approach that?

Liliana: So if it's a student on your caseload, you would've had to do a background assessment or just a family interview as part of the interview. I do ask these questions. I ask the families where they're from, what language is spoken at home, what information about the dialect. I let them know that it's more so for my assessment so that I can really understand how the child is communicating. So, just kind of making that point really straightforward, just saying that it's for the assessment purposes. But, I'm a pretty straightforward person. I will ask families about their preferences. I will, like I said earlier, ask them what language they prefer communication be in. In the beginning of the school year, I do kind of an activity where we talk about where we're from and just to really get to know one another and get to know my clients and get to know my students so that I can effectively provide them with just the intervention of with the assessments that they need.

Marisha: That's perfect. When you mentioned that, it reminded me of an article that one of the SLPs in my membership sent me. I think it was ... Yeah, it was this week. I just pulled it up real quick. The title is How to Celebrate Multicultural Diversity in Your Classroom. So it's geared at teachers, but it had a lot of similar things that you mentioned. They're activities to do with students, but some of ... I'll just share one or two of the quick ideas. But, they recommend having the students interview a parent or grandparent to learn more about their cultural heritage or just having ... Like you said, just talking about that in the speech room. That's an amazing language activity. So, it could kind of give us that information and also be therapeutic.
There's also sharing information about food. That's part of their cultural heritage. The blog post has ... Or like playing music from their culture. There's just so many different ideas on ... They're great therapy activities also, but they give us some really great information, and I think it's a cool way to celebrate all of the different cultures that we work with.

Liliana: Yeah. Once again, this just ties into how I mentioned earlier, just making sure that your practice, your intervention really celebrates and encourages, like you said, all cultures within the speech therapy room, and you're using materials or tools that are accurate and represent a variety of cultures or represent the student's culture. Because that's really important as well so that the student can also see themselves in the types of intervention that you're giving.

Marisha: Yeah, that's perfect. Then, I'm curious, too. This is backtracking a little bit, but I'm super curious. We talked about assessment, and we talked about selecting goals. Then, I'm curious, too. When it comes to the actual ... When it comes to treatment and diving into intervention, and with your current caseload, I guess might be the easiest way to start talking about it, how much of your intervention is in English versus Spanish? What does that look like? How do you structure that? Just some super ... I know that could be a three-hour course as well, but do you have any ... I'm just curious to get a quick snapshot of what that looks like for you with your caseload.

Liliana: Well, for me, for my specific caseload ... And this, it varies school to school, SLP to SLP based on their caseload's needs. At my school, there are two SLPs, myself and my colleague. The way we have divided our caseload is she takes all of the monolingual students, because she's monolingual, and I take all of the bilingual or predominantly Spanish-speaking students. Currently, on my caseload, I would say 90 or 85% of them, their therapy is in Spanish and Spanish only just simply because I work with a lot of preschoolers. The preschool students often come from environments where Spanish is the predominant language at home. And they come into school only speaking Spanish, and they're acquiring English in the school setting. So, intervention is in Spanish 100% with them.
It really varies. Once again, if you are trying to decide what language intervention should be in, once again, you really have to tie it back to your evaluation and all of the information that you obtain. Like I said, if there's cases where the student's intervention might be in both languages, cases where it might be in one language. So, it's hard to say exactly. But, just always keep in mind that you don't want to discount for the student's home environment. If the student is exposed to another language, then you definitely want to use both languages in intervention.

Marisha: Perfect. Thanks for humoring me with that backtrack there.

Liliana: No, crosstalk.

Marisha: I don't know. I thought that was super interesting to kind of address in terms of what that looks like, too. So now, circling back yet again, we were just talking about improving communication with parents who might not have English as their primary language or who prefer to communicate in another language. One of the things that you mentioned was working with interpreters. I know you have some really amazing tips to share in terms of how to effectively work with an interpreter. So for an SLP who maybe hasn't done that or isn't as comfortable just from the lack of experience, what should we definitely consider when we're working with those?

Liliana: Yeah. So, not necessarily in the school setting. I have worked with interpreters. Because like I said, most of my caseload has been Spanish, predominantly Spanish-speaking, which, I mean, I speak. However, in the early intervention setting, I have worked with interpreters. I have been able to kind of gather all of these tips just from my experience and also from just reading research articles. But, when I was in early intervention, I worked with several families who spoke Arabic. I had to work with interpreters with all of these families.
I'm just kind of going to go over the tips that I think are really, really important that I want to highlight. And the first one being that you really have to make sure you have access to a licensed and certified interpreter. It kind of goes along with the statement, again, that just because you're bilingual doesn't mean that you can translate or interpret. I'm sorry. Interpret everything adequately. So, you want to make sure that the interpreter is licensed, certified. Inadequate interpreting skills can definitely hinder the communication process. So, make sure that your interpreter is proficient in both languages, that they can convey meaning, and understand linguist variations of the particular language that you are working with. Make sure that they are familiar with your field's terminology. That one is super, super important. Also, ensure confidentiality and discuss it with the family as well.
Also, I would highly recommend that your interpreter is also very culturally aware. Once again, it's important. Just because someone speaks the language doesn't always guarantee that they understand the culture. When I was working with these families, there was a lot of things that at first that I didn't know about the family's specific culture, even though I had done my research. I had read several articles, but there was just so many things that I still had to learn, things from taking your shoes off when you enter the family's home. That was a big one for me as well. Just making sure that your interpreter can also help you with these questions and just kind of guide you with their own experiences is really important.
Then, one big point, too, is preparing before the session. That one is a huge one. Back when I was working with an interpreter, I would always meet at least an hour before the session. Or if you can't do it the same day, but definitely plan meetings prior to your session so that you can discuss, once again, the terminology, the process, everything that you're going to be doing that day, what you want him or her to say or how you them to say it is really, really important. So, just preparing before the session. Once you are in your session, I would highly recommend that you talk to the family and describe what the roles are. Describe how you're going to be the one working with the child, and the interpreter really just kind of serves as your voice to communicate with the family.
Always address the parent, that one's a big one, too, and not the interpreter. That one can seem ... I want to say you almost do it unconsciously when you want to communicate and you turn to look at the interpreter, but you really don't want to hinder your relationship with the family. So, looking at the family as you're talking and not the interpreter is a big one. So, making eye contact. And like I said, the interpreter just kind of serves as your voice, and that's it. You're still communicating with that family.
Remember to also take pauses. I also know this from experience just because, like I said earlier, I have interpreted for my family before. And if you're talking too fast, you can miss really important details. So, really take pauses as you are talking to the family, making sure that everything's getting interpreted. Check for questions. Always, I like to ask the families questions, backup questions to make sure that I understand that they understood what I was saying.
Remember to also take note of the nonverbal language. I like to make sure that I'm looking, once again, at the family directly. And if I notice any type of kind of nonverbal language like facial expressions, I kind of like to ask questions just once again to make sure that they understood what I am talking about.
Also, avoid oversimplification of diagnosis or recommendation. I think that's a big one, too. A lot of times you want everything to get interpreted correctly, and you try to word things in a way where you might want to make it more simple so that it gets communicated across more simple. But, don't oversimplify way too much. Be really straightforward as well with your recommendation.
Yeah, I would say those are kind of the big tips that I would recommend. Oh, and I almost forgot. One last one. Debriefing. That's a big one, too. After each of my sessions, I would debrief with the interpreter at the end just to make sure that their observations were the same as my observations and things were interpreted correctly, or if I missed anything, any concerns that the parent said, or a question that the parent might've had. Because when you're in the session, everything can move so fast. Time goes by so fast. So, always just kind of comparing observations at the end, debriefing at the end with the interpreter is key as well.

Marisha: Wow. Lots of great tips there. I so appreciate it. Thank you, Liliana.

Liliana: No problem.

Marisha: That brings us to the end of my content question list. I know we touched on a lot of different topics today. If SLPs want to learn more and kind of hear more about what you do, where can they find you?

Liliana: Well, definitely on social media. They can find me on Instagram, on Facebook. Always feel free to reach out, send me a message. I am currently working on my website. It is up right now, but it's under construction. But, I do have a website called bilingualspeechie.com where I do post several of these resources that I have mentioned, tips on bilingualism. So, definitely there as well. But, yeah, just feel free to reach out to me on social media if anyone has questions.

Marisha: Awesome. Then, any parting words of wisdom or advice or just the one ... If SLPs walk away with one thing today, what would you emphasize?

Liliana: If SLPs could walk out with ... Bilingualism does not cause language delays. And use multiple measures when assessing ELL students. Multiple measures, not just standardized assessments.

Marisha: Yeah, perfect. I definitely have a list of probably a hundred different takeaways, so hopefully people walk away with more than that. But, it's always interesting to hear what stands out to the presenter. That was so incredibly helpful. Thank you. Then, if SLPs are wanting to access any of the links that we mentioned, including Liliana's social media handles, and some of the research articles, and the blog posts, and all of that, you can go to slpnow.com/54. And that's a wrap, so thank you.

Liliana: Thank you.

Marisha: Hello there and welcome to the SLP Now Podcast. I am incredibly excited to have Kristie Knickerbocker on the show today. She is a speech language pathologist and singing voice specialist in Fort Worth, Texas. She rehabilitates voice and swallowing at her private practice, a tempo Voice Center and she also lectures on voice science nationally. So, she is an SLP rockstar and I've been waiting patiently or maybe a little impatiently to get to talk to her about all things voice, because she is such an amazing resource. I am really excited to get a peek at what she does today. But, she will also share some tips and suggestions for those of us who are working in the schools and trying to figure out what we're doing with these students. So without further ado, hello Kristie.

Kristie: Hi Marisha, how are you?

Marisha: Awesome. Super excited to get to learn a little bit about you today and all things voice. I'm super curious, can you tell us a little bit about your journey? How did you get started with voice therapy? We know that you have a private practice and I'm curious what that looks like for you today.

