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Marisha

#030: How to Address Communication Attitudes with Children who Stutter

December 4, 2019 by Marisha Leave a Comment

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In this episode, I sat down with Kristin Chmela to talk about a role that we take on as SLPs: Counselling. Many listeners have reached out about this topic, because it’s something that we end up doing even if we aren’t really comfortable with it.

Clearly, it’s time for some education. 🤓

Thanks to a recommendation from fellow SLP Lauren LaCour, I knew that Kristin was the right person to break it down for us. She is an SLP, and also a board-certified specialist in fluency who spends the majority of her time working with individuals of all ages at her clinic — the Chmela Fluency Center in the suburban Chicago area.

Kristin has lectured on the topic of childhood stuttering around the world, is Co-Founder and Co-Director of Camp Shout Out, and has collaborated extensively with the Stuttering Foundation throughout her (very impressive) career.

I’m so grateful for everything she shared during our conversation!

So grab your beverage of choice (I’ll have a chai latte!), put your feet up, and listen in.

Key Takeaways

– Why counseling is so important for children with fluency disorders
– The top three tips for SLPs who are unsure of where to start when addressing communication attitudes
– Three examples of what “counseling” looks like in practice
– Camp Shout Out: What the program is, and how Kristin incorporates counseling in that setting
– The role parents and caregivers play in helping children develop healthy communication attitudes
– How we can set parents up for success throughout the treatment process

Links Mentioned in the Podcast

– ChmelaFluencyCenter.com
– The Stuttering Foundation
– Basic Principle Problem Solving, Working with School-Age Children Who Stutter
– The Stuttering Foundation Workbook by Chmela and Reardon
– OASES (Overall Assessment of the Speaker’s Experience of Stuttering)
– How to Talk So Kids Will Listen and Listen So Kids Will Talk by Faber and Mazlish (affiliate)
– Counseling Persons With Communication Disorders and Their Families by David Luterman (affiliate)
– CampShoutOut.org

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Thanks so much!

Transcript

Transcript
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Marisha: Hi there, and welcome to the SLP Now Podcast. I cannot wait to introduce our guest today. Several listeners submitted questions related to a part of our roles that many of us frankly aren't as comfortable with. That role is counseling, particularly when it comes to counseling students who stutter. When these questions were coming in, I thought of Kristin Chmela. She was recommended actually by Lauren LaCour from Busy Bee Speech, because we were just chatting about like who could help break this down for us?

Marisha: So I cannot wait to dive in and ask her all of the questions that you have been asking. But before I do that, I just wanted to tell you a little bit more about Kristin. She is an SLP and she is also a board certified specialist in fluency. She spends the majority of her time working with individuals of all ages with fluency disorders at her clinic, which is the Chmela Fluency Center in the suburban Chicago area.

Marisha: She has lectured on the topic of childhood stuttering around the world, and she is the co-founder and co-director of Camp Shout Out, which is a therapeutic program for school-age children who stutter and a hands on training opportunity for professionals and graduate students. She's been very busy because that's not all.

Marisha: So throughout her career, Kristin has collaborated extensively with the Stuttering Foundation on training videos, conferences, publications. She's also the lead author of Basic Principle Problem Solving, Working with School-Age Children Who Stutter. So you've probably seen some of her work around there especially related to the Stuttering Foundation.

Marisha: Yeah, I cannot wait to dive into all of the practical tips and strategies related to counseling. But before we do that, Kristin, I'm really excited to hear a little bit about your experience as an SLP, and just getting to learn a little bit more about how you came to specialize in this area.

Kristin Chmela: Well, first of all, Marisha, I want to thank you for inviting me to be on this podcast. This is a wonderful opportunity for us to have a conversation about children who stutter, and of course, for us to reach many speech language pathologists who are helping children who stutter. Well, I can tell you that I graduated with my masters about 32 years ago, and I had no intention of working with people who stutter.

Kristin Chmela: I had started my own therapy when I was an undergraduate student at about the age of 19 for my own stuttering, and I became interested in the field, but I had no intention of going into stuttering. I took my first job in the schools and enjoyed it very much. And also got married and then started my family, and so I worked in the schools for a couple of years, first full-time and then part-time and I realized that I really wanted to know more about helping children who stutter.

Kristin Chmela: And so I went to my principal, and I said, "I think there's a need, and I would like to help fill it. And I'd like to learn more about this and be available for different therapists in the district if they need help." And so they asked me to do a workshop. I'll never forget that workshop. It was three hours long. And I thought, how am I going to do this? I've never even given a speech for five minutes.

Kristin Chmela: I really thought I was crazy when I got there that day and how I got myself into that, but I sat down and I started thinking well, what is it that we need to know and how can we help clinicians who don't feel comfortable with this disorder. This was the same back then as sometimes we hear now. And so I began doing some workshops, and I began consulting within my school district. I didn't know very much about stuttering, but yeah I think, because I grew up stuttering and I went to Northwestern University, which was a very well recognized university for fluency and stuttering at the time, I think people thought that I could share something.

Kristin Chmela: So, once I had a family, I started with the clients on my living room floor. And now as you've said in the introduction, I do run the Chmela Fluency Center and we do service probably about 60 to 70 fluency cases a week. So I've been really deep in this for a very, very long time. I think that I remember talking to my mentor, Dr. Hugo Gregory at the time, when I was a young clinician, he gave me a couple pieces of advice.

Kristin Chmela: One was, he said you can't really specialize in stuttering. There isn't enough work. I thought that was so interesting. So I began putting myself in positions where I got the clinical experience. And of course, now that's quite different. We can work in various settings where we do service more of this population. And the second thing he said to me was early in your career, you might be doing some things that perhaps people ask you to do, and there may not be great monetary value in that, but it will always come back to you.

Kristin Chmela: I will never forget that advice. I began providing some in service training and some collaboration for different organizations. And certainly, that was some very good advice that he gave me. So I was so interested in stuttering, I just got more clients and pretty soon that's what I was doing. I will say that I became a specialist over the years of work that I had put in before we even had specialty certification.

Kristin Chmela: I will say that my ongoing relationships with my mentors and various colleagues that I learned so much from when I used to teach for the Stuttering Foundation, those relationships really supported my skills as a specialist and the development of that. The other thing I want to mention is that many people think that I do a lot of lecturing and I was giving a seminar once and there were some women in the bathroom and I heard them talking and they said, "Oh, she doesn't do therapy. She goes around and lectures and teaches and publishes."

Kristin Chmela: And really it's the exact opposite. I spend the majority of my time at my clinic. I probably do at least 25 sessions a week by myself with clients. The other piece of advice that Dr. Gregory gave me was never stop treating the client. Never stopped doing the diagnosis and the therapy. Always keep your hand in it so that you can talk with people about how you are evolving as a clinician, all our latest clients, right? So I think that was very good advice as well.

Marisha: Wow, what an amazing mentor and what an amazing wealth of knowledge that you've just acquired over your career so far. It's kind of encouraging because you're here now and you have dedicated all of these years of experience to really learning so much about fluency. But you started out just like us, and you just kind of got on those bootstraps and just started exploring and figuring things out. I think that's encouraging because that means we can figure it out too. You're just an amazing guy to help us through that now.

Kristin Chmela: Sorry, Marisha. I thought you were done. The one thing that I firmly believe is that we can make a choice to keep evolving. I have felt that way about myself as a communicator, and I have felt that way about myself as a clinician. There's always things we can be learning from others. I won't stop evolving until I'm done, I guess my time on earth is done. Because I feel so strongly that we all have the potential to do that. As long as we keep doing the next thing and perhaps pushing ourselves maybe just slightly farther than we think we're capable, that is the makings of a great career, I think.

Marisha: Yeah, I love that, and that makes so much sense. And I could not agree more. So let's dive into all things counseling now. Before we talk about some more of the logistics, I'm curious, from your perspective, why is this such an important part of therapy when we are working with children who stutter?

Kristin Chmela: Well, the first thing I'd like to say is that counseling is important for all the children that we serve, all the clients that we serve. Because in order to provide genuine reinforcement, to help someone facilitate behavioral change, attitude change, we have to have a positive relationship. The definition I think of counseling begins with establishing that positive relationship.

Kristin Chmela: I do think that whenever we're helping any individual create change, that's our first priority. With that said, children who stutter, perhaps they can ... They do have a unique experience in that, number one, they're coping with a problem that is variable, and it doesn't always present itself. Some days are harder, some days are easier. The research shows that a very high percentage of children I want to say it's about 85% of children who stutter experienced some type of bullying, teasing, mimicking prior to the third grade. We also know from research that it is common for children to have more negative attitudes and emotions around themselves as communicators.

Kristin Chmela: The other reason why I think it's so important deals with the landscape of the problems. So there are external things we can observe with children who stutter. We can see them stuttering. We can see them starting to say a word, stopping, and then saying another word, or perhaps retreating from a situation. But there are also many internal aspects of the problem. The thoughts and the feelings, the amount of time, the child may be wondering if they can say the sentence on the paper that's coming, say the teacher is calling on children around the room, and they're already glancing down and wondering if they're going to be able to say it or not.

Kristin Chmela: I think that that piece of it makes it very complex, and yet I think if we think about many problems that people have, of course, there are internal features and external features to those. You will notice that as we talk about this, I tend to prefer to describe behavior than I use say labels for certain things. So, many individuals will say, well stuttering can be overt or covert. That person is a covert stutterer, meaning they hide the stuttering and they avoid and they don't communicate freely, whereas overt is the person that doesn't tend to do that.

Kristin Chmela: I really try to stay away from those labels. I think there are so many nuances to each of us. So, I do believe that counseling since I have started my career and have been in the field, I do believe that Dr. Gregory would be thrilled to see the progress that we've made in terms of talking about this, supporting children. It was a long time I think before we were able to recognize that these needs were just as important as the need to help children modify some communicative behaviors if that's what they wanted to do.

Kristin Chmela: I do believe and Dr. Gregory always told this to me that as professionals, we are the ones, speech pathologists are the professionals that can obtain and commit to getting trained in these areas and to best service these children. We are the profession that understands stuttering the most, and I'm not making a blanket statement stating that every professional in speech language pathology has the skills and the ability to do this, but we have the opportunity to develop those skills and to get that experience, and that we really are the ones that need to be addressing these issues unless they are out of the circle perhaps of what we would deal with.

Kristin Chmela: I had a client, for instance, whose father was so distraught because his son was stuttering. He also was a person who stutters, and the mother sent me a text. This is several years ago, and he had written a suicide letter and she had found it before it happened. And so obviously, that was something that was out of the realm of my scope of practice. And so of course, I made an immediate referral so that he could get help from another professional who was trained to deal with something like that.

Marisha: Yeah. Wow. I think that's part of what makes it a little bit scarier, because there are so many of those emotions and just different those negative attitudes that can be so incredibly strong. And so it makes it a little bit scary sometimes to start navigating that.

Kristin Chmela: One thing I want to say, Marisha, that is so important is that the more we learn about children, and what is a child who is eight years old, what is that child about? What is a 12-year-old child about? The more we read and understand the nature of the developmental stage of the child, I think the more successful we can be.

Kristin Chmela: I think that all of us come to this realization as we are helping counsel people, that emotions are normal and they are real and they are universal, and that a big part of our ability to approach this counseling aspect of our work is to also be working on our own feelings about things. The healthier we are, the more we can bring to the table that availability to create that positive relationship.

Marisha: Yeah, so powerful. Thank you for sharing that. I think you were starting to get into some tips that SLPs can use when they're starting to navigate this. So, let's just pick your three top tips. What three tips would you give speech language pathologists who are unsure of where to start and navigating that? I love what you said about kind of checking in with your own attitudes, like whether your own emotions, just your own emotional health in general, but I assume that applies to your attitudes about stuttering as well.

Kristin Chmela: Sure. Well, my first top tip would be to invest the time in the proper evaluation. What I mean by that, and I'm going to really address this more for the school-age child who perhaps is continuing to stutter, because we do exploration of these things differently for a school-age child and a teenager, but certainly for a young child as well. We take the time to understand, what does the child think about this? What do they think is going on?

Kristin Chmela: We usually begin that with some very informal questions as we're interacting. Do you like talking? Who do you like to talk to the most? What do you like to talk about? Is there anything about your talking that you think is not easy or is easy? Is there anything about it that you wish would be different? Many times, we get information from a child just through an informal, very non-threatening conversation, usually while we're doing something else. And then we may use some informal pencil paper tasks. These come from the Stuttering Foundation workbook, Chmela and Reardon, it's a nonprofit book.

Kristin Chmela: It's a very basic way of looking at some of this information. There are also some wonderful standardized measures for looking at the attitudes and feelings of children. One would be the OASES, so the Overall Assessment of the Speaker's Experience of Stuttering. There are different stages of development that OASES is appropriate for. There's one for elementary school children and then for teenagers, on up through adults. So the point is, and this is something that I continue to ask myself even to this day, do I know that about that child or am I making an assumption? Do I know that or is it an assumption?

Kristin Chmela: Many times a child will come in and have a particular situation that has happened or I will get wind of something from a school therapist or teacher, and I'll immediately assume the child might be thinking about that, worried about that, upset about that. When I talk with the child, it's completely the opposite. So it's taking the time to understand where that child is in terms of these perceptions and attitudes, as well as the parents' and others involved in the situation in the therapy process. That's number one.

Kristin Chmela: The one thing I will say that I think is very helpful for children, and I've mentioned this, but I'll say it again, is if you talk with them naturally while you're doing something else. You're not going to get a whole lot if you just look at a child and point blank say, "How do you feel about your speech?" Fine, is what they usually say or I don't know or nothing. But if we begin just asking some questions while we're doing something else, many times we will get more information. So, that's my first point.

Kristin Chmela: My second point is, which goes to what we were just talking about before, but a little bit more. If you want to engage in counseling with others, you must spend a little bit of time with yourself every day. The most basic way I can say this is to start your own mindfulness practice. I know the word mindfulness is used often now in many, many ways across many, many professions and disciplines. I am a meditator, and I just completed a 200 hour immersion and mindfulness yoga so that I could enhance my work with people who stutter.

Kristin Chmela: One of the things I think that's made a significant difference for me is committing to a daily 10 minute mindfulness practice that is my own. In doing that, we learn how to be compassionate towards ourselves and how to be perhaps less judgmental. Those are the characteristics or the qualities that we want to bring to the table when we have a child that is suffering, or parents that are suffering. We don't have to fix the problem. What we have to do is make space for it to come out, and we have to be able to validate it. And we have to be comfortable helping the individual move forward when they're ready.

Kristin Chmela: So, the best way to begin is by beginning with ourselves and committing to that 10 minute mindfulness practice. There are many apps and ways that individuals start that. I do think that mindfulness is going to be coming into our field more and more, I'm excited for that. But that would be the second very basic yet complex thing.

Kristin Chmela: The third thing is start with some resources. So, if I were to tell you the best resources that I feel could help any clinician, number one, it would be to read a very well known book by Faber and Mazlish called How to Talk So Kids Will Listen and Listen So Kids Will Talk. That book has been around since I was a very young parent. I studied the skills and concepts in that book. Many of them we adapted in our Stuttering Foundation book.

Kristin Chmela: But part of learning to counsel is learning the skills of how to talk with children, and how to get in with them. And so I would highly recommend that book. That is not a book in speech pathology. It's a book outside of our field. And then the other book that I would recommend is the latest edition of David Luterman's counseling book, which is within our field, he's an audiologist and has made significant contributions in the area of counseling families and others who have communication disorders.

Kristin Chmela: Along with that, the Stuttering Foundation has multiple resources that can assist a therapist in trying to understand where to begin, they have some trainings you can attend that will give you more insight into something called Acceptance and Commitment Therapy, and also Cognitive Behavioral Therapy. Those are approaches that help an individual learn how to relate to the problem in a different way. It helps us learn how to identify negative thinking and what to do about it.

Kristin Chmela: So those three things, I think, investing the time to thoroughly understand where the person is at, starting your own mindfulness practice, and going to some of these resources, those would be the top three. And then I'll just add number four, which is feel free to reach out to colleagues. Feel free to reach out to individuals that specialize in this area. Those of us that do are highly compassionate and passionate about this population and spend a lot of time supporting and assisting other clinicians in doing this work.

Marisha: I love all of those resources and such great places to start. I will share it because you mentioned a number of different resources that people might be able to find. So I'll put those in the show notes so that people can easily find links to those. It'll also give like a quick little recap. So that'll be at slpnow.com/30. So hopefully you are taking notes, but if you miss something, I've got the link for you.

Marisha: But yeah, I love those tips. And just because you've recapped them beautifully, but I just wanted to recap one more time because they were such helpful tips that investing in that proper evaluation is first using just like that informal conversation then some paper and pencil assessments. And then there's also standardized options like OASES, and then spending time with yourself.

Marisha: And wow, a 200 hour immersion sounds amazing. I want to learn more about what you did with that. But it doesn't have to be something crazy like that, we can just do like a daily 10 minute practice. Like you said, Kristin, there are some amazing apps out there that make that really easy to get started with. And then I love the books that you mentioned. Those would definitely help us get on the right track and those would help ... These strategies would help with our entire case load. So I love that that so much practical information there.

Kristin Chmela: Great.

Marisha: Okay, so I'm curious, if you ... Because I feel like we have a good place to start now. I feel like I learn best from just some examples. Would you mind diving into one or two examples of what counseling has looked like for you?

Kristin Chmela: Sure. I think that when we think about this notion of, how do we do counseling, what does this look like just like you said, the best way that I could create a picture of this for you is that the child is sitting in the room and perhaps it's a group of children, or it could be just one child, and I'm in the room. I usually never put anything in between the client and myself, so I never sit across from the table. I usually sit to the side and there's space to talk about things.

Kristin Chmela: I'm going to give you an example. We had a client that came in after he'd been gone for the summer. And he shared a story how he had been surfing, taking some surfing lessons, he was in about fifth grade. And the instructor began mocking his stuttering and called him a couple of names in addition to it. Our client was relaying this experience. First of all, this was not a child who was bullying a child. This was an adult who was bullying a child.

Kristin Chmela: He talked about this for about five minutes and he got very upset. And one of the most powerful things we can do as we're listening to a scenario like that, is make sure our arms and our legs are not crossed. And usually your feet are flat on the floor and your knees are bent, and you're just leaning a little bit forward. Sometimes your hands are in your lap, but they are open. When your palms are up, that is a very receiving body posture. Carl Rogers talked about this as joining, it's a joining body posture, which is communicating that you're not afraid of what's coming at you, and that you can handle it, and you're allowing space for the person to share it.

Kristin Chmela: When he was done sharing this story, and he was emotional, and of course on the inside, I'm absolutely furious at what I'm hearing, what I said to him was the first thing I want to say to you is how sorry I am that this happened to you. That is probably one of the most powerful things we can say to any person who was in distress and sharing an experience is how sorry we are that that happened and just allowing some silence.

Kristin Chmela: So sometimes when there's a situation that suddenly comes up, and we don't know what to say or what to do, most likely, it's because we're not supposed to say anything except listen and just be comfortable with that moment and just say how sorry we are. After that, I think we talked about what kinds of feelings really came with this.

Kristin Chmela: With children, one of the things that's so powerful and I learned this from Faber and Mazlish, if you give them some options, they will tell you exactly how they feel. Were you mad? Were you sad? Were you disappointed? So, he was able to share what those emotions were. For us just to validate those, it's okay to feel that way. That's very normal. That's very normal. So, that is one example of what counseling might look like.

Kristin Chmela: Another example is, I had a high school client come back, and we start ... She's really struggling, really thinking a lot about her speech during the day, not wanting to participate, not feeling comfortable talking in her classes. So, sometimes a piece of counseling is gathering information and getting some education about something that's going on. So we just made a list on a piece of paper. I said, take me through your schedule. Okay, the first class is this, your second class is this.

Kristin Chmela: She named all the classes, including lunch and whatever else. And then I gave her a rating scale. I said, okay, on a one to 10 scale, how much are you talking in each of these classes? We went through that. And then I said on a one to 10 scale, how worried are you about talking? And then she made the ratings. And so we were able to identify, I'm sorry, let me add one more thing after that. I talked about a rating of how comfortable are you with the teacher in these different classes?

Kristin Chmela: We came up with two different classes where she felt she had a high level of comfort with the teacher. And she also felt she had a peer in the class that was supportive, and we were problem solving and deciding, okay, how can we honor what you're feeling right now and be moving in the direction that you want to be moving in, which is to talk when you want? There's such a psychological ramification of an individual wanting to share something and holding it back, wanting to share something and holding back. That's that fight or flight response that we do not want to be conditioning over and over again in the brain.

Kristin Chmela: So we came up with one particular class. And again, we took the time to have this conversation. And so what was decided was that she would go ahead and email the teacher and let the teacher know how uncomfortable she is still feeling and with the teacher meet with her for a few minutes each week and talk with her individually to help move her in the direction of participating in the class like her peers are doing. That's another example of counseling.

Kristin Chmela: One of the things that we talk about with children and that we also work on ourselves is refining the ability to notice versus evaluate. So when we're evaluating, when the child is evaluating, the parent is evaluating, that's a judgment. It's what we think about something and it's good or it's bad, versus noticing behavior. For example, we may engage the child in some type of speaking situation that they're working on within the therapy room. And then we're asking the child to give his or her own feedback.

Kristin Chmela: We're giving feedback and we've made a rating scale, and we will use this language often, what is it that you want me to notice? And how can I give you that feedback? So we talk a lot about noticing what went well, and then noticing what the child might want to consider feeling a little bit more in his or her body or hearing as they're communicating. And we talk a lot about, it's hard for anyone to identify their thoughts around something.

Kristin Chmela: I think lots of times the emotions come first, and then we can get to the thinking around it. We talk a lot about the difference between that thought where I was evaluating, I stuttered, I didn't do a good job, versus what were you noticing about what it looked like and how would you want it to be different. So, those types of conversations are also pretty typical.

Kristin Chmela: The one thing I want to say is there are many children that really have a resilience about themselves as well as perhaps a different ability to monitor internally and also those social cues. They may have some moments of frustration, but they may not present as other children who have a significant amount of anxiety around their inability to communicate at times, and that's why it's so important that we ongoing check in with children.

Kristin Chmela: Sometimes I'll use a little wheel or I'll make something up on paper just checking in or any situations, did you feel something was a big success this week? Did you worry in a situation? Did you find yourself not talking as much as you wanted to? So, we may also have some conversations like that. Often, I've learned over the years, one of the greatest ways to get in with kids is to do things they don't expect. So lots of times I'll use material that they wouldn't expect, and do something sort of creative.

Kristin Chmela: Nothing spectacular, but I tend to I know this is giving away my age, I tend to not really use technology when I do therapy, because I really want the child to connect with me and connect with my face and to connect with, I want to feel that from their body. So I tend to use things that are real that we can touch. We do a lot of art sometimes if I have a child that likes art.

Kristin Chmela: I'm thinking of another child I worked with. She really started developing some fears about talking. She's a third grader and I knew she loved art, so we started during the session doing a little bit of painting. While we were painting in a very organic way, she started telling me something and I noticed her have a moment of stutter and she sort of turned away and kind of covered her mouth with her hand. I just very gently said, "It's okay. It's okay. It's okay for you to talk any way you want in here. And it's okay if you stutter. And perhaps as you're talking, if you feel a little bit of tension, see if you can hold on to my face with your eyes. Just try it. You'll get bigger than the stutter."

Kristin Chmela: She sort of looked at me and she began doing that, and her whole reaction to the stutter had changed. This is a bit of what we call desensitization. Every time it happened, I reinforced her. I love how you're just talking, we don't teach these children skills, and then they apply them and it's fixed. That's not how the game works with this disorder. And that's the most probably confusing part about it. What we want is for the body to experience things over and over.

Kristin Chmela: In my yoga training, we call it japa, the word japa, J-A-P-A, doing a little bit of something every single day over time creates something different in the body. It's experiencing how does it feel to let a stutter happen, but let go of the reaction and just observe it. That's so desensitizing. Over time, how does it feel to hold on to my face and what courage that took? I ask children often and this is part of counseling.

Kristin Chmela: I have a high school client, I said to him, "Do you have the courage? When you're in a block that's bigger than you want it to be, do you have the courage to stop for a second and hold the space? You're the one in charge in the conversation box if you're talking. Do you have the courage to do that and just feel, get in your body and then move on." It's this idea of how can we separate that emotional action to the moment of the stutter? And over time, how can we counter condition that fight or flight response in the brain?

Kristin Chmela: That's also what counseling looks like. Boy, I have so many situations every single day. One of the things that I will tell you, another part of counseling is making sure to set the child up to be successful. And if something happens, problem solving it, so it's understood by the child. Let me give you an example. So I had a particular client, who was not receiving services through an IEP, and the teacher wanted the child to do a reading fluency exam for comprehension. And the child said to this teacher, this is a child who's in fifth or sixth grade said to this teacher, "Oh, I can't do that. I can't read fast like that. I stutter."

Kristin Chmela: The teacher sort of brushed it off, and said, "There's no IEP saying that you don't have to. So you have to." And the child did this measure and did not have a positive experience. So what had to happen after that, that that was not okay. Because to the child, the child was put into a situation where she felt completely powerless, and was very upset after it happened. And so what we had to do then is go back and have a meeting with the child and the teacher and say, "Well, probably you weren't aware, but that's a measure that we will not be using, unless the child wants to."

Kristin Chmela: We had to have some kind of repair because the teacher didn't do it maliciously, she just said there was no accommodation in front of her and so she moved on. And so when situations occur, we go back and we problem solve with the adult in front of the child, if the child is comfortable, so that the child learns how to advocate for him or herself. That is critically important and it's a part of counseling as well.

Marisha: I love all of these example. It's so incredibly helpful and you just describe it in a way where I feel like I could imagine you and the student and the whole situation so incredibly powerful. Thank you for giving us some insight into your therapy space. So I'm curious too, because you do a lot more with therapy than one on one sessions.

Marisha: You also have this thing called Camp Shout Out, and I'm curious. I'm just curious in general about learning more about that program. I'm curious if you incorporate ... How you incorporate those elements of counseling in more of that group setting or is there a mix?

Kristin Chmela: Well, Camp Shout Out is, I smile when I think about it, we're going into our 10th year.

Marisha: Wow.

Kristin Chmela: The camp began when a parent approached me and a special recreation organization actually began in the Chicago area and then I moved the program to Michigan with a colleague to collaborate with her. But I was called and they asked if I'd be willing to do a camp, and I'd never been to camp, I've never thought about camp. I was always too afraid to go to camp. I was afraid to go places where I didn't know people, because they wouldn't know that I stuttered.

Kristin Chmela: And so I said yes. I think I was recovering from major surgery when they call me. And I said yes. And then I said, "I'll do a camp. And if I'm going to do it, I'm also going to make it an opportunity for clinicians and students to learn more about stuttering." That's how it began. This camp has evolved incredibly, and I think that if anything, any colleague that is involved in this camp, and that has been for the past several years will attest to the fact that perhaps I model what we teach, which is that we all can keep evolving.

Kristin Chmela: This camp brings together about 60 children from across the world who stutter, ages eight to 18 and then as well as the trainees from grad schools and also speech pathologists. I have about 11 people on my leadership team that are all highly immersed in fluency work that come to act as facilitators and we interact with the children in a regular overnight recreational summer camp environment. We all stay at the camp.

Kristin Chmela: What we do basically is we take, we create and utilize multiple opportunities every single day to set children up to feel power as communicators. That's really what we do. We obviously approach the therapeutic element a bit differently for the younger children versus the older children. But we do talk about what I call the five areas of focus of a competent communicator. These are all action related.

Kristin Chmela: They are starting with our thumb attentive, assertive, confident, effective and proactive. We often use the hand as a symbol for those. I'm actually working on an eBook right now about these five areas of focus. But what we do is we create opportunities for children to communicate, and they identify and work on speaking situations. The older children run the whole camp basically, when it comes to what do we need to do to get this day to work, all the announcements, they do presentations.

Kristin Chmela: So, there are multiple opportunities to stretch themselves as communicators. We also have the opportunity as many organizations do, and of course, there are many good things out there for children who stutter now, we have the opportunity for children to meet other children who stutter and to feel like they are not alone, and that they come to camp and they feel normal. They feel like it doesn't matter if they stutter or not. There are some kids that stutter more than them. Some kids that stutter less. I think that in itself has a therapeutic element.

Kristin Chmela: Throughout camp, we also engage in very specific activities to help children learn about emotions, about communicating emotions, and having those validated. I'll give an example once with the younger children, we had a huge canvas and we drew a silhouette of a body on the canvas. And then all the children gathered around the canvas and we were talking about how when we experience different emotions, usually they're somewhere in our body and where do you feel?

Kristin Chmela: We talked about a different emotion, let's say, anger, where do you feel that in your body and then they would place something on the part. We also talked a bit about how emotions can feel like they're a certain shape and a color. What might that be for you and about the importance of breathing in to difficult emotions. And some of this comes from Acceptance Commitment Therapy. Jane Hurley from the Michael Pollan Center runs a wonderful conference at Boston University, teaching clinicians about some of these ACT concepts.

Kristin Chmela: So, that would be an example of an activity. We had a very riveting discussion group this past summer with our older campers about what we call the imprint experiences, what was something that has happened to you that you think you'll never forget that was either really positive or really difficult around your stuttering? That was a very eye opening conversation. It was so intense that when it ended, nobody moved. So I got up and I realized no one's moving. So I just sat back down on the grass.

Kristin Chmela: What was incredible was to watch the children and how they shared, and then they supported each other and allowed each other the opportunity to be emotional just to say, basically, we've got your back. I think that's really powerful. When you can bring together a group of people and create this general community of reinforcement that is so powerful, this makes a big difference in terms of counseling children.

Kristin Chmela: The other thing that we stress in a very highly energetic and positive way, is the importance of cultivating a mindset around this disorder, and that you may stutter sometimes and it is a really smart idea to keep evolving as a communicator. That's what every smart person does, whether they stutter or not. And so we try and bring this concept as well, which I think also is a counseling aspect of dealing with this disorder.

Marisha: Wow, that sounds like such an amazing experience. Yeah, I'm excited to learn more about that. We are running a little bit close on time, but I really wanted to squeeze in this last question if that's okay with you.

Kristin Chmela: Yeah, of course.

Marisha: So, what role do parents play in like, how you bring in your patients' or your clients' parents, and if you have any suggestions in terms of how speech therapists might be able to do this in the schools?

Kristin Chmela: Yes. Of course, parents play an essential role. Whether it's a parent, it's a caregiver, it's someone else that is important in the child's life or it's someone else working at the school that you can engage in the process. There are times where in the school setting we don't get the parents in. But I think engaging with another adult can make a significant impact on the child and in the child's life.

Kristin Chmela: I think what's important is that we invest the time in allowing parents to talk about what this is like for them, and how they are feeling and to be able to also let them express those feelings and emotions and validate those coming from the parents as well. I think that there are different opportunities for parents to meet other parents. I have known clinicians that have gone the extra mile and started a parent group right in their school district and had all the parents of children who stutter from the different schools come together once a month.

Kristin Chmela: I think providing them education is very important not just sending them to a website, but giving them something or exactly what you want them to read, so that you're comfortable with the philosophy of what they're reading and what it says is very important and also helping them understand that it's okay if their child is experiencing some discomfort or they're having a hard time and modeling for them how to sit with the child, or how to respond.

Kristin Chmela: We have obviously in private practice, if someone is bringing the child, sometimes it's tricky to get parents and believe it or not, I do a lot of tele practice work as well and sometimes I do set up individual meetings with parents just so I can make sure that I'm aware of what's going on. I think that their approach to the problem models for the child how this is basically. It takes an awfully strong parent to walk into the ice cream store and stand right next to his or her child and watch them stutter and finish, and stand there proud.

Kristin Chmela: I think we take clients out to do these different speaking situations and we often model for parents how they can do that, and I think helping them keep the lines of communication open with their child talking about the speech sometimes. Every parent I think wants the best for their child and helping them recognize they're doing the best that they can. And I have to remind myself often to praise and reinforce what the parent is doing, because they need that reinforcement just as much as the child does.

Marisha: Yeah, I love those points. So, some of the takeaways there for me were just investing the time in those relationships and leaving space for the parents to talk about what it's like for them, expressing their feelings, validating that, providing opportunities to meet other parents, providing education.

Marisha: I love just the little insight that you gave with modeling how to sit with a child and just how a parent can model to their child about what that experience is and what that means, and then always praising and reinforcing. I think those are some really amazing takeaways. So, we are wrapping up on our time together. I'm curious if you had any last pieces of wisdom or anything that you wanted to share that we didn't get to yet.

Kristin Chmela: I think the last thing I'd like to say is that I believe that I have developed the counseling skills that I have through going through my own personal counseling, through attending and learning and doing different courses that focused in on counseling, and also through self-reflection. Self-reflection is something that's hard to do, and it's the greatest learning opportunity.

Kristin Chmela: So, when something would happen with a child, a client, a teacher or a parent, I would sit back and at first sometimes I would be saying something about the other person as we so quickly can do. And then I would step back and I would say, what was my part in that? What was it about that that caused me to react this way? And what am I going to do differently next time?

Kristin Chmela: That's probably the best piece of advice I could ever give anyone. When we begin to self-reflect, we understand our responses and we become more compassionate towards ourselves. It allows us to show up for the other person. I really enjoyed this, Marisha. I could talk with you for a long time about this. And of course, I so appreciate you committing this time to helping children who stutter.

Marisha: Yeah, and thank you for all of your wisdom and advice. I know I definitely took a lot of notes and I'm excited to be able to implement and start practicing some of these strategies myself, and I know that the other SLPs listening will be in the exact same boat. And then before we officially wrap up, where can people find out more about you?

Kristin Chmela: Well, they can go to my website at chmelafluencycenter.com. They can also go to campshoutout.org. Those would be some good places.

Marisha: Okay, perfect.

Kristin Chmela: I do need to probably learn more about these types of mediums and the social media and the things that the young person is using so much now. As soon as I stop working so much, I'm going to devote some time to that.

Marisha: Yeah. Well, if you ever want to chat, I'm happy to dive into all of those things. Yeah, you've provided so much wisdom and advice here. Like I said before, I'm so incredibly grateful and thank you for taking the time out of your busy schedule to share that with us. And yeah, that's all that we've got for today. So if you want to, head to slpnow.com/30, that's where you can find all of the show notes and resources that Kristin mentioned during our conversation today. And yeah, we'll see you next time. Thank you.

Kristin Chmela: Bye-bye.

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Filed Under: Podcast Tagged With: Fluency, Stuttering

#029: How to Target Phonological Awareness Goals

November 20, 2019 by Marisha Leave a Comment

Listen on Apple Podcasts Listen on Spotify

In this week’s episode I got to sit down with Nicole Allison, an SLP who works with students from preschool to high school and authors the blog Speech Peeps, where she shares resources, activities, and ideas that engage students *and* save busy SLPs time.

For the last two weeks we’ve been talking about getting started with literacy and phonological awareness — now we’re going to tie it all together really nicely with a conversation about strategies for targeting PA In therapy sessions.

There’s so much goodness packed in this hour, and you’ll walk away with a new confidence in your abilities to write goals that target phonological awareness, strategically select progress monitoring assessments, and choose appropriate (and effective!) therapy activities to tackle those PA goals.

So grab your beverage of choice (I’ll have a chai tea latte!) put your feet up, and listen in.

Key Takeaways

– What led Nicole to learn more about phonological awareness
– The whole child approach
– Working on articulation alongside other skills
– Research around pre-reading → Targeting PA improves articulation
– Tips for identifying students who might benefit from this approach
– When the best time to start therapy is
– Foundational skills required by the student
– Choosing activities and building on skills
– How Nicole approaches assessments + progress monitoring
– How to write goals + give examples
– Nicole’s favorite (fun!) treatment activities
– The importance of communication, and the research that supports it

Links Mentioned in the Podcast

– Gillon (2005) article
– Nicole’s blog post
– SpeechPeeps.com
– Find Nicole on Facebook and Instagram
– Nicole’s Phonological Awareness Resources

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Transcript

Transcript
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Marisha: Hi there and welcome to the SLP Now podcast. I am so incredibly excited to have Nicole Allison on the podcast today. And if you haven't heard of Nicole Allison, I'll just give a quick intro.

Marisha: She is a speech language pathologist who currently works with preschool through high school students. And she has presented at local, state, and national conventions on topics related to speech and language pathology. And her presentations are always a big hit, so I cannot wait for her to dive into all things phonological awareness today.

Marisha: But she creates amazing resources that are incredibly engaging and helps us save time, which we definitely need with our busy workload. And she's also the author of the blog Speech Peeps, and she shares tons of practical activities and ideas for us to use there. So without further ado, I am excited to welcome Nicole Allison.

Marisha: So before we dive into all of the practical things related to phonological awareness, I'm curious if you'd like to tell us a little bit about your story, and also leading into what led you to learn more about phonological awareness.

Nicole Allison: Sure. So thank you so much for having me. I'm thrilled to be on this podcast. I've been listening more and more to podcasts, so it's just such an honor to be here myself. And I just thank you so much for having me.

Nicole Allison: So I actually in college, it's interesting, I was a math major. So I was on the opposite side of the brain and I've always really liked the numbers and just how things fit together with math. But then I started taking some courses and realized no, this is not what I want to do for the rest of my life. So I attended a seminar on speech language pathology while I was in college and I actually had had speech therapy when I was younger for inaudible when I was in fifth grade. So I was one of those later kids. But it's always just peaked my interest and I went to a seminar and I just absolutely fell in love with this profession. So I switched over to the other side of the brain I feel like language, and I've never really looked back.

Nicole Allison: But in regards to phonological awareness, for years I've been coming up with ideas on how to integrate working on multiple skills at the same time. And I've always been drawn to the sort of whole child approach to learning. So instead of drawing a line around certain skills, like for example, only working on articulation or only on increasing vocabulary, only working on phonological awareness. Really looking at the whole picture and how we can integrate these sort of areas together.

Nicole Allison: So I'm fully aware, not all of the skills work this way. But I think especially for goals like articulation, it's just very easy to incorporate them into other skill areas.

Nicole Allison: And I was thinking about it because this is really what our kids are expected to do outside our therapy rooms. No one is simply asking them to say words with their sound in isolation or their sound and sentences, but instead they're needing to learn these skills while reading out loud in class or while talking to a friend on the monkey bars. So I've always been drawn to working on articulation while working on other skills, because of this whole child mentality that I've had.

Nicole Allison: So then with that background, it led me to start digging into the link between articulation and phonological awareness skills. And when I talk about phonological awareness skills, I'm talking about those pre-reading his skills that are so important for literacy. Things like repeating words and sentences, rhyming, adding sounds, deleting sounds, manipulating sounds. All these skills that are so really the foundation a child needs before they even read their first word.

Nicole Allison: So interestingly enough, these are also the same skills that many of our children with articulation and phonology disorders have difficulty with, which I found really interesting. So when we talk about those phonological awareness and articulation, I don't think that many of us are super surprised that there's a strong link between the two. But what's interesting though is that studies are now determining that directly working on phonological awareness is also shown to concurrently increase speech intelligibility and improve articulation sounds.

Nicole Allison: So there was a study done, and they just worked on, they took some kids that had both phonological awareness deficits and articulation deficits. And they simply worked on phonological awareness skills. And then at the end, they re-examined and they found that even without working directly on those articulation skills, those kids had improved with both their phonological awareness skills and their articulation skills.

Nicole Allison: So this is just really pretty exciting for us, I feel like. And it really makes sense. I have an example that I think really highlights this benefit. So I say suppose I told you to tell me about your day about, but while speaking, to substitute every R sound with W sound. Do you think you could do that Marisha?

Marisha: That would be very tricky.

Nicole Allison: It would be really hard. And I think even for grown SLP, it would be extremely difficult because we're so used to the way that we talk. Okay. And this is what we ask our kids to do all the time. But, suppose I handed you a typed paragraph now and told you to read it, substituting every R sound for a W sound. So it'd be tricky still, but I feel like it's much more doable with the visual because now we can see the sounds on the page, we can see how they form the words. And this is why once kids begin working on reading, and sounds, and letters, I typically see a huge increase with their speech intelligibility and articulation skills. Because now they have that visual, and they can literally see that S in the word stop instead of trying to produce sounds and speech with any frame of reference. So really what the phonological awareness skills do when we're working on those phonological awareness skills, they provide those concrete visuals and that frame of reference for our students with speech down difficulties. So it really works well together I think.

Marisha: Oh my goodness, that makes so much sense. I've never thought of it in that way, but I've seen this happen so many times with so many students. And I love that example that you gave. Because I'm definitely going to put this in my pocket for parent meetings, because I've used this approach as well. But I love asking the questions that you asked, how hard would it be to replace sounds as you're speaking compared to when you're reading? And you're so right. Having that visual and that reference makes it that much easier. That really helps break it down. Thank you.

Nicole Allison: Yeah, yeah, I've used that thing. I think it does click with parents in meetings where especially with preschoolers, if before they're reading, if we can incorporate some of those sounds and the letters. I tell them that is going to help their speech so much because I give that example and it just clicks like oh yeah, that would be a visual then.

Marisha: I love it. Thank you. And then I think I also wanted to emphasize too that study that you mentioned. It sounds like there's several studies. It's not just one study that has documented the impact of targeting phonological awareness on articulation.

Marisha: We were talking about this before we went live, but I was with a second grader a couple of years ago who was really struggling with articulation and reading skills. And I had taken a couple of courses on phonological awareness, and I knew enough to look into assessing it. And then I gave him an assessment and I realized that oh man, he's missing a lot of these skills. And I started looking into the research more, and I came across one of the articles that you were talking about that showed that just targeting ... because I wanted to have some evidence behind what I was doing since it was still fairly new.

Marisha: But it's amazing. I feel like, I don't know, I always get really excited when I find things like that in the literature because you're so right about that whole child approach. And we have so limited time in therapy, and a lot of times our students are struggling in a lot of areas. It's not just those few sounds. It's impacting other areas, and the same is true with language. So it's always so incredibly exciting when we can find ways to work smarter as SLPs and target multiple skills at a time. So I'm excited to dive into how we could do this. So do you have any tips when it comes to identifying students who might benefit from this approach?

Nicole Allison: Yeah. So for me, personally I found that kindergarten is typically the best starting age for this approach. So the skills themselves are pre-reading skills. The students aren't required to read anything. But they do need to have a basic understanding of sounds. And this approach also works best if the student is able to say at least the sound at the word level. I'll give a few examples of what this looks like.

Nicole Allison: So say we have a student working on L sounds. I'd say the simplest level to do is oral repetition. That's just me saying a sentence containing their sound, and them repeating it back. And I do like to write it down, because even if they can't read, again that visual is just really beneficial for them. So I would write out just a simple sentence like my leg hurts or the lamp is on. And I'd have them point to their L sound and say the sentence, and they just repeat it back. And it's just getting them familiar with where their sound falls in that sentence and how it relates to the words, how it just all structures together.

Nicole Allison: So I just have them point to their L sound in that sentence. And they just repeat it back to me because it just gets them used to how the sounds work together to form words, and then the words are in sentences, and just all works together. So that's basically where I start.

Nicole Allison: And then, I would move on to the phonemes. Actually first, sorry. I'm going to move onto the syllables. So syllables are easier to hear for kids. You have the clapping. I remember doing that in school, and they still do that in school. But what I would do is I give them a word and I would segment the word first, like lad-der. And they would just have to put it together and say ladder. Or Ju-lie. And they would just have to be hearing those sounds to put that word together and form that word.

Nicole Allison: You can even once they do that, it's easier than for me to say a blended word and for them then to segment it. So if I said reptile, then it's easier for them to go rep-ti-le, and just segment those sounds. And it gets them used to breaking down those syllables within the word. After that, the hierarchy is sort of phonemes and just breaking down the sounds.

Nicole Allison: So usually what I want them to do is identify a sound position for me in a word. So I might say, "Repeat the word that I say and then tell me the sound that you hear at the beginning of the word. Luck. What sound do you hear at the beginning of that word?" Or, "What sound do you hear at the beginning of dollar?" It doesn't always have to be the L sound at the beginning, but it's in the word and they are just figuring out where is the sound that I'm hearing at the beginning of the word.

Nicole Allison: And then we go on to just blending sounds to form words. So this is sort of the syllables, but now it's broken down even more. So I could give them the word lad and just go "lad." And they would have to form that together to form lad. So they're getting used to just hearing those sounds and how they form that word. If I said, "Girl," and then they'd just say girl. And then we'd switched.

Nicole Allison: Then I was doing this teacher thing and I say, "Now you're the teacher, you tell me a word blended together and I will segment it." So we just go back and forth, and the kids just really enjoy this.

Nicole Allison: After blending sounds, once they can blend in segments, then we can start manipulating those sounds. And that gets more challenging. But this is where I feel like it's so beneficial, this kind of therapy. So we can start changing the words and I can have them add sounds and delete sounds, and then just actually change the sounds. So I could say something like, "Say the word line and now say it without lie." Or, "Say the word life and now change the 'L' to a 'W.'" And it'd be wife. Or, "Say the word load. Now change the 'D' to a 'F' sound," it'd be loaf. So you can change all the sounds. And again, they're not reading anything. So this is just them auditory, just listening to these sounds and changing them.

Nicole Allison: Then we can also do some rhyming and things like that. I think a lot of people associate, they know rhyming goes with phonological awareness. So you can just simply, usually where I start is having them recognize if words rhyme. And then going on to if I give them three words and then they are selecting the two words that rhyme, and then finally generating rhymes themselves.

Nicole Allison: So that's that the hierarchy that I use. It's not research based or anything. But it just starts with that, again, that oral repetition. And then syllables. And then phonings and rhyming. So that's just what I do, I found it really beneficial to especially like I said, those adding sounds or deleting sounds, or even changing the sounds and words. So yeah, that's what I do here and how I target.

Marisha: Yeah, that's super helpful. And I love getting to hear the different strategies that different SLPs use, and you gave so many great examples. And I'm curious in terms of when you're working through this with a student, do you work through the hierarchy in one session, or however many sessions the student needs? You would just work on the repetition, or are you working on multiple skills at the same time?

Nicole Allison: Yeah, that's a great question. Usually, I just try to focus on one skill at a time and then the next session will go through and I just kind of mark where we were in the hierarchy and move on to the next one. If they were doing well or maybe they might need some more practice on just the oral repetition. So what gets tricky I think, and it's good to challenge the kids is at that phoning level to then incorporate sometimes maybe especially if they're advanced and they can do this kind of thing, to do adding phonemes and deleting phonemes, so that would really get their brain working. And they really have to think about the word. So I usually, to answer your question, I usually just target one specific skill at a time.

Nicole Allison: But another reason that I love this approach, it's just I feel like it makes sense in that we're not just feeding them the words. They're actually having to really think about them, think about where their sound as in the word. And it gives their brain a little bit of an extra challenge for them instead of just saying the word, repeating back the word, or anything like that. They have to think about it.

Marisha: Yeah, I love that. And especially when you get to the sound manipulation, even as an adult, sometimes the task, I really have to think about it. Maybe that says something about my working memory or lack thereof. It gets challenging. And I think, especially if we're providing them with the supports, I think students like a little bit of a challenge like that. And especially if we can explain the why behind it and tell them, because this is amazing because there's so many whys behind it. It will help them make progress on their speech goals, but it also helps with their reading. If they're seeing us, it's probably something that they struggle with. So I think if we can explain the why behind that, there'll be a lot of that motivation too.

Nicole Allison: Definitely.

Marisha: Cool. And then in terms of how you actually implement this, because I've gotten to see some of your resources. And it looks like you're not just picking random words, right?? How do you put this together in terms of how you select the words?

Nicole Allison: Sure. Yeah. So I have a resource that has all these sounds broken up, but this is something that you can easily do with any sound. So I just make sure that the sound is in the word. It shouldn't always be in the initial position actually. And just repeating the word, they're going to be saying that sound. So I always have them repeat the word. For example, if we go back to say life, now change the L to a W. They're going to be saying that life. And then they're going to be saying wife, which doesn't have the target sound in it. But they're always going to at least be saying a word with a target sound in it least one time.

Nicole Allison: But even words at the end, like if I said, "Say eight, now put an L in front of it. Late." So you can do it in all different ways, or you could say ... I can't think of one now that has it at the end of the word. But it can work however you want, as long as they're still practicing that sound. They're just changing the sounds within the word, if that makes sense.

Marisha: Yeah. Yeah. And the cool thing is that if an SLP is comfortable with these activities and they're like, "I've got this," you can use any of that word list that you already have and just pick the activity that meets the student's level. And it doesn't involve a lot of prep. This is something that would be easy to start implementing just in your regular articulation practice.

Nicole Allison: Right. Yeah. And going along with that, so I use this intervention book with students that are on IEP and just receiving like intervention or RTI. And I've actually really been loving using the system with my five minute articulation students. So I do a five minute articulation out in the hallway. And this is just for kids that aren't on IEPs, they're just receiving intervention. But what it is, is I see them two to three times per week, just for five minutes, and we just simply drill. So there's no games, no even wasting time walking all the way back to my room and then walking back to the classroom. I pull them right outside their classroom, we're in the hallway, and I take my list of words, and we just drill these sounds and these target words in there.

Nicole Allison: And I can usually get up to about 100 productions doing this approach with kids that way. But then they're not missing a lot of class time either. So it's really easy to explain to parents why I use that approach. They're getting the research based approach that's going to be beneficial to them, but then they're also not missing a lot of class time doing unnecessary tasks.

Nicole Allison: So that's how I do mine. I wish I could figure out a way to do the five minute articulation with my kids that have IEPs a little bit better. But you need to write those minutes very specific, and I haven't figured out a good approach. So I usually have them back in my class and I do that phonological awareness still with them. But it's not during the five minute.

Nicole Allison: So, depending on your district, you could ... and then I'm thinking of how you write goals too. So I usually write the goals like I do my other goals. But so a few examples would be given words containing their target sound, a student would repeat, or add, or delete, manipulate, or rhyme sounds. You could do any of those or a combination of them, sounds or syllables with 80% accuracy in three consecutive sessions or whatever accuracy you would feel would be beneficial to them.

Nicole Allison: And depending on your district, you could write out those separately, like I said, to just target one area, or together, or however you went. But I think the important thing is providing a few examples to parents and really making sure parents and administrators understand what phonological awareness is. Because I think there's a lot of confusion around phonological awareness. There's phonological awareness, there's phonemic awareness. So just explaining what you're actually doing and how it relates to articulation, and how this is going to improve their intelligibility and their speech sounds.

Nicole Allison: So bring the research to the meeting. I have a blog post that has that article that I talked about. And start talking about how this could really work with their child to increase their articulation skills and also their pre-reading skills. I just feel like this is an area that could be really helpful to speech therapists in schools.

Marisha: Yeah, that's so helpful. And we'll definitely share a link to the blog post. So we typically put together show notes. That includes, I'll include some of the ... or actually we'll just send them to your blog posts for the citations and all of that. And then I'll also share the other resources and links that have been mentioned. So that'll be at slpnow.com/29. And I so love that you gave us an example of an actual goal. I know that's something that SLPs really look for, and it's a question that they're always asking. So yeah, I so appreciate that. That was helpful to see how you actually implement that.

Nicole Allison: I love when people write out goals inaudible I could write it that way, yes. The more ideas, the better.

Marisha: Yeah. And the cool thing is that once you have a foundation to start, then we obviously want to make sure that it makes sense for our students. But just having that example I feel like gives us a jumpstart in figuring that out. So that's super helpful. Okay. And then in terms of, so do you do this with all of your students? When you're deciding which level to start with, whether you're saying the word in sentences, or dividing into syllables, or whatever it may be. Do you start with an assessment to figure out that level? How do you decide which level you're starting with?

Nicole Allison: Yeah, so an assessment would be really helpful. Just know is the student not able to say the sound at all. This probably wouldn't be a good starting point for that student. Probably you're just going to be working on saying that sound, and saying that sound in syllables only.

Nicole Allison: But then once they can start saying it in the words but they're just not saying it consistently, that's when this approach really comes into play. Because you think about it, they're able to say the word with the found in it. They are just not carrying it over into their conversation. And that's exactly what this approach does because it mixes ... it sounds awful, but I feel like I view it almost like those exercise programs that want to confuse your muscles so that they get stronger. I kind of feel like that's where this goes, where if not, obviously we don't want to confuse our students. But it's making them do more and think about where their sound is in the word, and how it fits into the word in a conversation and in the bigger picture in sentences, and in paragraphs, and things like that. So it's making them think outside of that just simple word level and sentence level, if that makes sense. So you definitely want them to be able to say that sound in a word first, but then this helps them with that carry over. It really helps speed things up too. I've seen personally with my caseload, it helps them generate that carryover faster in my opinion.

Marisha: Yeah, that makes so much sense. And then in terms of, because I guess it would be pretty easy to figure out. You could just get a list of words and then have the student go through the hierarchy of activities and see where the student, what they're already successful at. If we're trying to decide when we're writing that goal, do we want to write a goal for the sound manipulation level or is that going to be too much of a stretch? Maybe we want to work on just blending sounds with those words, and we can work through it that way.

Nicole Allison: I have had a few kindergarteners that I've started out with this, and they're really good at the oral repeating and blending sounds together, but then it just gets a little bit too difficult for them to start manipulating those sounds. We definitely want to make sure where you're starting out something that they can do at starting point now to make them successful.

Marisha: Yeah, that makes so much sense. And then just from, I'm curious from your experience, if you're ... and I know this would vary depending on a lot of different factors, including what grade the student is in. But with your kindergarteners, because they're at the very beginning of these pre-reading skills. So would you say that you typically work towards maybe with those students, do you typically write goals more based on the going up to the syllable level and then maybe with the older grades you would go up to manipulating sounds? Do you have any rules of thumb that you found in your practice?

Nicole Allison: No, I think it really does depend on where the student is at. Because like I said, there are kindergarteners that they just were not ready for that. But then I've had other kindergartners that surprisingly were able to manipulate sounds. And they were able to do those tasks. They just really got that.

Nicole Allison: So I don't know if it's grade specific, but I know a lot of people have asked me about preschool, doing this method with preschool. And I'm just not sure that they're ready yet for this kind of approach. You could do some of the things. You could do the repeating of the sentence or even just blending the syllables probably like ladder, and having them put that word together and saying ladder. But that level is, they're pretty young to be doing a lot of those tasks. But otherwise, I don't know if it's a specific grade or age. It's ore on their ability and what they're capable of doing I think.

Marisha: Yeah, that helps. And I think maybe with our preschoolers or if we're in the middle of an IEP period for some of our students and we're not able to change that goal. I think this is something that we can use. We're still working on that articulation goal, so we can write our traditional goals and just embed some of this, and see how it works. It shouldn't hurt the student. So yeah, maybe with our preschoolers, if we're working on articulation, we can just do some syllable clapping, just embedding it as we go along. And then even if we're not able to write that formal goal, we can just play around with some of these skills. If it helps, then that's amazing. That's an added bonus there.

Nicole Allison: I would even say to do that, almost. I have wrote goals specifically for the phonological awareness. But I feel like even if you have a goal that just very generic that a lot of times we write. A student will, given a word, a student will say their target sound at the word level for 80% accuracy in three consecutive trials, or however you might write that goal. But you are still working on that goal like you said, by doing the phonological awareness task. You're targeting that word at the word level just by embedding some of these quick phonological awareness interventions in your regular sessions.

Nicole Allison: So it really does work. And that would be an easy way, even if your goals aren't written that way. It's just another approach I feel like so it doesn't have to be, and we don't have to really write approaches in our IEPs. We just have to be targeting those goals. So definitely.

Marisha: We just get to find all the tools to add to the tool belt to help our students. Yeah. So just to help our students make more progress. And then speaking of progress, do you have any tips when it comes to progress monitoring? How do you set that up when you're tracking progress for that type of goal? When given their target sounds, student will manipulate sounds in words by adding, deleting sounds with 80% accuracy. Do you just do that activity in therapy and take data on it, or do you have any special tricks when it comes to that?

Nicole Allison: I think that's where probably the difference in writing the goals comes in, or to write student will manipulate the sounds, then that's what you're really looking for. You're looking for them to be able to manipulate the sounds with their target sound in there. But not necessarily ... so you will be stating that they got it correct if they are able to manipulate the sounds, but not necessarily if they're saying their target sound correctly, if that makes sense. But if you write the goal focusing on their target sound, then that's where you're going to be. That's where your focus is going to be. And that's where you're going to write whether they did it or not.

Nicole Allison: So I think either one of those could be used, I'm not sure if there's one that's better than the other. And they might be different for different students. But I think it's important to realize what are we writing our goal four and then go for that. But just like the article said, they weren't necessarily working on articulation during that. But both phonological skills and articulation improved. Which is really neat I feel like. So even if we write a goal saying student will manipulate the sounds within a target word that has their sound, we're working on that phonological awareness. But I feel like we're also working on that articulation, but we're looking more at the phonological awareness aspect of it. But I think both will improve. I think that's what people will see is both end up improving.

Marisha: Yeah. And that's the best part about that goal because they target something completely different and see generalization, which is really exciting. Then I was curious too, do you have any favorite tips? And it sounds like if the student is really struggling with it, then maybe they're not ready for this type of activity yet. But I'm curious if there's anything that you do to help students who seem ready, but they're just struggling a little bit. Do you have any favorite visuals or strategies that you use to help students be able to maybe ... because I feel like manipulating sounds is the trickiest part. Because I love the strategies that you gave when you were explaining the activities. Like when we're working on syllables, you gave lots of different steps to scaffold it when we first say the two parts of the word and then help the student put it together. And then you gave a lot of those examples for that. But I'm curious if you have any favorites when it comes to manipulating those sounds.

Nicole Allison: Yeah. I think the best thing that you can do when doing this work is even though they're not reading yet, a lot of our students probably aren't at the reading level yet. Maybe some of them are, that would be great if they are. But either way, even if they're pre-reader or reader, I think the best thing that we can do is write the word down and just provide that visual. Especially if they're struggling with that. Because again, you think about it. If I said, "Say the word light. Now change the L to an N." "Night." It'd be so much easier if we saw the word in print and then I could circle the L or erase the L and put an N there. And that would just help them even if they're not, what I found is even if they're not reading yet, putting it in print just does something. It's like it does something magical, and just really helps them because it provides that visual again.

Nicole Allison: So I think that would be an area, that's a cue or a prompt that you could easily give them is just simply writing it down. We do a lot of that with just CVC words, especially in kindergarten. I'll write out a list of 10 CVC words containing their sound. And then we just tap on them. I tap each sound and they say it, so we'll add, or what's another one with L? I'm trying to think. Lip. So seeing those sounds in print, it's like you have all of your senses working together. So you hear the sound, you see it. And then even touching or tapping your fingers together as you make the sound. It's just working all of those senses so that it comes together a little bit better I think.

Marisha: Yeah, that's super helpful. And I've also seen some SLPs use, and I don't know which would be better. Because I think that giving them exposure to that print while they're doing that practice, that makes so much sense. And like you were saying, it gives them even more sensory inputs because then they can see it and touch it as they're saying it and all of that. So that makes so much sense.

Marisha: And I've also seen I think this, I've seen SLPs do this and read about it in some articles too, where they just have colored chips or blocks. They use those to represent the different sounds. But I don't know which one would be better. That would be worth looking into. But I think it also depends on the student, so we can mix and match depending on what works best for them.

Nicole Allison: Very true, yeah.

Marisha: But I love those examples, and I think that's super helpful. And another example of that whole child approach and combining all the different elements, which is super cool. Then I'm curious too, what are some of your favorite treatment activities? So you gave us a lot of different ideas in terms of what we can do as we move through the hierarchy. But we talked about this can be kind of challenging for students and it might not be the most fun activity in the world. So I'm curious if you have any tips or strategies around how to keep students motivated through this, whether it's some activity that you're doing as you're practicing this, or something that you do to set up the session. Whatever it may be, I'm curious.

Nicole Allison: Yeah. So for my five minute articulation, that's why one of the reasons that I love it because it's so minimalist, I feel like there's no games or anything like that. There's no setup. And you can typically keep a child's attention for five minutes even without a game, or any activity like that.

Nicole Allison: So that works really well for that. But it's super easy to incorporate a game. You can make a game. And on each turn, they have to do five to 10 phonological awareness activities. Or something that I like to do is just I have a whiteboard in my room and it's very simple. But sometimes it's the simplest things I found that kids, I kind of turn it into a competition if I have a group. And it's just writing out their sounds. So I give them a CVC word with their sound in it. Or even if we're working on diagraphs like the th sound, I would just give them a simple word and then it's like a race. They have to write that out. Or I've done it at the upper level where they have to write a sentence containing as many words with their sounds as they can. And whoever has the most words with their sounds in the sentence wins. And it can't be a run on sentence I say, it has to be a regular length, a sentence that makes sense and it's grammatically correct.

Nicole Allison: And honestly, I don't know. It's just really the simplest things when you turn them into games or have some fun with them. If you're having fun, I feel like the kids are much more likely to have fun. So if you are excited about something, it can be the most boring activity ever. But often if I'm excited about it, then that excitement wears off on my kids and my students.

Nicole Allison: So those are just some ideas, but you can easily incorporate this into any game or activity because it's only a few, it's just like saying a word or any articulation activity. It's just really easy to do, I feel like.

Marisha: Yeah, those are really great tips. Yeah, using games. And I love that whiteboard idea as well. I think the sentence idea is pretty genius because it helps them work on so many different goals because they have to think about their articulation sounds, and then there's grammar, and vocabulary. And all the things. So that's super smart. I love it. Yeah, just little things. And we don't have to have a ton of crazy materials or spend all of our lives prepping and laminating to have really awesome therapy sessions. So I love all of these ideas so much, so incredibly helpful.

Marisha: Then I'm curious if you have anything else that you wanted to share about phonological awareness or just any tips in general that you want to share with the SLPs listening today?

Nicole Allison: No, but I think, I'm just going to reiterate. No tips. I think I talked about them all. I covered them all, but I did want to reiterate just how important that communication aspect is. Especially when you're writing these goals or if this is something that is new to you, or that you haven't done before. I feel like it's really important to just communicate to the parents that this is backed by research, that is really effective. And try to just describe what that phonological awareness looks like and how it's going to impact and improve their child's speech. Because I feel like what I've learned or what I've discovered is the more I communicate up front, the easier it is to implement something. So if I've communicated it upfront, then when parents get some practice pages doing some of those phonological awareness skills with that target sound in there, they're not taken off guard or anything like that. They kind of know what's going on. And I just make sure to explain it and give directions on how to do this, because it's very easy to practice at home too, and to do some of that carry over. So I just feel like that communication piece is key.

Nicole Allison: And especially if you come into a meeting with a research article that says, or multiple research articles that say this is really effective, and this is going to speed up the time probably that your child will likely be in speech. That's always a good thing.

Marisha: Yeah, that definitely gives us some different credibility points. And then that brought up another question for me too in terms of sending home activities. What do you typically send home? How do you decide which level of activity-

Nicole Allison: crosstalk doing really well and I feel like they are able to do it with another person, then I'll send home some carry over activities. And it's just really sort of a word list that has their target sounds. You could write this out, and then you could just give a few examples in the directions. Like have them, if they're working on blending a word together. You would say the word a lip, and then the student would say lip. And just giving those examples and sending that home, that really works out well too. Because the child too can help explain it to the parents because they've been doing it in speech. But then just having those examples at the top too helps.

Marisha: Yeah. And that's so easy to put together too. We could even just grab a quick note, or take a copy of any word list and just jot down whatever level we want them to work at. If we want them to clap out the syllables or put together words when given two of the syllables, or whatever it may be. That doesn't have to take a ton of work either. That's so cool. Then I'm curious too, where can people find out. If they loved these ideas, which I'm sure they did. Where can they find out more about you? Where do you hang out in the internet world? And then I'd also love to hear more about the resource that you created and what that would include.

Nicole Allison: So I blog over on the Speech Peeps. Anybody can contact me through email, [email protected]. I'm over on Instagram as @nicoleallisonslp. And then on Facebook, Allison Speech Peeps. So you can contact me through those. I'm usually pretty fast about my email, just because I know I like to have people respond to me pretty fast. So I will get back to you if you ever reach out to me. And then Marisha mentioned I have a phonological awareness resource. And this is something that I put together last year just because I felt like I really needed it for my caseload, just looking at the research and how beneficial this type of intervention was going to be. So I went through actually in did all of those hierarchies that I talked about for every sound.

Nicole Allison: So this is something that you could look up and you could do all of these things and find words. But if you don't want to spend that time, this might be a resource that would be really beneficial to you because all that is already done. And the nice thing is because it's pre-reading and the student's not reading anything, they're not writing anything. You can even pull this up on an iPad or your computer, or even I pulled it up on my phone. Because really I'm just going through these words and say mats. Now change the M to a C. Cats. They can do all these things. And you can just pull it up right there if you don't want to print it. So that is something that I use now with any child that I'm working on with articulation, at the grade level. So kindergarten and up, I incorporate phonological awareness skills in. And I just feel like it's really been beneficial to my students.

Marisha: Thank you so much for sharing all of these amazing tips and tricks that I feel like I could use this in my session, this afternoon. I could implement it right away, so I so appreciate you sharing all of this. And yeah, thank you for your time. And if the listeners want to find any of the resources that I mentioned, I'll include links to Nicole's site, and the blog post, and her resources, all that good stuff. And you can find that at slpnow.com/29. But yeah, thank you so much. I so appreciate you, Nicole.

Nicole Allison: Thanks Marisha. I appreciate you too.

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Filed Under: Podcast Tagged With: Articulation

#028: Where to Start with Phonological Awareness

November 13, 2019 by Marisha Leave a Comment

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I am so excited that Mikayla and Corey are back again for another episode of the SLP Now podcast!