Kristie: That's a really great question. I'm an interesting story. When I was in high school and growing up, I've always been a singer, so I enjoy singing, I'm very musical. I enjoy writing, I enjoy playing instruments. I sat down on the back porch with my parents in high school, when you decide what are you going to do, are you going to go to college? I told them I really, really, really wanted to do music. So, I had auditioned for a music scholarship to go to Texas Christian University for a vocal performance degree, and I got the scholarship. So, we had all decided as a family that I was going to do that.
That same senior year, I was prepping for a competition where I had to sing a song, an art song by myself, and something was going on with my voice. It was nothing I could control. It was the weirdest thing. I just knew the sound wasn't coming out right. It wasn't coming out correctly. I discovered that if I pushed on my throat to the side, it didn't make that weird noise. So, I went to the competition and sang, and performed pushing on the side of my throat. The judge looked at me and asked, "Why are you doing that? What's wrong with you?" I said, "Well, my voice sounds really weird." So, she asked me a couple of questions and basically said what I was afraid she was going to say, which was, "You probably need to go see an ear, nose, throat doctor."
That was the push I needed to go get looked at. There was a bump on my vocal cord and I was devastated, been worried about next steps right away. I was told I needed to go see a voice therapist, a speech therapist is what they called it at the time. I was so concerned that this speech therapist wouldn't know anything about music, would know nothing about singing. I went and I met her. I was pleasantly surprised. She was a singer as well. She knew lots about music, and knew exactly where I was coming from, and that was really comforting because it was a really scary time. But, I ended up having surgery, and had the bump removed, and I was then in rehabilitation. So I had more voice therapy and then went and continued on in college like an injured athlete, where I wasn't really singing very difficult songs, trying to take care of things as I healed.
My voice teacher had a meeting with me and said, "You need to probably think about a different career path, because there's no way you're going to graduate on time with this injury." So, I was again, devastated but then got to thinking, "Well, what can I do?" I had considered doing nurse practitioner or a physician at some point during that backyard conversation with my parents. I said, "Well, what about doing the speech pathology? Doing what my speech pathologist had done for me, being that person that knows about singing, music, voice and then being able to marry that love of healthcare person, patient care with music at the same time."
So, fast forward to graduating graduate school, I had taken a semester, extra class on entrepreneur mindset and things you might need to be thinking about if you ever wanted to start a private practice. I thought that was really neat. I was scared of it though at the same time. I decided that I would incorporate after I got my license. So, my husband helped me. We chose the name O tempo Voice Center, because O tempo is a musical term. It means that you deviate, you have a rhythm, the beat of a song, you start off with that certain timing and that certain rhythm. You may deviate from that throughout the song to a slower part or a faster part, but then, the musical notation, it's like the map, it tells you o tempo, which means go back to the tempo that you started with. So, just like I try and do for my voice patients, and what I knew with my vision, to help them get back to that baseline. I wanted it to be named something healing, something that they could identify with.
It's not the best name when you're trying to talk to insurance companies because and they don't know, they expect an H after it. But, it's been an interesting journey to do that. It just found me, and then I found it and it has become me now.

Marisha: I love that. That is so cool, and very unfortunate that all of those things happened. But, I feel like sometimes things happen for a reason and now you get to help all of these other singers and musicians find their way back too, which is really cool.

Kristie: It's the best feeling. It really is, to be able to work with someone who you know exactly how scared they are for one. They're coming to you, not because it's me, it's like, "Oh, I'm coming to voice therapy." They're freaking out inside. They think that things are over for them. To give them answers, to get them goals to help them get back to what they were doing, is the best feeling.

Marisha: Yeah, that's amazing. So cool. You've lived it, so you're probably... I know you're amazing when it comes to, I don't know, just being there for them and knowing what to say and how to support and all that. So that's amazing.

Kristie: Yeah.

Marisha: Now, let's dive into some of the nitty gritty voice therapy stuff. The first thing that we decided to talk about was just the difference between behavioral and physiological voice therapy. So, can you tell us a little about that?

Kristie: When you think about voice therapy, maybe if you're listening to this, you had a little bit of a class part of a class, maybe half a semester, maybe you got a whole semester or maybe you got more than that in school, maybe you even got an extern placement where voice patients were being seen. But, it was always something that I was confused about. It was usually the way it was presented in class. So, voice therapy was this thing in the corner that nobody wanted to touch, nobody wanted to look at, but I was super excited about it because I knew that's what I wanted to do. But for everybody else, it was very visible to me that it was challenging. It was either they didn't know enough about it, so they just didn't care. They said somebody else can do that. But, I got to thinking, "Maybe it's just because the information is presented in a confusing way."
So, I want to talk about this because, I think it's important to help you piece together what these differences are, so that you know the types of voice therapy that you might need to give to very specific patients. Because, not all voice therapy approaches aren't created equal. Sometimes patients need more of those types than others. Sometimes they just need one approach. So, I wanted to dive into talking about the differences between that, so you understand it better.
The most common I think, behavioral voice therapy technique is resonant voice therapy. If you're thinking behavioral, this is the type of voice therapy where we're teaching patients what to do in the middle of their voice production. We're changing the technique of how they're creating sound, how they're using air and the shape of their throat and mouth to project that sound. It's something that's happening in the moment. So, that's what behavioral is. Then, physiological voice therapy is slightly different because, you're completing vocal tasks that might tax the system and overload it muscular-wise breath-wise, trying to get gains in what someone's able to do. An example of physiological voice therapy would be like LSVT, Lee Silverman Voice Therapy. Another example would be Joe Stemple's Vocal Function Exercises, the he, the glide up to glide down, and then there's five different notes that the person's singing. These are programs that are implemented with the idea that the person will make gains with how many times they're doing them per day.
Back to behavioral, the most common is resonant voice therapy. This is where you're humming or you're creating a very buzzy sound at the front of the face, vv or, zz, and most commonly hums, where you're trying to get vibration sensation somewhere in the mouth, somewhere in the nose, your cheekbones, and feeling what happens when you do that. The humming, the vv, zz, those are all types of semi occluded vocal tract exercises. That seems like a really scary long way to describe something, but in layman's terms, it is where your vocal cords are creating sound and then you're doing something to the tube that shapes that sound.
So, the throat is part of that tube, the pharynx is part of that tube, the mouth, the oral cavity is part of that tube. If you're putting something in the way of that tube being open for an ah, like you're closing your lips or you're bringing your tongue to your teeth, or you're completely shutting your mouth and having something come only out of your nose, your nostrils, that is a type of semi-occlusion, you're putting something in the way of that tube. That humming is one thing.
The benefits of semi-occlusion are that, it helps the vocal folds come together and not vibrate where they're colliding so hard. This is helpful for our patients who may have lesions, where we're not wanting the vocal cords to slap together so many times a second or so hard. It's helpful for patients who may have excess tension, and we're having them re-coordinate those behaviors. If they're straining because of that excess tension, or if they have pain from that excess tension, resonant voice therapy's a really great option. You may have heard of straw phonation, that is another type of semi-occluded vocal tract exercise, lip trills, tongue trills. There's even a new one. I was at a fall voice conference last year in 2019, and the guy was presenting research, and it was humming, but he was closing the nostril slightly with both fingers, so it was a muffled hum. That provided even more semi-occlusion, with the fingers almost sticking up the nose, sticking up the nostrils. So, I'm looking forward to reading research on that as well.
Then, another type of behavioral voice therapy is stretch and flow. This is where a person may be exhibiting breath holding patterns, or again tension or perhaps we want to again, alleviate some lesion by spacing the vocal folds out a little bit further, and not having them come together fully when you're creating sound. Stretch and flow is created by taking... It's the only approach that takes completely vocal cord vibrations away, but it keeps the articulation there. What I mean by that is you may start with just blowing on an U, and then you advance to actual articulation tasks. Some are rote like counting, and then you're able to advance up those counting hierarchies. You can mix and match days in the week, months in a year, just easy on the brain, but all, one, two, where your throat's really open and there's no vocal cord vibration. Then, you bring the vocal cord vibration back in, but you have it very, very minimally. So something like one, and then you can count like that, two, three.
A little bit different from the resident voice where, one, two, three, you're trying to aim for vibration at the front. The stretch and flow is more of how much air is coming out, how open and relaxed is your throat. But again, all of those are techniques that we can try to help shape what a person is doing and then have them continue on into their conversational speech, which is the ultimate goal. The goal shouldn't be they can do straw phonation with 100% accuracy. It should really be, they can use a variety of these tools, of these behavioral voice therapy tools to get the desired outcome, whether that's less pain when they talk, they sound better to themselves, they have better acoustic measures that we can test, that kind of thing.
But then the physiological, like I was saying earlier with the vocal function exercises, those were created by Joe Stemple, and there's a really good MedBridge course that he did where he describes exactly what they are, exactly how to do them. I think there's no better way to describe all those because he's actually teaching a patient in those videos. So, it's a perfect way to learn those. Like I was saying earlier, LSVT is another type of physiological voice therapy. A newer one is a PhoRTE. This is Edie Hapner and Aaron Ziegler, and they are creating again, a protocol the patient does daily. Then, you're taking these measures to see how well they're doing, and then you advance them as they respond to this type of therapy, and then you change it based on the patient's output.
So, there are different types of voice therapy. It's not a crazy amount of different types, but there definitely are considerations for your patient based on what their needs are. If you had somebody with both vocal cords where they are atrophying and not touching all the way, you might not want to put them on stretch and flow and make them breath here. We would potentially want to put them on the physiological type where they're really taxing their system, trying to bring the vocal cords a little closer together. Then if they were rough, we might throw in some resonant voice to help them sound less rough, that kind of thing.

Marisha: That's super helpful. I love that overview. I think this definitely is more of a crash course and a comprehensive of how to do everything. But, I'm definitely interested in learning more like, how do we decide all of those? But, I think this is a great starting point, and it gives us just enough of a foundational knowledge to... Like if we have a student on our caseload who's receiving voice, then we at least have a basic overview of what might be happening depending on the approach, or if we are in a position where we're deciding, we at least have a starting point to figure out which approaches to look into. So, that's super helpful. Then I'm curious too, because I've heard a lot about straw phonation, where does that come in and when would you use that?

Kristie: That's a great question. Straw phonation falls under behavioral voice therapy. It is a type of semi-occluded vocal tract exercise. It was researched very heavily by a man named Ingo Titze. He found out with many studies that what was happening was that, when you're creating sound and air into a straw, you're putting your lips completely around the straw, and you're blowing air and sound through it, that, that creates something called inertive reactance. Again, a fancy word. But, you can just call it back pressure. That back pressure travels from where the straw limits where the air and sound's coming out at your lips, and it forces it back down towards the vocal cord level, the glottic level. It encourages the vocal folds to not vibrate so hard, they don't slam so hard together.
This is a really great tool I think for all ages. I'll tell you why. You can use, we've been calling it Blowfish, but where your lips are slightly parted, your cheeks are puffed up, where you're making the straw shape with your lips. I find that it's not appropriate for every patient. I also find that the straw gives the person something to hold, and when they see it becomes a visual cue. So, they're able to be reminded, "Oh yeah, I need to do my voice work today," or it's almost fun, right? They can grab the straw and say, "I'm doing something really great for my voice because, I have this tool and I'm able to do it," versus just maybe relying on their mouth or their lips. It takes it out of their body. Because, a lot of times if the tension is present, it's hard for us to get out of that mentally. If we can have an external thing, potentially we can help alleviate that.
So you would use straw phonation if you had a patient who has excess tension, or they may have dysphonia, which is just the fancy word for rough voice. But, you would want to test on probe just like we do for speech therapy anyway, to see if they're appropriate, to see if the straw actually does something that's good for them. In my evaluation sessions, I will hand the patient a straw after evaluating, to see if they're a good candidate for it, just because it's usually very easy to explain. Again, with that thing in their hand, they're reminded visually, "Oh yeah, I have to do something." So I'll have them wrap their lips around the straw and make noise. I'll have them pick a pitch and travel up and down in pitch to see where they feel the most vibration at their lips also. Then I'll ask them, "Do you feel if there's strain? Do you feel if you're pushing at the throat level?"
A lot of times you might hear that push or that strain, they might sound something like hoo, because their pattern of how they're creating sound is so tight, it's so uncoordinated and that's all that their body is remembering how to do when you ask them to vibrate their vocal cords. We see this a lot with people who have had an illness like laryngitis, or they have had some cold or upper respiratory infection where they cough a lot, or they're straining to make sound because their vocal cords are so swollen. This a lot of times will help break that habit for them. So, straw phonation is easy to do. You can have them do one to two minutes. You can even put just sounds, single notes. You can have him put it in water and blow bubbles into the water while they're making the sound. Sometimes that adds a little resistance, and it has them use breath in a different way. So I think that that's helpful as well.
But, straw phonation is not for everybody. It could cause more tension than you think it should. So, listen to your gut, right? Follow your instincts with it. Because, while it's good in theory, a lot of times I will try it with a patient because I'm thinking this is going to be perfect for them in the clinic, and then they try it and I completely throw it out the window, and they're walking out the door because I've given them something else by this time, and they will say, "What about that straw thing?" I'm like, "Forget we even did that. I tossed it. We don't need that." So, straw phonation is a good thing to know about. It's good to have in your toolbox, but it's not the end all be all.

Marisha: Okay, perfect. Let's do a quick recap. We talked about three different behavioral approaches. There's resonant voice therapy, stretch and flow and straw phonation. Then for straw phonation, you said that it's ideal for patients who have, or it can be a good approach for patients with excess tension or dysphonia, but we want to abandon that if we find that using the straw actually causes more tension. So who would you say, who would we use resonant voice therapy with? What would we see or what would an ideal patient be for that?

Kristie: Great question, very similar. So, somebody who may like routine and things where they can try a type of voice therapy in multiple occasions. The resonant voice therapy can be used in a hierarchy fashion where you're doing, Katy Verdolini Abbott calls it the Basic Training Gesture, mm-hmm (affirmative), like you're answering a yes question, and single words mention or moon. There's a chant version as well, where they're sustaining sound. My mom mails me money.
But, this will be good for patients who might have just, I mean, straw phonation too, might've just come off of vocal surgery and they need something that's not very taxing on the vocal folds. Any gentle phonation or gentle sound production to start off with might be good for patients again, who have pain when talking. If they come to you and they sound like this, and you need to rebalance how they're using breath and vocal cord vibration and resonance, you can teach them how to make the sound and then create that, take them way over their comfort zone, and naturalness of speech, because I sound really strange doing this right now. Teach them how to do this and then teach them how to draw back from that, where it actually sounds more normal, like natural conversation.
But, if they find themselves going back to that pattern, they can breathe in and then check back in with that resonant voice. So, it's more of something you're going to have a little bit more cognitive load to do that versus, stop do the straw for about a minute and then come back in. So, it's something that can be put within the context of a person's speech in a little bit of a different way. But yeah, it's a great approach. I think it is just like straw phonation, I think patient dependent. Sometimes we'll do really great with a patient with straw phonation during a session. They do it for one week, it's really great. They come back the second week and things have gone really downhill. We'll throw a resonant voice in there and then that helps things. Then, they can rely on both straw phonation and resonant voice to help them reach their target outcome.

Marisha: Awesome. Then, what about stretch and flow? Is that also similar in terms of crosstalk.

Kristie: For stretch and flow, you would want to use that on a patient who has a really difficult... A lot of times patients will have difficult time humming where it's relaxed. You would think that's not that hard, I can hum. But, sometimes their patterns or how they sound doesn't necessarily create smooth quality. They can't break the pattern of the tightness or the dysphonia with the humming alone, because it's too similar to their everyday speech. So, for those patients, and there's actually a study it was a non-inferiority study, meaning one wasn't worse than the other, and it looked at comparing resonant voice therapy to stretch and flow, finding that both were able to make an impact positively for patients. So, this would be if your patient can't do resonant voice therapy really well or if you think they're holding their breath and you want to go ahead and start there, you can.
But, because it takes away the vocal cord vibration and it focuses on airflow and output of air, I think it's a really good one, if your patient's personality or their presentation is one where their shoulders are really tight, they're holding their breath, they're talking really fast like this, absolutely it is like that, you really need to break down the systems so that you can build them back up again.
So you can say, "Hey patient, let's talk about breath. I want to teach you how to really focus and slow down on your articulation, how you're forming words. Breath happens the whole time." You're able to teach them utterances on one breath and how that feels. Then, you throw the voice back in. Because, sometimes it's too much to think about for a patient, because they've been vocalizing one way for so long.

Marisha: That makes a lot of sense. Thank you for that overview. Then, what about the physiological one? We talked about LSVT, then Joe Stemple's vocal exercises and PhoRTE. So, Who would you use LSVT with?

Kristie: Yeah, great question. LSVT was formulated with a specific group of patients in mind, and that's patients with Parkinson's disease. Those patients with Parkinson's lose volume, they lose intelligibility. A lot of times they get, because of their age bode vocal cords. So, we're combating three things all at once. The LSVT is Lorraine Ramig and Cynthia Fox, and they created this where the person is holding out these long ohs. Their tagline is think loud. Speak Out is Samantha Elandary, she's doing something really similar with that as well. These long, loud productions of sound so many times a day, so many times a week, and they're aiming for overall system improvement and overall system change, by just physically completing those exercises. So, getting gains like you would at the gym, okay?

Marisha: Mm-hmm (affirmative), perfect.

Kristie: PhoRTE is really similar. It takes into consideration some vibrant talking, some exuberant voice exercises. It looks a little different from LSVT and Speak Out as well. However, it's different in that it's less sessions. The patient does a lot of work from home. LSVT has a component where you a lot of times will get dementia progressing slowly or rapidly with the Parkinson's. The LSVT requires the patient to complete the session with the therapist four times a week for four weeks. PhoRTE's a little bit different because, you can have these check-in sessions and we expect the patient to have a pretty high ability to be self motivated, cognitively aware enough to do what we ask them to do, because they're measuring their sound as they do it. So, I think PhoRTE's a great option. The patient's able to have more flexibility and not come in as frequently, or not be seen as frequently and getting great gains that last. I think that covered it.
What I didn't mention and I should have, I didn't, for behavioral voice therapy there's a newer one for behavioral as well called Conversation Training Therapy. That's Jackie Gartner-Schmidt and Amanda Gillespie. It's the first therapy, this also has a really great MedBridge course on it. It's great because for speech therapy, for language therapy, for things that you all are doing every day, most of the time you're doing a hierarchy approach, right? You're getting the child to a certain level or maybe even the adult. You're doing something and then they meet that criteria and then you're moving to a higher level. For conversation training therapy, you start with a certain type of cue and then you're able to add these other tenets of the therapy whenever and wherever you want.
So, I think it requires a good understanding of how voice therapy flows. But, I think both women do a great job explaining the how of it during that MedBridge course, where you're able to say, "That makes complete sense. I can always start there and then add these other components in. Then, I probably was doing that already with my other patients and I just didn't realize it." So, what they're finding with that is while traditional voice therapy may have required multiple sessions weekly for months, the CTT is actually creating an ability for patients to not be seen very frequently. They're learning it from the first session, learning how to generalize. Then, the results are lasting as well for quite a long time after. So, it's groundbreaking because why wouldn't you want your patient to advance as fast as possible? Of course, you would want that. But, I think the right type of patient for this training as well, needs to be taken into consideration, and cognitive level, the ability to multitask is one of those components.