Their names and voices are probably super familiar because they were also on last week’s episode, A Crash Course in Literacy for SLPs! Pop back and give it a listen if you haven’t already, because it will give you a really solid introduction to all things literacy and help lay the foundation for today’s conversation about phonological awareness.

We’re going to get really specific and tactical with you this week, and break down exactly what we can do to help our students with literacy deficits. 💪

So, grab your beverage of choice (I’ll have a chai latte!), put your feet up, and listen in.

Key Takeaways + Topics Covered

– Reviewing the literacy triangle
– What’s an SLP’s role in phonological awareness?
– Why is it important to spend time focusing on phonological awareness?
– The hierarchy of PA skills
– Key skill areas to focus on
– Sharing strategies with teachers and parents
– How long you typically need to work on these skills to see progress
– Helping students understand why phonological awareness is important
– Connecting phonology → letters → words → sentences, using manipulatives
– Moving between skills with the structured approach
– Staying in sync with the special education teacher
– Ways that SLPs can pull additional PA skills into our sessions
– The structure required for targeting PA vs. the whole literacy triangle

Links + Resources Mentioned in the Podcast

– Orton Gillingham
– Ascend Smarter Intervention
– Click here to access the freebie links!

Subscribe & Review in iTunes

Are you subscribed to the podcast? If you’re not, subscribe today to get the latest episodes sent directly to you → Click here to subscribe in iTunes!

Bonus points if you leave us a review, because those reviews help other SLPs find the podcast, and I love reading your feedback! Just click here to review → select “Ratings and Reviews” → “Write a Review,” and let me know what your favorite part of the podcast is.

Thanks so much!

Transcript

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Marisha: Hi there, and welcome to The SLP Now Podcast. I am so excited that Mikayla and Corey are back again for another episode, we really wanted to be able to dive into phonological awareness and get super specific and tactical with you guys and break down exactly what we can do to help our students with literacy deficits, and these ladies are going to break it down and help it make so much more sense. And if you think you've heard from Corey and Mikayla before, you have. They were here on the last episode, episode 27, so if you want to get the introduction to all things literacy, you might want to head to episode 27 to hear more about their story and how they got to this point, and then also all of the basics to get you a really nice foundation when it comes to literacy.

Marisha: And then just a quick recap in case you're wanting to dive into phonological awareness, Corey and Mikayla are from inaudible spark smarter intervention. And it's a Denver based educational consulting practice, and they are dedicated to getting SPLs the support they need to feel confident in structured literacy intervention. And if you want to hear more about their backgrounds, definitely check out the show notes or head to the last episode. But let's just dive right into all things phonological awareness.

Corey: Yay. That sounds super exciting. I'm so excited to get into this conversation. We love phonological awareness. So excited to get started.

Mikayla: Yes, this is one of my favorite topics, so I'm excited to jump right in.

Marisha: Yes. Okay. So before we dive into all of those practical tips, I'm curious, we talked about this a little bit last week. But maybe let's first just start with a quick recap of the triangle that you told us about, because I think that's a really helpful framework and a good reminder before we get super specific here.

Corey: Yeah, absolutely. So in terms of literacy development, so thinking about reading and writing skills development, we know that there are three core parts to the brain that really needs to come together to create efficiency and effective knowledge of reading and writing. And so those three core components in the brain start with the foundation, which is phonology or phonological awareness. So understanding that sound structure of the English language and how that comes together to create words. And then the second piece that next building block is orthography. So orthography is where we begin to tie visuals. So like the visual picture of a letter onto the sound that it makes. So actually recognizing an A as an A, and recognizing a B as a B would be that orthographic component. Also recognizing that that moves beyond just letters, but recognizing a word as a whole as a word, and just seeing a picture of those letters coming together is the next piece.

Corey: And then the third piece to that triangle, the top of the triangle is semantics. So semantics is really your comprehension of the word or the sentence or the passage that you're reading. And so when we think about those three neural processes coming together, we really like to look at that as a triangle. And we call it the literacy processing triangle. And we have to recognize that all three of those components have to come together at less than half of a second, to have fluency that we need in order to create comprehension. And so what we talked about last week was the critical role that speech language pathologist play in this, recognizing that you are so familiar with the phonology aspect or the sound structure of our language and you're also so knowledgeable in semantics.

Corey: And so really thinking about SLPs role here, it's so important and literacy, and so we're so excited to really dive in deep to that phonological awareness or that phonology section of the triangle because it's so critical in the whole of literacy development.

Marisha: Thank you so much for that breakdown Corey. And then now I'm curious, what is the SLPs role when it comes to phonological awareness?

Corey: Yeah. So I think this is really interesting because I think what we have to keep in mind in addition to the three part framework where we've got that literacy processing triangle, the other thing that we have to recognize in terms of research around reading development is that there's what's known as the big five in reading. And the big five is, phonological awareness, phonics, reading fluency, vocabulary and comprehension.

Corey: So when we start to think about reading skills development and we start to think about where speech language pathologists fit into that big five, those five core components, we recognize that speech language pathologists can really help support development in phonological awareness, in that vocabulary development, in that comprehension development. So definitely when we think about those big five, potentially leaving out the phonics and reading fluency piece because that's potentially someone else's space. That's special education, general education, classroom teacher that's going to be on them. And so again, when we're kind of thinking about that triangle and then those five pillars, we start to look at where can SLPs help to support those abilities that may be falling flat. And so one of the things that we'd like to think about here is, one, we all want to help these kids.

Corey: We know that we went into this field because we want to make a massive difference. And so we need to start thinking about, whose role is it? Is it a speech language pathologist role or is it a special educator or a teacher's role? And one of the things that we have to recognize is that an SLP's role could simply be in training or providing support to the special education team or to the classroom teacher. When we think about phonology as a whole, we know that phonological awareness is a piece of that. The other thing that we would think about is articulation. There's a lot of pieces that fall into this. But when we develop phonological awareness, we are thinking about words without letters, right? We're just thinking about the sounds and how our language breaks down. And so oftentimes SLPs have the best training in phonological awareness, in understanding how language breaks down and how to correct those breakdowns.

Corey: A lot of times phonological awareness has gotten a lot of good press recently. And so there's a lot of teachers who are trying to incorporate this into the classroom. But what we see is we see that they're trying to train some basic skills like how to rhyme and how to break words into syllables, and how to do all of these different things, but they don't necessarily know how it pulls in. And when they start to recognize, uh-oh, Billy can't rhyme or uh-oh Billy can't tell the difference between the B and the V sound. A B and a V for example, or a TH and an F for example, we start to run into problems because teachers and special educators can recognize this breakdown, but we don't necessarily have the training, necessarily to understand how to correct some of those breakdowns. I think big picture and SLPs role could be one, training on the importance of phonological awareness, and then two, helping support when we start to see actual breakdowns.

Mikayla: Yeah. And that's so critical because we know that this phonological awareness skill set is a foundational building block in order for a student to be able to read and to be able to spell. So it's definitely a critical place that we need these students to be honing in on these skills and developing these skills. So SLPs offer a really unique skill set in order to support that.

Marisha: Yeah, that makes so much sense. And thank you for breaking that down for us. We've touched on this a little bit, but we're spread super thin, we talked about this last week and there are so many different skills that we want to target. So why is it particularly important to spend time focusing on phonological awareness? You mentioned that it's like a huge part of literacy and it's part of that triangle under the phonology element, but any other important elements that we would want to address or know about in terms of why it matters?

Corey: Yeah, absolutely. And I think that's a great question because even like I mentioned earlier, because there's been a lot of talk, because phonological awareness and phonology are being recognized in all of the research as being critical components of that literacy processing triangle, and of the big five that the national reading panel put together I think the year of 2000 when they put this huge Meta analysis of research together, that was great. And so that started to get incorporated. But what happened was there wasn't necessarily a connection of why it mattered or what it was helping to support. And so we know that it's a foundational building block because if students cannot begin to isolate the individual sounds that you're getting in your words, and start to be able to blend those sounds together or pull those sounds apart, we can't sound out words.

Corey: So for so long we've been telling students, we'll sound it out, sound it out. That's all well and good, but they didn't have the skills necessary to be able to sound it out for reading or spelling, because we weren't necessarily connecting. Why are we teaching how many syllables are in this word? Why are we teaching how many sounds are in this word? And so it's important that we're spending time focusing on that because we're asking students again and again and again sound it out, sound it out, sound it out.

Corey: Well, we have to help them understand if you understand the sounds of our language and you understand how they blend together to create words, and you understand how they pull apart to spell words, then we can start to ask them to sound things out without getting blank stares. Because so often we're I'm getting people, parents, and sometimes even educators asking students to sound out words like night, well you're trying to sound out words like night, and you've got a problem because what you have to recognize is that we only have three sounds, N, ight and that I sound is actually comprised of the orthographic pattern. I-G-H. So I-G-H saying I in that.

Corey: And so we have to start teaching students the background and the basis before we can start pairing those letter groups and pairing those orthographic patterns on. And ultimately that's going to impact comprehension as well, because sometimes we're getting breakdowns in different words in the way that we say it. So we talked about a potential phonology breakdown of not understanding the difference between TH and F. Well, if we don't hear or we don't perceive the difference or we can't produce the difference between TH and F, all of a sudden we can't pair an orthographic pattern appropriately. And the difference between the word thin with a TH and fin with an F, has a different semantic category, has a different meaning.

Corey: And so all of a sudden what we recognize is if we don't have that kind of core foundation, we are breaking down in that orthographic side, which is also that phonics kind of pairing as well as that semantics piece or that comprehension piece. So I think that's why it's so important to spend time there because it's really the bottom layer of this Jenga tower that we're thinking about, it has to be in place for these students.

Marisha: Yeah, I love that breakdown. And this reminds me a little bit of the conversation that we had last time. Like the example that you gave with night, like all SLPs know that that is three sounds, and we know a lot of these things that we take for granted, we think, oh, if I know that everyone must know that, especially the special education teacher. But sometimes it's not common knowledge, especially in the general education classroom. So we do bring that really unique skill set, and I think these types of conversations are particularly helpful in helping us identify our own superpowers in the areas that we are very knowledgeable about. So thank you for that breakdown and thank you for that reminder too, because I think that's so incredibly important.

Marisha: Just kind of a side note, we were talking about this before we went live. But we don't always feel like we have the knowledge or anything to contribute when it comes to literacy, but I hope that after Mikayla and Corey have broken this down for us, that you realize that you have so many skills as an SLP that make you an integral part of this team when it comes to helping students with literacy deficits. So if you don't have any other takeaways, I hope you walk away with that one, because that's such an important component. And I don't know if either of you have anything that you wanted to add to that?

Corey: I think that's so true. I just agree with that so much because I think the other thing that you may not recognize at this point is that you are a missing link to a lot of this. And I think not recognizing that the background and the training of other people is just so very different. And I think a lot of times we think that other people have more in depth knowledge of some of these things than they actually do. And so again, coming from this background and this training, we were sort of told, you need to hit on all of these things, but we weren't necessarily told why or how that contributed to the bigger whole. And so I think it's so important that as an SLP also just being able to make that connection for students like, hey, the work that we're doing in here, this is why we're doing it and this is how it impacts.

Corey: And also recognizing that sometimes you're having to fight for services a little bit for a student. You may have a student on caseload that this school is saying, well we're going to have to discharge them from services because there's no educational impact. Well hopefully this conversation can help you to see when we do have these breakdowns, there is an educational impact for sure.

Mikayla: Yeah, I think you absolutely hit the nail on the head because so often when we're working with SLPs we'll hear, well literacy's not my space. And it absolutely is and it absolutely can be. And like Corey mentioned in the last episode, when a student has inaudible students that have language disorders, there is a high risk of them having a literacy based disorder as well. So being able to take your amazing superpowers as you put it, and generalize those into the literacy space is going to do an amazing service for these students.

Corey: And it's not meant to step on special educators toes. It's not meant to do that. It's meant to supplement to augment, to really help support what it is that they're doing. And sometimes I think it's just about the communication of, hey, here's what I had and here's what I can offer, and tell me a little bit more about what it looks like in your session. And I think just opening that up so that they don't feel like, oh, this is my space for it, it's this tug of war of like whose space is at. Well really it's all of our space, let's just sit down and have a conversation about what I'm doing in my sessions and what you're doing in yours so that we can see where there's some give and take, because I get it as an SLP, you have a crazy caseload and you may have a number of different things that you're working on. So if there's anything you can hand off, great, let's just do some trainings so we can hand some of these things off, but make sure that they understand the why behind all of it.

Mikayla: That team based approach is definitely going to serve the students worlds better than having different segmented pieces. So the communication piece there is going to be huge.

Marisha: Yes. Yeah. Having that team approach is definitely huge. And I love all of the tips and strategies that you're sharing to totally make that possible. Because Mikayla said that some SLPs are saying that literacy isn't their space, and hopefully you've gotten enough information from here to realize that it is your space, you are helping with those building blocks. And then there's also information from ASHA saying that literacy is also in our space. So it's definitely in our scope of practice. It's not just some random new thing that's coming up, it's something that we definitely have the foundational skills for and ASHA supports that as part of our scope of practice as well. So we got a little bit of a different discussion. And so we'll bring it back to phonological awareness. But I do think that was super important just to bring home again. But can you help us break down the hierarchy of phonological awareness skills, what are we looking at here?

Corey: Yeah, absolutely. So I'm going to let Mikayla speak a little bit to this, but I think it is important to recognize that there is a very clear hierarchy of the way that these skills can come together, but also keeping in mind that you may have, this is kind of like a Jenga tower too. We like to use our analogies in things, and so phonological awareness skills even on their own can be a little bit of a Jenga Tower. And so really it is kind of figuring out where you may have holes and gaps, but I'll let Mikayla speak a little bit to that hierarchy of skills.

Mikayla: Absolutely. There is an absolute hierarchy to these. But I do want to note as well that sometimes students will have gaps that we'll talk about a little bit later, where even though we are teaching in a hierarchy and we're looking at it, sometimes a student will have a gap that falls further down on the hierarchy, but they're able to do more advanced skills. But we'll get into that later. I'm getting ahead of myself there. But in terms of the hierarchy, when we're looking at segmenting, for example, we will have a student first learn how to segment sentences before they move into syllables and sounds. So if the sentence is, the cat sat under the window, they're going to know that there's six words in that sentence before they're able to say, okay, the word under is two syllables, window is two syllables. And then even further that window has the sounds, w, i, n, d, ow there's five sounds.

Mikayla: And the same goes for blending. So being able to put words into a sentence, put syllables together. For example, if I gave the students the syllable can, did, what word is that? The word is candid. That's going to be an easier scope for them to accomplish before we then give them sounds and have them put together these sounds in a word, for example, s, l, i, p, er is the word slipper, that's going to be more advanced than putting together the syllables. So there absolutely is a hierarchy that we'll work through and we're teaching phonological awareness skills. And we'll look at all of that when we're testing phonological awareness skills as well.

Corey: And we have a resource that we use in terms of when we are getting a baseline assessment or when we are progress monitoring in really the way in which we're pulling those skills together. So one of the first things, and these are things that you guys are looking at too oftentimes in your assessments and in things like that, but for example, one of the first things we would want to look at is sentence repetition. Can they just a sentence back to you. That's going to be the first level of blending. And then after that we would look at sentence segmenting. So if you give them a sentence, can they tell you each of those words? So that's kind of like step one. And then the next step would be looking at rhyming skills. So the first one that we would want to look at would be can a student identify when two words rhyme.

Corey: So if you give them two words, can they say yes, those two words rhyme or no, those two words do not rhyme. Again, this is when we're starting to very basically play with sounds of words and recognizing those sounds of words. Can we hear it? After that rhyme discrimination, we want to look at Ryan production. Can they produce a rhyme for me. So if I give them a word can they produce a word that rhymes with that? So moving from that sentence level on to that rhyming or whole word level, then we would start to look at sound isolation. So can they isolate the first sound in a word? Can they tell you what's the first sound in bat? What's the first sound in thin? We can start to do that. And then we would look at final sound. So can we start to isolate the final sound in a word?

Corey: After that final sound isolation, then we might start looking at medial sound in a word, before we start breaking down to more of that isolation. But just being able to tell like what's the first sound, what's the last sound, what are the sounds that you're hearing? And then from there we'll kind of jump into what Mikayla was talking about even more, we want to start looking at blending and segmenting at both the syllable and the sound level. So again, we do have like kind of a step by step hierarchy based on norms of like when students should be developing each of these skills. But we can definitely attach a little chart for you guys for that hierarchy because there definitely, definitely is one.

Marisha: That's super helpful. And then do you have any norms in terms of what we should expect based on a certain age? Do we expect the students to have these skills a certain level in kindergarten, first grade, or do you have any broad expectations just to put a typical developing age on it?

Corey: Absolutely. So big picture, if you're working with students fourth grade and up, they should be able to do all of these skills. They should able to manipulate, they should be able to substitute sounds in words. They should be able to really understand the sound structure and be pretty fluent with that. Sometimes it still takes a little bit of work. I know when I was working at children's hospital, I worked under a neuro psychologist who would always like to give me a little quizzes. I felt like he was constantly assessing my IQ for me. But he would always give us like little like, say you know this word backward or what's sail backward? And so I'm kind of having to think like, s, a, il, il, a, s place.

Corey: But you would expect by fourth grade that students generally can have all of those skills. It might take a little bit of time. What I'm saying here is you might not have a huge automaticity, but definitely you should have those skills in place. And when we start working backward, if you're working with students who are in kinder through third or even kind of that pre-K through third, yes, there's definitely developmental norms that we would expect for each of those areas. So, typically when we're looking at pre-K, kindergarten, we want students to have at least about 80 to 90% accuracy in their ability to recall sentences for you.

Corey: So I know with a lot of our speech language students, they really struggle with repeating back sentences, but they should be able to repeat back four to five word sentences to you with accuracy. They should also have accuracy with rhyming. So being able to detect, rhyme, being able to produce rhyme, and they may start to be able to move into that phoneme isolation space. So that's kind of that beginning spot there. Once you get into first and second grade, you would expect that those skills that they should have already had mastered are clearly fully mastered, and at that point we start to expect that they can manipulate well, at the syllable level. So if we're asking them to blend syllables together, if we're asking them to segment syllables into each of their individuals, they should be able to do that with at least 90% accuracy at that age.

Corey: By the time, and I again, I kind of grouped first and second grade together, but also looking at second grade into third, fourth grade, that's when we should start to be able to also isolate and blend segment individual phoniums, individual sounds into their own pieces. So we're starting to get more and more granular as we're going and we expect them to have really that 90%. Sometimes I say 80, but really 90% is going to be showing mastery on something, I know as somebody who loves data, sometimes I only have time for five trials. So that's why I'll say 80% accuracy sometimes, but I just want to throw that out there. But that they should be showing you mastery of all the way into those sound level skills. And then by the time we're in fourth grade and above, again, we should be able to manipulate and we should be in all those higher level skills.

Corey: So in this chart that we're going to give you, it breaks that down for you and kind of what your expectation of what your norm is for each of those, so that you just have that and you can use it and you're not trying to like piece this together as I'm like talking about it.

Marisha: That is so helpful. I am really excited that we have like some more specific guidelines to go with, because we often don't get that. So I so appreciate that. That was amazing and I cannot wait to get that chart into people's hands. That is amazing. So anything else that you wanted to touch on when it comes to the hierarchy of these skills?

Corey: I don't think so. And I think part of the reason is because we know that these skills really do come in a hierarchy. And so obviously if we're working with kindergarten students, we don't want to be doing complex phonological manipulation skills expecting that they have these skills in place. But like Mikayla mentioned, I think a lot of times it's going to be important that we take a really holistic view of the fact that all of these skills are necessary to be able to read rights, and just manipulate, just spoken language as a whole we're going to need all of them. And so sometimes in terms of how we're working through these things, it doesn't necessarily look like that, it doesn't look like, okay, first we're going to hit this and then we're going to hit this. So we'll talk about that. That's why I say like, no, in terms of the hierarchy, yes, there definitely is one, but we don't have to hold ourselves with the, like, it must be this way. I must teach it this way.

Marisha: Okay. Awesome. That helps. So now let's get into some therapy. So what would this look like in terms of our sessions and what we're working on with students?

Corey: Yeah, I'll let Mikayla throw some ideas out for you.

Mikayla: Yeah. So I think at the easiest level it would definitely just be when you're with a student and you have a word that you're working on, pulling in some of those questions and those tasks like, hey, how many syllables are in this word or how many sounds are in this word? To start getting them segmenting that and being able to break them down. Or you can also flip that and say, I'm going to give you sounds. I know in the last episode Corey had said, you can give the student inaudible what word is that, if they're working on that c, sound? So definitely being able to do that. A fun way you can do it. This is getting a little bit more into executive functioning and working memory. I like to play a game sometimes with my students where I see how many words, I'm sorry, how many sounds they can hold on to and repeat back to me, and it doesn't have to make a word you can just give them inaudible Can you repeat them back? Kind of like the sentences that Corey mentioned early and repeating them back. It would be done the same way, but with sounds.

Mikayla: So those are great ways to pull them into your sessions. Another big thing that we want to make sure we're doing however, is helping them understand why we're doing this. Because if you're just asking them to break words into syllables, and you're not explaining why or you're not explaining why it's important to know how to rhyme, and why it's important to know that an F and a TH make different sounds. It's not going to land for your students and it's going to be really difficult for them to take these skills, buy into, wanting to improve these skills and then apply and generalize them as well.

Corey: Yeah, and I think that's so critical. And I think that's the missing component that I think can be really critical, as an SLP working with these students. Because again, like I mentioned before phonological awareness has gotten some good press recently in terms of how important it is. And so when I went to observe my own kiddos in their classes, what I saw was that teachers were doing a nice job of like, what's the word that rhymes with this? Or doing a nice job of how many syllables in this word? But I think what's going to be critical is starting to pair that to, if I'm asking you to count how many words are in a syllable, the reason that I'm doing that is because that's how we spell words. So for example, if we were targeting that c, sound in therapy again, and we wanted to do the word cupcake, okay, let's take that word cupcake.

Corey: How many syllables in cupcake? Two. All right, let's go ahead and just take a little whiteboard or take a piece of paper and let's make two scoops. So we call this our scoop spelling. So I'm going to make two scoops for cup, cake. And then what we can do is, okay, let's take the first syllable cup. How many sounds do you hear in cup? And have them just draw a little line, I hear, c, u, p in cup. What you can do then at that point is what's the sound we were working on today? Can they find it? Can they isolate? Where was that initial c sound? And they can be like, oh it's that first sound. You're right. That first sound in the word cupcake that we were just talking about is at the beginning of the word. Great.

Corey: Now let's move on to the second syllable. What's the second syllable? Cake. Okay, great. Let's go ahead and how many sounds do we hear in cake? C, a, ke. Okay, perfect. We're going to go ahead and make three lines for cake. Where do you hear the sounds? Oh, that first sound and that last sound were also that sound that we were targeting. And so what that can start to do is again, then we have to start to get into like, okay, well why do we spell it with an E at the end? Which is really not necessarily, unless you're diving into literacy as a whole thing, you don't necessarily have to worry about why, you can just say, oh, and there's an E at the end that doesn't say anything, how crazy is that? And that's plenty. But the good thing is, is that it's continuing to solidify what were you working on? What were you working on? What sounds were you targeting while also pulling out phonological awareness right into it so that they start to see, this is how we spell? That's why we care about it because this is how we spell. Or when Mikayla gave the example of like, why does it matter how many sounds I can hold on to?

Corey: Well, because when trying to sound out a word, we have to hold on to each one of those individual sounds, each one of those individual phonemes long enough to blend the whole segment together. And so oftentimes what we do and the reason that we need to teach students to blend sounds together and then to blend syllables together, is because when we've got multisyllabic words that we're trying to help support them with, we have to take the first syllable and we have to look at each individual letter or think about each individual sound. For example, if they were trying to read the word cupcake, they would have to hold onto c, u, p. What word did you just say? Or what syllable did you just say? Cup.

Corey: Okay, let's move on to the second one. C, a, ke. Okay. You just blended that together. What syllable did you just make? Cake. Okay, you told me cup, cake. What's the entire word? Cupcake. And so what we have to do is we have to make it clear when we are focusing on these phonological awareness skills, we are not doing it because it's just fun. We are not just doing it because we should do it, and somebody told us that it was one of the five core components of reading. We are doing it because it explicitly and directly correlates to reading and spelling. So I think in terms of what that looks like, it doesn't have to be hard. It doesn't have to be something that you have task cards for.

Corey: I love some task cards. I absolutely love it. And I think also if ever you have mixed groups and you realize you've got a student who has phonological awareness struggles, you can definitely use those task cards that have the word that then breaks it down to like how many syllables are in this word. But I think you don't even have to do that, you can just use whatever it is that you're targeting, whatever words, whatever patterns you're doing, and just tie it in just like that. Like I'm going to pull one word out of this and let's do this fun little activity with it.

Marisha: Yeah. And I love that scoop spelling example. Because I have read some studies where they just use like blocks and other manipulatives instead of actually going into the orthography components. Is that something that you ever do or have you read anything about that?

Corey: For sure. We do that a lot. And a lot of times if you're not trying to target orthography at all, you don't need to. And in fact most of the time, we use, hold on Mikayla she's got all kinds of fun things. But yeah, we definitely used manipulatives instead. The one thing that we do want to do is, at the very least have the instructor then go then pair that orthography to it at the end. Like, great, we're just focusing on sounds but I just want to show you that connection because that's what's missing, is that connection between, okay, great, but why? And that's even something that perhaps you just shoot over to your special education team, or the classroom teacher is, here's this great strategy, this is how we focus on the sound level, the phonology level. Now they need to go tie the orthography in. But somebody has to connect to that because what happens is nobody else is and they expect students to pick up on that implicitly.

Corey: And our struggling students really struggle with implicit learning. So we can't just expect like, we taught phonological awareness, we taught all the letters. So now it all make sense. It doesn't make sense unless we show them. But yeah, Mikayla you can kind of jump into manipulatives.

Mikayla: Yeah. So I can explain a little bit about how we go from our phonological awareness task using those manipulatives to connecting it to written letters to words, to sentences. So whenever we get to the part of our lesson where we are going to do phonological awareness, we will use manipulatives. And I have like Corey said used a number of different things from Unifix Cubes to just these little tiny counter chips. If you're going to get those I recommend getting the magnetic ones because when a student knocks a hundred counter chips over onto the floor, they're a nightmare to pick up. But I've used all of those, and I just used different colored items so that students have something to move around and have a visual to tie those sounds too. So if they are trying to use counter chips to spell out or to represent the sounds in the word milk, again they'd have a different chip for m, i, l, k.

Mikayla: And then from there you can have them change different sound within a word by replacing the different chips and move through your phonological awareness activity. After we do that, we will move into our auditory drill, where we then give them a single sound and they need to come up with all of the different ways to produce that sound. So if it's, I, I know earlier Corey brought up the word night, I-G-H is going to make that I sound, but so will the letter I by itself. So knowing all of the different ways to produce that sound, or if it's the found A knowing A can say, A, AI, AY EA. There's a whole host of different things that will make that sound. And then we'll go into spelling and do the scoop spelling thing that Corey mentioned earlier, and we can say if we want to get even deeper into it, okay, if we're spelling cake with that A sound, that's where we'll get into more of those literacy-based rules to know which sounded to use.

Mikayla: I wouldn't go totally down that rabbit hole. We can save that for another podcast. But we do try to very explicitly connected for a student, how we're moving from using those little counter chips to putting that into word and then putting those words into sentences. Because oftentimes, like Courtney said, they don't just implicitly pick up on that. And as an instructor, that took me awhile to recognize, and students ask one day, they're like, I don't understand why we do this every week, and it was at that point I realized that I needed to actually very explicitly explain to them, we do the phonological awareness and our auditory drill activities because when you are spelling a word, that's the process your brain needs to go through to be able to register, okay what letters do I need to put into this word? inaudible they need to go in and how do they then put into correctly spelled word.

Mikayla: If you don't have manipulatives like that and you want to still do an activity where a student has that visual, there were days where I forgot my manipulatives or I didn't have them and I've used paperclips or I've used crayons or highlighters. Just something that the student can physically manipulate and have that colored visual, has been helpful enough for them to be able to do that task. You don't need to go and buy fancy things as much as we love the pretty Unifix Cubes and the little counter chips and kids like them. They're not necessary as long as you have something you can use.

Corey: And I think it's so important to just be thinking again about like, in your sessions. One, I think the most critical component is recognizing how this plays a bigger part. And then two, recognizing like with the orthography component or with understanding all the different ways we could get the I sound or all the different ways we could get the E sound, all of those pieces. Really what you can start to do is take a look at from your special education team or your classroom teacher, how are they teaching these things? Are there ways that you can just do that training of here's a great way to help your students with those literacy components specifically just in the general classroom? So this might be an opportunity where you start to teach the students a little bit how to do that just with words that you're using at the very least, breaking words into syllables and sounds and then blending syllables and sounds.

Corey: If I had to think about like the four key phonological awareness tasks, if I could not focus on any of the others, the four key ones that I would focus on would be syllable blending and segmenting, and phoneme blending and segmenting, because that's the literacy component. That's what we absolutely need. Now, clearly if you're working on articulation, if you're working on other things, there might be other times where you need to do more complex manipulation. But at the very least, trying to incorporate that into your session, and just using some of those strategies or those manipulatives or things to teach them how to do it. And then showing the classroom teacher, hey, if you're doing spelling word list, hey, if you're working on some of these things, here are some strategies that you can use as more of a push in model, or more of kind of that training support model to help make sure that some of these things are actually happening more in the classroom.

Corey: I would just say if you're working on some of these articulation pieces or things like that anyway, it's a great opportunity to bridge that gap and show them how it connects again to that literacy piece.

Marisha: I love the idea of sharing this strategy with teachers because I'm sure they'll be grateful for ideas to help support their students, but it also helps bridge that gap because sometimes the skills that we target in our speech, like they just stay in speech and the students don't know that they can use that to help them with their spelling. So I definitely think that talking to them about the why and discussing it there with the student is really helpful. But if you can share that with the teachers and have them use the same kind of language and examples around it, that's so incredibly powerful. I love that.

Corey: Yeah. We've even started using that as code practice for our parents. So trying to teach parents these things because a lot of times what happens is the things that you're teaching in therapy, it's hard because they don't generalize as quickly as they could because you don't have support in the classroom or you don't have support at home. And so we even started giving little spelling word list and things. So again, I know oftentimes in speech therapy you're giving a word list of different sound patterns that you potentially want targeted. For example, that might just be one type of home practice activity that you would give. What you could do is you could also just give a little phonological awareness task as part of that. So if we have a bunch of different words that are targeting that c sound, have the student go through and mark, we just make little grids, which again, happy to share with you. But little grids where they then need to mark each of the sounds that they hear in that word.

Corey: So again, they're just taking what they're doing and they're doing it at a deeper level. They're having more opportunities to look at that a little bit differently, and parents start to feel more empowered so that you don't get parents who are hoping to help, trying to help but are actually harming things. Like, for example, for us, when we have parents who are telling their kids sound out the word, sound out the word and we're like, ah, but actually don't because that's not a strategy that's working. This is just a way to help bridge the gap between classroom and home as well. So just keeping that in mind too.

Marisha: Yeah, so helpful. And I always curious too, because you mentioned like syncing up with what the special education teacher was doing. And I'm curious like let's say that the special education teacher is using a structured literacy approach and they're working through all of that orthography. What would be the best way if we're doing some of those phonological activities you mentioned, like the top four and you gave some ideas that we could embed that, but is there anything that we need to watch out for or anything that we could do to like have even more impact with what we're doing?

Corey: Yeah, so honestly I think there's a lot of value in doing this in one of two ways. So keeping in mind that there's not a right or a wrong way, I think there's two ways that you can do this and have it be really effective. So one of the things is if you do have a special education team who is working through a structured systematic scope and sequence, at the very least just knowing it is just saying ahead of time, like, hey, do you have an order in which you're teaching these phonogram patterns or these orthographic patterns that they're going to need to be looking at? Hopefully they do. Hopefully they're using an approach like that, but if so just kind of being connected on what that is, so that if there's ever a time where you have overlap and you are focusing on a specific pattern or a specific target for the kiddo, and it aligns or sort of overlaps with something that the special education teacher might be doing, that could be really great, you could even just ask the student like, hey, what did you learn about with miss or Mr. So, and so like, what was that pattern? Tell me a little bit about it. And see if you can pull in some words that would also target what you're doing.

Corey: So if you're working on a language component and you have a vocabulary word that kind of aligns with that pattern, great. Or if you're working on articulation for example, and you have a word that might align with that pattern. Great. That's awesome. That's great. That's also a lot of work. I get that. That's like, yeah, I don't have time for that. No judgment here, I completely understand that. So if at all possible, that's awesome. Like if everybody can kind of get on the same page, that's great. If that's not possible, then I think the other opportunity that you have here that you have to recognize is that even if you're out of sync with the scope and sequence that the special education teacher is teaching, you are still helping to generalize these skills.