Marisha: That's super helpful. Again, thank you. We've got a quick overview of the different types of therapy that we might use. Then, what do you do if you're one or multiple approaches and the child just isn't responding? What would you recommend then?

Kristie: That's a really, really great question. The type of therapy, you always want to start with what the child is stimulatable for. So, you may go through multiple, you may have them lip trill, you may have them hum, you may have them yawn and sigh on that yawn, you may have them blow bubbles in the cup with a straw, you may have them get louder, right? Whatever makes the best sound, you should go with. But, that may change the next time you see the child because maybe that isn't something they're responding to. So, you can always switch mid session. You can switch the next day, next time you see that child if they're not responding, and jumped around those techniques all while trying to attain where the child is going goal-wise.
You find this by discussing not only with the child, but the teacher and the family to determine why the child is in voice therapy in the first place. What are you trying to improve? What is out of the range of normal? But, maybe the child isn't responding to therapy at all, right? You're doing these indirect voice therapy things, and indirect is the component of voice therapy where we talk about hygiene or vocal wellness. We talk about preventing phonotrauma, so avoiding the throat clears, avoiding the yelling, that kind of thing, drinking the water, how well are you hydrated. These are all important things. Are you resting your voice after? Do you have a routine for your voice? Is there a warm up that you do? Those indirect things? Limiting the time you're on the playground because maybe you're helping to limit the yelling, as the child just can't stop yelling on the playground. Or changing what recess looks like for that child for a little while.
But, if they're not responding at all, meaning they haven't been able to carry over, maybe that's what that means to me, they're not responding. Meaning they may not, meaning carry over, I would want to know and talk with the family. I might make a couple of phone calls. How is Johnny doing his practice at home with you? What does that look like? Do you do the cards that we send home? Do you do the worksheets? Oh, that's boring, okay. What do you do at dinner? What does talking look like? Can you incorporate some of these techniques when you guys are talking at a meal? What does bath time routine look like? Or if the child's older, what are you doing when you drive Johnny to soccer practice? Is there a conversation going on in the car? I would really probe how the family is involved.
Also, there is a really great article, let me see here. I think it's Barbara Weinrich, it's Lisa Kelchner and some other person, Susan Baker Brehm. I was like, "If I can't remember it, I'm going to be..." I thought of it. But, their article looking at how voice therapy really impacts or how it's impacted by the family involvement, the therapy techniques may do very little to impact what we look at as the outcome. But, a huge component of that is how the family views voice therapy, what importance the family gives to doing the practice, carrying it over. So, I think if the response isn't there, I want to know what's happening at home.
Then, the other phone call would be to the teacher, or maybe trying to hop in and chat with him or her after the class one time, to see what's going on in the classroom, how the teacher is able to help facilitate the new voicing, phonotrauma prevention, the hydration, that kind of thing. See if there's something you can do to help troubleshoot. That's the first thing I would do.
Then, if you do that for a while and there's still no response to the therapy, I would really suggest potentially getting a reevaluation by the doctor. That might include getting visualized again. So, another video stroboscopy or at the very least a nasal endoscopy where they're going through the nose. Maybe they don't have the light to look at it in so much, but maybe they can look with the nose scope, to see if it's really what we thought it was to begin with. Sometimes you get the kid scoped and you think, "Oh, it looks like vocal nodules. These will go away if we do therapy and vocal rest." Then, if nothing's improving, you may go back in and then discover maybe with a more specific test, like a video stroboscopy you say, "Oh, this wasn't nodules at all. This looks like a cyst on one side and it's swollen on the other side, because the cyst has been hitting that other vocal cord every time they talk, and it's going to require surgical removal."
In that case, it's great because there's a reason the child wasn't responding to therapy, right? The child was doing everything, the family was doing everything, teacher, they were all superstars, but it was something that needed to be fixed surgically. So, had you not visualized, had you gone and continue to do what you do, Johnny will get better, year two goes by, nothing changes, you have frustrated parents, frustrated teacher. Johnny thinks he is the worst child ever because they can't fix his voice, when the easy answer was let's get another visualization here, and really see what's the problem.

Marisha: That makes a lot of sense. I remember from my voice classes that it was really important to have that exam before starting therapy. So, is that the truth? Why would that be the case?

Kristie: Yeah. I think most definitely it's the truth. We need to visualize what's going on, just like eating habits. I was talking about this at Sin City Laryngology in February, making a case for visualization before treatment, just like a doctor would not do any recommendations before an X Ray, for a broken arm or a broken leg. You wouldn't want to have any surgery on something unless you had done a scan, a CT scan or an MRI. We do these scans so we can have a better idea of what we're looking at. I think that's absolutely the same for voice therapy because, if you're not looking and you're creating a treatment plan you are saying, here's what I believe the problem to be based on what you hear, what you see the patient doing from the outside, and you're missing that inside component, you may be setting yourself up for harm in the way that what you do is futile. Everything you're doing is not going to fix the problem because the problem really needed to be fixed with surgery.
That doesn't mean that the surgery... Like you wouldn't do voice therapy if the person had had surgery, right? It's always a better outcome when there's a combination there. But, the expectation I think is the most important part. You have to be real and truthful with your patients about what they can expect. If they just expect voice therapy to fix the problem and it's not fixing the problem, there becomes a trust issue with you as the provider. You're no longer trustworthy because what you said was going to help is not helping. What are they supposed to do now?
I think having that video stroboscopy completed before implementing any treatment plan, helps you help them, it helps everybody. You get a lot of pushback because, if you see patients in the school and you're saying, "Hey, this kiddo needs an exam," the school doesn't necessarily want to pay for that. But, I think it's really important. A lot of times the parents may be scared. They may not want to have their child get examined. So, if they're very adamant that they don't want that exam, you can't force them to get that exam. But, I think you have to have these conversations about not... Limited knowledge on your part resulting in limited improvement potentially, you may not be able to have the whole picture. So, you may not be able to give them the outcome that they desire.

Marisha: Okay. Perfect. Thank you for that overview. I think that's a good reminder and refresh too. So, what other recommendations do you have for school-based SLPs? Maybe we can start with students who are seeing a voice therapist and who have gotten all of the visualizations like video stroboscopy, like there's the voice expert working with them. What do you recommend for SLPs in that situation?

Kristie: Well, a good behavioral voice exam. If you've had the doctor do the exam or an SLP in your area who does video stroboscopy, you have that done and that comes back to you, you still need to know what the child does well, where you're going to head with therapy. So, a good ability for behavioral probing, I would start there. I would gather acoustics, acoustic measures if I could, meaning fundamental frequency. So, the average pitch that the patient talks at, you could run acoustic measures, something like the Acoustic Voice Quality Index that gives you a number that indicates if dysphonia is present or not. So dysphonia again, messed up sound like hoarseness. The Acoustic Voice Quality Index supersedes jitter and shimmer. Those are maybe words that you look back in your brain and you think, "Oh yeah, that was something we learned in school. I can't remember what that means."
But, something has come out in recent years called Cepstral Peak Prominence. It is a much more sensitive indicator. It contains the ability to measure connected speech. So, the child talking in a sentence as well as sustained bell, where you may have only used jitter and shimmer to measure ah, and maybe the child sounds really great doing ah. But then, they start talking like this. So, how can you measure something that is really representative of what the child's output is? So, enter the Acoustic Voice Quality Index because that contains part of that Cepstral Peak Prominence and some other measures as well. You can gather some aerodynamic measurements as well. You can get vital capacity for the child to find out phonation quotient or estimated mean flow rate, to determine if the child's using air adequately.
All of those... I've put together a guideline on how to obtain those measures with a really concise measurement tool in Excel that I have in my online store. To walk you through and guide you with how to administer a behavioral acoustic or a dynamic evaluation. I added cards so that the child can hold the cards and then flip to the next one, where you have the target what they're about to do, they can read it out loud and then they have an idea of where they're headed. It's tangible. They can flip through the cards so they're not distracted.
Then, you would start determining goals. You would decide what they sounded best at, what made them sound better. Then, you would discuss with the child. I think it's super important to see where he or she has any opinion on the situation. That's going to help with motivation. I think that's really important as well as the family and the teacher, just discussing what support system they have at home, how they're going to practice, what that's going to look like. You can explain what it'll look like at school, and then how your check-ins are going to be, how the odds are going to look for the voice goals for that child.

Marisha: Awesome. I love that you have that voice assessment guide, because I know that could... If it's something that we don't do a lot of, I know that can be intimidating to dig up all of the notes, but that's an amazing resource.

Kristie: It was super intimidating to make Marisha because, I've been worried to make it for such a long time because, I was thinking, "How am I ever going to throw all the knowledge I have about what you do in an evaluation into something that can be replicated? That can be recreated and utilized?" But, the more I talked to people who really were just using S/Z Ratio and calling it a voice evaluation, I was like, "I can make something that can give them so much more information, and the ability to help mark progress in such a better way." So I made it. I had it tested. I had lots of people try it and give me feedback on it. I changed a lot of things about it as it was being made.
But, I had been making these other resources for my store for like resonant voice therapy games, stretch and flow games, straw phonation games, breathing training, that kind of thing, for pediatric patients because, why should speech and language kids have all the fun? You're looking for things for mixed groups and it's like, "I have nothing for this child with a voice disorder that's on my caseload." So I said, "There's nothing, so I'm going to make it."
But then, I kept getting these questions about, well, how do I know when to use resonant voice? How do I know when to implement straw phonation? So, part of the reason that guide was made as well is because it has suggestions and probing in it, like the no prep voice workbook that's in the store as well, the one that has... It's like, I want to say 120, or 128 pages I think, maybe it's more. But, that goes through again, probing what the child sounds like and then activities where you can bounce back and forth. If they're doing great with straw phonation one day and you need stretch and flow the next day, and then you have activities on that to work with your mixed groups.
So, out of that came... Out of making these came the need for guidance on how to implement them as well. So, that's why the guide I think is so important and great to use because, it includes a video demonstration of how to implement all of the measures, the testing, and shows you exactly what to do. So, you don't have to just do S/Z Ratio, you have a lot more at your disposal.

Marisha: That is so cool. Then, I will put the link to the voice assessment and then the voice therapy workbook in the show notes. So, those will be at slpnow.com/51. There's even more resources that you've made that are amazing. So, I'll just put the link to your story there too. Then, what recommendations would you have for a student who, like we get a referral from the teacher, we find that they have, like their voice, they're having some dysphonia or whatever it may be. I assume that we still want to have that good behavioral voice exam. Then, we talked about trying to get a physician to look at the vocal folds before starting anything. But, do you have any other suggestions on how to navigate that?

Kristie: Yeah. That brings up a good point. I have a lot in the past in our clinic, been able to do video stroboscopy for SLPs who send their children, and then the child gets treated in the school. So, we can do the exam at our clinic and then collaborate with that SLP to say, here's what the child was really good at and here's your starting points, and then collaborate. You can collaborate with the SLP who may do voice all the time in your area, so that you know what to do and where to go with that child. So, I think that we're better together regarding our experiences because, if you don't know much about voice and you're trying to treat that child and you're thinking, "Well, I know enough where I can probably not harm the child," but I think it's really important to get the opinion of the specialist SLP because, you can still make a difference in the school. Maybe you need a little guidance, need a little collaboration with that person.
So, I would suggest in your area, getting an exam or at least giving a call to the SLP to say, "Hey, what would you do with this child? I have this child in my caseload. Here's what I'm thinking. What are your thoughts on that?" A mentor situation where you're going to benefit as the school SLP because you'll know what to do with the next child with a voice disorder. But then, that child's going to benefit too because, you're going to be a lot more equipped with better knowledge after that consult. Because, the thing you find, I find, is that if you didn't have a placement opportunity where you could go and watch voice therapy be done, it's scary or strange or odd.
Leah Helou actually talked at Sin City Laryngology in February also, about the Meta Therapy. What she describes is our dialogue, the things that we're saying, how we're saying it, the schemas that we build in our mind, the routines. It's how we as clinicians do these things methodically, to get the result we want in a session. It's our attempt at programming a framework that we use in each session. It may not look the same in every session, but if you're watching it go down, you know what that speech pathologist is doing.
So, this type of thing, and trying to let somebody know how that's happening, maybe by having that SLP come and observe, maybe the school says you can go observe at this voice clinic so you can learn how to treat our students better, I think that that's helpful as well. Because, then they get to see the Meta Therapy and they're not so bogged down with, "Okay, great. They did their hum in a hum level, now we can do an M word level." They have the idea of you don't have to have 50 M word sounds really resonant to move on. The repetitions are important, yes, but you need to be able to have that skill of stepping back and looking at the framework that you're using to conduct a session.
You all have frameworks so you use all the time with your speech and language arctic children. It looks the same with voice, but there's a little bit different considerations for that. So, I think if you're an SLP in a school and you have a student that needs an exam, maybe you can go and watch that exam, right? That's how you're going to learn, or potentially you can go and observe the SLP do the scope or the SLP do the eval, who maybe does voice more frequently or you can at least give a consult phone call to somebody who can mentor you and support you as you're supporting that student.

Marisha: Yeah, that's perfect. I love those ideas, and just getting really strategic with the resources that we have available. Yeah, definitely that mentorship, collaboration approach seems like it would benefit everyone involved.

Kristie: Yeah, most definitely. I really do feel like we're better if we can collaborate, but it's not always intuitive, right? Because you have so many students on your caseload, you're crammed with stuff to do until the day is over, you probably take work home with you and then it's time to hang out with your family because they need you too. But, I think it's important to collaborate nonetheless, to try to do better for your patients. Because, that's why we do this in the first place. We don't we don't go into speech language pathology without big hearts and loving what we do. We do that because we love our patients and we want them to succeed.

Marisha: Yes, I couldn't agree more. I mean, I wish... I feel like we could talk about all of this stuff for hours and hours, but we're almost at the end of our time. So, if SLPs want to find out more about you, where can they connect with you? I'll definitely be linking to your Teachers Pay Teachers store and your website, but where do you hang out and where can SLPs find out more?

Kristie: I do hang out on Instagram pretty frequently. My handle is @Kristie_voice. That's K-R-I-S-T-I-E_voice.

Marisha: Well, thank you so much, Kristie. This was an absolute treat. I so appreciate your time, and thank you for sharing your time with us.

Kristie: Thanks so much for having me, Marisha. I really appreciated it.

Marisha: Hi there, and welcome to The SLP Now Podcast. I cannot wait to chat with Jessi Andricks today about all things stress management. And before we dive in, just a little bit about Jessi. She earned her master's degree in speech therapy from the Medical University of South Carolina. And she has worked in many settings including teletherapy, which is especially exciting in this time. But she's also a trained integrative coach and yoga teacher. And she also runs a site jessiandricks.com. She's presented at multiple conferences and conventions, and she focuses on helping SLPs reduce burnout and stress through evidence-based stress management tools and techniques. So I cannot wait to learn from her because I could definitely use some of this myself. But before we dive into kind of all the evidence based strategies and good stuff, Jessi, first of all, welcome to the podcast.

Jessi: Thanks. Thanks for having me on today.

Marisha: Yeah. And I'm just really curious to hear about your, because your bio kind of tells a little bit of your story. But I'm curious what that path looked like for you. Where you started out as an SLP and then how you got to the roles that you're playing today. And doing all of these amazing presentations, and courses, and education. I'd love to hear a little bit of how that all evolved and came together.

Jessi: Yeah. It's nowhere that I ever thought that I would be in grad school or undergrad, because I went and got my degree in communication sciences and disorders for undergrad too. So this is never where I imagined, even the teletherapy part because that was not a thing. At least not the way it is now back when I graduated.
So I started out. After I graduated in 2008, which seems not that long ago, but I'm realizing that was forever ago. I worked in probably every setting imaginable within, or at least that was available within three years. And some of it was just circumstances like positions being cut or new things opening up. And then some of it was from feeling really stressed and just assuming okay, this might not be the right setting for me to be in. I'll see what else is around.
But I started out in a skilled nursing facility in a really small rural town in South Carolina. And I loved it, but I knew that I wouldn't be there forever. And I had an opportunity come up at a rural hospital in doing inpatient and outpatient with adults. And if they ever, for some reason had pediatric clients, I would see them as well. So it was kind of like everything. And it was somewhere I had done clinicals at. So I jumped on that opportunity because I thought this was my dream job. And it was amazing. And I am so thankful for that. But it was an hour commute every day from my house.
So that started to take a toll. And that's really where the stress started to build for me. And I started to kind of start to question things and think, "Well, maybe this isn't really my dream job." Or, "What do I do?" But there wasn't anything like it closer to where I lived. So I started to just really feel stuck. And I thought one good thing might be pursuing some hobbies or doing some other things that I really loved. So I started to take yoga classes because I thought you hear yoga and you hear about how wonderful it is for stress, and for managing stress. So I started taking classes. And I didn't necessarily feel the big, super peaceful after class or all my stress was gone. But I thought it looked really cool, and they knew so much stuff. And I wanted to learn how to teach that.
So I ended up doing yoga training while I was also commuting in the other direction, an hour from my house. So for about five months, most days of the week I would be on the road for an hour and a half in each direction. 30 minutes to the yoga training, an hour in the other way.
So physically, the stress was starting to build. Mentally the stress was building, and then my position was actually cut. So it wasn't I got to a point where I was like, "Okay, this is too much. I quit." I kind of was going to stick it out. But it was 2009 I think, 2010. The recession had definitely hit, and it was rural. It was small. So my position was unfortunately cut. They decided they only needed one SLP instead of multiple at the hospital.
So I ended up working in the schools after that, contract, because that was the only thing that was available where I lived. And as much as I love the schools. And my mom, my sister both worked in schools in regular ed, in special ed. So as much as I'd kind of grown up around that, that was definitely the position that after being there for two school years, or pieces of two school years, that's kind of the one that led me to say I'm done.
And I ended up quitting being an SLP for four years. And I quit quit. I would think about going back at first, but I eventually quit. And if someone was, "What do you do?" Meaning did you go to school for something? What type of job do you have? I would never mention that I went to school for speech therapy unless they asked something about it. And instead I taught yoga, because it was the thing I had trained in and I loved it so much. And I just assumed that I had chosen the complete wrong career and spent all of this time, all of this money doing the wrong thing. So I decided I'm going to teach yoga, which is definitely not as full time as being an SLP. Which SLP is over 40 hours a week for a lot of us. And teaching yoga was kind of here and there.
But I dove kind of into that side of things. Teaching yoga classes, training in it, mind body fitness, health coaching. Kind of focusing some on what we're eating but also our stress and the wellness aspects that we don't always focus on.
And I did all of this because I thought this was what I was just so passionate about. But looking back, I can tell that it was what was healing and what was managing the stress that I had been feeling for years and years as an SLP.
And there really wasn't anything specific that happened or some really crazy caseload or anything when I was an SLP that caused me to need to quit. It was just the slow and steady buildup of stress and of the daily schedules, things being either really far away or when I worked from home, having to start very early and kind of end a little bit later in the day. And just all of those little things that we all experience building, and building, and building, and building, until I didn't know what to do except assume that it was the wrong career.
So that's what I ended up doing for four years was ignoring that I had ever been an SLP. And if people ask me what I did, it was just, "I'm a yoga teacher." And that was it. And the only time I'd really ever mentioned that I was an SLP was when people would ask me or they'd kind of say, "You seem smart, why didn't you go to college?" And I would say, "Well, I actually a master's degree. I was a speech therapist for about three years. And then I decided not to do it. It was just the wrong career for me."
I think you can imagine the kind of funny looks I would get from that type of response. It was kind of a, "Oh my gosh, you did that and now you teach yoga." But to me it just made total sense at the time. Yeah, this is what I meant to do.
And then eventually I came back to the field. Things just shifted. I had a baby. The studio was helping run, the owner moved and it was closing. So I just wanted some stability, and I decided I'll give this speech therapy thing a try. And I've been in it ever since in some form, in some way.
And it's been a different perspective for sure. Having taken that time off and trained in these different things. And that has definitely helped me come at it with a different attitude, a different take on it. And also just knowing what I need each day or recognizing that when the stress is building, what is kind of off balance for me or what have I not been doing that is usually really helpful. So it's been kind of a crazy ride since graduating way back in 2008 and getting to where we are now.