Corey: I think too often using kind of that Orton Gillingham approach, what happened is we got so stuck on kids can only read these words and they can only practice these words and they only focus on these words, that they didn't see how it applied to any other context. And so I think it's important to even recognize that even if you have no communication with the special education team at all, which I don't recommend, but I know it's a reality sometimes, is just continuing to do it with the words that you are using, recognizing that some of the things might be beyond the scope or the pattern that the child knows, but that they'll start to see, hey, you may not have learned this yet, but I'm just exposing you to it. I'm giving you exposure, so that at a time when that becomes more relevant, you're like, oh yeah, I know that. I remember that.

Corey: And that offers significant value too. So I don't ever want people to think like, Oh, if I'm not completely in sync with my special education teacher, I'm doing kids a ton of harm, no, that's not necessarily the case at all. Just use your words, use your targets and see when and if you can kind of pull some of these things in.

Marisha: Yeah, that makes a lot of sense. And thank you for breaking that down. And then I'm also curious in terms of like you gave us this hierarchy and for some of the examples, because it sounds like students first learn to identify, like it's easier to isolate the first sound in a word and then it's second easiest to do the final sound and the middle sound or the medial sound is the hardest. So if we're embedding this into our therapy, should we just focus on the first sound until they get that or is it okay to do like first and final or should we do all three altogether? Any tips and suggestions in terms of that implementation going down the hierarchy?

Corey: Yeah, I think it depends on the age of your students really and who you're working with. So if you're working with a kindergarten group, we wouldn't necessarily be expecting them to be able to isolate each of the different sounds in words and being able to recognize that. And so in that case, you do want to kind of use that hierarchy as a benchmark for what do I need to be teaching? Like, what are the skills that they should have? We don't want to work on things that are developmentally inappropriate clearly. But, if you have students who are in that even second grade and up, by the time they're in second grade and up, they really should be able to identify individual syllables, individual sounds and words. At that point, it's okay to start requiring more from them.

Corey: It's a little bit tricky because you don't want to overwhelm students and so it's a little bit student dependent on what that looks like. But for example, in our curriculum, one of the key pieces that we always work on is phoneme manipulation. So like changing sounds. So for example, Mikayla gave the example of milk, okay, what if we change the first sound in milk to s. Great, now we have silk. And we can kind of do some of those things. So we always work on phoneme manipulation, even though it's the most complicated task that a student will have.

Corey: What we can start to do though is then work backwards to fill in any of those other gaps. So I think what's important here is that yes, you could foreseeably work on all of those things at once. Or if you've got groups of students, you might have students working on different pieces, it's helpful for them to see how it all comes together. When we work too long on one isolated skill, they get kind of stuck. And again, not seeing how this fits into the big picture. And so it's good for them to have exposure to all of those different pieces to see this is just how we play with language, we're just going to play with words a little bit here. It's really important.

Marisha: Yeah, that makes so much sense. Thank you for that. And then, let's see. I know there's so many variables here, but in terms of working through the phonological awareness hierarchy, I know we have the development and we expect those skills to be in place around fourth grade. But I'm curious, how long do you end up working on that? What ages do you work through? And if you start working, hopefully we're working with these students before fourth grade. But I'm just curious in terms of the timing and how long we would expect to work on a skill if we're working on that rhyming, how long do you typically spend on that or if you have a range before a student masters that?

Corey: Yeah, and that's so depends. It really depends on the student. I think what I always keep in mind as a clinician and an educator is, what is the end goal? So I don't want to teach rhyming just for the sake of rhyming. We understand that this is kind of a foundational piece. But the reason that we teach rhyming is to help make spelling hopefully a little bit more fluent for students, or reading a little bit more fluent for students so that they can start to recognize some of those patterns. And so I think there's two parts to answer your question. I think one, we don't want to spend more time than we need to, if the outcome of phonological awareness is met. So the reason again that we're going to teach phonological awareness is because one, that's how we make sure that we're articulating properly, that we've got all of the individual sounds and the words have come out correctly.

Corey: So if you've got a student who is struggling with that articulation or production piece, you need to work on these things as long as you need until you've got adequate performance on the outcome measure. So phonological awareness in itself is not the outcome, the outcome is that we can produce sounds with intelligibility or the outcome is that we can blend sounds together when we're reading, to be able to read appropriately or we can segment sounds appropriately so that we can spell correctly. So I think the first piece of that is I would never work on a goal, if the end goal has already been attained. So if they're already articulating appropriately, and they can blend patterns together long enough to read or spell, that's going to be the key piece. If you have a student who doesn't have these individual phonological awareness pieces in place and they continue to struggle with articulation, reading or spelling, then it's one of those things that you sort of need to work on it as long as it takes, to get the desired outcome.

Corey: For us, I know Mikayla you might be able to speak a little bit to this too, but in terms of how long it takes, it's so student dependent and some of our students continue to struggle with it longer than we would like to see. But I would say typically students once they've been exposed to it, can start to get the gist or the pattern of this within about three to six months of ongoing therapy and exposure to it more or faster if you can get the teacher on board, and even faster if you can get parents on board. But I would definitely not spend a ton, a ton of time focusing on each individual piece unless you can see how it's specifically impacting the outcome that it's hindering.

Mikayla: Yeah, I would agree with that three to six months typical range. Again, very student dependent, and Corey you can talk maybe more to this as well, but I'm typically seeing if it's taking a student a lot longer than that, it might be more of an issue or at least worth looking into the issue of a working memory or attention concern as well. Especially if they've had that explicit instruction from me, from their teacher, from any other supports and then parents, that's always a red flag for me that's inaudible going on as well. But yes, definitely around that three to six months. And then we're also really careful when Corey said that we will absolutely hit on this as long as it takes to get students that end goal.

Mikayla: If we have a student that's coming in, like you said before, hopefully we're seeing them before fourth grade, but if I have a seventh grader coming in, I'm going to be a little bit more careful about how I introduce some of these tasks, especially ones like rhyming because while they can still be important to get that desired outcome, we want to make sure that the students feel like they're being respected as well and that they're not doing baby work as often or not as often we are very careful, but as is often a concern.

Marisha: Yeah. So helpful. And I think that I really love how you focused in on the final outcome, because no one's going to get a job because they can rhyme. But being able to read and spell will definitely impact that. So I think that is such a great reminder, because we're wanting to embed that and share that with our students as we're going through these tasks, and that's what we're all ultimately working towards. So that is an amazing reminder. And then just one last question because you've been talking about this structured literacy program and I think you've kind of alluded to the answer through your different examples here. But does an SLP need to use a structured program or do they have to have a really expanded set of materials to teach phonological awareness correctly?

Corey: So yeah, I'll let Mikayla talk about this. But this is crazy because I've heard this come up a lot. So it's an interesting point.

Mikayla: Yeah. So I would say no. If you are looking again to pull in the full literacy, processing triangle and hit everything, that's where we much more require a structured and systematic approach. But if you are kind of hit on phonological awareness as its own literacy sprinkle, and pulling it into your sessions, it can be so much more off the cuff, it can be just a verbal response with the students. So asking them, okay, you're working on the word milk again, how many sounds are in there? Let's change m to s. And just going off of that without any of those fancy materials or a complete structure program.

Corey: I think what is important with considering a structured program, I think the benefit to that is that we're not leaving things out. Right? So I definitely agree with Mikayla, we do not need to use a structured program. We do not necessarily need to use structured materials. But what we do need to know is we do need to have some type of baseline or some type of assessment that helps us to recognize where those holes and those gaps are occurring. Because otherwise, what sometimes will happen is, as we mentioned earlier, you'll have a student who's struggling either with articulation, who's struggling with reading, who's struggling with spelling. And we know that we have a phonological awareness breakdown, but we're not entirely sure where it is. That's where having a hierarchy and recognizing that there are distinct categories of phonological awareness are so important.

Corey: And so when we're looking at assessment and we're thinking about, for example, all the comprehensive test of phonological processing is a really great measure. I absolutely love it. I think it gives a ton of very valuable data. But what it doesn't do is it does not break those phonological awareness skills down for you very far. And so you need to recognize that you may need to do some assessment and take some data to figure out from that hierarchy, and that sort of systematic building, where are the holes and the gaps. So if we look at that Jenga Tower of phonological awareness skills, where are those? And we can just fill them in, we don't need to build from the bottom up like we would need to do with a full structured literacy or Orton Gillingham approach to literacy, phonological awareness is a little bit different in that.

Marisha: Yeah, that makes a lot of sense. And I think that's true for anything that we do. We want to have data to show why we're working on the skills that we're working on, and use that to support. And then we also need that to make sure the students are making adequate progress and that what we're doing is working. So that makes a ton of sense. And you're speaking to my database, clinician heart. I wanted to share that.

Corey: It's just so important again, to make sure that we keep in mind, like we've reiterated a few times here, phonological awareness is not your end goal. So we want to one, make sure that our phonological awareness scores are going up, that we're targeting the right places, but that ultimately that's moving the needle on whatever the end goal is. Because, we don't want to focus just on data for like this one point and be like, yoo-hoo we made 100%, but my articulation's still awful, or but my spelling is still awful, then it's like, well, great, we targeted the underlying concept and it didn't help support the end goal. So we've got to focus on both of those data points.

Marisha: Yes, I love it. Well. Thank you Corey and Mikayla so much for breaking this down for us. If you want to find any of the resources that we mentioned today, you can find them @slpnow.com/28. And thank you again. I so appreciate you sharing all of your time and expertise with us.

Corey: Of course. Thank you so much for having us.

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Filed Under: Podcast Tagged With: Literacy-Based Therapy

#027: A Crash Course in Literacy for SLPs

November 6, 2019 by Marisha 8 Comments

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In this week’s episode of the SLP Now podcast, I sat down with Corey and Mikayla from Ascend SMARTER Intervention to talk about literacy. This dynamic duo works together at a Denver-based educational consulting practice dedicated to getting SLPs the support they need to feel confident in structured literacy-intervention.

Corey, the founder of Ascend, is a data-driven + analytical educational therapist and diagnostician who is deeply passionate about helping struggling readers close the gap between where they are and where they want to be.

Mikayla joined the Ascend Team in 2017. She is a passionate and eager educational therapist with a background in psychology and special education, who cares deeply about helping kids see that they are capable of learning and helping them change their lives.

I’m so thrilled they joined me to share what they’ve learned in their years of practice, and hope you enjoy the conversation as much as I did!

So grab your beverage of choice (I’ll have a chai tea!) put your feet up, and listen in.

Key Takeaways

– How Corey and Mikayla came to learn so much about literacy
– The role an SLP plays in literacy
– What sets us apart from special educators and teachers
– The literacy processing triangle and why it matters (Phonology, Orthography, Semantics)
– How to identify a student’s core deficit
– Curriculum-based measures and standardized measures
– How our role changes depending on the core deficit, especially in a school setting
– Why it’s critical to have assessment in oral language and reading comprehension
– Why we need need a structured, systematic approach to literacy
– Examples of how SLPs can implement this in practice

Links Mentioned in the Podcast

– Orton-Gillingham
– Lindamood-Bell
– Clinical Evaluation of Language Fundamentals (CELF)
– Wechsler Individualized Achievement Test (WIAT)
– The Comprehensive Test of Phonological Processing (CTOPP)
– The Phonological Awareness Test (PAT)
– Smarter Intervention Training Program
– Click here to access the freebie links!

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Bonus points if you leave us a review over on iTunes! Those reviews help other SLPs find the podcast, and I love reading your feedback! Just click here to review, select “Ratings and Reviews” and “Write a Review,” and let me know what your favorite part of the podcast is.

Thanks so much!

Transcript

Transcript
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Marisha: Hi there, and welcome to the SLP Now podcast. Today we have Corey and Mikayla here to help us dive into all things literacy. You guys have been asking a bunch of questions about this, and I feel like Corey and Mikayla are the perfect people to break this down for us.

Marisha: So Corey and Mikayla are a dynamic duo, and they are determined to get effective and accessible literacy intervention materials into the hands of struggling students everywhere. They have a really unique setup. They have a educational consulting practice in Denver, Colorado. They work with SLPs and educators to help them feel confident about their structured literacy intervention, and they also work students in their clinic as well.

Marisha: So a little bit about Corey. She is a data driven and analytical educational therapist and diagnostician. She's deeply passionate about helping struggling readers close the gap between where they are and where they want to be. She spent over 10 years working at leading research and clinical institutes, including Johns Hopkins University, Children's Hospital Colorado, and the University of Denver before opening her own private practice, Ascend Learning and Educational Consulting in 2015.

Marisha: Then Mikayla joined the Ascend team in 2017 and has been working as an educational therapist for the last two years. She's a passionate and eager professional with a background in psychology and special education. Her passion is in helping kids see that they are helping of learning and helping them change their life.

Marisha: So they clearly have a really unique set of experiences and I can't wait for them to share all of this expertise. Also in addition to all of the private practice work and consulting they do, they work all over the country with online professional development training programs. We'll share links in the show notes to find out more about all of the amazing things that they have going on.

Marisha: So without further do, Hi Corey and Mikayla.

Corey: Hi.

Mikayla: Hello.

Marisha: How are you? Amazing. I cannot wait to dive into this topic. Before we get into all of the nitty-gritty, all the tips and tactics that you have for us, I'm really curious. How did you guys, both of you, come to learn so much about this topic in particular? I'm really curious about a little bit of your story.

Corey: Absolutely. So first of all thank you so much for having us. We are so excited to share all things literacy, because Mikayla and I are both so passionate about this, and especially passionate about the role that SLPs play here. So first of all, thank you.

Corey: So in terms of how I got into this field. I actually started out my career working with students on the autism spectrum at Johns Hopkins University. That really sparked my love of language, and development in children as a whole. From there I moved onto working in neuropsychology, so working specifically with neuropsychologists with students who had any number of academic, language, social-emotional struggles. And I loved that so much. It was so interesting seeing just the different backgrounds of students and how those would come together, what assessments showed you about what they needed. From there I started to recognize, wow, I can see the profiles of these students. I can see where there are holes and where there are gaps, but I'm really curious about what it looks like in terms of actually closing those gaps and helping those students make real measurable gains and differences in their lives.

Corey: So from there I transitioned into the Learning Services Department at Children's Hospital Colorado. We were so lucky to be in an umbrella with a learning support team, a speech language team, and an audiology team. So we were really under this big umbrella which gave me this really unique and interesting opportunity to get to work closely with our speech and language team to see how we could support these students together who had learning issues. And I started to see there's major overlaps, specifically in the area of literacy, although it expands way beyond that. But specifically literacy in terms of what does that look like from a reading interventionist or a learning therapist role. And what does that look like from a speech language pathologist role. I just love it.

Corey: I absolutely loved my time there and I wanted to have the opportunity to work more closely in this multi-disciplinary way. So ultimately that's where I jumped into private practice. I have just absolutely loved continuing to learn about literacy. I've taken every training under the sun, from Orton-Gilllingham, to Lindamood-Bell, to just about anything I could get my hands on, because I was so fascinated in how the brain developed literacy skills. So that's my background. That's how I really moved from the beginning to the end of where I'm at in my career right now in terms of literacy.

Marisha: That's amazing. Such a unique set of all these different skills. And then what about you Mikayla.

Mikayla: Yeah. So when I was in school. I had a background, like you mentioned before, in psychology and special education, and knew that when I graduated I wanted to do something with children. I've wanted to help kids ever since I was a child myself. But I really didn't know exactly what that was going to look like. So I did few different things and worked in a couple of different roles in classrooms and with speech language pathologists, and tried to get any experience I could to help me narrow it down. We joke that this opportunity kind of fell out of the sky a little bit. I just decided I was going to move to Colorado, and went searching for an opportunity and for a job, and ended up finding Ascend and finding Corey.

Mikayla: When I first spoke with her I disclosed that I didn't have a background in literacy intervention. I knew I wanted to work with kids. I had had some experience in an educational setting. But I didn't have any literacy background. But she trusted me and I came onto the team and got all of my training through her and her expertise, and all of the knowledge she's built up with all of her amazing experiences, and all of the amazing roles she's held in the past. I jumped in. I did my research, and I started working with students. And I've been working here for the last two years as an educational therapist, as well as a part of our team supporting SLPs in that online professional development space. And have really started to jump into the executive functioning space and how it relates to literacy as well as all of the private practice pieces that come with that.

Marisha: Oh, that's amazing. You mentioned executive function. We've been getting a ton of questions about that. Maybe we need to talk about that more in another episode. How interesting. But since we're focusing on literacy today, I'm really curious. I talk about literacy based therapy all the time. I love using books in therapy. But when it comes to the core foundations of literacy and when you're looking at orthography and all of those different components, I know, at least when I was first starting out, I was a little bit unsure of what my role was in that. So can you help break that down for us a little bit?

Corey: Absolutely. So I am, again, so passionate about specifically SLPs and their role in literacy, because I think when we can fully understand how the reading and writing brain works, we can really understand how the background and training that SLPs have supports this development just incredibly.

Corey: So really when we think about how the reading brain works and what the neural processes are in order to be able to read, spell, write with competence we have to look at three specific areas. I like to look at this as a literacy processing triangle. That's really what it's been known to be called, at least in our field over here in the learning world, that literacy processing triangle. It's made up of three distinct components.

Corey: The first piece is phonology. That's kind of one of those foundational building blocks. So we know when we think about core components of literacy development, phonological awareness skills is a huge one that we look at. And it's really tied into the phonology development, so understanding of the sound structure of our English language.

Corey: The second piece that's really important, that's kind of the next building block there, would be orthography. So orthography is being able to see and look at letters or symbols and recognize what that letter is. So we've created the little picture that we've decided to call an A, and we need to be able to make that recognition. So that's what the orthography is, is really the sight piece of that processing triangle.

Corey: And then the last piece is semantics. So semantics, clearly as you know as a speech language pathologist, is the understanding or the comprehension of the language. So really this marriage of the sounds, understanding the sounds, understanding the pictures or seeing the visual component, and then being able to create comprehension off of that. So I always like to use the word "bat" for example. When we're looking at the word bat, we know we have distinct sounds, b-at, that are coming together. We know that we have those distinct letter patterns. You could look at a B. You could look at an A. You could look at a T. And we need to make that connection between the orthography and the phonology, so the sound and the symbol. And then we need to be able to make a comprehension out of that. So we need to recognize that "bat" is a concept that I know, and it could either be a baseball bat. It could be a nocturnal flying animal. But we need that whole connection to come together.

Corey: And it has to come together really quickly. So really it has to come together in less than half of a second in order to be able to read or write with fluency that would be necessary for comprehension or composition that is up to grade level standards at any age. So I think understanding that that's the neural process that has to happen. When we really break that down we recognize that SLPs have a really critical understanding of phonology, of the sound structure of our language. That's what you work on. That's what you target. Also you have a really critical understanding of semantics and creating comprehension from the oral language. Because essentially when we're reading we are just creating oral language in our head. Same thing when you're writing. You're just taking oral language and putting that down onto paper.

Corey: And so understanding that, SLPs understand more about phonology and semantics than most people who are actually working in this field. As a special educator, as a reading interventionist, we don't receive training or background on how to develop phonology, how to develop semantics. So what that leaves us with, is it leaves us with this understanding of the orthographic piece, the letters. A lot of people will say, "Oh, phonics instruction," and things like that. That's what's going on. That's what the special educator does. That's great. And in that background we got training on orthography, but nothing else.

Corey: So I think it's really important to recognize SLPs can absolutely play this critical role in making that whole connection come together. Whether that's working directly with students or whether that's providing professional development or support to your special education team to help them better understand how they can further develop that semantic piece or that phonology in the work that they're doing. So that's my long-winded answer to your question there.

Marisha: That is so incredibly helpful. I'm just picturing that triangle in my head. I've heard you present on this before but the first time you presented on it, I was like, "Oh, I've got phonology." And orthography, you're right, was a little bit trickier. And then you mentioned semantics. I'm like, "Oh, we're got this." So they are definitely areas that we're super familiar with, and it's a matter of then just figuring out how we can leverage that to work with students who have literacy deficits. And then also figuring out how to provide support to the team. That's such a helpful perspective. I'm really excited to be able to dive into that a little bit more.

Marisha: But before we talk about what we can actually do, because I'm sure there's different profiles that we see with students who you are seeing for literacy support. And then how do you go about identifying that core deficit to figure out which approach makes the most sense? And how to start navigating that all together?

Corey: Yeah. I think you make a great point here, and I wanted to create just a little bit of clarity here too. Because I also realize one of the things that I said in terms of an SLPs role in literacy, one of the things that I think is important to think about as we start thinking about core deficits, is that really SLPs as special educators are working with students who this process isn't coming naturally. So typically what we're going to be doing is we're looking at that literacy processing triangle, and we're recognizing that students who are not gaining literacy skills, so either reading or writing, at a level that's not consistent with their peers, have a breakdown somewhere.

Corey: In that literacy processing triangle something is not connecting. So it could either be phonology. It could be orthography. Or it could be semantics. But there is a break somewhere in there. Or we might have some students who have some foundational skills in each of those areas but the fluency, so the act of that coming together in less than half of a second, is not necessarily happening. So what we're doing in special education, in speech language pathologists' role in the schools and privately, is we are working with the students who have those breakdowns. If you have students who are reading and writing on grade level, clearly they don't have a breakdown. That whole system's running smoothly. We're not working with them.

Corey: So you bring up this question about identifying a core deficit. We've got two ways in which we can do that. We can do it through curriculum based measures or we can do it through standardized measures. I'll let Mikayla speak to the curriculum based measures and how we can start taking a look at identifying the core deficit that way. And then I'll chat a little bit about standardized measures that we can use as well.

Mikayla: Absolutely. So like Corey said, we have these two different types of assessments that we'll use in order to figure out where that deficit and where that breakdown in the triangle is falling. When we have a curriculum based measure we will look at a number of different things, like their chronological awareness, which we will get more into later on. We'll look at their phonics and we'll look at their comprehension to see, Okay, when we're looking at that triangle are they breaking down in any of these areas?

Mikayla: And now a curriculum based measure is great because when we're using a standardized measure which Corey will bring up in a second, we can only do those every so often. They have time constraints on them. But if you're looking to see if what you're doing is making progress from week to week and more frequently, we can absolutely be using a curriculum based measure. So progress monitor every few weeks or every month to see where are students falling in terms of the instruction they're receiving. And where can we put more supports to fill in those gaps as we go.

Corey: And then in terms of the standardized measure typically what we're doing is we're looking at assessments that are going to specifically target those core areas as well. So we're looking at specific assessments to target phonological awareness or phonology. We're looking at orthography measure. So usually that's like a phonics based assessment, and seeing like, "Hey, if we give you a list of all of the different letters and sound patterns, can you provide the sounds that that pattern makes?" And then some type of semantics assessment.

Corey: So in the terms of literacy we're usually looking at reading comprehension because that's kind of the highest end pillar of what we're looking at with the reading. So in terms of assessment, we typically like to give a battery that contains both the curriculum based measure as well as the standardized measure. In the beginning we might look at something like the CTOPP, so the Comprehensive Test of Phonological Processing, as a really great way of looking at phonological awareness. We might also look at the Phonological Awareness Test, which is another great one, the PAT. There's a number of really great ones out there. I know a lot of people have said, What about this one? Or, what about that one? There's a lot of great phonological awareness tests out there. It doesn't matter as much what you're using as long as you're getting some baseline of how is this student doing in terms of their understanding of the sound structure of the language.

Corey: One of the things we love about curriculum based measures is that you can start to dive down a little bit deeper sometimes that you'll get with like the CTOPP give you kind of a big picture. You'll see, Oh, phonological awareness is breaking down but I don't know exactly where. Those curriculum based measures can help you pinpoint exactly where it's breaking down.

Corey: Then we can also take a look at the orthography piece. So again that phonics based piece. And you can do that through a number of different assessments. So a word identification and spelling test. You can do that through, again, a phonological awareness test also has an orthography component which I absolutely love. So that's something that you can do. And then you can also use curriculum based measures there of just giving letters and saying, Okay, do you know what these say? Sometimes that's something that's more appropriate for a special educator to be doing. So this is where you might have that multidisciplinary approach whereas a speech language pathologist you're looking at the phonological awareness piece. And then you're handing off that orthography piece to a special educator, which is great too. And it's great to have that consistent communication.

Corey: Then in terms of reading comprehension, we like to have a standard, formal measure of reading comprehension that we can look at to see how our student's performing in comparison to their peers and their aged based buddies in the classroom. But then also having a curriculum based measure so that we can start to recognize if comprehension is breaking down, is it breaking down because they can't identify main idea in detail? Is it because they can't make inferences? Is it because they have limited vocabulary? We have to start to recognize what's causing the breakdown. So that's another reason why we like to use those standardized assessments as well as the curriculum based measures.

Corey: So it's important as a speech language pathologist, one, if you're going to be working with literacy, to understand where literacy is breaking down. But in addition you may have some students who come to you, and come to your caseload, and they're primarily concern is actually language, right? That's ideal as a speech language pathologist to be working with students whose primary concern is language. And if that's the case, what we don't want to do, is we don't want to pull too far away from what you're already doing and we want to figure out how we can start to just incorporate little tidbits of literacy in. Because we know that students how have language based disorders are at a very high risk of having literacy based disorders as well.

Corey: So it's important to recognize as you're working through this multidisciplinary team, if you've got a student who's struggling with both language and literacy skills, we need to really start looking at what's the bigger issue. So that you can determine when you're working with these students, are you trying to pull a special educator into what you're doing? Or if literacy is the primary concern and there's just some little hints of language struggles, then can we offer that special educator more support on that end?

Corey: And really want we can do if we're using those standardized assessments, is we can see is semantics is really the biggest hole, and the biggest gap. And you have maybe a little bit of difficulty in orthography and a little bit of difficulty in phonology. Then that's a language kid. That's your primary language kid. Those are the ones that you see most often. If we're seeing that orthography is the primary deficit, then that's somebody who's going to be best supported by your special education team that you can potentially offer some support on how can they amp up their instruction in phonology and semantics. If you've got a kid whose phonology is the primary deficit, then it gets to be a little bit interesting. We can talk more in the next episode about phonological awareness, and when you've got a kid whose primary deficit is phonology who's the best person to support and what does that look like.

Corey: So, again, there's my super long response to identifying a core deficit.

Marisha: That's so helpful, and I am so excited to dive into all of the things that come after this. But I was curious. Do guys typically used a curriculum base measure for the orthography component. Because you mentioned that some of the phonological awareness assessments, you mentioned that sometimes they look at orthography. Is there anything in particular that you would recommend for that? Just so we know what we might be looking for in a special educator's assessment.

Corey: Yeah, absolutely. So we do have a baseline assessment that we provide, and we're happy to share that with your listeners just so they can kind of start to get an idea of what are the things that we're looking at and what are the umbrellas that that fall under. When we developed our baseline assessment we tried to make sure that we had a very clear picture of here's the phonological awareness piece to that triangle. Here's the orthography piece. Because really you just need to know that students have sound-symbol correspondence. So it's really just knowing all of your letter patterns and what sounds would they make.

Corey: So in terms of standardized assessment, we use the word identification and spelling test for that. But we have a curriculum based measure that works really well for that too, if people don't have access or just want to give something to their special education team and they don't have a standardized measure. We don't want you to skip it just because you don't have access to it. So that's why we created our curriculum based measure as well.

Marisha: Yeah. That's so helpful. And I've found that a lot of general education classroom teachers are giving these types of assessments, especially in the early grades. So it's just knowing what to look out for, or even just what to ask for if you're curious about that. Because a lot of this data is being collected all of the time, so that would be super helpful.

Marisha: I'm also curious if you have any favorite assessments for the comprehension component. Because I know as SLPs we got lots of assessments that look at that. I was just curious if you had any favorites.

Corey: Yeah, so I think there's two things that we need to look at when we are looking at comprehension. Because what we have to recognize with that semantics piece is that you're looking at oral comprehension. So what does a student understand when the information is provided orally. So I know a common one that's given from SLPs is the CELF, and they've got that Understanding Spoken Paragraphs, which is helpful. We've need to have that information to know what happens when we don't have to read. And then we also need to have a reading comprehension measure.

Corey: So here in our clinic what we use, we use the WIAT. People call it all kinds of different things, but the Wechsler Individualized Achievement Test, because it has both a listening comprehension section as well as a reading comprehension section. Another great one is the Tested Integrated Language and Literacy Skills, the TILLs, is a great assessment that will give you information on both the oral comprehension and the reading comprehension.

Corey: Whatever assessment that you're giving, of if you're giving a battery of assessments and you're trying to pick from what you have available to you, is just making sure that you have that measure of both oral and reading comprehension. Because we need to see if there is a breakdown between the two. And that's another way to see which is primary. If we're thinking about core deficits, if a student's listening comprehension is stronger than their reading comprehension we know we have a reading gap that we need to fill. If a student's reading comprehension is stronger than their listening comprehension, we've got a language gap that we need to fill.

Corey: So in terms of the semantics piece, I think you can use what you have but just make sure that you have a reading comprehension measure and a oral comprehension measure.

Marisha: Yeah. That's so helpful. I'm really glad that you shared those specific tests to look out for. Because again those were tests that either we're administering or the special education teacher, or maybe even the school psychologist, is giving. So a lot of that information is already out there. We just need to know what to look for. So super helpful.

Marisha: And then was there anything else that you wanted to share in terms of identifying the core deficit before we talk about our roles based on the different deficits? Or are we good to dive into that?

Corey: No. I think the only other thing that I would add, like you just said, is that oftentimes especially if you have a student on an IEP and so, if you're in the schools and you're servicing these kiddos, most of them are probably on IEPs. And so really it is just taking the data that you already have available to you as part of even that eligibility assessment or that triannual assessment. So if you've got some of those measures, you can take a look back because a lot of these things are relatively stable without intensive intervention as well. So even if the testing's not super recent, which is ideal to have super recent testing. But even if you have to go back and look at historical data you can take a look at those assessment periods and see, Okay, what data do we have.

Corey: And in a best case scenario you have data around language. You have data around academic performance, specifically that literacy performance. And best, best case scenario, you also have some phonological awareness testing. That one I see a little bit less. In looking at IEPs we don't get that quite as often, but that's another critical, critical piece that we want to have included in those IEPs. So if you are part of that assessment team and have any pull or say, potentially just saying, Hey, it looks like we don't have a phonological awareness measure. Is that a way that we could add that in? So that you have that data moving forward.

Marisha: Yes. So helpful. Thank you for breaking that down a little bit more for us. Such good information.

Marisha: So now let's talk about our role. I know that school based SLPs especially, we are spread pretty thin. So what have you seen from your consulting and working with other SLPs, can you tell us a little bit about what you see them doing in terms of the three components of the triangle? And just giving a really quick overview of just those three core components.

Corey: Yeah. I'll let Mikayla take this one away.

Mikayla: Yeah. So like I said before, when we figure out what a student's core deficit is we're typically finding that there is some kind of gap or some sort of deficit in one of those three points in the triangle. If we are finding that it's an orthographically based deficit, the students are struggling in that orthography corner of the triangle, this is typically where we'll see them best supported by a special educator or in a general education classroom, depending on the severity of that deficit.

Mikayla: If it's a phonological deficit, and they are struggling in the phonology area, this is something where we really recommend that an SLP come in and be involved as with semantics because of the unique training and the unique background SLPs have in those two areas. So whether that's the student coming in working with the SLP or the SLP providing that professional development and that training to the special education team, we definitely want them involved in that phonology area.

Mikayla: I won't dive too deep into the role changing in that area yet because I know in the next episode we're going to dive specifically into phonological awareness and what that will look like. But that's where we're going to want to see an SLP come in as well as semantics, which I'll let Corey talk about a little bit.

Corey: Yeah. So in terms of what the role is going to look like for a student who a semantics deficit, this is where it's really critical where we have that assessment in both oral language and reading comprehension. Because in terms of the literacy processing triangle and that top piece, that semantics piece that we're thinking about, we could have a semantics breakdown for one of two reasons.

Corey: So one could be that we have an oral language issue and that students just aren't comprehending even if the information is provided orally to them. So what the role is going to look like for a speech language pathologist is addressing that is going to be exactly what you've always been doing. You don't need to change anything. You don't need to do anything different. You just need to recognize this is what's going to support the reading comprehension. So the reading comprehension gap, it's not just about teaching reading comprehension strategies. If they don't have the oral language, they're not going to be able to do it in print.

Corey: The bottom line is that we have this hierarchy of skills and oral language skills have to be developed before we can start looking at being able to do those same skills in reading. Or at the even highest level, being able to produce written content. We can't expect a student to be able to produce an essay or to be able to produce something like that if they can't comprehend language at this more basic level.

Corey: So in terms of what that looks like in an oral language, just do what you do. That's perfect. And recognize and be able to tell your team, Hey, we don't have the reading comprehension because we don't have the oral language comprehension. So that's what we're working on in our speech language therapy.