Marisha: Wow. What a cool story of. I love that progression. And I think that it's a pretty unique set of experiences I think. Well I don't know, who knows how many SLPs become yoga teachers instead and then come back to the field and do all of the amazing work that you're doing. But that's super interesting. And I think that gives you a really, because you've gotten all of that additional training and just different experience too, that I think is super helpful when helping us figure out how to manage our stress without having to explore all these different career opportunities.
Because I think we choose, there could be a case that speech therapy isn't the ideal career for someone who's listening. But I think a lot of us really love what we do. It's just the stress of all of the different elements that break us down over time. So I'm really excited to dive into those areas with you today.

Jessi: Yeah. And it's so true. When I was going through it, I had decided that I just didn't love it anymore. And I loved, when I decided that this was going to be when I was an undergrad, I actually switched from early childhood education to CSD major. And I didn't know a lot about it, but I was like, "Yeah, want to work at the schools, but I want to do something a little bit different." And then when I found out all that we could do, I was just so excited and just wanted to go to class every day, which is not the case for a lot of people in college. A lot of the time it's like what class can I skip out on? And I was just so excited to learn and loved it.
And then when I was going through it, it was like a total shift in my the way I was thinking about it. I don't have any interest in this. It's just totally the wrong thing. And when you're chronically stressed and eventually it leads to burnout. One of the big kind of hallmark signs of that is kind of apathetic or cynical attitude. And it's exactly what happens a lot of the time when we start to think that way. "Oh, this isn't even working or it's not doing anything. Nobody even knows who we are anyway. We're just the SLP that no one cares about." We kind of get stuck in that spiral of cynicism, that I think it's really easy to get stuck in and then keep feeling that way. And then eventually, if that's all that we can connect to with our career choice and with being an SLP, it's really hard to pull out of that and to not just appreciate what we can do in the field, but find that passion that we used to have or even just the interest that we used to have in it.
And I do think that's why a lot of people feel like, "I must've made the wrong choice or I need to get out of this field." Even though, really somewhere that love of it is still there. It's just been taken over by the stress. So yeah, I think so too. I think that once in a while, you could find someone that really chose the wrong career totally. But a lot of times it's just that stress becoming so overwhelming.

Marisha: That is so fascinating. I love that. And that makes so much sense. If we're in that stressed, burned out place, then we are more apathetic and cynical. And it's easy to convince ourselves that we never loved it in the first place, or that we'll never be able to love it again.

Jessi: Yeah.

Marisha: Yeah. Wow. Okay. So if we're in that stressed out space, where do we even start. How do we start navigating that and what can we do as SLPs to manage that stress?

Jessi: The things that we can do are not anything, I always feel bad at this part. They're not anything all that crazy or mind blowing, or secret. Like here's the secret magic thing to do. It's like the things that we can do are pretty routine, and things that you may already have tried to do.
I went to a course one time that talked about this. It's like knowing something and then actually doing something are two totally different things. We can know how to do something and tell someone all the things to do, all the steps to do, everything about it. But actually doing it, we can't always do.
And it's kind of like we see that sometimes with our students, or patients, or clients we work with. There are times where you may be working on something with a student. Like maybe you're working on a sound and they can tell you all the things that they're supposed to do to make the sound. But then actually doing it and carrying it over into conversation, they get stuck on. So it's like that but with our stress.
So the things that we can do are simple things like mindfulness and awareness. And awareness is really the first, kind of the first step. Just recognizing that you are stressed or recognizing that something is not working for you in your daily routine or in your work. And being aware of how you're moving through your day, or how your day is kind of affecting you, or certain things that might be triggering you. Even if you don't do anything about them, but you're just aware that it's happening, that can help you start to make that shift to manage the stress.
So really, awareness is the first thing. Just kind of thinking about your day or thinking about what's going on, why am I so stressed? When do I get stressed during the day? And trying to pinpoint some of the things that might be, and sometimes it's really easy. It might be the pile of paperwork that you have or the crazy caseload. But being able to kind of see okay, how is this affecting me? How am I reacting when it's time to figure out when to do my paperwork? Or how am I feeling when I have more patients or students added to my caseload, and what is that triggering?
And then when we go to actually manage it and do something about it, it's using the tools of mindfulness and stress management. So taking time. A lot of it is just taking time for yourself. So organizing things and planning things are awesome. And I mean they definitely help. Because if you're completely, things are just unmanageable with the paperwork that you're doing, with the billing you're doing, with the caseload you're doing, then of course you're going to be stressed. So having things to help with that absolutely helps. But then having things that just help you personally. Like noticing what your energy levels are during the day, and if you need some time between sessions to kind of regroup. Or if you need to switch around the students that you're seeing to meet if you have high energy students maybe, and you're seeing them in the afternoon when you're feeling really drained. That might not work out so well. Or just knowing do you need something to help you transition from work to home so that you can get your head more clear where you're not thinking about work all the time when you're at home.
I find that happens to me a lot. I was not someone that would bring work, physically bring it home ever. Some of that, it sounds really good. That makes it sound like I was super organized. But I think it was more that burnout. "I'm not going to take this home. No way. I'm going to ignore it. I'll deal with it another time." But in my head mentally, I was still thinking about, "What am I going to do with this person? Oh my gosh, I have this thing to do tomorrow. I don't know what activity to do." It was just thinking about it or if I had a really hard meeting, just kind of replaying things all the time where I didn't get that head space.
So having something that you can do to help you say, "Okay, work is done. Let me shift shift my mind into being at home and letting work go so I could be present while I'm at home." And sometimes it's just having a buffer at the beginning of your day or at the end of your day. And I think this is really important when you're working from home, which a lot of us are right now, are doing teletherapy. Because if your space is in your home, then it's really hard to leave work sometimes. And you kind of feel like you can work right up to the end of the day and just step out of your office and into your home. But without having those little buffers that give you some downtime to yourself to regroup and to just check in and see how you're doing, it can make that stress grow.
And those things sound really simple. But I think when we look at our day, we usually aren't doing them. Those are the things that we cut when we're feeling stressed and overwhelmed. Those are the things that we're like, "Okay, I don't need these. I can just get rid of that and just focus on the work instead." And I think that does happen a lot. I know that happened for me a lot. If someone asked me to take on more students, even if I knew I could say no, I'd just say yes. But then my extra time during my day would get cut, and then I'd feel stressed. So it's that kind of cycle we get stuck in a lot.

Marisha: Yeah. Those are such great tips. So many good things that we can do. Okay. So a couple of things that were really interesting. I love that you mentioned the energy levels. And then just being strategic with how we set up our sessions and our schedule. And I know we sometimes, we feel like we don't have a lot of space to make that happen. But I think just one shift can change your whole day, I feel like that's super powerful.
I love what you mentioned about transitioning from work to home, and how we might be bringing our work home mentally and not just physically bringing home reports to write. But if we're replaying the day and just mentally being focused on work even while we're at home and not being present. And I'm curious, because you mentioned having a buffer at the beginning or end of the day. But what does that look like? What has worked for you or what have you seen other SLPs do to navigate that?

Jessi: Yeah. So for the buffer, I kind of like to think of it as you can start really small and then you can build it out a little bit. So a little buffer would be just making sure that you have time before you actually have to start work, and you have time after you actually finish to just settle in or to just kind of get ready to head home and kind of have a transition there of some kind. So you could have, and again I think this is really important when you're working from home too.
But let's say that you know you have to be at work at 8:00 AM. Or you have to be at work at, that's when if you're working in the school, that's when your first student's going to walk in, or it's 8:30.
Planning some time before that. And if you can, before your student just to settle in and check in with yourself, and see how you're doing when you arrive. And if you're working from home in teletherapy, one of the things that's really awesome is that there's no commute. So sometimes it's like your first student starts at 8:30, you walk in and turn on your computer at 8:25, and you start.
And that kind of sounds like almost lazy, but it's not lazy. It's kind of just like there can be so many other things going on at home and without that commute where you're having to get out the door. Sometimes you kind of give yourself, "Well I need a few minutes." So it's okay.
But giving yourself time to settle in. And if you're eventually in an office or a classroom somewhere and you physically are just sitting at your desk. Give yourself time to check in. And just do a mental check in. See how you're feeling, notice how your breath is. If it's nice, and calm, and steady. If it feels short, if you feel a lot of tension in your body that's going to build up or letting you know that maybe you're holding onto some stress. But just kind of checking in.
And then at the end of the day, planning time beyond just the end of the day wrap up where you might be finishing your billing or planning and prepping for the next day. But giving yourself time to just kind of regroup. And again, check in and notice if you're really drained, do you just need maybe five minutes extra before you head out the door and before you start work again to just sit and breathe for a few minutes? Or to listen to your favorite song, or to do something that doesn't have to do with work and that gives you a moment. Almost like a little mini break to just shift out of work mode and to give yourself something for you.
And this could extend into a full blown morning or evening routine. If you wanted to really set up your whole morning, you could maybe start the day by giving yourself some time to again, check in right when you wake up.
And one thing I had someone say to me one time was that you don't have to aim for 100% every day. You don't have to show up 100% every day, because it's impossible. So if you check in with yourself, you can see when you wake up, am I feeling 100% percent or am I feeling at 40 today? And I think right now with everything that's going on in the world, we're probably not at 100%. And a lot of times we may be at the lower end. But knowing that okay, if I am not 100% and I expect myself to be, I'm going to be let down, I'm going to be stressed, I'm going to be frustrated. But if I know that this is where I am today and I'm going to do the best with that, then you kind of set your day up from there. And know that you may have some struggles, and that's okay.
And you could even do some movement of some kind to start your day just to kind of feel like you've done something good for yourself. You could do meditation, which is really great for your brain, but also really great for reducing the stress response that gets triggered in our brain and in our body. And you can even do some kind of journaling like setting your intention for the day or setting goals for the day. And those could be woven into a bigger morning routine. And of course a cup of coffee if you need it.
And then in the evening, you could do things that kind of help you wind down. So it could be right at the end of your workday. Maybe instead of just that little buffer, maybe you have something like you go outside for a walk if you're able to. Or you get up and move a little bit if you've been sitting at your desk all day. But you can take a little more time if you have it.
And then if you wanted some kind of end of the evening routine to help you wind down, you could again, kind of stretch out a little bit. If you've been sitting at a desk all day, you might feel kind of tense in your shoulders, your back, your neck. Or you could do a meditation that just kind of helps you to unwind so that you sleep better.
Or even a journaling practice. There's two that are really good in the evening. One is called a brain dump where you just, any thoughts that might be stuck in your head replaying from the day, you just put them down on paper so that they can live somewhere else instead of just being in your thoughts. And then a gratitude journal, which helps you end your day on a positive note, remembering three things from your day that you are grateful for or that went well. Or that you can just kind of highlight as little positive moments from your day. And that can help you end your day or your work day on a positive note.
So again, they're not huge. Oh my gosh, this is the big thing I've been waiting to hear. This big secret about managing stress or about setting up my day. But there are things that we may not actually be doing. Like we've heard of doing or we've kind of played with here and there. But to actually get into a routine of doing them and creating your day around those can really start to make some big shifts.

Marisha: Yeah. And I couldn't agree more and I feel it's easy to be like, "Well, I've tried it or that sounds silly. That's not going to change anything for me. I have all of these big issues that I'm dealing with."
But just a personal experience share. I think everyone has struggled with a little bit during, or is still struggling with just the recent changes. And I don't know, just quarantining, and social distancing, and all of that. And I feel like my morning routine especially was, I would wake up and just feel, I don't know. I did not feel very good. But I had a morning routine. And I've been working on it for a long time. But I feel like that's what kept me sane and saved me. I was very intentional with what I added to the routine. And there are things that I know set me up for success and helped me feel good. I do the meditation, the journal, coffee. I did add exercise and stuff. But I feel like after going through that routine, and you can make it as short as long as you want. But after going through that, I felt like a whole new person which allowed me to show up and do all the things that I do during my day and have fun doing it. So yeah, I think it's incredibly powerful.

Jessi: Yeah. I feel the same with the morning routine. With everything, mine kind of got thrown off. And then I have a baby. He's not even a year old yet, so that totally was already thrown off morning routine wise. But it used to be my husband would take my daughter to school in the mornings, and I have time before work to get ready and get kind of settled, and have my morning routine. And even with the baby, that was still kind of the case. And then when all of this happened, everyone's at home.
So at first it was really awesome because it was, "We don't have to have any kind of morning routine, we can just kind of go with it." But then I realized I missed that. The same thing. I missed that start to my day where I felt like I was taking charge of the day, or that I was energizing for the day instead of the day kind of taking charge and overwhelming me right from the spot. So instead of hitting the ground running and running out of steam right away, having that morning routine and slowly easing into my day was something that I really needed. And me personally, I'm still slowly building back into that. and every little bit is definitely helpful.
And I think that's something too. We don't have to make huge shifts right away. But like you said, just those little changes and adding things back in and really tweaking things, or slowly putting them into practice can really, really help. So it doesn't mean that you have to go out and get this huge morning routine now, and then do this big process in the evening. But if you just wake up, give yourself five or 10 minutes in the morning. Or if there's something that you usually do that you don't have to do and you can make a swap, and you sit, and you journal, and you write out your intentions for the day. Not a to do list, but what you want to get from the day or how you want to be from the day, or whatever it might be. Or you sit and you do a meditation, or you just sit and you have a hot cup of coffee with no interruptions for a little bit. Just this kind of moment of Zen and meditation in kind of a totally different way. That can really shift your whole day.
And for me, again personally for me with little ones at home right now. Getting up, and one morning routine thing that definitely has a shift for me is getting dressed before they are up is a huge shift. Because otherwise, it's like that one little action sets up the day totally differently. But if I don't do that, then I feel like I'm behind on doing anything with them and getting anything done throughout the day.
So it can be really small stuff, but these small things can make big shifts or they can slowly build into more and more things that you can do that really help. But yeah, and just kind of figuring out what works for you and knowing it doesn't have to be perfect, and doesn't have to be a huge thing, can help.

Marisha: Yeah. I love that. And that's totally actionable and doable. Just starting with one minute of just even thinking before we get out of bed potentially. Just what's my intention for today? There's little tiny things that we can add on. And I feel like once, if we pick something that's really easy and really doable, it's easy to add on to that over time, which is really cool.

Jessi: Yeah. Little mindful moments throughout the day.

Marisha: Yeah. And then I love the ideas of, just I think setting ourselves up for success with kind of more of the routine based things. And I think that helps us manage when the crazy things come up. But do you have any? Because I feel like sometimes we're just kind of in crisis mode. Do you have any suggestions for when we're, if something really crazy happens. If we, I don't know. Progress reports are due for example. Or we just find out that they're adding 15 kids to our caseload or whatever. When those really stressful things come up, do you have any strategies for that in the moment?

Jessi: Yeah, absolutely. And it is true that some of the things would not be, if you have a crazy IEP meeting whether you're at home or it's something that you've experienced when you were able to go to the schools. Or if next year if your school is going back and you're in a meeting. There are some things that would be really, you're not going to just stand up and start walking around in a meeting and being, "Oh well I'm trying to reduce my stress." That would not be okay. And slipping into a full blown meditation. Closing your eyes in the middle of a meeting does not always work. So there are definitely things that you would do outside.
But there are things you can do. Like if you know that something stressful is coming up like a meeting or progress report time. You can build in some, really it's self care. What it boils down to, that word is so trendy and sometimes almost kind of overused. But being mindful of what you need. So really focusing on your self-care at those times. If you know that something's going to be really stressful like progress report time, make sure that you have in your calendar or maybe set a reminder or something, some things that you can do for yourself that are not related to work. Something that you can do that's going to help you check in with yourself, that's going to help you see how you're doing and then will help you feel better in the long run.
And those are the things that we tend to cut a lot of the times when we're so stressed. We have so much work we need to do. I'm just not going to go for a walk today. Or I'm just not going to take a lunch break today and eat my lunch. I'm just going to totally cut that out of my day and just scarf something down really quick and keep going.
But giving yourself breaks and giving yourself time to get up and move, time to check in. Those are all even more important during those times that are kind of crazy.
And if it's something like a meeting. If you have one where you just know that it's going to be one of those really, really stressful meetings. Preparing yourself beforehand. So not just giving yourself time before, but maybe taking, doing a meditation where you do some deep breaths and you try and kind of find that little bit of calm before you go in. So you're more grounded, you're more steady, and you're not feeling as anxious or stressed where you're able to really think more clearly and process things more clearly. That can help in that.
And then when it's those times where you go into work and you think you know how the day's going to be. And then you get an email that's like, "Hey, you have five more students. And I know you're already full and you have no room for these, but schedule them." When it's something like that where it's just you don't even know what to do. Taking time to just be aware and just say, "Okay, how am I feeling?" Of course I'm feeling this way. It's okay for this to be stressful. And then remember that it's not going to be this way forever. That this in this moment is stressful. But not just that it'll pass, but that there are things you can do for the stress. So yes, this is stressful. But I can take a few deep breaths. I can try and problem solve through this. But before I problem solve, I've got to get that stress managed so that I can fully focus on it and I can fully think through it.
Because one of the things that stress does is not only, sometimes when it's leaning towards burnout gives us that cynical attitude. But when we have the stress response triggered in our brain, it kind of takes over. And the parts of our brain that like to process things, and problem solve, and think things through, and give us these really clear steps on what to do our overwritten. And that's why when you're really stressed, it's so hard to think and to figure out what to do next. So when we're in that state for so long, that's why we feel like we just can't figure out what to do.
So when you have things, knowing that it's stressful but then taking a few deep breaths or going out for, taking a break. Maybe getting up and getting some fresh air or doing some stretches next to your desk or whatever it might be, to give you a moment. So that when you're ready to dive into it and figure out what to do, you can do it. And again, knowing that it doesn't have to be perfect and it might be really messy. But that's okay and it's not always going to be that way.
So when we manage our stress, it doesn't mean that stress will be gone or that we won't ever be affected by it. It's that we are a little bit more resilient to it. Or when we realize that we are not resilient to it and we are totally weighed down. We can figure out, and we know we have tools of what to do or how to check in and see what is not going right for me right now and what can I do to better manage this?

Marisha: Yeah. I love that distinction though. Because I don't know, I think life in general is just, there are going to be hard things. And then especially at SLPs, there will be hard things.
Because I think that perspective is really helpful. Because if we're expecting perfection, if we're expecting to love every minute and just be completely stress-free and zen, and just totally loving it all the time. Then when those things come up, I think that's even more stressful. But if we kind of expect, like sometimes it will be stressful and that's okay.