Corey: If we recognize, Hey, yes, we have a semantics deficit, but it's more specifically a reading comprehension deficit, and it's not necessarily an oral language deficit. Then what that role can look more like is, it can look more like supporting your special education team and helping them understand, Hey, here are the reading comprehension strategies that we need to use based on what we already know about how oral language develops. And keeping in mind that depending on your team, we just didn't receive background or training or anything on how to develop these skills. So oftentimes all we're really given is a bunch of worksheets and we're not quite sure what's the hierarchy in which we should be teaching reading comprehension skills and things like that.

Corey: So in terms of, depending on the core deficit, and depending on what that looks like, we need to recognize that that may impact how much your role is directly facing a student, versus how much of that is supporting your team.

Marisha: That's so helpful. And I love that you're building that decision tree for us. It's like we're doing that assessment, looking at the results, figuring out which point of the triangle is the biggest down, and then we get to decide. Like if it's orthography, that's something that we can leave to the special education teacher. We don't have to get a ton of training or anything to be able to support that. But there are SLPs who do focus on that when it comes to specializing in private practice. Maybe we can talk about that in just a second.

Marisha: But then so there's that decision tree. We've got the orthography happening. Then if it's phonology, we can do what we typically do. And if you have any questions about that, we'll deficit tie into that next time. And then with the semantics, a lot of it we get to continue doing whatever we have been doing. But I love the point of looking at oral language versus reading comprehension, and then potentially supporting the special education teacher in that way.

Marisha: So I just feel like that little tree helps break it down and make it so much less overwhelming. So thank you for that.

Marisha: And then, I'm curious too. Can you give some examples of maybe what you would recommend to a special education teacher? Just giving a couple of tactical examples of what that would look like in terms of how the SLP could support the special education teacher. What are some examples that you think that could help?

Corey: Absolutely. Yeah. It's a great question. So what I would say is that some of the best training and resources that I have seen in the area of reading comprehension specifically ... So thinking about that piece first, or that semantics piece first ... they're coming from speech language pathologists. And the reason that the best reading comprehension strategies and techniques that we're getting are coming from speech language pathologists is because of the understanding of, again, how oral language develops.

Corey: So oftentimes what we see happening in the special education world, and again I have a background with special education myself, it's because we just didn't get this training. But what happens is we're really looking at just worksheets. So when we're teaching reading comprehension we're giving students a passage to read through, and then we're just randomly asking them questions about it. Or we have different resources that we've got that just have random reading comprehension question. And what happens is we're just giving those over and over and over again hoping, praying, that with enough exposure that students are going to get it.

Corey: But what we know is that our struggling students don't get these skills by just repeated exposure, exposure, exposure. They need explicit instruction. So one of the things that I've seen coming out really well, or a good suggestion, that you as a speech language pathologist could make to your special education team would be, Hey, we actually need to explicit voice down how to start to recognize a main idea and key detail. So for example, one of the first things that you guys do as speech language pathologists, is you work on categorizing, right? You work on categorizing different concepts and different topics into little categorization maps. And essentially that's going to be the foundation of building our main idea and key details.

Corey: So really what it is in terms of giving them some suggestions is helping them understand, Hey, in order to be able to do main idea and key details, we need to understand how to categorize. Here are some different activities that you can use as a special educator to start to work on categorization. So just some of those types of things are really helpful.

Corey: I think one of the other things that can be helpful is helping them recognize that reading comprehension is not just like one big block of themes. But really it's an umbrella. And that we actually need to start breaking that down to main idea and key detail. Making inferences. Understanding vocabulary. Each of those individual pieces are critically important. We have a resource that breaks this down a little, so again, we're happy to share with your listeners in what are those pieces that really come under that umbrella term of reading comprehension. And just starting to say, Hey, here are the things that we do. Here's some resources that specifically fall into helping them understand how to make inferences, or how to do some of these things. Because there's just been a gap in understanding how exactly that needs to look in terms of oral language straight onto reading comprehension.

Corey: So really go ahead and just use this umbrella map that we're going to give to you. You can start to use that to try and understand, Okay, does your special education team understand that reading comprehension is not just a big block but it's actually a number of discreet, individual tasks that need to come together to comprehend material.

Marisha: That is so incredibly helpful. And just that perspective. I feel like we would be a little too ... because unless we spend time in the special education teacher's classroom, we don't know how she's teaching those components. So what you mentioned about in general, and this is of course a generalization, but a lot of teachers don't have that training. So they are just using those general worksheets. If we just spent a couple of minutes in the classroom observing her teaching that, we would really quickly be able to see, like, Oh, wait, wait, wait. We can tell this student is struggling to make inferences. That's why they always get a 60% score on that. Whereas the teacher might not be able to identify that. And I'm sure that all of us, we have easy access to a visual or some kind of activity to help break down that really specific skill.

Marisha: So I love that as a way to bridge the gap. And it's just seeing what they're doing and seeing what we can add or do to support. I love that perspective. That's super helpful.

Marisha: Let's skip into some super specific examples. Actually before we do that, let's talk about the orthography. So there are SLPs who do focus on orthography, right?

Corey: Absolutely. Yep. For sure.

Marisha: So what does that look like? If there's an SLP who's interested in diving into that, what would you recommend?

Corey: Yes. If you have SLPs who, especially like you mentioned, there are a subset of SLPs who, one, either are primarily responsible for supporting all of the literacy needs in the school. Less so in public schools and more so potentially in private schools. But definitely that can happen, or those who are looking to bridge the gap in private practice. So I'll let Mikayla speak a little bit to you what that looks like in terms of the SLPs that we work with who are either using this because they're fully responsible for literacy in the classroom as far as the support, or are using this in private practice as well.

Mikayla: Yeah. Absolutely. So starting at the most basic level, of that sound level, when you are working with a student on their sounds, just showing them a card that has a letter on it so that they can tie a visual from the sound that they're trying to produce to the letter that makes that sound. So, for example, if you're working on the letter "f" when you're asking them to make that sound, having a letter card there with the letter f on it so that visually they can see what letter they're trying to produce the sound for.

Mikayla: Then moving up to the word level, it's going to be the same thing. If they're trying to say a word, showing them a word card so that they can make that connection on the literacy processing triangle from the sound that they're producing to the word. And then tying it back up that semantic piece as well. So like Corey said earlier with bat. If they're trying to say bat instead of pat or you're working on something with that word, inaudible to get them to produce it, showing them the word and asking them about the semantic piece will tie in that orthography.

Mikayla: We like to say if an SLP wants to pull orthography in it's definitely something that's doable. It does not have to be hard. It's just adding in that one extra step to what you're already doing so that students can get that full connection of the triangle there and see how it connects.

Corey: So in terms of just adding this in, and honestly you can do those pieces even if you have a special education team who's supporting. Because oftentimes what's happening is these kids are getting breakdowns, like they're getting all these skills is isolation and they don't see how it connects. So that's a great way to create that connection between what you're doing and what the special education team is doing too. So keep that in mind. You have to just do that if you're fully responsible for literacy. You can do that regardless of your role in the school.

Corey: In terms of if you are fully responsible for literacy, what we do want to make sure with orthography that is very important, especially if you have a student who's very much struggling in reading and spelling. You want to make sure that you're using a systematic approach. So we want to make sure that we're using a sequential order in which we're teaching these letter patterns. Too often what I see is that students who are struggling with literacy are struggling because they're just getting kind of a random phonics approach, or are getting this piece mealed approach, and they don't necessarily have anybody who's working them through a systematic instruction of like, first we're going to teach all of the consonants. And then we're going to teach diagraphs. And then we're going to teach blends. And we're going to move onto more complex sound patterns as we go.

Corey: What we need to make sure of is if you're are doing this is private practice, or if you are supporting literacy as the sole literacy provider, you to make sure if you're targeting orthography, you are using a scope and sequence of letter introduction. So that's when we start to look more at a structured literacy approach as a whole as opposed to supplementing what you're doing and just adding some literacy sprinkles in. Literacy sprinkles are great. I love literacy sprinkles. But if you're fully responsible for supporting a student's literacy development and they are struggling, we need to make sure that we are using a structured, systematic approach. It's often been known as Orton Gillingham, the field is sort of shifting away from that term to more of a structured literacy approach. But it's the same idea that we're making sure that we're doing that in a systematic way.

Corey: So I want to be clear. There is a difference in what it looks like when you're supporting literacy as a primary deficit, and when you are supporting literacy as a sprinkle onto your language based therapy.

Marisha: Yeah. Absolutely. That's super helpful. Because I'm sure if we Googled Orton Gilllingham we could find some different trainings that way. Do you have any other recommendations in terms of where to go if an SLP is looking for that?

Corey: Yeah. Well, we have a training that we absolutely love that we put together. The way that we put this together, we really put it together with the thought of giving people the least amount of overwhelm possible. So what is the least amount of information that you can take and consume and be able to implement right away. And so the great thing about Orton Gillingham is that has a fantastic background. The methodology there is amazing. We absolutely love it. The problem is when you go to Orton Gillingham training you're still responsible for developing a comprehensive curriculum using the methodology that they've just taught you.

Corey: So what we went ahead and did is we took all of the best parts of those trainings. We stuck them together and then built a curriculum around it so that you can jump right in. Because what we've learned, and I'll let Mikayla speak a little bit to this, but what we've learned is that action brings a lot of clarity. So as you start getting in there and working with students, you start to make these connections of, Oh, orthography, the semantics, the phonology. You start making that literacy processing triangle connection more. But you have to get in there, and you have to be working with students. What we learned is that you kind of need a backbone to that.

Corey: You need some type of curriculum or something that you can use to start getting into action. Because when you go to Orton Gillingham you have a lot of great thoughts and ideas, but nothing that's actionable. And so without that action you lack clarity. So I'll let Mikayla speak a little bit to that because she came from this perspective of, No idea what literacy ... like I don't know what structured literacy looks like. How does that pull together?

Mikayla: Yeah. So the reason I brought up in the beginning that my background didn't include a literacy training is because so often we work with SLPs or other professionals that come into our program, we hear, Oh, literacy isn't my space. Or I don't have a background in it. I can't do this. And I'm the first to say, I didn't have a background in this either, but with the proper tools you absolutely can do this.

Mikayla: And that's especially true for SLPs, knowing you already have so much training in phonology and semantics. So with that structured scope and sequence in curriculum that Corey mentioned, all we really had to do, or when I started all I had to do was follow that program that we'd built so that I can be hitting on the orthography, phonology, and semantics together in order to get students back to being on grade level and help with their literacy skills.

Mikayla: So it definitely helps to get in there with students and see how this works because there are so many terms floating around and there are so many different moving parts to it. There's those three points to the triangle, how they're connecting, executive functioning like we talked about in the very beginning is a huge part of how those three points are connecting. And it's not until you're really sitting there with a child seeing how it's all coming together for them as an individual that you really start to see, okay, if I'm working with a student and they're constantly doing this, that means I need to pull in more support for the phonology piece of the triangle. Or if they're doing this, I need to be pulling an inference worksheet for semantics instead of main idea. We can absolutely find all from assessments, but the action will absolutely bring clarity as you move through the therapy with a child to see what they need and what you need to be doing in order to get them back to where they want to be and closing the gap for them there.

Marisha: I love that. You guys have so many amazing actionable tips. It's the best. I especially loved how, Corey, you called these literacy sprinkles. And I loved Mikayla's example of just having sound cards. Like if we're working on sound in isolation with our articulation kiddos. And then as we move into the word level, including those words. I'm sure we could continue that throughout the entire level, and include that written input as much as possible. But I'm curious if you guys have any other magical literacy sprinkle examples you could share.

Corey: Oh, goodness. So many literacy sprinkles. We can definitely dive even deeper into this in the next episode, but there's a lot of things that you can be doing in terms of every single one of those pieces of the triangle and thinking about what that looks like. So, yeah, Mikayla offered such an amazing example of an orthography literacy sprinkle of we're targeting this concept. So because we're targeting this concept let's just pair it to print. Anytime that you're are targeting anything, if you can even just write it down if you have a whiteboard or something.

Corey: You don't have to have a ton of materials. I think that's one of the things that I always felt like. Like, oh, I can't get into that piece because I don't have all my beautiful printed organized materials around it, which I know Marisha, you're right there with us loving like the organized beautiful materials, which are amazing. But sometimes you're in a session and you're like, I honestly can't pull another thing. So when you're thinking about that orthography piece, you can just write it on the whiteboard. You don't have to have complicated materials to make this work. So keeping that in mind for the orthography piece, just pair print to whatever you're doing.

Corey: In terms of phonology, one of the things that you can be doing is, if for example, you're working on the "k" sound and you're providing the word cupcake and you're hoping that they're going to get cupcake for you. We could also break that down and say, great, how many syllables in cupcake? Great. How many sounds in cupcake? Can you show me what those letters look like? And of course, you don't have to get too much into that if you don't have time, but something as simple as, I just asked a question of you. I didn't have extra materials, I'm just asking you for that. Or I'm working on the "k" sound for you, so let's play a little game. I'm going to tell you a bunch of sounds and I want you to guess what word I'm thinking of. And you might get [inaudible 00:50:31]. What word am I thinking of? You can even have them produce those back to you, and all of a sudden you've added a phonology component there where you're asking them to blend sounds together. That's fantastic. That's what they're doing when they're reading. We need that to be a really fluent process.

Corey: And then in terms of semantics what you're doing with your literacy based therapy in pulling books in and things like that. That is the perfect way to be making sure that you're building and developing those oral language skills. And then you're immediately pulling that connection in with the printed text and being able to see how does this translate into what I'm reading.

Corey: Then for your older students you could even have a little written response that they provide you. And that's really closing that gap too, between oral language, reading, and writing. Those three pieces that we like to think about. So those would be the big things that I would definitely recommend. We can talk, again, more about phonology specifically because there's a lot that can be done there specifically to support these little literacy sprinkles inside of your session.

Marisha: Such good information. And I'm curious too. Do you have any tips in terms of the written responses. Because I know that our sessions are so short and we're trying to get so much done in that time. Sometimes if a student writes out a sentence for me a lot of times there's lots of different errors that we could be focusing on. Do you have any tips in terms what would be most ... How do we decide what to focus on there? Or how can we maximize the time that we spend on that writing?

Corey: Yes. That is such a great question because I've had a number of people ask me. Like, I don't have time to work on handwriting. And I don't have time to work on the spelling. And I completely understand that. So I think in terms of an SLP's role one of the best things that you can be doing for writing support is anytime that you are using any type of graphic organizer or visual that you're using to help instruct a certain concept. So for example, if you were looking at main idea and key details, if you had some type of graphic organizer that you were using for that, just showing them quickly how they could write even just a couple of words into that mind map of sorts. Because I think as an SLP, one of the best things that you can bring is an understanding of really the function of language and how that works as opposed to the actual, like the spelling and the capitalization and the handwriting and all of those.

Corey: I think those are tasks that you're going to leave to your special education team. Those are things that we can really pass off to them. One of the things as an SLP that you might want to look at is can they recognize errors. Like, Hey, we're going to send out the cops. That's one thing that we use a lot. Let's send out the cops real quick. I just want you to tell me, do you have capital? Do you believe that you have good sentence structure or good organization? Do you have a punctuation? Do you have spelling? One of the things that you can look at, not that you have to fix all of those things, but just do you even recognize it? Do they even have any of that executive functioning or metacognitive skills to recognize that their sentence wasn't good? Sometimes they know. Sometimes they'll say, I don't think this sentence is structured appropriately. And sometimes they don't.

Corey: And I think really the key role of an SLP is to be able to articulate where those errors are for the special education team. So, hey, we did a sentence and there was a lot of errors that I could correct. What I noticed was I noticed we struggled with mechanics, the capitals and the punctuation. Or we struggled with sentence structure. Or we struggled with the spelling piece. And really just identifying that to hand it off. Because I think as an SLP you have too much other pieces of the puzzle on your plate to be able to get into anything more in depth than that.

Corey: So, again, I would focus primarily for writing, if you're doing anything oral language, if you're doing anything reading comprehension wise with graphic organizers, have them just produce something quick, short, just tangible. It can be a couple of words in each of those so that they can start their thinking and organize their language around what they want to write. But in terms of sentences and thing like that, I think it's really going to be more about collecting data and providing that data to your special education team.

Mikayla: Okay. And on that same note, one of the activities that I'll do with my students, I try to overlap as much of this as I can, is if we are working on the "k" sound, like Corey mentioned earlier and the student was tasked with figuring out the word milk after having the different sounds, I'll then have them use that in their sentences. So I'll say, Okay, you need to use the word when you're writing a sentence. You need a who or a what, your subject, did what, predicate, and then adding the adverbial, why, when, where, or how. And we have that nice record organizer for them so that we're hitting on all of the same skills, overlapping to save that time. A lot of it can be saved for that special education team and that teacher, but if you have the extra minute, definitely having them break down the syntax of that sentence. And breaking it down there, making sure they can use the words appropriately in that vocabulary piece is always great data to take. I always find it super interesting with my students when I have them do that.

Marisha: I love that example, and that's especially helpful when we're working with mixed groups too. Because we might have a student working on saying that final k sound and then maybe someone else is working on irregular past tense verbs, and someone else is working on pronouns. All sorts of goals together. And so that example is such a great way to put all of those skills together. We often have visual and graphic organizers to support that, like Mikayla said, and so it's just a way to put those skills together, and then to anchor it with that written response. Maybe even the kids can work together on that. I love that. Such a good example.

Corey: Yeah. And we have a great visual for that too. So we will share that. I have a little packet that you guys can just download, but that shows exactly what looks like in terms of us. Like here's the word that we're targeting, or the sound pattern that we're targeting, and then here's your little graphic organizer in terms of the who or what, did what, why, when, how. I do, I love that Mikayla, because I think that's such a great language construct that we can start to take a look at and that a lot of our students are really, really struggling with.

Marisha: Love it. And then I had just one random question related to the written responses. Do you know of any research or anything that shows whether there's a benefit to ... If I was modeling the graphic organizer on the board and each of the students had their own, if there a benefit for them to be copying what I write? Or it is better for them to generate on their own? Do you have any feedback or input there?

Corey: Yeah. So in terms of teaching those graphic organization strategies, usually there's going to be a hierarchy. So in the beginning when you first introduce a new organization, or graphic organization strategy, you would model that for them. So you would go through the passage, or go through your book, or whatever you're using to target that concept and then you would show them, Here's what I'm thinking. Like let's do this graphic organizer together. I'm going to walk you through my process. So let's go ahead and you copy mine as a model, and then you use that as your model moving forward.

Corey: But then you want them to graduate to that next level of them being able to take that and do it on their own. And so it's a great opportunity too, if you're using those graphic organizers, once you've explicitly taught it, you've modeled it, they have a model to follow. They're going to do their own. If you've got a mixed groups, too, or even just a group of any students, it doesn't matter how well aligned they are in their topics, but it's a great opportunity for conversation. Because what you're going to get, is you're going to get students going off the graphic organizer a little bit differently. So you can talk about, Oh, how interesting that so and so put this, and so and so put that. And all of a sudden you have a perspective taking activity. All of a sudden you've got a lot of gems of information coming out just from that conversation of them filling that out independently.

Corey: So there's a lot of great research around the benefit and the use of graphic organization strategies as a primary tool for teaching reading comprehension. Yeah. It's really good to graduate them away from the modeling onto independent work with it.

Marisha: And does that also apply is they're doing writing? Let's say last session I had them write a sentence and there were just way to many issues with it. Would it still benefit the student if I wrote down a sentence or a word and have them copy it onto their organizer or whatever? Does that same kind of model apply when it comes to written language?

Corey: Yeah. For sure. Absolutely. And that's why we really like the idea, too, of really modeling the sentence frames that Mikayla brought up. So the who or the what, did what, why, when, how. Because a lot of times there are a lot of errors in that written structure. So what we do, I can let Mikayla speak a little bit to this, but in our earlier curriculum what that look like in terms building that skill by providing some of that to them. So I'll let you talk a little bit about that, Mikayla, our little sentence building.

Mikayla: Yeah. So in the beginning I will definitely model for the students. But I'll typically ask them then to create a sentence, maybe using that same key word, but choosing their own answer. So if I gave them, okay, the who is Jenny. Drank her milk. At the table. Okay, now you need to pick a new who and the adverbial. So maybe they'll say, Oh, Rogan spilled the milk this morning. And try to get them to model those different pieces so that they can see how mind came together, but then they need to come up with their own pieces so that they're applying and generalizing what I gave them. But it's easier said than done, so often I'll ask my students and they will try to give me the same who for five sentences in a row. And the same did what for five sentences in a row. So I need to give them that extra task of saying, Okay, you're going to write five sentences. Maybe they all have that "k" sound in the key word, but you can't use the same person twice. Or you can't use the same action twice.

Mikayla: So it's definitely working on so many skills all together, including some of those higher level thought processes. And just that creative writing piece, trying to come up with who am I going write about and how do I make them different. But modeling is going to be super, super important for them as they go. Sometimes I'll have students try to break up their sentences with a who did what, and then the why, when, how. And they are breaking it down incorrectly. I had one the other day come in and they put the action in the why box because they tried to break it up word for word instead of the different pieces of the sentence. So it's definitely going to be child dependent how they're performing and what errors they make in all these different pieces.

Mikayla: But we are big on modeling here, and scaffolding. So sometimes my students will ask, "Well, can't you give me an example first?" And I'll try to graduate them through and say, "Oh, I gave you an example last time, and you did really well. I want to see if you can do this on your own today." And then we'll work together to figure out how we can make it better or if it's correct. And definitely trying to scaffold it for them throughout the process.

Corey: I think a key piece to keep in mind here, is if you have students who can't do that at all, the way that you scaffold that down even further is that we have a number of times where we will offer the who or what. So we'll give them three choices of a who or what. And then we'll give them three choices of a did what. And we'll give them three choices of a why, when, how. So like at our more basic level we actually have word cards that we will provide for each of those. And then basically it's like a choose your own adventure with your three choices. So we call them silly sentences, and you can just pick.

Corey: So the great thing about that is then it is sort of copying. So then underneath of that we'll have them write the sentence. Then what we're looking for is, Okay, did you add a capital? Did you add a punctuation? You had the words in front of you, essentially to copy, but the great thing is, is what we do, we align that to whatever concept we're targeting. So if we're targeting the "k" sound, we're going to have a bunch of just different who's that have a "k", a bunch of different did what's that have a "k", and a bunch of different why, when, or how's that have a "k", to try and get them practicing. So, again, you're really pulling in multiple of those skills at the same time so that they can see how is the work that I'm doing with my articulation group, how does that also then correlate into what I'm reading and what I'm writing. Reading and writing are reciprocal processes. So we always keep that in mind too.

Mikayla: Absolutely. And you can also work on, once they've got those skills down and being able to identify or produce the three different pieces and put together a correctly formed sentence, seeing if they can reorder it to work on some of those pieces as well. So instead of having, I went to the park on Saturday, reordering it and saying, On Saturday I went to the park. And seeing if they can manipulate those sentences in that way for a higher level skill as well.

Marisha: So good. So many amazing tips. Thank you, Corey and Mikayla. I can't wait to dive into phonological awareness in the next episode. It's going to be amazing, just like this one was.

Marisha: For those of you listening, if you want to access any of the resources that we mentioned, including their freebies and links to what Corey and Mikayla are up to, if you want to learn more about them, you can head to slpnow.com/27. And then we'll all get together again next week to talk all about phonological awareness.

Corey: Thank you so much.

Mikayla: Thank ...

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Filed Under: Podcast Tagged With: Literacy-Based Therapy

#026: Tips for Success with Social Language Groups

October 30, 2019 by Marisha Leave a Comment

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In this episode, I got to sit down with the incredibly knowledgable Dr. Anna Vagin, an SLP with a private practice in California. She provides individual sessions and social learning groups to children, young adults, and their families, and is the author of Movie Time Social Learning (2012) and YouCue Feelings: Using Online Videos for Social Learning (2015).

We’ve gotten so many questions about social language groups, so I was super excited when Anna agreed to this interview. I know she’ll be the perfect person to break this all down for us.

Anna’s expertise is working with students who have diagnoses ranging from ASD, ADHD, NVLD, anxiety disorder, language disorders, and social communication disorders.

She has a wealth of experience to draw from, and I learned so much about getting the most out of working with these students in mixed groups. I hope you learn a ton too!! 🤓

So grab your beverage of choice (I’ll have a green tea!), get cozy, and listen in.

Key Takeaways

– What led Anna to specialize in social language
– How to group students effectively, making sure all group members are able to “give” and “get”
– Creating groups when students display challenging behavior
– Effectively using visuals in your groups
– Behavior expectations
– Feeling trackers and fixers
– Favorite games for social language groups
– Setting up groups for behavioral management success
– Incorporating explicit teaching of social concepts
– Our favorite activities for mixed groups
– Tips + strategies for monitoring progress in social groups

Links Mentioned in the Podcast

– Movie Time Social Learning
– YouCue Feelings: Using Online Videos for Social Learning
– Sarah Ward: The queen of executive function
– Mole Rats in Space
– Hanabi
– Ice Cool
– Sushi Go
– Michelle Garcia Winner’s Thinkables and Unthinkables
– Story Grammar Marker
– Game Changer
– Soar by Alyce Tzue

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✨ Bonus points if you leave us a review over while you’re there! iTunes reviews help other SLPs find the podcast, and honestly, I love reading your feedback! Click here to review, select “Ratings and Reviews” and “Write a Review” → let me know what your favorite part of the podcast is. ✨

Thanks so much!!

Transcript

Transcript
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Marisha: Hi there, and welcome to the SLP Now Podcast. We have received several questions about social language groups, and I cannot wait to dive into this topic with Dr Anna Vagin today. Anna Vagin is a licensed speech language pathologist with over 30 years of experience and in her private practice in Marin County, California, she provides individual services and social learning groups to children, young adults and their families.

Marisha: Her particular interest is in using media to support social thinking and students with diagnoses such as ASD, ADHD, NVLD, language disorder, anxiety disorder, social communication disorder, and twice exceptional. She clearly has a wealth of knowledge and experience that she is going to share with us today. If you've heard of Dr Anna Vagin, you might be familiar with her books, Movie Time Social Learning and YouCue Feelings: Using Online Videos for Social Learning. Those are some really great resources that I've loved. Without further ado, let's dive into our conversation with Dr Vagin today.

Anna Vagin: How are you? Thanks for having me on today.

Marisha: I am so incredibly excited for this conversation. Like we were talking about before, we've gotten so many questions about social language groups and I was incredibly excited when you agree to the interview, because I know you'll be the perfect person to break this all down for us. But before we dive into all of those questions, can you tell us a little bit more about your experience and what led you to specialize in social language?

Anna Vagin: Absolutely. You know, I think we all take our path as our work career unfolds. When I was an undergraduate at UC Santa Barbara, back in the late 70s, I studied with Carol [Prutting 00:02:07]. Carol Prutting was really at the forefront in the field of speech language pathology, thinking and talking and teaching and researching the area of pragmatics, which for the younger listeners before we had really information on social cognition and social learning, it was really about pragmatics, about how to use language. What led people to use language better, and what sometimes help people back and how we could help them with that. Really from my undergraduate career on, I was very interested in pragmatics.

Anna Vagin: When I went back for my doctorate, I had two additional experiences that really helped me, I think develop where I am, especially in how I consider the importance of emotional development and feelings. Because, I studied in a very finite area called attachment theory which looked at, how do infants attach with parents? How do parents foster attachment in their children, with Mary Main over at UC Berkeley. I just learned so much from her and it really opened my eyes to looking at communication and interaction through a different lens and that was really exciting to me.

Anna Vagin: Then I also had the opportunity to work with Anne Fernald down at Stanford. Anne Fernald focused on baby talk, child directed speech, and studying it internationally and looking at very, very young interaction. And again, once I learned how to set up split screen cameras and recorders, and there were so many wires, I was way overwhelmed, I really loved looking at this interplay between two communicators and learning about how it developed. Somehow, that led me to as I was developing my practice and there were many more students being diagnosed with autism spectrum disorder, it just unfolded in that way. I absolutely love what I do, I love the students and families with whom I work, I love talking about this topic and I really appreciate the opportunity for us to have this conversation today.

Marisha: I just love that story. That's so amazing. It's always fascinating to hear all the little pieces that lead us to where we end up. It's just super exciting. That was super helpful. Let's just dive in and talk about how we set up the social language groups, because you actually set these up in your clinic, which is really interesting. But, how do you figure out which students can be grouped together? How do you make those first decisions?

Anna Vagin: You know, I think the more you do it, the better you get at it and the more you can anticipate good groupings and more importantly, anticipate groupings that you do not want to put together. Because, a good group is magical and the growth is just ... It's a fabulous place to be. On the flip side of that, a group that is not working can really be unpleasant. I think we have to really be careful and look not just at age, or grade level, or schedules, although sometimes that will influence how we put students together because reality can sometimes be a factor as we make these decisions.

Anna Vagin: All of the groups that I have work on social cognition, but there are subgroups underneath that. I may have a group that is more focused on anxiety, I may have a group that's a little bit more focused on regulation or on anger management, or a group that's a little bit more defiant, or a group that needs a little bit more support on narrative and language processing, or a group that is super smart academically. I think, sometimes what happens when we put children together in a group or young adults is that when they come to the group, they look around at the other members of the group and they think, "Is that who I am since I'm in this group?" We really want to support students as they go through that exploration then to do that, the more carefully we put groups together, the better.

Anna Vagin: Now, I also usually take students who are not in the same school. Sometimes I will make an exception, but it's very, very rare, and I'm able to do that because I'm in private practice. Obviously if you work in a public school setting, you cannot do that. That also can have benefits, but I find that being outside of a school system where I can't be frequently on the blacktop or in the classroom, I prefer to have the schools be separate. And again, because I am not in a school setting, I also look at parents because I want the parents to be compatible.

Anna Vagin: Oftentimes when I have a group that's meeting, I will also meet with the parents outside of the kids session. And again, I want parents who will look at each other and often feel, "That parent understands me. I know what that child is like, I can give support to that parent." I have these overarching subgroups that I think are very helpful.

Anna Vagin: I want to also say something about those defiant students that we have. The students who may not recognize their challenges, who may be more on the continuum of liking to argue, not always very kind. First of all, I don't want one of those children in each group over three hours, because then I have three hours of dealing with a child who was going to challenge me on patience, and on kindness, and on helping them move through their defiance and move through their argumentative nature.

Anna Vagin: If I put them all together, they get a taste of their own medicine, which is very, very helpful, because they'll sit there and argue, and argue, and argue with each other and they'll say, "You're a jerk," "Well, you're a jerk to," and all of a sudden it's like, huh, huh, am I looking in the mirror again? That looking at the group members and thinking, "Is that what I'm like?" For a lot of students, that can really be a breakthrough of, "I don't really want to be like that. How can we change?" And, how can we find solidarity and find shared interests, even though we may be a little bit prickly with everyone?

Anna Vagin: Because I'm in private practice, I also have ... I'm very, very lucky with my work, because I can work with the same group of kids for years and for many of our students with social cognitive challenges who don't have a lot of friends. Sometimes the friends they have in group are the only friends they have. It's very important to them, it's important for students to be able to find those who are similar to them and who understand them and who they understand. I have a couple of videos that are very powerful of students talking in group about deaths in their family.

Anna Vagin: If we think about, obviously all of these students will have death touch their family at some point, often with a grandparent or a pet. Whereas when you're a typical peers, students who have friends have other kids they can talk to about this and get some support. But these students without friends, they need to hear it from peers to, they need to be able to share it. I think that's one of the most powerful things that a group can do, is provide a family for some of these students where they can get support, they can share a sense of humor, they can share those common interests.

Anna Vagin: I had a group a while back and oftentimes I'd give them, I don't know, eight to 10 minutes of free conversation. I'm usually out of the room, I want them practicing conversation. Can you stay appropriate? Can you do what's expected when I'm not even in the room? They had this incredible conversation on, what is your favorite element in the periodic table? This was lively and they were laughing, and they were experiencing what friendship gives sauce. But, it was about a topic that many students in their schools, they don't want to talk about what is your favorite elements on the periodic table. We want students giving and we want students getting from their groups.

Anna Vagin: It is a challenge, especially with schedule limitations but, again, the other thing I think is important is if you have a group that is not working and you really feel the ship is sinking, you can try to, you know, how can you change a group? Could you change what you're doing? But you also have to know when to call it a day and say, "You know what, I think we're going to reconfigure this group," and go back to the drawing board. Often only one little change, sometimes taking a student out and putting them in another group, all of a sudden the group works. You have to be willing to experiment when experimentation is called for.

Marisha: So many amazing nuggets in that answer. I was scribbling away different notes, but I just resonated with the, a good group is magic, that is a good quote there. I love the idea of with the challenging students, giving them a taste of their own medicine because it's really powerful. It made me think back to some of my social language groups where we did some video modeling and they saw themselves on video. It was a student just like that and seeing himself in that video was like, "Oh, I do that?" I think it's even more powerful if they can see their peers and experience that emotion behind it to. That's so powerful.

Anna Vagin: I totally, totally agree with you that video taping and then having students watch video tape is an incredibly powerful tool. I have two very different examples about that. One was, I do think ... I had a student who was very argumentative, and kind of chest puffing and I had a really good clip that I had recorded of him with another student. The student's really giving him that nonverbal information that he's missing that's saying, "You're really not being very pleasant right now," and I wanted to show it to him.

Anna Vagin: But, he also was not very resilient. He had that combination of full of yourself, but also that is hiding that you're very non-resilient and very sensitive. I think with some students the review, if we can do it one-on-one can be better than doing it in front of the group. I think sometimes that video review is best done if we can find a time to just show it to the student, because we don't want to call a student out on their behavior in front of a group when they're not able to tolerate that.

Anna Vagin: Many students will look and they'll get feedback from each other and they're like, "Yeah, I was a jerk. I get that." But other students, I could just see this one. If I had done that with this student, he would just have turned red as a beak and he would just have been fighting back tears and have felt terrible. I think we have to use that clinical judgment in how we show students videotape of themselves. Some of them are not quite ready to see what they're like in real life. That's one vignette.

Anna Vagin: Then very recently, I was videotaping two students, and I was playing also because I use games a lot for building resilience and for managing feelings. We were playing this thing I invented called Rule Change. Rule Changes I when you have a very basic board game. We were using a game called Race to the Roof, which is basically a Candy Land type game. There's a board, you roll the dice, you move, or you get a car that takes you forward or back. That's all good and well, but it's kind of boring. It's not the most exciting game to play for an extended period of time.

Anna Vagin: So, Rule Change is every minute, you change the rule. We were playing, I might have the rule that if you roll an odd number, you go back 10 spaces. I make up a rule, we play by it for one minute, that's it, and then the next student makes up a rule, whatever rule they want. One student had if you roll an even number, you go back to start, kind of a cutthroat rule, but that lets everyone practice being uncomfortable, and worried, and happy.

Anna Vagin: One student was doing really ... Both of these guys were loving doing real change. A lot more conversation, a lot more social engagement than if you're just rolling and moving. Every time that student that had to go back, we could see it on video and I said, "How big was your mad there?" He say, "I think it was a two." We use a one to five scale. We watched again and he said, "No, that was a one. I handled that really well." He was able to see himself doing something that is incredibly difficult and even as he watched the video, he was angry that he had to go back. He was angrier watching the video that he had been actually playing the game. And so, I agree with you that video is so, so powerful with our students, letting them see their successes and take a look at some of the things that they may still need to work on.

Marisha: I love those examples, so incredibly helpful. And that Rule Change game is a game changer I think. I've never done that, but I think I want pull that out next time because that is such an amazing way to ... I imagine that there are so many opportunities that come up in that.

Anna Vagin: Yes, yes. Actually, I did a training Tuesday and I showed this video. The audience, they were just shocked at how engaged the students were, and how happy they were, and how nervous they looked, and how excited they looked, and how worried they were sometimes, but they got through it and enjoyed it at the same time. Because frankly, how long can you play Candy Land by the real rules? You could play a long time before someone wins and it has to be interesting for everybody, it has to be fresh. I'm glad you liked that. Good luck with it, it's fun.

Marisha: I'm so excited. All the opportunities for all of the social language calls with that one. Amazing, thank you. Going on to the next question, how do you set up your group? You shared so many great ideas for that embedded practice of the skills, but how do you set up your students for success before going into like playing a board game or whatever other discussions they're having? Do you have any ... Maybe starting with visuals would be a good place to discuss?

Anna Vagin: I think it's so wonderful that you're bringing up visuals because they're really critical for the students with whom work, even the students who are really smart academically. I have many, many conversations with teachers and therapists who are struggling with some of these students on the autism spectrum, who we would've referred to them as having Asperger's. They're very smart academically and they have a lot of language. I'm often saying to teachers and to therapists, "It doesn't matter if he has a lot of language and is a good processor, because he will not have good language and good processing about emotional information and about social information," and so the visuals are critical.

Anna Vagin: I'd love to go over several of them know. The first one, and this is a good starting place for new groups. Sometimes kids have worked with me individually and sometimes they haven't. They've all met me individually, and some of them may have had even two or three appointments. Particularly if they're on the anxious side, I want to really know them and have them know me and know what their strengths are so I can speak to those in group and bring those out. But, there's a ... The diva, queen of executive function for me is Sarah Ward, and I hope your listeners know her. If not, look up Sarah Ward, find Sarah Ward and run, don't walk to her workshop, because you will never be the same.

Anna Vagin: One of the things that Sarah Ward talks about in figuring out helping to support students in expected versus unexpected behavior is the OODA Loop. The OODA Loop Sarah Ward did not invent. That's a term that you can find on Wikipedia, O-O-D-A, and then the word loop. It's how fighter pilots know what to do and how to keep scanning the environment and making changes in their behavior, which is what we want our students doing, which is what we all do, hopefully all the time. Observe, orient, decide and act.

Anna Vagin: Now, Sarah's contribution to this is that when you orient, you have to orient to space, time, objects and people, because that's how you know what is expected. We can't start with, oh, what's expected in group? We have to go back to, let's figure out where we are and what's happening, because that will guide what is expected. For example, I'll do a really super fast OODA Loop right now. Marisha, I'm on line with you, I'm doing this podcast, it's going from ... We're on for about an hour, it's Friday, I'm at my office. This is all giving me information about what's expected.

Anna Vagin: It's not expected right now that I start folding my billing that is on my desk. It's not expected that I stop and put hand lotion on, even though I have hand lotion on my desk. There are many things that are unexpected. I have a brace on my hand because I had surgery, I can't undo the Velcro right now, that would be too loud and it would be disruptive. So, what am I supposed to be doing? What is expected given that I'm doing a podcast right now online? Well, I'm keeping an eye on the time to see how are we doing in our time frame. I have a little crib sheet of topics that you and I said we would talk about. I've got that here. I've got my water in case I feel I need to take sip. I'm making sure that my internet stays on, and my podkit and my little AirPods are working. That's what's expected.

Anna Vagin: That's a great place to start with our students. We're here in social group from two to three. Does that mean it's time to be laying on the floor? No. What is expected and what is unexpected? We generate this list based on the OODA Loop. Then oftentimes we have that list available then when they come in. There is our list about what we know about group. This is what is expected when you're here and this is what's unexpected. That's a behavior oriented, social behavior oriented visual.

Anna Vagin: Another visual that I find I use all the time are these feeling trackers that I have made. A feeling tracker, very easy to make. Mine are on foam board, a little eight and a half by 11 foam board and there are four one to five scales. On one side we have a happy, and that goes from one to five. Then at the bottom it says okay. Then I have the trifecta of uncomfortable feelings, sad, mad and worried. Each of those has a little one to five scale and an okay at the bottom, and then each of these columns has little sticky notes.

Anna Vagin: What students learn to do is, for example as we're playing a game, Marisha if you and I are playing a game, we're playing Monopoly and I get all the greens, I might move my happy marker up to like a two, yeah I'm doing pretty well. But then you get all the reds and all of the railroads, and I moved my worried up a little, maybe to a one and a half. Maybe I get a bad rule and I'm in jail, I'm sad a little bit to a one. Then you get Monopoly place, I'm sorry, then you get Boardwalk and Park Place and I met at a three. You use these for students to indicate how they are feeling at any given moment because as we know, feeling this coming combination. I might not just be mad, I might be mad and worried.

Anna Vagin: In addition to that, with the feeling trackers I have posted feeling fixtures and game playing fixtures. Let's say that you just got that Boardwalk and Park Place on Monopoly and I'm mad at a two and a half. I thought I was going to win. I had all the greens, I had all the utilities, I bought the railroads, but then you go and you get Boardwalk and Park Place, which as we know are the two best. I'm at a two and a half. I look at the feeling fixtures and the feeling fixtures say things like, it's okay, it's just a game and I'm like, "Oh yeah, it's just a game."

Anna Vagin: You know what, I'm not going to be mad at a two and a half. I'm just mad at a one and a half, and so I can move that feeling tracker down. I'm not really sad anymore because I like you, you were fun to play with, I move my sad tracker down to okay. In my practice, that is a critical, very important visual support.

Anna Vagin: I think maybe the third and last and then I'd love to hear your reactions to this, is I have students do a lot of illustrating themselves, and writing and drawing up situations that they're in, feelings they've had, experiences that they're going into, worries they might have for the future. Because when we ask our students to draw, first of all even students who don't have good fine motor control ... I'm the worst artist on the team anyhow, so they're all better than I am in some instances. Their drawing, even if it may be rudimentary will show us their understanding.

Anna Vagin: It'll show us what they know about facial expression, it will show us what they know about perspective taking. Most of my students now I want to see talk bubbles, I want to see thought bubbles. That will tell me, does the student have perspective taking in place for whatever situation they're illustrating? I think having students make their own visual supports in some ways, if I want a student to tell me about what might have happened on the blacktop that didn't go so well, I'm going to first ask them to illustrate it. It may take for big marker boards, because I'm looking for a progression of events.

Anna Vagin: They may draw one scene and I might say, "Oh, wow! What happened after that? Can you draw me what was next?" Or, "Wow! That's so interesting. What was happening before? Draw me that picture." Because then we can really break it down and make it visual. If it's visual, the learning will be deeper, the conversation will be longer, students will stay with it longer, they'll be better regulated. It's just a win-win situation when we have students drawing social issues and abstract concepts. Those are my first three biggies.

Marisha: Oh, my goodness, mind blown.

Anna Vagin: Did I do too much?

Marisha: No, so good. I've heard you present and other presentations and I've heard some of these ideas before, but it's just so, I'm so excited that they're all in one nice little package now. But yeah, I love the idea of the OODA Loop. Just to recap, that's observe, orient, decide act?

Anna Vagin: Yes. Everything guys think about OODA Loop is Sarah Ward's work with the stop, orient to space, time, objects and people. That is totally Sarah Ward's work. I just worship her.

Marisha: I've heard her present a couple of times to, she's amazing.

Anna Vagin: It's a whirlwind.

Marisha: Yeah, so good. That is an ... Go ahead.

Anna Vagin: I didn't mean to interrupt, but I want to just pop something in before it leaves my social cognition. One I've learned over all these many years, you reminded me how many it is in the introduction, I think I've learned to be more patient with how quickly I want the work to go. We all want results overnight, we really do. We want results on the blacktop, we want parents to see the results when they go on vacation because we want parents happy. We really want things to happen quickly, sometimes even in our therapy session because we've made this plan. We have our lesson plan and this is what we want to cover.

Anna Vagin: But, that doesn't mean we will get through it all in a particular session. Because when we talk about having students illustrate, I'm not going to rush a student through their illustration just because I'm looking at the clock. It's really hard sometimes not to do that, especially if you have three or four kids drawing and there's always one who's a little bit slower, who takes a little bit longer, then asking others just, "Could you add more detail? Could you add more thought bubbles? That looks terrific, I wonder if you could add a little extra to it."

Anna Vagin: Because I think we really need to be patient and respect what we learned in Psych 101 about assimilation and accommodation. We can only push a brain to change so quickly. We can't make it happen any faster than it will. I think once we come to grips with that law of brain function and development, we can relax a little bit and not feel, "Oh, I've got to get through this. I've got to get through this, I've got to get through this." Because while it's true, there are only so many years before kids are out of the school system, kids are heading off to college and the job market, so every hour is precious and needs to be used in the best way possible. I think often that best way possible includes patience and a slower pace on our part, which I struggle with daily because I like to be quick.

Marisha: That is such great wisdom and I think that can ... Because, it is okay for these processes to take time. It's a big change for these students. They're big skills that we're tackling, so I totally agree and I love that you're reinforcing that, and it's okay to just take it a little bit slower. We're not going to conquer the whole social language world in one session and that okay. It might take several years, but that's okay.

Anna Vagin: It might take several decades. It can take a long time. I'm seeing more and more young adults in my practice. The first wave and a half after all of this work on social cognition has been available and there's still a lot of challenges. It takes a long time for maturation to kick in, for students to want to really change and for them to be really focused on what they want. It's a big job and it's hard to be in the trenches sometimes doing this work.

Marisha: Yeah, that's so interesting. That would be a whole other conversation, talking about navigating this with young adults. Oh my goodness, so good. But yeah, I love the three visuals that you shared. Definitely storing the OODA Loop and Sarah Ward's additions to that, and the feeling trackers. Do you have examples of those anywhere or is that something you just made on your own?

Anna Vagin: I made them. I use them when I ... Pretty much always when I present now, I show them either in slide form or in person. When I presented on Tuesday and I was presenting about games, I had three volunteers from the audience to play the game and to use the feeling trackers, and then I had to therapists play therapists. They were the ones holding the game fixtures and the stuck fixtures, all these thought bubbles that would bring feelings of discomfort down. Every time I do this, it's very funny, people really like doing it although it's hard to get those first volunteers.

Anna Vagin: The first time I think I presented this at ASHA, I had such competitive volunteers. Oh my word, they were getting mad and they were getting worried, and they were sad. They were all over the map with their emotions. It was a great example of initially when we think of games, we think, "Oh wow, they're fun." Yes, as long as you're doing well and even if you're doing well, you can be worried that someone's going to catch up to you, someone's going to pass you. I've had one student, he finally went the game and I said, "So, how was it?" He looked exhausted and he said, "I'm so happy I won, because I don't have to feel uncomfortable anymore."

Anna Vagin: I think talking with parents also, and I spoke with teachers this week also that games are great, but games for many of our students are very stressful. Some of these students are very competitive, some of them are very sensitive, some of them have no resilience and game playing for them is not always a good time. It's filled with worry, and frustration, and sadness. It's hard to even enjoy being ahead because my gosh, what if someone passes me or what if I don't end up winning? I so want to win. I think we've had this conversation, I use games a lot for a variety of things because they're so powerful and right now is a very exciting time to be using games, because the game developers have just taken off and there are amazingly fabulous games out there.

Marisha: What are some of your favorite? Can you give us like three favorites?

Anna Vagin: Only three? How can I do only three? I'll try to do only three. Often I have students play cooperative boardgames, or cooperative games. If they're really competitive, I want them all to be competitive together, although even that for some is different. So, cooperative boardgames games. I really like Mole Rats in Space, number one. It won all the ... It's an award-winning game. It's kind of like Chutes and Ladders, but much more interesting. Mole Rats in Space is fabulous.

Anna Vagin: A cooperative card game that is very interesting, is called Hanabi H-A-N-A-B-I. This is a fireworks building game played with cards. You all are building fireworks together but the trick is, you see everyone's cards but not your own. You hold your card facing out, so you cannot see them. Isn't that intriguing? And knowing how impulsive some of our kids are, they're going to want to peek.

Anna Vagin: Anyhow, moving on. Another absolute all time favorite right now, these are competitive games now. Ice Cool. Ice Cool won all the awards a couple of years ago. I mean, they swept the awards. This is a flicking game, where you flick penguins through doorways. It is a fabulous game. You may be thinking, kids we see are not going to be good flickers. Not true, they're the best wonders I've ever seen, and now there's an expansion pack for Ice Cool. Dragonwood is another really great game. A good game, third graders were like them and high school students were like, that's a good game. It's not bound by age. Dragonwood is a fabulous game.

Anna Vagin: One of my new all time favorites is called Pyramid of Pengqueen. This is made by the makers of Ice Cool. It is a fabulous game. It's kind of like Battleship because it has that vertical board. You're either playing as a treasure hunter or you're playing as the mummy and everybody ... It's a magnet moving game so if the mummy gets you, they drag you down into the sarcophagus. It's great, love it. Kids really are liking Pyramid of Pengqueen.

Anna Vagin: I guess my last go-to right now is called Sushi Go. Sushi Go is a card game. Get the first set. Don't go for the party pack immediately because the party pack is very complicated. But Sushi Go again, I'm in California, all my kids eat sushi. I like sushi, so it's a really fun game. And Yamslam, actually a dice game. That's the one I do when I do a demo. Yamslam is a dice game. There you go. I think I was down to five maybe. You said only three, but there are so many and we haven't even talked about video games. There are so many great board games right now.

Marisha: That's a great place for us to start looking to maybe refresh the games that we're using in therapy with these groups. I so appreciate those different suggestions.

Anna Vagin: A tip about games, because I don't like having to figure out a game. I don't like having to read the instructions. For me they're not always clear, I'd start trying to play the game. If you go on YouTube, now you can always find a four minute, a 10 minute YouTube video that tells you how to play the game. So, no more of this trying to read the directions in a 30-page direction thing. Watch the YouTube on how to play the game, it's a shortcut.

Marisha: Oh, I love that, that's good. That in and of itself as a whole activity, is getting the students to understand and agree on the rules of the game.

Anna Vagin: Yes. Often when I have a high school or a college group, I just give them the box. I give them Mole Rats in Space because it's a group that likes to play games, and I say, "Okay guys, have fun," and they have to, I mean, sometimes it takes a minute just to open the box. Well, let's open the box. It's an executive function task, it's an incredible social task. Who's going to be the leader in this? Is it always the guy who's the really good game player? Sometimes he ays, "You know, I just don't want to do it this time. Someone else ... I always have to teach you guys. I don't want to do it this time. Someone else has to pick up the ball." There's a lot of room for ... What we're looking for is social engagement, figuring out how to make life work, so I love just giving it to them and just say, "I'm out."

Marisha: Yeah, that's so great. And then in terms of, because you talked a little bit about some of the visuals for behavior management and the expectations of the group. But, are there any tips or tricks that you have in terms of setting the group up for success when it comes to behavior management and those expectations?

Anna Vagin: You know, my groups generally have a framework. Pretty much every group starts with, tell me a comfortable and an uncomfortable feeling you've had today. It doesn't take very long. We just go around, tell me an uncomfortable feeling, and no, hungry is a body feeling, not a heart feeling. We were wanting to talk about sadness, anger, anxiety, those types of feelings, but we also want to say, tell me a time that you felt good today, do you recognize that?

Anna Vagin: We'll go around and do that, and sometimes I'll ask other students for suggestions. Has that ever happened to you? What tips could you give him? How could he handle that next time? Because, there's often patterns of somebody did this to me in PE or something like that. We can have some peer support happening there. Sometimes there will be newcomers to group who will say, "I don't feel ... I never get angry. I never get sad. I had a great day, felt good the whole time," and I'll say, "Well, we all feel uncomfortable sometimes. Every day we'll feel uncomfortable."

Anna Vagin: That's okay, because for that student just to hear other students sharing their discomfort is moving them forward and usually after a couple of weeks, "Well yeah, I did get just a little bit angry today," they'll start coming out of the background on that and start recognizing their feelings. We always start with that. Then usually there's a "lesson" period. That might be working on structured conversation practice, we might be watching a YouTube and doing something with the YouTube, we might be ...

Anna Vagin: I've been playing around a lot with Michelle Winner's Thinkables and Unthinkables lately, really emphasizing the Thinkables, which came out much later than the Unthinkable but I think are incredibly powerful. I'm finding that many of the students have seen the Thinkables and Unthinkables but are only doing a one to one correspondence, so that Rex Flexinator, the flexible one only matches up with [inaudible 00:41:41]. I'm trying to break that apart and say, "These can come in teams so if we're feeling you know worried, there are multiple Thinkables who can be on the team that helps us."

Anna Vagin: Really we're watching YouTube's thinking about the Thinkables and Unthinkables. We might be working on texting with my older students. e might have a formal lesson on texting, we might have a more formal lesson looking at perspective taking. And then because my sessions are an hour, there's a lot of time, we'll always do some kind of a practice in action situation. That might be about playing a game, or it might be doing a building project. I have a lot of interesting materials that are like tracks, and trains, and ramps and elevators, called Rokenbok. That's a fabulous system, takes up half a room. Working on sharing, cooperation, sharing imagination together, or playing a video game.

Anna Vagin: When we're going into that unstructured time, we will usually preview the activity. For example, let's say that four guys are going to go into play with the Rokenbok which has remotely trolls, and cars, and trucks and elevators, balls and all this huge system. What challenges might we face when you're going off to do that? Well, last week we noticed that some of you went off and were doing your own thing. Remember, being in group is not being together. You can go off if you need to take a little break, but then how are you going to get yourself back in group. You're going to remember you need to get fresh gum if you need gum.

Anna Vagin: I remember we had this thing last week where people were kind of taking over each other's trucks that really was not very cool last week. Do you think that might happen again this week? You never know. How are you going to handle that? Remember, you're going to stop and notice that other people have thoughts. You're going to remember it's a time when you have to say sorry, you might've done that inadvertently. If you're making a plan together and you're arguing, that might happen. What are you going to do when that happens? How are you going to keep control of your feelings and stay regulated and remember to work it through?

Anna Vagin: We'll always preview the activity and what could go wrong and how you're going to fix it, and then preview, what do you want to be doing? What are we focusing on? Because one thing to remember again, many of our students are so good at telling us whether they're not supposed to do. If you say, "Well, when you're playing the Rokenbok, what are you supposed to do?" "Well, we're not supposed to fight< we're not supposed to argue, we're not supposed to do this." When we say, "What are you supposed to do," they're like, "Get along?" "Well, what does that mean?" "I don't know."

Anna Vagin: We might have something like, "What are you supposed to do if you're sharing imagination?" "Well, it means that we're being flexible. It means that we're putting our ideas together. It means that we're stopping to listen to each other." We want that also to preview, what are you working on? What are you practicing? Maybe you're practicing being a good sport, maybe you're practicing not bragging when you get ahead in a board game so that kids know what they're working on both in problem areas and tools, triggers and tools we call them or, "This is what you want to focus on, because I know you're working on it. You did really well last week, keep it up this week." So, always previewing I think is super important. That's how my sessions generally go, kind of the framework.

Marisha: That is incredibly helpful. That was such a good framework. I feel like I can picture what you're doing in the session, which is always amazing. So yeah, I love that. Can we dive in a little bit more in terms of the explicit teaching component? Because you shared a lot of different ideas. I don't know if we maybe just want to pick one to dive into a little bit more, but you talked about, like the second, you have your where each group members shares a comfortable and uncomfortable feeling and you have discussion around that, and then you transition into that lesson period.

Marisha: Some of the examples you gave were like that structured conversation, YouTube, you gave the example of Michelle Garcia Winner's Thinkables and Unthinkables. You also gave the example of texting and perspective taking. I know that we could be targeting ... There's so much we could target in that lesson period, but do you have any general tips for success when you're doing that explicit teaching, or if it's easier to dive into one specific example?

Anna Vagin: What if we dive into narrative and Story Grammar Marker?

Marisha: Yeah, let's do it.

Anna Vagin: Okay, because I think ... I love Maryellen Rooney Moreau. She's another person I just worship because she's given us so many amazing tools. Even though Story Grammar Marker at its foundation is for narrative, it's so important also for social understanding and for conversation. Although you may not initially think that, because what do we need for conversation? We need to be interesting, we need to be able to tell a story. We need to be able to put our words together.

Anna Vagin: If I'm focusing on using Story Grammar Marker, we might watch a video and then every student has to ... Let's pretend that these are, I don't know, fourth and fifth graders. Every student with their marker board has to maybe think of a critical thinking triangle, which is a kickoff. Something exciting happened, there was a feeling and then there was a plan made. Maybe everyone has to think of one that they noticed in that video and draw it, or illustrate it or fill it out, or write it down and then we share those.

Anna Vagin: The largest groups I have of school age kids is four. I don't have groups that ... I might have a group of five and middle school if I think I can make it work, because part of the process of a group is juggling that many students. When I do the structured work, that's why the drawing can be so helpful, because everyone then can make their own product. If we're doing something that is more freeform and verbal, it can be trickier to manage what happens with all the dialogue of four students trying to get their ideas out. I think sometimes it's good to try and even structure that a little bit with more ...

Anna Vagin: I had this example with, we watched this video called Game Changer, which has a girl character and a muscle man doll character. We were working on perspective taking and what I wanted the students to do was to one time, talk through the story in the character of the girl, which I was surprised to find the boys were very willing to do. Then, talk through the whole story from the perspective of the muscle man doll, because they were two very different perspectives.

Anna Vagin: We just were able to ... I don't have a rain stick, you know that conversation rain stick like if you've got the stick, you can talk. I don't have anything that formal, but we kind of like one student would talk, I say "Great, now you pick it up from there." We were able to contain the conversation, because I think in groups that's part of the challenge, how do I make it freeform but still not have it be chaotic? Because what we want is, we want students engaging with each other, but we also need to know when to step in and reorganize it and be the social cognition Butler who comes in and brings everyone up to speed on what everyone has agreed on, and then takes it forward more.

Anna Vagin: Because, I think that is a challenge. We have to go into the sessions ready to think, "How are we going to do that? Am I going to have every ..." With the Thinkables and Unthinkables, every student might've picked an Unthinkable, and then collected which Thinkable cards they think would be on the team to battle them. Part of it is I think having enough materials also that every kid has access to enough that they can do with. Does that make sense? Am I answering your question?

Marisha: Yeah, that doesn't make sense. That helps. I think just having, because you're like ... We're playing the role as the facilitator and the different things that we talked about in terms of ... Because you would do a lot of ... And we would come back to the framework like you said, of the OODA Loop. Like if we're getting off track or whatnot, we would just reference that and use that to manage. Just continuing to incorporate all of those different tactics makes a lot of sense.

Anna Vagin: And again, I think part of it is, the creativity part of what we do and the thinking on our feet. I have this one group they actually met last night, and one of the kids in this group is working on not ranting. He will say, "I go on Google Rants, and he does, where he just takes off like a rocket ship. He doesn't have eye contact anymore, he's just staring off into space and he is talking at 20 miles a minute and it's very hard to stop him. But he knows he's doing it, he's he's working on it, he kind of has a sense of humor about it.

Anna Vagin: And so, somehow somebody in this group around my office found this buzzer, this orange buzzer. I had ordered them all, they didn't do what I wanted and he said, "Buzz me," and so the buzzer is on the table in this group and anybody can hit the buzzer when they think he starts ranting and it works for him. He likes the buzzer whereas I would usually not think that the buzzer would be a good idea. But for this group, it worked.

Marisha: I love that. I think that's where like you were saying, it's that clinical judgment piece, especially with social language. It's definitely not like articulation where we can have a little bit more a manual and you all in terms of first this, than this and then this. That's where that clinical judgment comes in. We get to be problem solvers and we get to think on our feet and there's like that buzzer like you said, it works for that one student, but it might not work for just another student in the group, or maybe even that same student next month or last month.

Anna Vagin: Exactly, exactly. We have to be flexible.

Marisha: Oh, is that a social language concept to?

Anna Vagin: I think it is. It's one of those tough ones.

Marisha: Our world is full of it. We can never escape it.

Anna Vagin: Well, my students often say to me, "Don't you have to be flexible? We think you should be flexible on this and let us play the video game first." It's like, "Well okay, maybe you're right. I should be flexible." It's hard to be flexible and I can say, "It's really hard to be flexible, but okay, fine."

Marisha: That's so interesting when they turn on you to and use it for their goals.

Anna Vagin: That's what social communication is about. We all want to get what we want in a way that works for everybody and they were absolutely right.

Marisha: Yeah, I love that. That's so smart. The other question, because we talked about some of your favorite activities for those groups already, but I know you do a ton of work with YouTube and I ... You have another podcast. I will add this into the show notes if people want to find out more about how to use YouTube videos for these sessions, but can you give us just a quick overview, or maybe like one favorite example, just as a little teaser?

Anna Vagin: Sure. Well, the idea behind the YouTube ... First of all, a lot of research has been telling us that students on the autism spectrum, one of their big deficits is in processing social movement and if we know that from a number of studies, why are we working with pictures that don't move? That's the research support for using YouTube. There are fabulous, short, incredibly beautifully crafted stories on YouTube that are between two and four minutes in length that we can use to build emotional vocabulary, we can use them to talk with students about very abstract concepts like cooperation, like not getting along, like misunderstandings.

Anna Vagin: Many of the social cognitive ideas that we are working with are very abstract and they're very hard to explain. And so if we can show examples, or show examples of uncomfortable feelings, first of all, it's building their understanding of the concept. But, it's also building their comfort in talking about these important concepts as they relate to engaging characters, not themselves. It can be very hard for the students to have to face their own challenges right off the bat, but if we want to talk about, if we want to watch a super cute video, I'm trying to think of one of my new favorites.

Anna Vagin: Let's go back to Game Changer, the one with the little girl who's trying to win the muscle man doll. There's a lot we could just ... We can talk about how she's frustrated, she gets really frustrated. We could talk about how the muscle man changes his mind because he realizes something about her. She's very resilient. It's all these things that we can talk about. Talk with the students, and then often students will say, "Oh, that happened to me," or they'll say, "Yeah, my brother does that all the time. Sesame Street, Ernie accounts fruit. Ernie's just not listening to his friend. Kids will say, "My brother does that," or, "Someone did that to me yesterday in PE."

Anna Vagin: Then you're off to the races because now they're sharing of themselves. It can be very organic in how you start with the characters and the next thing you know, the group is talking about themselves and their own experiences, and helping each other or relating to each other. What we really want ... I've been doing a lot of work on annoyance. Being annoying and getting annoyed, because I think it's a huge thing for our students. The way that after watching some videos kids are able to say not only through the top three things that annoy me, but things that I do that annoy others.

Anna Vagin: Then we were able to talk about, "Okay, so you do these things," and some kids were saying, "I like doing them. I like annoying other people." "Okay, if you're telling me that you like annoying other people, we've got to work on that feeling first before you're going to change, because I can talk till I'm blue in the face about how you should change but if at your core you is still like nudging people, we got to deal with that first." I just think that YouTube is really engaging and engaged students learn deeper, and better, and more easily. It makes the learning more fun. As students get older and they've been in therapy for a long time, they've seen a lot of these materials and they're like, "Oh man, this again. I already know that, I've already done that." We have to excite them about this social learning, and I have yet to find a student who doesn't want to watch a YouTube video.

Marisha: That makes so much sense. Like I said, I got to take some of your courses in the past and I've been able to implement some of it, but they're just so incredibly powerful. I especially resonate with the idea that it's easier to talk about other characters, because sometimes students can be resistant initially. It's just so helpful in this super engaging format, because I love literacy based therapy too, but the fact that it's a movement just like the social world is also incredibly powerful.

Anna Vagin: And the stories are so lovely. There are lovely, beautiful ... Some of them are fun, but like Soar by Alyce Tzue, it is a beautiful story. She just tells a great story in just a few minutes.

Marisha: Yeah, and they're so short to, you get so much bang for your buck. The students love it and it's like, how can we not do this? I will definitely share the link in the show notes, or lots of links in the show notes to all of the different things that we talked about. I'll also share the link to the podcast where you dive into all things YouTube, as well as your books which have amazing resources for using these books as well, or YouTube and other movies.

Marisha: That can be found at slpnow.com/26, but Anna thank you so much for your time. This was incredibly helpful. I know that the listeners are walking away with tons of practical tips and strategies that they can use with their social language groups, so thank you so much for sharing all of that with us.

Anna Vagin: Thank you for having me on. I've really enjoyed our conversation today.

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Filed Under: Podcast Tagged With: Language, Mixed Groups

#025: How to Navigate Bullying with Students Who Stutter

October 23, 2019 by Marisha Leave a Comment

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In this week’s episode of the SLP Now podcast, I got to sit down with the Nina Reeves to talk about how we can best support students who stutter and get bullied.

But first, a bit of background about Nina: She is a board-certified specialist in fluency disorders for Frisco ISD, a fluency specialist consultant for the San Diego Unified Schools, the author of several amazing clinically-based materials, the co-owner of Stuttering Therapy Resources, a recipient of numerous awards for outstanding contributions to speech therapy in public schools…and more.

Suffice to say this conversation was really illuminating for me, and it comes at a really great time for a couple of reasons.

First of all, I have been getting so many questions from the SLP community about how to handle this topic — bullying is tough to navigate at the best of times, and it’s often a bigger problem for students who struggle with disfluency than it is for their peers.

Secondly, October is Bullying Prevention Month, and this upcoming Wednesday (10/23/19) is Unity Day — a day to wear and share orange to show we are together against bullying and UNITED for kindness, acceptance, and inclusion.

One of the messages Nina is most passionate about sharing is that stuttering is okay, and a big part of success in speech therapy is accepting that. If we understand that, we can educate others and help to dispel some of the stigma around fluency — hopefully minimizing some of the bullying that accompanies that stigma. 💪

So grab your beverage of choice (I’ll have…something orange?), put your feet up, and listen in!

Key Takeaways

– What led Nina Reeves to become a fluency expert
– What is the difference between bullying and teasing?
– What the research tells us about bullying for students who stutter
– What an SLP’s role is in decreasing the impact of bullying for students who stutter
– How we can help to change the conversation about stuttering
– Focusing on the facts surrounding fluency
– Helping a child who stutters to understand bullying, and setting them up to respond
– Shoring up support systems: parents, teachers, siblings, and peers
– How to be stakeholder savvy and set up support systems
– What can SLPs do to support the parents of a student who is being bullied?
– What can teachers do to support their students?