Jessi: Yeah.

Marisha: It's really helpful.

Jessi: And I think it's really hard for us as SLPs because we tend to be perfectionists. Whether it's a good thing or not. It's just how, and I always wonder if that's why we get into the field or if the process of going through grad school kind of turns us into perfectionists. But it happens. So we want to do everything. We want to do a great job. We want to be the best that we can be. We want to get everything done, and do it well, and be productive, and then that can cause so much stress.
But just knowing that it doesn't have to be perfect. It doesn't mean it's going to be bad if it's not perfect. And knowing that handling our stress that life, all of that is not going to be perfect. That there will be ups and downs, but that we can do things about it even when it is really hard. Or that if it is really hard, it doesn't have to stay that way forever.
And when I talk about balance, there's always this debate about work life balance and how, does it really exist? Is it really even possible? And I kind of like to think about it as more it doesn't mean that it has to be perfect all the time. There'll be times when work takes over and is kind of more of what you're doing. But there'll also be times when life takes over and you're more focused on that. And it's kind of just letting it swing from each side, but knowing that you're not going to be stuck in one forever. And that when you need to, there'll be times when we really do need to focus on work and let that be a bigger part of our life. But knowing what to do to get back to bringing in the other aspects as well. And then when life takes over. And things from home, we start to kind of let those take over and focus less on work, knowing how to bring it back to the center from there too. I kind of think that's kind of where all that balance with our stress and just with all of it comes to. If that made any sense at all.

Marisha: No, that makes a lot of sense. And it's just like it's okay if it's a little bit more towards one or the other sometimes. We'll figure it out. Yeah. No, that's great.
And then I was curious too. You mentioned when we're managing those really stressful events, you talked about finding things that help you feel better in the long run. Which I think is really important. So you mentioned going for a walk, taking a lunch break. What would be on your list of things that, just some other brainstorming for things that might help us feel better in the long run.

Jessi: Yeah. So anything that really helps you tune in or check into how you're doing. So there is definitely when we think of self-care, there's definitely kind of the joke, but it's also because we're actually doing it of binge watching things. Binging Netflix, or really just binging. Drinking a whole bottle of wine every night just to get through. You like to process the day to make it to the next day. Or watching an entire season of something in one day.
So knowing that that is not going to be what gets you through for the long run. That is definitely what's going to get you through in short term. Because that makes you check out. It gives you a break where you don't have to think about anything. You don't have to think about any of the stress you've experienced or any of the work that you feel like you should be doing, or any of it. It's a total checkout where you just sit on your couch, turn on Netflix, and that's what you've got. And that's it for the evening.
And that is totally okay sometimes. Because we have those days where you're just so mentally exhausted that you cannot process or think about anything. And it's just like you have no energy to do anything else.
But you don't want to be that way every day. It's not sustainable. I don't think anybody would want to feel that way that drained at the end of every single day. So checking in and doing something that helps you feel good.
So for me, I know that if I don't get up and move, and have some sort of not necessarily exercise. I mean it is exercise, but some sort of a movement practice or mindful movement throughout my day. Whether I go on a walk outside, we've been doing that a lot just because there's not a lot else to do. And we're fortunate enough to live in a really quiet neighborhood with a lot of green space. So going out and taking a walk every day is something that if I don't do that, I really miss it. Because it kind of just gives me this, whether it's at the start of the day, it gives me a really nice kind of way to ease into the day. And if it's at the end of our day or after dinner, it's a nice way to close everything out.
I also really enjoy yoga. That is an important type of movement for me because it helps me breathe deeper. I always feel like it kind of resets my stress for me, and I feel better after. But I know that for some people, movement is not, they don't feel good when they do it. Or it's just not the thing that they crave. So it could be journaling, it could be that you'd like to get into the creative process and create something.
A lot of people like to bake for stress. Which I love baking, so I totally get that. But there are people that really like to create something like that. Or a lot of people that do knitting as their kind of mindful thing for the day.
But doing something that you can sit and maybe have some time to yourself, or have somewhere that you can focus on yourself while you're doing it and really see what do I need, how am I actually doing?
And it doesn't mean that it'll always be really easy. Sitting and meditating can be really nice, but it could also be really hard because you may actually notice I'm feeling really stressed today and I don't like the way this feels in my body. I don't like the thoughts that I'm having with it. I really wish I could just ignore this instead.
Getting up and moving can be the same thing. You might start to notice that you just feel really stiff from the day and you really don't like the way that feels. But knowing that sometimes it'll be hard. But overall, it will help you and kind of keep you going and keep you able to really connect to the work you're doing, and stay connected to your day, and not be as overwhelmed by the things that are stressful that happen during the day.

Marisha: Yeah, that's perfect. And I love that distinction between things that help us feel better in the short term versus the long term. And that it's not always easy to do the things that help us feel better in the longterm.

Jessi: Yeah, it's so true. And I never want someone to think that I don't watch Netflix, because I definitely do. I always think that. I never want anyone to think that I'm against it. I totally watch something every night, but it's not my self-care. And then the times where it does become my self-care, then I know just from my own experiences and from everything that I've learned. That's kind of one of the things that for me it's okay, if I've been leaning on this a little bit too much, then it's when I know something's out of balance and I need to get back to the things that are actually going to work and actually help me manage my stress and not hide from it.

Marisha: Love it. Super helpful. And then I think we have time for one last question. But a lot of us, and you touched on this already a little bit. But maybe just recapping some strategies and adding any additional ones if you have them. But a lot of us are working from home. And I'm curious what strategies you have to navigate that. You mentioned having a buffer. But what else do you think would help just in this particular situation?

Jessi: It's crazy working from home when you signed up for it. And you went into teletherapy and you've been kind of trained and ready for it. It's even crazier now when you're thrown into it, and you also have a lot of possibly other people at your house, and family members while you're doing it.
So a few things that are helpful are having those buffers for sure. Giving yourself time to start your day and something, to give yourself time to plan and prep at the end of your day for sure. But then have that transition of sorts, something you do that's just for you, that helps your brain know, "Okay, work is done. I don't need to think about it anymore. I'm physically stepping out of this office, but I'm also mentally stepping out and I'm going to be home now."
But giving yourself breaks. It's really easy when you're working from home to sit at your desk for eight hours. Because we forget to get up a lot of the time, or we try and cram everything in scheduled back to back sessions. But giving yourself time to move.
And it doesn't have to be that you go for an hour long or even 10 minute walk. You could just do a few stretches at your desk in between sessions while you're waiting for someone to log in. Or I've been doing this, but I keep a yoga mat unrolled where no one could see me if I had to get on the computer. It's nowhere near, but it's in my office. And I actually started doing that because the therapist I worked with told me that that was kind of her trick that she would do is she would just have it. And then go and do a few stretches in between sessions while she had two minutes. And that those little two minutes throughout her day really helped her feel better.
And making sure you have time to get up and go grab water, or coffee, or a snack if you need it. And have some sort of a lunch break. That is super important, to give yourself that time to actually eat and reenergize. But also to let your brain have a break, let your body have a break from sitting.
And if you can, if you're starting to create your whole schedule from scratch, batching your day around your energy. So if you know in the morning you're more energized. Maybe that's when you have most of your sessions where you really need to be on and really, really fully, fully engaged. And if you're feeling a little bit more drained towards the afternoons, maybe saving that for some of the time that you do quieter planning prep, or quieter sessions, kind of less energized sessions. Planning your day around that and making sure that you take breaks throughout the morning and throughout the afternoon, not just a lunch break. That can really help.
And of course that's ideal, right? That's ideal stuff. But like we mentioned before, just doing as much as you can or doing a few, planning some small shifts in your day can really, really start to build and help you get to where you need to be, where you can sustain this and keep going with it.

Marisha: Yeah. And I love how you keep reminding us of that because you definitely know who's listening inaudible then it's like okay. Okay so I'm planning this out, but I'm wanting to do all of the things. And I can't do all the things, so I'm not going to do any of it. I love the reminder that just a little shift. So if it's, I don't know, making sure that you have water at your desk. Could even be a start.

Jessi: Yeah.

Marisha: Making sure to take a sip in between sessions.

Jessi: Absolutely. Absolutely. And then you start to feel better. So then you want to keep going with the things that make you feel good. And you end up finding more time for them. Yeah, absolutely.

Marisha: Awesome. Okay, well this was super helpful. I love all of these ideas and strategies. And just realistic, you're very real about it in terms of this would be wonderful to do all the things,. But we can start small and take small steps towards just feeling better. Because I don't think any of us want to feel stressed. So I love just the realistic approach. That's super helpful.

Jessi: Thank you.

Marisha: And if people want to find out more about what you do. They got some good strategies but they're still feeling like they want to learn more or just have additional information. Where can they find out more about what you do, where can they connect with you?

Jessi: Yeah. So you can connect with me definitely on Instagram @jessiandricks. And on my site jessiandricks.com where you can find podcast episodes, blog posts, and the subscriber free resource bank called the SLP toolbox with meditations that you can download. Movement audio you can download, some journal templates, just kind of all the little goodies that help you throughout your day to reduce your stress. And if you're really looking to dive into this, you can also check out the online course SLP Stress Management that you can find at jessiandricks.com

Marisha: Awesome. Well, thank you so much for sharing your time with us. And yeah, definitely walking away with tons of helpful strategies. And yeah if you want to, I'll share links to all of the things that you mentioned today like your Instagram and your site, and the course, all that good stuff in the show notes at slpnow.com/53. Or you can just go, if you're listening, you can go straight to jessiandricks.com. So it's J-E-S-S-I A-N-D-R-I-C-K-S. And yeah, that's all we've got. That's a wrap. Thank you.

Jessi: Thank you.