Links Mentioned in the Podcast

– Langevin and her colleagues (Research on bullying and children who stutter)
– National Stuttering Association
– British Stammering Association

Find Out More About Nina

– Web: NinaReeves.com
– E-Mail: [email protected]
– Stuttering Therapy Services & Seminars
– Stuttering Therapy Resources
– Ongoing Blog and Upcoming Vlogs
– Clinical Guide and workbooks for dealing with teasing and bullying for SLPs, students who stutter, and their stakeholders
– Clinical Guides for comprehensive information of both EC and SA stuttering therapy
– OASES

Subscribe & Review in iTunes

Are you subscribed to the podcast? 🤔

If not, sign up today to get the latest episodes sent directly to you → Click here to subscribe in iTunes!

Bonus points if you leave a review while you’re there! Your reviews help other SLPs find the podcast, and I just love reading your feedback!

Click here to review → select “Ratings and Reviews” → “Write a Review” → let me know what your favorite part of the podcast is.

Thanks so much! ☺️

Transcript

Transcript
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Speaker 1: Hi there and welcome to the SLP Now Podcast. I am so excited to be introducing our guests today. Nina Reeves will be answering a bunch of our, the questions that you guys have submitted related to navigating bullying with students who stutter. I have read her books and resources on this and I know she's going to share so many amazing tips with us and I think this might even apply to other students on our caseload. So, definitely listening.

Speaker 1: A little bit about Nina, she is a board certified specialist in fluency disorders and she is also a staff fluency specialist for Frisco ISD and a fluency specialist consultant for the San Diego Unified Schools. She's a nationally recognized workshop presenter in the area of fluency disorders, and is an author of several amazing clinically based materials. She is the co-owner of Stuttering Therapy Resources and she's also a recipient of numerous awards including the Ash Foundation Van Hattum Award for outstanding contributions to the public schools, and most recently she is also the recipient of the Ashes Certificate of Recognition for special contributions in preschool through grade 12 education settings.

Speaker 1: So she is definitely a well established expert in the world of fluency and has made so many amazing contributions to the field, and I cannot wait for her to share her wisdom with us when it comes to working with students and navigating bullying.

Speaker 1: Before we jump in, Nina, can you tell us a little bit how you started on this journey and how you came to be such an expert in this area of fluency?

Nina Reeves: Oh, well that's a tangled word. First of all, thanks for having me on. I'm really excited to be back with you. We've done some things in the past and I've always really enjoyed them. The, how did I come to learn? Well, it was purely accidental. I actually had speech therapy when I was a child. I had a cleft palate, and so I had a speech therapist from the time I was three years old, all the way through eighth grade. I knew I was going to be a speech therapist when I was seven or eight years old, maybe nine. I knew my career choice.

Nina Reeves: But of course I was going to work with oral facial anomalies and I was going to work in cleft palate world. But the universe has different choices sometimes. After I graduated I went to work in a small rural school districts of Illinois and met my first actual student who stutters, who wasn't just in a clinic. I knew after very little bit of time that I didn't know enough, and that I was only doing a small bit of good for this young man and he needed me to know a lot more about what I was doing.

Nina Reeves: So I did a lot of self study and a lot of jumping in and getting involved in the stuttering community and being a part of the National Stuttering Association, and going to Stuttering Foundation workshops and reading everything I could. Then I started to hang around with people who were really smart in this area as well, and it's just been a complete professional learning all of my career. But I'm very passionate about this area of our field.

Speaker 1: That is such an amazing story. I got some goosebumps. So cool. Thank you so much for sharing that. Let's just dive into all the nitty gritty details. Can you break down a little bit for us? What's the difference between bullying and teasing? Just a little bit of the research and what that tells us about bullying for students who stutter.

Nina Reeves: It's very fascinating. These are things that one of my co-authors and I were putting together our guides for minimizing bullying. It was interesting to me that how much people use the words bullying and teasing interchangeably, but they are very different from each other in the way that and as the researchers and the professionals in this area, like Tatum has a great book from 1989 who really defined for us, that teasing is that harmless, let me call it banter, from family and friends. Everyone is having fun, everybody's in on the joke. It's just a little pushing everybody's buttons. But nothing that is meant to be hurtful.

Nina Reeves: Bullying on the other hand is a defined as a conscious effort to harm someone. Okay. That is where, if somebody quote unquote teasing but someone's feelings are being hurt, then they're bullying. They're no longer teasing. That's something that our students, our young people have a hard time figuring out. “Oh, I was just teasing you.” They'll say. But you know what? You keep doing that and you know that I'm hurt by it. Now you're bullying me.

Nina Reeves: It's a fine line, but it's a definitive line. If not everybody's having fun and on the joke, it's bullying.

Speaker 1: That's really helpful.

Nina Reeves: Yeah. And Barbara Colarusso did a quintessential book in 2008, and I love the way that she describes the people that are involved in this dynamic. There's the bully, the bullied and the bystander. Because there's three players in this app. In the common ground way, bullies are trying to gain their power. Okay, they're trying to put others down to gain some sense of power. The bullied is a person who stands out in some way. Something about this person stands out in some way and so they can become a target, and what's most interesting to me is the bystanders. These are all of us in the circle who either are part of the bullying episode because we either encourage the bully, we join in with the bully and become a bully ourselves in that instance, or we ignore.

Nina Reeves: By simply ignoring, when bystanders ignore what's going on, they're part of the problem and not the solution. I think when she described that, I thought, wow. Lots of us fall into all three of those categories from our young years, I believe. I can remember times in grade school where I might've fallen into every one of those categories and I think it's something for us to really think about and help our students understand.

Speaker 1: That's such an important element to think about, that the bystanders are part of that. It's not just, because we typically focus on the bully and the person being bullied. But that bystander perspective is so important, and I, because I've used that guide that you wrote. I thought a lot of the suggestions in there are focused actually on the bystanders, which was really interesting.

Nina Reeves: The research will tell us that that's where we can do a lot of work as a social movement. We do want to try to help the bullies. Yes. But that's in speech pathology world, not our deal. That's not our wheelhouse. For the most part, we need to help bullies understand the disorder of stuttering in some ways, because sometimes bullying is about ignorance. But if there's a chronic bullying from a child, then sometimes that's part of a counseling world that we can pair up with to help the bully. For certain, we're helping the bullied and I'll get into some of the research about how much children who stutter are bullied.

Nina Reeves: But the bystander, as you said, we write a lot about that part of it and Barbara Colarusso was... she was a big proponent of this. We can make a lot of progress with the bystanders. Because these are the students who, if given five minutes alone with a child who stutters, they would never bully the child. But when they're in the bystander mode, they don't want to get picked on by the bully so they join in, or they just do nothing because they're fearful, or they don't know what to do so they don't do anything. And it's moving with them how they can support a child who stutters or any child on our caseload's, to help them know the right things to do and to become part of that student support system. We can make some good end roads.

Speaker 1: I love that, and it just made... because I was, I reached towards that resource when I was struggling with a couple of different students on my own caseload, and it was just, that approach was so incredibly helpful, so I'm excited. Talk a little bit more about that as we go through. But before we dive into those components, can you tell us a little bit about the research for students who stutter.

Nina Reeves: Mm-hmm (affirmative).

Speaker 1: And bullying.

Nina Reeves: Yes, for sure, it's not going to be a surprise to anyone that has worked with students who stutter, that clinically and anecdotally, we already know and feel that they get bullied at a higher rate than most of the other kids that we know. Well but all of them, but most. And so, the research bears that out, like Lungavine and her colleagues they do a lot of work in this area. They talk about the fact that, just in some of their research about 60%, this is the general population of students in elementary school, report being occasionally bullied, 60% with 15% of them reporting some chronic bullying at least once a week. For children who stutter 59% in one of Lungavine's studies showed that 59% of children who stutter or bullied about their stutter chronically.

Nina Reeves: So that difference between the 15% of general elementary school students reporting chronic bullying and almost 60% of children who stutter reporting some chronic bullying about their stuttering. And so, I know we should all say wow.

Speaker 1: Right.

Nina Reeves: It comes many forms. The research shows that it comes, verbally and physically. It can escalate to physical, and that relational bullying, which is where a lot of my stories from childhood come in, where there would be, one student may be setting other students against a young child who stutters. Trying to get the mob mentality. So that's where our bully our bystanders come in, and then of course there's cyber bullying, which is a bigger and bigger problem all the time.

Nina Reeves: All of this bullying leads to the psychological literature that points to diminish self-worth, diminished educational performance, a large increase in social rejection, a feeling of being rejected socially, which of course leads to increase depression, and then there's the withdrawal and the helplessness feeling, and that's just, generally and for children who stutter, that increased isolation, and then that feedback that your stutter is bad.

Nina Reeves: So, that increases the negative feelings about stuttering, which then increases avoidances of stuttering and avoidances of communication overall, which feeds back into this withdrawal and the isolation and it's just this cycle that can become really hard to break and really destructive to the self esteem and the communication of kids who stutter.

Speaker 1: That definitely does not sound like a good cycle. Now we're acutely aware of the impact that this has on students, and I'm sure that we all were aware of this already, but it sometimes can be really helpful to put some numbers on it into... I was pretty blown away by that statistic that 59% of children who stuttered report chronic stuttering or bullying, which is pretty, that's pretty intense.

Speaker 1: Let's talk about what we can do to help these students or to potentially do something around the bullying that's happening. Where would you suggest, because maybe we can talk about what we can do first with the students.

Nina Reeves: That would be great. I think that I'm going to piggy back on what you just said though, to lead us into what we can do as professionals and as speech therapists. It's important to have those numbers because one of the things that happens is that bullies don't bully in front of us. And kids who stutter don't always report the bullying. So I'm off doing consultations and I'm working in my district and people are going, “Oh, I don't think he's bullied.” Or, “He doesn't report any bullying.” I bristle at that, because I wonder how many times we've gotten into the discussion, how often, how we've done it, have we done it in a way that allows the child to feel safe reporting it to us?

Nina Reeves: Just because it hasn't been seen doesn't mean it hasn't happened. It's about the bus, the bathroom, the cafeteria, and the playground. Those are not places where speech pathologists are, where usually teachers are. There's a lot of staff, and then there's a lot of places where staff isn't at all, and these are the places and the times when children are bullied because kids who bully are smart enough to know that they shouldn't do it in front of an adult. So those statistics are really helpful for us to say, oh my gosh, wow, I really should look at this and say, even if I haven't heard it or seen it or had it reported to me, maybe I need to be diving into this part of this child's existence and seeing what we can dig up.

Nina Reeves: I guess that would be part of one of our roles. But I'm going to go through five roles that I think we have as speech pathologists and try to congeal the information as much as I can. You're going to hear my most passionate one first. I call it a message make over. Because I think the number one thing and the other four things I'm going to talk about are going to fall under this, but the most important thing we can do to help diminish bullying, to decrease it, I don't know that we can eliminate it, but if wishing, where to make it so.

Nina Reeves: But the number one thing I think we can do to minimize bullying for children who stutter is to overarchingly the messing stuttering. Okay. I think that we have to stop sending the message either intended or otherwise, that fluent speech is a gold standard of communication. I want to sit with that for a second. Okay. No matter where you were trained, no matter what you learned in 1979, it's important to think that the world has changed.

Nina Reeves: I hear too many times the praises for fluency. “Oh, isn't it wonderful? He didn't stutter at all.” Okay. I hear the corrections of stutters. “Oh that one was tight. Let's try it again, easy.” These are things that can send a message to our students that they are doing something wrong. Okay. And I think that we have to be very careful. I'm going to talk about that because we do have to walk a line of helping students communicate in an easier way, but not drive the fluency train.

Nina Reeves: What I mean by that is that, this is a neurologically based disorder, and I'm going to go into a slight bit of hyper bully so here's your warning. But it's to drive home. What I believe is a quintessential point. We would never say to any of our other students with neurologically based disorders that they need to do something 10% less. A child with cerebral palsy, you need to be 30% less attack sick, have less attack sick muscle movements during your day. We would never say to them, you must have fluent walking. That's the right way.

Nina Reeves: I'm trying to drive home a point that we're talking about neurologically based issues, and that it's not realistic to set a bar of what we want to hear. It's about what this child is able to do and excepting that stuttering is a part of their speech. And we're talking about school age today, and I want to make that disclaimer. When I go and speak, school age and early childhood therapy are vastly different from each other. They have some crossovers in assessment and some parts of the treatment, but just like the therapy is different for these two age ranges. What I'm talking about in some of the specifics that we'll be going through are really about school aged kids.

Nina Reeves: But the acceptance piece that I'm talking about first, that transcends everything. It is okay to stutter, all of it. Not just some of it, not just 2% of it, not just 5% of it, but it has to be okay, bottom line. That's our inform of our therapy that it is okay to stutter. And I think that if we as professionals can decrease that stigma around stuttering by what we do, and what we say and how we present information about stuttering to our students and families and teachers, I think we can do a lot of good to decrease bullying. Because bullying, obviously is surrounded by stigma, that something is wrong with our children who stutter. It's not, it's natural and normal for children who stutter to stutter.

Speaker 1: Oh my goodness. So many good closing here. I don't like scribbling away like crazy. Oh my gosh. I just want to recap a couple of them. I know we have four more items in terms of our role in decreasing the impact of stuttering, but this is too good to not unpack a little more. So, the most important thing that we can do to minimize bullying is to overarchingly change the message surrounding stuttering, which is amazing. Some of the other takeaways under that is fluent speech is not a gold standard of convenience. We can't help students communicate in an easier way, and that's the goal, and again, emphasizing that point, it's okay to stutter all of it.

Speaker 1: I feel like we need posters of these and just put them around our speech rooms because that is... I think that just encapsulates so much of what I've learned from you, and I thought that was incredibly helpful. So thank you.

Nina Reeves: Thank you for that recap. I'm glad those messages came out because it really... We have many things to do in therapy, so it's not like it's okay to stutter. You don't need therapy. We have to begin and end with acceptance. If we begin and end with the idea of acceptance and not tolerance, because I believe the word tolerance is a slight. It's like, you know the word tolerance, like I have to tolerate that. That just means something's icky. But I'm just going to be okay with it. No, I mean accept, full on acceptance, and when we begin and end with that, we can also meet our students where they are. We can help them learn to communicate easier and with less struggle. But all through the idea of everything we do in therapy, the underlying drive for us and what informs our therapy is acceptance.

Speaker 1: I love that. And I really like... because sometimes you might, like I think some SLPs might be thinking, well if we you alluded to, if we're accepting it then why are we working on it? But the goal is to help students communicate more easily, because it's not easy to communicate when that's happening. And it's okay to stutter but we want to make it easier for them.

Nina Reeves: Exactly. Exactly. You've got it. That message makeover is number one, and then these other things that can help minimize bullying. Okay. Because we're not, I wish we had two more hours and we'd get into actual the therapy stuff. With the techniques and all of that. How do you manage that, if it's okay to give a kid a technique, of course it is, but not because so that they won't stutter. We don't give them techniques so they won't stutter, we give them techniques to communicate easier. And that's the best part of the message makeover.

Nina Reeves: I wish we had more time, but once we get that idea and start formulating from there, I think when we focus on facts, that's number two, is to focus on facts to help decrease, to help minimize bullying for children who stutter is that we get really informed about the facts about stuttering and then we give it. We help our kids understand the facts at their levels of readiness and cognitive abilities. Because, once you get to know what's going on with stuttering as a person who stutters, it can help to decrease those negative affective or reactions, the thoughts or the feelings around communication.

Nina Reeves: When you learn the science of stuttering and the history of stuttering at whatever age level you can, as therapists, we adapt that through the age levels. But even little kids can learn some of these things and make it less mystery filled or quotes air quotes weird that stuttering happens. Then that shores them up for being able to handle reactions from other people. When my kids learn to understand about their own communication struggles, they can matter of factly talk to other people about it. It's like, “Oh yeah, I stutter sometimes. That's the way I talk sometimes, that's stuttering.”

Nina Reeves: It becomes more of a matter of fact, I always tell my students, listeners will take their cues from you. When you come into the space as okay with yourself and some stuttering, then you're going to give off the idea that you can't be targeted. Bring it on dude. It's just stuttering, I don't know what your deal is. I'm sorry, that was my little... I work with a lot of adolescents.

Speaker 1: I've love that. It's so true. This could apply. You could replace stuttering with any other thing that anyone has going on, even as adults. So I think that's such an important lesson and if that's something that we can share with our students, that's amazing. Thank you so much for breaking that down.

Nina Reeves: The facts are important and when we focus on facts, then the kids can help other people understand those facts. Number three would be moving them into response readiness. Sorry for all the alliteration but these are things that help me remember stuff so. Number three would be response readiness. That would be helping a child who stutters understand bullying, the way we've described it today and that's why... in our bundle that we created, we have a workbook for students and one for parents, one for teachers and administrators and of course the guide for SLPs to walk everybody through this.

Nina Reeves: Because understanding the difference between a curious comment and a bully comment helps students who stutter learn, pick their battles and what is what. And when they learn to understand bullying, they can start to develop a trove of responses that make sense to them. So we're going to help kids get ready to respond. Whatever that looks like, whatever's appropriate in that moment, but they need someone to brainstorm with them. That's us to coach them and say, well, how did that work? And do you want to change that a little bit or does that make sense?

Nina Reeves: Because some of the things that people say you should do in the bullying literature, general bullying, is to tell them about things. Well, that's great, but I'm a kid who stutters. In this moment of being bullied. Do you really expect me to give this bully information about stuttering? Are you kidding me? I'm getting bullied because I just stuttered, and you want me to have a conversation. I'm not sure a lot of my students would be willing to do that. They might be able to master a couple of sentences or... But they have to come up with what's good for them, and they have to come up with a lot of different responses that make sense in different ways.

Nina Reeves: Brainstorming and getting a menu going and, Bill Murphy talked about making a movie role playing how you would react if somebody said this or that or did this or that. It helps prepare kids to do this on their own. But we are there as their coaches.

Speaker 1: I love that. And as you're talking through that, I was trying to think of how I would, if I was a child who stuttered and how, what responses I would add to just to my little menu of our big menu of resources potentially, and it's so interesting. Do you have any favorites that you've come across over the years?

Nina Reeves: Well, thank you for asking because yes, I do. Well my number one favorite thing to do is to start a list of the difference between curious and bullying. Because kids are going to get asked about their speech sometimes, in ways like, “Oh, why do you talk like that? Why do you go [inaudible 00:30:10]” Now, is that a bullying thing? Could be, it depends on how sensitive the child who stutters feels at that moment. But if they can start to say to themselves and help digest, is this some person trying to be mean right now, and am I feeling attacked? Or is this somebody who's curious and I can give them information, short bits of information? That helped me.

Nina Reeves: So, we start there. Then I'd like to brainstorm as a group, get everybody... Here are some things I think are good ideas we read from books. And there's lots of books out there, concept books about bullying and teasing just in general, and you can get some information from that usually written by psychologists.

Nina Reeves: But you can get those ideas and get them all on paper and let the child see that menu. The child comes up with ideas, the parents, maybe a sibling or a peer can come up with ideas, and then have the child be able to choose. One that has worked for me with certain kids is more like the look. We call it the look. I know we're not on a video cast, but it's you just give him the look, really, it's that really look, like really? Or walk away with attitude, not just walk away, because we have to make sure we're not walking away going in our heads, “Oh, he's right. I can't talk. This is so weird.” But more like, walking away with that attitude like, “You do not deserve my time. That is so egregious. What you just did is so mean. I'm not even going to get involved with you.” And then there's other things, there's so many. I have a lot of adolescent boys who just look at them and go, “Dude, really?” or, “Wow, so not cool.”

Nina Reeves: It depends on their lingo. I let them pick, it's the idea of, so not cool, although I think that's rather dated. I let them pick their own ideas. But the idea is to not overly engaged in that moment all the time. You have to pick and choose when you can engage and when it's time to not give the person what they want, and studies will tell you. Research shows us that bullies feed, they call it the need to feed. Bullies feed on reaction. So if you can find a way to respond to a bully in a way that helps you and doesn't feed them, then that's the balance.

Speaker 1: That is so key. I love that. One of the things that I really like, if the child who stutters has a friend... I don't know, I haven't actually had this discussion with a child who stutters and one of their peers, but if they can enlist their peers to help like, “Hey, next time Johnny says this, can you help me?” And maybe they can come up with a way to... I know that can get tricky with adolescence. I'm curious if you've ever done that because it would be even more powerful if the peer who doesn't stutter says, “Wow, so not cool."

Nina Reeves: Exactly. crosstalk Agrees or says at first. I have done that. That's that part where you get the bystanders involved, that's what we wrote a lot in those books, about is because it would be bring a friend to speech day and maybe that would be a topic. We would talk about, well how would you respond if someone said that, I would be the bully and I would use a Bill Murphy quote, they go stutter head, stutter head, and see what we would role play, what might be a way to respond and how would you support your friend in this moment. But we have to be very careful to not enable the young child who stutters to rely on other people to take care of this for them.

Nina Reeves: We balance it as this is your support system while we're shoring you up to handle these things on your own in your future. Because we don't want parents always swooping in, we want parents and teachers swooping in if there's any level here that is just so egregious or egregious enough to warrant that. But we also want parents and teachers to be involved in it while bringing the child along in understanding how they want to handle it and whether it'll help or harm.

Nina Reeves: Because I think we all have, we may all, I'm just going to say, I have of moments from my adolescence where my mom got involved in something and it was worse, because she got involved. And so it would have been much better if we would've figured out a way for her to help me and support me in finding a way to handle that, maybe with teacher or principal support. So, it's a balance and that's why people write books on this and that's why there's resources on this all over the place. Is because we're not counselors, but when it comes to communication disorders, this is our scope of practice and we need to be ready to be part of that support system.

Speaker 1: That is a helpful recap of that. And I love that... that's such a helpful perspective too that we can maybe enlist the friends in the beginning, but that we really want to empower the child or student who stutters to have those skills to defend themselves because they won't always have a friend. And I definitely agree that sometimes having teachers and parents intervene just makes it worse because like you said, all of those contexts where the teachers and parents aren't in the bathrooms and the lunch room and the bus, I think that sometimes just makes it get worse. So that's really a really good reminder there.

Nina Reeves: As you said, each situation is so individualized. There is no right or wrong answer to any of this. There is no one way to do it. Parents and teachers are not always worse, sometimes it's absolutely imperative. But it's the how. It's not always the if, to get others involved. It's the how. And then it's how long, because like I said, you want to make sure that we're empowering that child. And I think that's a great segue to number four, which is to shore up support systems. That brings in our parents, our teachers, our peers, and by the way, our siblings of kids who stutter. Because those siblings are sometimes really great advocates for their siblings and sometimes they're the ones doing the bullying.

Nina Reeves: I have a wonderful saying that I don't know who I learned from, but your siblings know where your buttons are because they installed them. And I think that's an amazing way to think about it. Sometimes siblings know how to get you and so they can actually be part of a problem. So we have to be very good detectives about where is this child having the most trouble with negative reactions to their stuttering or ignorant reactions to their stuttering. Then we're going to, pardon me, rally the support systems around this child.

Speaker 1: Okay, perfect. And then did you have some information to share with us about rally those support systems or should we jump to number five?

Nina Reeves: I absolutely do. Just as a part of being in the public schools, what I find wonderful is that even if the parent isn't as easily accessible, the lots of times the siblings are and for sure their peers are and their teachers are. And this is where these children spend 180 days, six hours a day. And these are very big parts of their communication environment. So we have to get people, at least in the same book about stuttering, if not on the same page. And that goes back to the message makeover and focusing on the facts, and preparing children to be ready to respond to inappropriate albeit sometimes, not mean, but inappropriate responses to their stuttering. And by getting involved with those people in the child's environment and helping them understand stuttering and understand what is appropriate to discuss or not discuss or not discuss. Let's just give you this one.

Nina Reeves: I had a teacher I was working with and we were getting the child to get ready for a class presentation. This was months and months and months of work because the child had been getting out of all the presentations, not because the speech therapist said it was a good idea, because the teacher just didn't want to make the child nervous. So that loving, wonderful teacher was putting the wrong... lowering expectations for this child who stutters and in turn, the child who stutters wasn't getting ready to speak like the other kids in class. So, we were working on this and the child eventually got to do their presentation in class. The goal was to talk the way you talk and not to let your stutters roll. The child wanted to use pausing, so that was one of his goals and then the teacher came up afterwards and said to the Child, "Oh, that was so good. You didn't stutter once."

Nina Reeves: And so there was this moment where all of the work that we had been doing about letting you be okay with how you talk came unraveling. Inadvertently the teacher had focused on fluency and congratulated on fluency instead of congratulated on the risk for getting up in front of the class and the risk of being maybe singled out by your classmates. So, shoring up those support systems meant that that teacher needed me and the child to help her understand what that child needed at that time, which was not to think about how he was talking, but the fact that he was. So, that transcends all those areas.

Nina Reeves: And the last thing I want to say about support systems is, it's a very big part of my career with kids who stutter to get them involved with support organizations outside of therapy. In whatever way that looks, being on a Facebook page or being part of an Instagram page for the National Stuttering Association, or attending a chapter meeting of a kids group or a team group. Going to a friend's conference or an NSA conference or... there's many and I can send you lots of say, and the British Stammering Association has an amazing new initiatives.

Nina Reeves: Whatever that looks like for a child to be more involved with people who stutter, and have families, be more involved with families of people who stutter. Because that's where the experiential learning is just as much, if not more important, than anything you learn in therapy. It's, "I'm okay and it's okay to stutter and these people are successful and everybody's doing their thing and I can achieve whatever I want." And that comes from at least being connected to some type of organization or resource out there.

Speaker 1: I love those suggestions, so incredibly helpful. Can you tell us a little bit about the fifth strategy that we can use?

Nina Reeves: I can. This Leads us nicely into the next question of which I believe we were going to talk about what others can do. When we shore up those support systems and then we try to help as speech pathologists, we try to help find out about the stakeholders. So we become stakeholder savvy to keep the alliteration going. We want to help, to first of all, find out what do the teachers know, what do the parents know and what do the administrators understand about stuttering in general and about the effects of bullying, about stuttering in specific? And so we want to help those stakeholders set a positive communication environment, which means that the school, the home therapy is a safe place.

Nina Reeves: It's a safe space to stutter, it's a safe space to play with your stutter, to learn about stuttering, to complain about your stutter, to... all of that stuff. To talk about your experiences of being a child who stutters in an academic, in a social environment. Again, we're going to help them learn the facts. So our role is to help the teachers learn the facts and that shores them up to do the more appropriate things in the classroom and be able to handle a lot of things on their own, even though we're in the wings to help. We want teachers and others to get better at watching for bullying.

Nina Reeves: I'm not sure that... I know that there are initiatives across the country to help teachers and administrators and school staff be more cognizant that this can be happening and what to look for and how to look for it, and then not only watch out for it, but learn better ways to handle it. Who do I go to if I see? I'm the cafeteria monitor, who am I supposed to go to if I see this happening, what am I looking for and who do I go to. Or do I try to handle it on my own, and has anybody trained me?

Nina Reeves: And then to create the support systems within the school setting, where people can reach out and everyone knows their roles and when to refer. I'm a big believer in when in doubt refer out. When in my scope of practice, my role as a speech language pathologist, if it rises to a level that is no longer just part of the communication issue but bigger than that, then I'm referring to the school psychologist or the counselors. That's because I know what the support system looks like for this in my district. So, that stakeholder savvy really helps us figure out how to work together. Because when we all work together and have some of the same expectations and goals and savvy we can really move the needle and make great strides in minimizing bullying for kids who stutter.

Speaker 1: It's such an amazing picture to think of if all the things that you described, if those would be happening, that would be absolutely amazing. But I know that there's probably some SLPs listening who are really thinking like, “Wow, that sounds so incredibly amazing. I don't feel like I have any of that at my school.” What suggestions would you give for an SLP in that situation? What do you think are some, maybe one or two easy things that they could do to start working towards that goal?

Nina Reeves: Great question. Off the top of my head, I'm going to say that if I was starting from scratch again, the number one thing that I would want to do is hook up with my administrators team and say, you know what, I'm going to talk to you about children who stutter right now and I'm going to talk to you about these statistics that are just really more than I ever understood, and I'm going to say that I'd like to know how we can start tapping in the special needs arena to the resources that are already on the ground for. You can't just say zero tolerance without something to back that up. So, what are the resources on the ground already in our district or on my campus that I can get hooked into. And then how can I help support?

Nina Reeves: Because look, I have this booklet from stuttering... I'm not trying to sell everybody a book, but I'm saying, here's this booklet from stuttering therapy resources for administrators and teachers. I want you to take a look at this and see if you can meet with me again. It's a little baby read and you could do it on your lunch hour, and I respect your time, but I want to meet with you again and talk about, how can we start to set a safe space? And just like you said at the top of this, this isn't really just about stuttering. I don't know about you, but I hope everybody is thinking about their kids with autism and any other challenge that's noticeable and that kids, especially kids who bully, will hone in on.

Nina Reeves: So we're making it a safe space to have differences because we all have differences. This isn't just about our kids on our caseload, but the kid who's not in any specialized services has differences from the other kids sitting across from them. So, it's just this environment. How can we create this safe space and celebrate our differences? And I would start there. That's where I'd start. I would learn a little bit about especially one area of my service and use that as the jumping off point.

Speaker 1: That makes so much sense. And that's something that is completely actionable, because you've already shared those statistics and maybe if I were going into a school that didn't have anything in place, I might re-listen to some of the statistics you shared, jot down some notes and then I have that booklet, so I would bring that with me and we can share the link to it in case anyone else wants to take a look. Then just starting that conversation, and like you said, the booklet focuses on students who stutter, but I really think it could apply across our caseload and across the school as a whole because you're right, we all have differences and it should be a safe space for all of the differences.

Speaker 1: I've even had students on my caseload, just articulation only students have, if they just have one sound error, they get teased and bullied for that. So it's just... it's happening all of the time unfortunately and so taking action can have such an amazing impact for so many students.

Nina Reeves: I don't want anybody listening to this to think I'm adding yet another big project to your already over worked little world. Because I totally get it and I'm in the trenches and I understand that we're not going to, maybe or maybe not, be the bullying bullying girl of our district. That's why I say go to whatever team. If the administration doesn't go for it, then go to the Special Ed team, your administrators in special services and see if you can get something going there.

Nina Reeves: But that's what I mean though, go to a team, which means everybody has something to do. It doesn't fall all on you. You're just bringing something to light that's in the darkness. People do not always understand what we do, raise your hand if you think that's true. They don't always understand what the quiet kid in the back of the room, I never hear him stutter. Well that's because he's not talking. Why isn't he talking? Because he's afraid to take the risk that he'll be bullied. There's a number of reasons why they don't take the risk but one of them is being singled out and being different at a time in their lives when no one wants to be different.

Nina Reeves: And so, we have to just shine a light on it and then things can happen from there. But come armed with your statistics and some solution, the booklet has solutions. Here are some things you can put in place. Administrator, here are some things you can do in your classroom. Teacher, mom and dad when the child is at home, these are things you can do. There's a booklet for each and every one of those people that I just talked about. And when I say parent, think of grand parent or whatever care giver that child has. As a team, we can find ways to minimize the bullying and to increase that child's ability to effectively deal with bullying that will happen.

Nina Reeves: We can't erase it at this point, so how are we going to shore up our students who stutter to find out they are just fine no matter what anybody else says about their speech.

Speaker 1: That's so good. I just wanted to have that sink in a second, and that's so incredibly helpful. I also love what you said too that it doesn't have to be a big giant project that we're taking on. We can reach out and get a team together to help us do this and there's amazing resources out there to make it. We don't have to start from scratch. We've got the research already that we can pull and we've guides and tools that can help us get that set up.

Speaker 1: So thank you so much Nina for putting this altogether. I absolutely love the five step framework and the alliteration there to help us remember, and I so appreciate the actionable steps that you shared with us and it definitely shows that you've been in the trenches and I'm just so grateful that you shared your wealth of knowledge and experience with us to hopefully be able to impact some students in our own schools and help tackle some of the bullying that's happening.

Nina Reeves: Well, I appreciate you letting me talk about this topic because it's very much a part of our role as therapists and part of our therapy planning. I love the idea of getting kids ready even when it's not happening so they can, instead of a reaction, it's proactive and the kids can learn to respond rather than react and that's always a much more thoughtful way to do it. Do you mind if I give a discount code?

Speaker 1: Yeah, go for it.

Nina Reeves: Okay. Well, because you're wonderful and because we got to chance to do this, I want to give the opportunity for the listeners to have a 10% discount on stutteringtherapyresources.com and you'll use the code SLP now.

Speaker 1: Perfect. Thank you so much. So we can all go grab some of those wonderful resources that you just mentioned. And just to make it easy for people, if you go to slpnow.com/25, you can get links to all of the resources that Nina mentioned and I'll work on tracking down the citations and everything too. But then I'll also link to Nina Reeves site and her email and where you can find those different resources that we mentioned. So that'll be a really nice hub to access all of the things.

Speaker 1: So thank you so much, Nina.

Nina Reeves: Thank you so much. You have a wonderful day.

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Filed Under: Podcast Tagged With: Fluency, Stuttering

#024: A Crash Course in Classroom-Based Service Delivery for SLPs

October 16, 2019 by Marisha Leave a Comment

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In this episode, I got to sit down with Dr. Lyndsey Zurawski, an SLPD who accidentally fell into the world of inclusion therapy very early in her career, when the alternative was working in a closet. Literally.

This was one of those conversations that had me scrambling to take as many notes as I could. There was a great deal of emphatic head nodding and gesturing (on my part) as we talked about using inclusive therapy practices and creating classroom environments that are the most conducive to your students’ learning.

As per usual, there are a ton of practical takeaways and actionable tips for you to walk away with because Dr. Zurawski has really been in the trenches of inclusion therapy and has a wealth of experience to share. There’s also a great discussion about getting outside of our SLP comfort zones, and diving into something new… I hope it leaves you feeling inspired. 🤓

So grab your beverage of choice (I’ll have a pumpkin spice latte because, October!), put your feet up, and listen in.

Key Takeaways

– How Dr. Zurawski accidentally got started with inclusion therapy
– Why SLPs should consider using inclusive therapy practices in the classroom
– What it looks like to put your students’ needs first when considering inclusive therapy
– What inclusive therapy/creating the least restrictive environment (LRE) is
– What does the emerging research tell us about inclusion therapy?
– When are classroom-based services appropriate?
– When are other service delivery models more appropriate?
– The four Es: effective, efficient, evidence-based, economical
– Knowing when to teach and when to generalize/support skills
– Knowing how to change intensity and duration
– Providing collaborative/classroom-based services outside of general education classroom
– Examples across grades: whole group language lessons, supporting a teacher’s instruction, using books, etc.
– Suggestions for data collection in the classroom
– Tips for scheduling when implementing inclusive and flexible delivery models
– Tips for working with teachers
– Caseload vs. Workload

Links Mentioned in the Podcast

– School-Based SLP and Inclusive Service Delivery: What are the First Steps? (2014)
– Throneberg et al. (2000): Comparative study of three service delivery models
– Cirrin et al. (2010): Systematic review of service delivery models
– Schmitt & Justice (2011): SLPs assisting with setting up a students’ environment
– Brandel & Loeb (2011)
– Articles in ASHA Leader re: service delivery
– Larson, McKinley, Boley (1993): Service delivery for adolescents
– Nippold (2012): Different models for different communication disorders
– Salley (2012): Service delivery for dolescents
– Models from Florida Inclusion Network (FIN)
– Hear more from Dr. Zurawski at speechtothecore.com or on Instagram!
– Click to download Dr. Zurawski’s full reference list.

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Thanks so much!

Transcript

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Marisha: Hi there, it's Marisha from SLP Now and I am so incredibly excited to introduce you to today's guests. This is a question that I've been wondering a lot about, and it's probably the most requested topic that we've had. And we get to talk about inclusion with Dr. Lyndsey Zurawski. And so she is a doctor. She earned her PhD and she's also a speech language pathologist. She works as a diagnostician and SLP in the school district of Palm Beach County, and she created and maintains the popular SLP blog, Speech to the Core, and she also authors numerous e-products in the area of language and literacy.

Marisha: And if you've recognize her name, not from any of those things, she was also the 2017 to 2019 president for the Florida Association of SLPs and Audiologists so FLASHA. She is a very busy and accomplished SLP and she also has a wealth of knowledge to share with us when it comes to inclusion and all things service delivery. So before we dive into all of the nitty gritty, Lyndsey, I'm super curious to hear how you came to learn so much about this area.

Lyndsey: So the first to thank you so much for having me on. I am very excited. This is the first time I'm doing a podcast interview or being a part of one, so a little nervous but very excited to be here. So my experiences may be different than some but I think more likely than not very like most others.

Lyndsey: I started as a clinical fellow in a school district and I thought, "Yeah, I know what I'm doing. I'm coming out of grad school. I'm very prepared." Grad school doesn't prepare us for the real world. It doesn't prepare us for real life.

Lyndsey: And so I was working down in Miami Dade Public Schools. I was working with a contract company and so I was filling in for a lot of different individuals, maternity leaves and whatnot. So I was having to hop schools quite a bit.

Lyndsey: And as a CF, that's hard, I think as any individual that's hard, but as a CF, it's really difficult. But one of my first jobs was in elementary school, and they brought me to my office and I was super excited, but my office was a closet inside of a teacher's room.

Lyndsey: And I know, we see the memes and the funny stories and things like that, but I was shocked. I was like, "I actually have to parade a group of students in through this woman's classroom every 30 minutes." I would have to interrupt her class, get my kids and I had this tiny little closet with a horseshoe table and I had to squeeze like five kids around this horseshoe table and I actually had to climb over the table to get to my chair.

Lyndsey: And so I just decided that, that wasn't the best fit for myself as a therapist, my kids, the teacher whose classroom it was, and I just started going into classrooms and providing the services. It really did work out because a lot of my kids had already been sort of grouped together, which I had nothing to do with, but it worked out.

Lyndsey: And I just sort of accidentally started doing inclusive therapy, and it worked, and I loved it. I love being in the classroom. I love being able to support my students with what they needed. And that was how it started and I never looked back. So that is 15 years ago now that I started doing inclusive based practices.

Marisha: Oh, I love that story. I'm kind of glad that you had that closet, because I think when we're trying something new, it's uncomfortable and hard. I think if you had, had a super comfortable, cozy therapy room, you wouldn't have been pushed into the classroom in that way. I'm kind of selfishly grateful that, that happened, because you've shared so many great tips and resources to help SLPs with this. So yeah, I love that story. That's super helpful.

Marisha: So if there's another SLP in the same boat as you, they're feeling like, "Something about my therapy and my therapy room isn't working the way that it should." What tips do you have for them to get started? Like what should an SLP consider before starting to provide services in the classroom? I'm just curious if you have some general starter tips there.

Lyndsey: This question comes up a lot. In about five years ago, I want to say it was 2014, I actually wrote an article for SIG 16 Perspectives titled, School-Based SLP and Inclusive Service Delivery: What are the First Steps? And that's really because I was getting all these questions, what do I do, and how do I do it?

Lyndsey: And not that by any means am I an expert. I just think it's something that I do and I happen to work. I've been at the same school now for 13 years and we are a school that's considered a model school for inclusive and classroom-based service delivery models.

Lyndsey: And so when I wrote that article, I really sat down to think of what do people need to know. It's hard because I think the first thing I always say is start small. You need to figure out where to go, who do you know, do you have a rapport with somebody? Because when we're really thinking about this, I think We tend to make it about ourselves as speech language pathologist, but it's not about us. It's about the students we work with.

Lyndsey: And I think that's the first thing that we need to do is take a step back and think about the students that we're working with and think about what are their needs, and how are we going to be able to help them. Because we oftentimes really are thinking about, "Well, I am not happy in my closet, in my office. What is it that we need to do to make ourselves happy to be able to provide services?"

Lyndsey: But instead, we really need to think about what do our students need, and how are we going to do that. So, when I'm thinking about this, I think we need to look at a couple different things. Keeping in mind that we need to make sure that we are providing services in the least restrictive environment. And I think there does seem to be some confusion over what least restrictive environment is, though.

Lyndsey: So, I do want to maybe touch on that a little bit, because when we're thinking about that, it should be really making sure that least restrictive environment, as defined by the law, is that the students with disabilities are educated to the fullest extent possible with non-disabled peers.

Lyndsey: And LRE specifically states that a child with a disability is not to be removed from an education and age appropriate regular classroom solely because of needed modifications in the general education curriculum. And I think for us, the first thing we do is we pull out of the classroom because it's what we've always been doing. It's what the SLP did before we got to that school. It's what we were taught when we were in school, in graduate school. And it's really the model that we're most comfortable with. It's our comfort zone.

Lyndsey: But what about what's most comfortable for the student? What about what actually is the least restrictive environment for that student?

Lyndsey: So also, we need to take this into consideration that we need to be thinking about FAPE, so free and appropriate public education. In order to be in compliance with the law with IDEA. So I think just really taking those things into consideration but making sure that we are thinking about the student's needs first and foremost and not our own as the speech language pathologist.

Marisha: Yeah, that makes so much sense. And I really appreciate that overview. I think you said to start small and maybe finding one place to start and going from there. Because it is hard. It's something different and we have to step outside of that comfort zone. So thinking about what's best for our students, looking at that least restrictive environment, also considering FAPE as all of these things that make it worth stepping outside of the comfort zone, even if it is a little bit scary.

Marisha: And I'm super excited, because I think you will kind of break things down in a way that will make it maybe a little bit less scary. But hopefully, we're convinced now that it's worth giving it a try. And actually, before we go into some of the more specifics, I'm curious. Because I know there's not a ton of research out there, but can you tell us a little bit about what you have found when it comes to inclusion and kind of the things that we're talking about here?

Lyndsey: Sure. So just like you mentioned, there's really not a lot of research about inclusive service delivery models. It's really an emerging body or area of research, one that really needs to be studied more. And I know for myself as someone who has a doctorate, but who's a clinician, in the trenches, I know, I've been trying to pair with some of my fellow colleagues in academia to say, "Hey, let's get that clinician to research our partnership to look at the effectiveness of classroom-based service delivery models."

Lyndsey: Because I know in my heart of hearts that what I'm doing is effective. We just need research studies that show that. So we're working. I think there's a few of us that want to partner up and look at those classroom-based service delivery models in the future. It's just a matter of getting it done. So stay tuned for that I guess I should say, maybe 10 years from now, but coming in the future.

Lyndsey: But there have been some studies, I would say since the early 90s, in which evidence-based practices have been used and where services were conducted within classroom-based or collaborative-based models and have shown that they were effective in some way or another.

Lyndsey: Throneburg et al. had found that there was ... There was a study conducted. It was a comparative study, and they looked at three service delivery models and the effectiveness on vocabulary development, and they had found that the collaborative model was more effective for teaching curriculum vocabulary.

Lyndsey: In 2010, there was a systematic review of the literature. And what the results revealed was that collaborative classroom models may provide advantages over pull out models. However, there's not really evidence that one model is significantly more successful than the other or provides disadvantages over the other, but that we really need to consider the individual needs of the child.

Lyndsey: And then in 2011, Schmidt and Justice discussed the idea that school-based SLPs do not operate in a vacuum, which we know. We're not in a silo. We are not an Island. We're not all by ourselves. Although when we put ourselves in our little office or our closets or wherever we might be, we tend to isolate ourselves.

Lyndsey: So what Schmidt and Justice said was that basically, we can as SLPs assist with setting up a student's environment to help them to be the most successful they can be. So that environment includes classroom environment, and as well as the teacher.

Lyndsey: Additional studies that have been done, not just about the effectiveness of service delivery, but there's more about program intensities. So Brandel & Loeb looked at this in 2011. Hugh Catts looked at the language basis of reading and reading disabilities and a longitudinal study, which isn't necessarily about service delivery, but there was just discussion about how reading and reading disabilities affects us. And that is really important to how and the type of materials we use in therapy, which I think really goes along with inclusive or classroom-based service delivery models.

Lyndsey: And then when we look at ... There have been a lot of articles published in the ASHA Leader about service delivery. And then there's also been Larson, McKinley, and Boley did an article in a study in 1993 about service delivery models for adolescents with language disorders, which I think is important for us to look at the differences not just in elementary school, but also with our middle and high school students. But there's also been some additional research on pre-K children and how important it is to provide them supports within that classroom-based environment as well.

Lyndsey: And then Marilyn Nippold did an article in 2012 about different service delivery models for different communication disorders. And then Sally had an article in 2012 service delivery models used with adolescents, a pilot study. So there are research or articles out there. There's just not a ton of it. Not like in some of the other areas in which we provide services.

Lyndsey: And I think what we're really looking for when we think about research and service delivery, we want someone to tell us that one model is better than the other. We want somebody to say definitively you should be providing services in the classroom. But it's not service delivery, it's a continuum. And in order to be doing or providing services with an evidence-based practice in mind, we really need to consider that continuum approach and making sure we're adhering to that.

Lyndsey: And that we're really, again, going back to the needs of the student and that we're individualizing it to the student. I know people might be saying or thinking to themselves as they're listening, "Well, she doesn't have a caseload of 75."

Lyndsey: I know, Marisha, when you introduced me, we didn't talk about what my current position is or what my current job is, but I am a current practicing clinician in the schools and I do have a caseload. I'm not full time as a clinician, because I am a diagnostician and a supervisor. But I have a caseload and so I have to manage caseload and workload and a lot of other things. But I used to have a caseload of over 75.

Lyndsey: So I think it's important that we think about it's not just about our numbers, it's still about the needs of our students. And we have to think about how we can make that work effectively. What I've found is from being in the classroom, if I'm grouping my students accordingly, I can actually better service my students.

Lyndsey: And classroom-based service delivery model is not appropriate for everyone, but when I am doing it and doing it the way that it's meant to be, I am finding significant growth and impact and really making a difference for my students who are in the lowest 25%. And in which my administrators are expecting to show growth on that AYP, that annual yearly progress.

Lyndsey: So I think when we're looking at being that team player and how do we work with and collaborate with our staffs at schools, those are some things that we need to consider. So I sort of veered off from the research piece but I'm tying that all together.

Marisha: Now, that was the perfect little boat. You wrap up all those things. I know I was scribbling away different notes. So if you are wondering about the specific research articles, if you go to slpnow.com/24, no worries, we all have the list there for you, as well as any other resources and things that we mentioned. So we've got you covered. But that was so incredibly helpful. I'm really grateful that you were able to break that down for us.

Marisha: And you did mention a little bit ... Like I loved what you said about service delivery is a continuum. It's not just about our numbers, it's about the needs of our students. And you had a little tidbit in there where you talked about the classroom based services might not be appropriate for all students, or you also alluded to that continuum.

Marisha: Can you tell us a little bit about, one, what that looks like for you and what that continuum is like? And when might you decide that it's not appropriate for a student?

Lyndsey: So I think that it's hard to generalize that. Right? I think that, again, we want somebody to say, "This is what it looks like. We want a rubric for service delivery." Which would make life so much easier, and I get that. It would be so nice to have someone say, "Okay, let's look down this column and look across this row. And this is based on the communication disorder and the severity, and this is what you should do."

Lyndsey: And then as I'm saying that I'm like, "Oh, maybe I should develop something." But that's not reality, so I digress, because in all actuality, when we're looking at it, it really truly is not a one size fits all model. We think about when we first make a child eligible, say for an articulation disorder, phonological disorder, a severe phonological disorder, I couldn't imagine providing those services in the classroom.

Lyndsey: However, do I hope that after providing that student with direct therapy outside of the classroom that I will be able to move that student to be able to receive their services for artic and phonology within the classroom? Absolutely.

Lyndsey: So I think that we also need to think about that. That's where that dynamic process, that continuum comes in. And I think when we think about the dynamic process, it's really about thinking about that we can consider and make changes to service delivery models continuously or throughout time. We don't have to say, "Okay, we wrote the IEP, and this is all we can do."

Lyndsey: The nice part about having IEPs is that it's a working document and we can call a parent in for a meeting and say, "We've met this goal or we feel like this would be a better way to provide the services to your child." And so we can think about treatment setting, we can think about format, we can think about intensity, we can think about frequency and we can think about duration when we're talking about the types of services that we provide to our students.

Lyndsey: And I really liked Barbara Moore and Judy Montgomery. They wrote a book. It's Speech Language Pathologists in Public Schools. It's actually the third edition. That's what I use when I teach my course at Nova for school-based practices, but what I like is that they discuss how SLP should be utilizing service delivery models that are effective, efficient, economical and evidence-based. So I guess the four Es.

Lyndsey: But I really like that we need to be thinking about those things in order to ensure accountability for the work that we do. And when we stop and think about, "Well, how do we do that?" Well, we can consider those four Es when considering which service delivery model to use for which students. And I refer back to Moore and Montgomery and how they refer to that need to consider four different ideas when considering all service delivery models.

Lyndsey: So these four things would be the overall effectiveness, coordination with other programs and services. So other special education services, what other supports are there, the commitment of all parties. This would include anything from, say, paraprofessionals all the way up to your administrators, and including your collaborative teachers in between, as well as the commitment of yourself as the speech language pathologist.

Lyndsey: And the fourth thing would be resources available. So what resources available do you have to make this an effective, efficient, economical and evidence-based service delivery model? So those are some of the things that I consider when I'm doing it.

Lyndsey: But as I mentioned, a student with a severe articulation or phonological disorder when we first place them might not be the best fit when we're first considering classroom-based service delivery. However, when I think about I have students on my caseload now, I have a student with autism who is receiving services in the classroom. And one of the students' goals is about conflict resolution and being able to manage communication breakdowns with peers.

Lyndsey: Well, we can teach those skills in isolation in a social skills group, which we do at the school I work at. However, at some point, we have to be able to generalize those skills into other settings. So a small group with peers who also have communication disorders isn't going to have ... We aren't going to see those same generalizations as we will for providing those services in the classroom.

Lyndsey: We can talk about mastery of goals within a small social skills group. But if we put that child into a classroom, that same goal may not be mastered within the classroom. And that's where we need to be able to provide those services on a continuum.

Lyndsey: So again, I think it's about knowing when we need to teach the skills and when we need to be able to support and help to generalize those skills. And that's also about knowing how to change the intensity and the duration of our services as well.

Lyndsey: Our language impaired students, I find that they're most successful when they're receiving their services in the classroom, because we're not pulling them out of their classrooms. They're not missing that academic support, and they're not having to make up any work.

Lyndsey: One of the questions that I get asked a lot is don't parents care that you are not pulling them out? And I say, "Really? Because No, I never get that question." The only question sometimes I get is, "My child said they didn't have speech therapy." I'm like, "No, your child had speech and language therapy. They just sometimes don't always realize it because I'm in the classroom, but they always have their therapy."

Lyndsey: But when we are first explaining our model to parents, they're not upset that their child is not being pulled out of the classroom. They're not upset that their child will be segregated from their peers. They're actually really excited that their child will be able to be in their general education classroom, or whatever least restrictive environment it is for their student.

Lyndsey: Now, one thing I want to point out is I really have been calling it collaborative, our classroom-based services, because we can provide ... We think of mostly inclusive-based services as being provided in the general education classroom, but we can provide collaborative or classroom-based services in other ways that might not be the general education setting, but it is the least restrictive environment for those students.

Lyndsey: This could be self-contained special education classrooms for students with intellectual disabilities or self-contained classrooms for students with autism spectrum disorders. This could be students with emotional behavioral disorders. So in those cases, we can still provide classroom-based services to these students, but it's just not in that general education setting. But it is in the least restrictive environment, so it's allowing us to adhere to FAPE and allowing us to adhere to LRE and really be in compliance with IDEA in providing those services to our students.

Lyndsey: So I think when we think about that, we really want to make sure that our therapy is also having that educational relevance. It's culturally competent, so we really are considering the cultural and linguistic needs of our students. And really, again, going back to that student centered focus about our students when we're determining what their needs are and which service delivery or who will be most appropriate for receiving those services.

Marisha: Wow, such a helpful breakdown. Oh, my goodness. I took all the notes again. And so one follow up question. This is one that has come up several times like when people message me, and when they submit questions. Because you talked about like there's a time to teach and then there's a time to work on generalization and supporting that skill in the classroom.

Marisha: Just from my experience, I've seen it kind of like there's some teaching, and then there's some application and you kind of hop between the two. And I'm curious, because you were ... I'm especially wondering about your language students, because I think that makes so much sense that they would do better with supports in the classroom, because then they can actually access what's happening there and they're not continuing to get behind.

Marisha: But what does that look like in that situation? Like, do you do teaching within the classroom? Or how do you make that work? Maybe just giving like one or two examples to illustrate, because I know it definitely varies, then we get to use our clinical judgment.

Lyndsey: So I was going to say that's a very broad question, but I understand. Yes. So the application pieces is huge for our students and it does very much go back and forth between teaching application, and then it's very cyclical, just like a lot of what we do.

Lyndsey: But I think one of the things that we as clinicians focus on is data. Right? We think we need to take data every single time we are with that student, but that doesn't happen. When we're actually teaching students, we're actually doing therapy with them. There isn't a place to take data. We can take anecdotal notes, we can take what I like to call my soft data, my qualitative data, but that's not the hard data, which is going to show us mastery towards the goal. Our pluses and minuses or the progress on a rubric.

Lyndsey: But, we really need to look at what are we doing. It's not all about just the pluses and minuses. We need to actually teach our students what to do. So we do teach within the class room. And that's where we can look at the different models within collaborative or classroom-based service delivery. We can look at what those look like, and how would we do it because I think also there's some misconceptions of, "Well, if I go into the classroom, I'm going to be looked at like a tutor or a paraprofessional."

Lyndsey: And I can tell you, I absolutely do not feel like a paraprofessional or a tutor when I go into a classroom. Some of that is based on the respect that I have from my teachers. But also, some of that is knowing what my role is, and how to apply that role to the work that I do with my students.

Lyndsey: And I'll come back to this, but another question I get is how do I actually address my students' IEP goals when I'm in the classroom, but that's another side topic. But when we're actually teaching, so when we look at service delivery models, we can break those down even further.

Lyndsey: And we know we have our traditional pull out model, we have alternative therapy models where we can provide services like on a playground, or in the cafeteria, field trips, things like that, work-based settings. But when we're talking about classroom-based or inclusive-based models, Cook and Friend in 1995, developed a variety of in-class models. And then in 2002, Friend and Bursa, they updated and adapted these a little bit more.

Lyndsey: So I would like to say I think I kind of use the same model most of the time, but there are many different ways that this can look within a classroom. So complementary teaching, or as it was updated in 2002 to a lead and support. This would be like where one teacher leads and the other supports, and specifically being like one teacher plans the lessons while the other plans for learning or behavioral needs. And this would really be dependent on the type of classroom environment that I think you're going into.

Lyndsey: And I think some of these, I'll be honest, I think some of them overlap and sort of mesh into one another. But then you have team teaching where you're jointly planning. So the SLP, the general education teacher, possibly the special education teacher are jointly planning and then going back and forth between the two individuals during the lesson.

Lyndsey: This is the model that I use the most is team teaching. But this is one of the models that they'll tell you is one that comes over time. A lot of times, you can't just jump into team teaching, because you have to have that rapport. I like to call it the good cop, bad cop rapport. But how to be able to go back and forth without kind of feeling like you're stepping on somebody else's toes.

Lyndsey: Then you have parallel teaching where you jointly plan but you're delivering the same content to two different small groups that you as the speech language pathologist could be providing the services to one group, and then the teacher could be providing it to another group, but you're teaching that same material.

Lyndsey: And then station teaching is kind of similar, but not necessarily. Station teaching, you break up the kids into heterogeneous groups, and you rotate those to the stations. So in this case, the difference between station and parallel being that you are not necessarily teaching the same content. So you as the speech language pathologist could be working on your own content, and then the students rotate through.

Lyndsey: The nice part about having heterogeneous groups is that you are not necessarily ... You have models, peer models for your students. Now, this doesn't always work, it would be ideal if you could do this. But sometimes station teaching is simply just having your small group of your students when you're in the classroom because of the time constraints or the needs of what the general education or the special education teacher also need to be able to do.

Lyndsey: And then supplemental teaching, I think. I don't use this model as much, but where possibly one is teaching to the large group, and then somebody else is pre-teaching, re-teaching, or providing some supplemental activities to the students. And I think picking which model within that collaborative or co-teaching model is going to be most effective for you is where you're going to find the most success.

Lyndsey: But it also, again, is a fluid approach too because we go back and forth in the classroom. I work in a second grade classroom and a third grade classroom. I spend almost two hours in ... Because I'm only a 0.2, and I'm there two half days, I have a student that has two hours a week of therapy. And I build that into the two half days I'm there, so I have a lot of therapy to fill into the part of the time that I'm there.

Lyndsey: And I spend a lot of time in the third grade language arts classroom this year. It wasn't like that last year, but when I'm in there, I'm in there for we co-teach, then we do some station teaching. And then we sort of do a little bit of, I guess, we could call it some supportive where it's like I'm pulling out but within the classroom but I'm not really because it's where all of the students are doing independent work. And then I'm working with my individual students.

Lyndsey: So within just that one block of time that I'm in the classroom, I could use three to four different models within that time. So I think that this allows us the flexibility, but we're able to teach to our students. We're able to support our students, We're able to provide, allow our students to apply their knowledge. And then we're also able to be there and see the generalization of those skills. And then if one of those areas isn't working, we can adopt or change what we are doing to help our students be even more successful.

Marisha: Yeah, I love that. Because I really liked the breakdown of the different types of ways that we could approach this, so the complementary teaching, team teaching, parallel teaching, station teaching, supplemental teaching. I think I got them all. There's five.

Marisha: And I'm curious. Could you give just a couple examples, maybe like your top three. Or if you want to share one for each of the types. Can you share something that you've done or something that you think we could do for each of those types? Like just picking a random goal. And I know of what we could do with that. Just to give us a couple more concrete examples.

Lyndsey: Sure. So a lot of us use books in therapy, right? And I know you're a big fan of using books and therapy just like I am. And so I think that's one of our easiest ways to target so many goals with one therapeutic material, right? But it's not really a therapeutic material. It's really a curriculum-based material when we think about it.

Lyndsey: So one way that we've been able to be really successful with this is by using books in therapy. I'm going to go back to last year, but I kind of plan about a two week kind of thematic unit. I know a lot of SLPs like themes also because they're like, "Okay, this allows me to kind of plan out and do this."

Lyndsey: I'm not super big into themes as far as I'm going to use the same theme for X amount of time. I don't typically do that unless it's something big. What I did was I did something big. I made a penguin unit. And really, I did all the planning, but I made sure that it worked around what my teacher was doing.

Lyndsey: So it was a second grade classroom. And she said, "We're working on nonfiction." And we have to cover X, Y and Z, and the X, Y and Z was really about knowing our nonfiction text features. It was about being able to conduct research, and it was about collaborative groups.

Lyndsey: So for our students, they need to be able to touch on the speaking and listening skills within the standards. So I was like, "Well, I can do all those things. There's so much we can do with this as speech language pathologists." So what we did was we started with looking at penguins, and we talked about we read a nonfiction article that I had created about penguins. We did a KWL chart.

Lyndsey: So what we want to know, what we already know, and then what they learned, we fill out after we're already done with the article. So we have them fill out the K and the W. We start with that, and they've had a lot of practice by this point in the year of what we expect from them, but we expect three bullet points under each column.

Lyndsey: And they did the K and the W. And then they read the nonfiction article. We modeled it. We circled the title. We talked about vocabulary. So we talked about things like what is blubber. We talked about continents. We talked about all these different vocabulary words, within the context.

Lyndsey: And so I'm hitting vocab goals, I'm hitting comprehension goals, and then I have a page of comprehension questions that my students are able to answer. And even if I'm not in the room the day that we do the comprehension questions, the teacher has the students answer the comprehension questions independently. And I'm able to collect my data from those comprehension questions after the fact because I already taught them those skills, and then I can collect the data on that afterwards.

Lyndsey: So we did all that, then what we did was we started working on a penguin lap book that I had created. So we split them up into groups. We had four or five groups of students in groups of three or four, depending on the students and we mix their levels.

Lyndsey: So we did not just have students that were students with disabilities. We mixed their group so that we could have pure models. And what they had to do was they had to complete their lab book, which talked about different types of penguins, facts about penguins, where they're located.

Lyndsey: And what they had to do is they actually had to take books about penguins. They had to also research them, we had ReadWorks articles, from readworks.org about penguins, and the different penguin species. So species was one of our vocab words, and we broke it down. And so they had all of this.

Lyndsey: Then once they finished our lap book, and they also compared and contrast. And so they had a Venn diagram on the back of the lap book about comparing and contrasting two species of penguins. Then what we had them do was, then we did like a STEM activity.

Lyndsey: So our STEM activity was we had five stations. One was I had gotten this giant penguin bowling set off of Amazon. I mean, you can pretty much get anything off Amazon, right? So we did a penguin bowling, and underneath was a vocabulary words and their definitions. And when they knocked pins over, they had to match the vocab words with their definitions. They did a sensory bin with Arctic animals, and they compare and contrast the animals.

Lyndsey: Then we did a blubber activity. We also did a STEM activity where they had to build an igloo out of sugar cubes. And then we had one where they cut out pieces of penguin body parts, and then they they built a penguin, and then they had to label it. So bringing back in those non-fiction text features.

Lyndsey: And then at the end, after all that, then they presented their lap books and their research. And that was we had a rubric for what was the expectations for them. And that was their speaking and listening goals as well. So there, I can hit my grammar goals. And again, I have comprehension, I can have compare and contrast. I have so many goals tied in to this two week, two or three week lesson that I'm doing. So that's just one thing that I'm able to do with multiple goals, but multiple activities as well.

Marisha: Oh, so many awesome ideas in there. Thank you for sharing that, Lyndsey. Yeah, I agree. Because this sounds really familiar to what I do in like my literacy-based therapy units. And sometimes, I haven't done as much in the classroom as you have, but it sounds like there's a lot of carryover. And I think it would be even more effective to do these kinds of things in the classroom because you get that added benefit. So that's really awesome.

Marisha: And yeah, I found too that you can target pretty much any goal with these types of activities, because they all require communication. It covers all of our grammar goals, our vocabulary goals, our comprehension goals. We can easily cover all of the bases. We just need to find a way to support that.

Marisha: And I loved how you mentioned too. I always say talk about this too, and it's a question I hear a lot about feeling like a tutor versus a therapist. And I'm curious, do you maybe have just a couple favorite strategies that you use to make sure that you are being a therapist?

Marisha: Because I know that planning out the unit and working with the teacher in this way, and being strategic about what you're selecting is a huge step. But are there any little things that you do throughout the unit to make sure so that you can feel confident that you're being therapeutic?

Lyndsey: So I think some of that is just going back to the basics of how we do therapy. When I'm in the classroom, I think it's about focusing on our students, and even if I'm doing a whole group lesson, I'm still focusing on, I'll say, my students, my ones that are on my caseload.

Lyndsey: If my students can't answer the questions or do the activity that I want them to do in the way that I'm trying to scaffold and mold and shape it into those responses, I use pure models and pure models are a great way for our students to learn. But the other thing about this is, is that the general education teacher is able to learn from the way that we scaffold and change and use our language flexibly to help our students be successful.

Lyndsey: And we have to remember that we're not the ones in the classroom all day long, day in day out. We pop in there for a short amount of time. And if we help our teachers to understand ways for our students to be more successful, it's going to be easier for them.

Lyndsey: I know a lot of my teachers have said, "Gosh, sometimes students with language impairments are more difficult than the learning disabled students." And I said, "I know." And a lot of that goes back to the comprehension and the expression, right? If they can't express themselves, the teachers get frustrated. If they aren't understanding things over and over and over again.

Lyndsey: So it's about that scaffolding, it's about teaching our teachers how to break it down for them a little bit more. And we might say, "Okay. Well, we have those as accommodations on IEPs." We do, but not everybody knows how to implement those accommodations, or truly break it down into language that our students can understand.

Lyndsey: We as SLPs, we have that ability. We are the ones that understand, as Barbara Aaron would say, those language underpinnings. We understand those metacognitive abilities that our students are required to utilize to be successful.

Lyndsey: And so if we can model that for our teachers, and I think it's really about being collaborative. We have to remember, ultimately, that's their space. And we're coming into their space. But whenever I'm in a classroom, my teachers don't make me feel like it's their space. They make it feel like it's our space. So I feel like it's about developing rapport.

Lyndsey: And at the beginning of this podcast, you'd asked me like, "What are some of those first steps?" And I said, "Well, start small. Find someone that you have that rapport with, because finding someone that you have that rapport with is going to be easier."

Lyndsey: I wouldn't say though, find your best friend, because co-teaching with your best friend isn't always the best idea. Because you have to be flexible in the way that you are team teaching, and it's not always the same. You want somebody you get along with. But you also you also want to be able to learn from that person, and you want to be able to have that give and take.

Lyndsey: I also think it's about the culture of your school. It's about having support from the top down. And so if your administrators don't treat you like tutors or paraprofessionals, then your teachers and your staff won't treat you that way. But it's also about your own perception as well.

Lyndsey: So making sure that when you go into the classroom, you're prepared and you have what you need to be able to be successful with a lesson or with whatever might be going on in the classroom that day. Having the support from the top down, but establishing that rapport and taking on a very much collaborative attitude.

Lyndsey: And then being able to adapt and use differentiated material so we can show teachers how to use and differentiate those materials to be successful. And again, it's really about going back to the roots of our therapeutic practices, and being able to utilize those within the classroom.

Marisha: Yeah. I'm so glad that my video wasn't recorded, because I was like head nodding, moving my arms around and said, "Yes, yes, yes." And I absolutely love what you said about being in the classroom. Because, one, I think that we take our skills for granted sometimes, because we really learned a ton about communication and we probably are the most knowledgeable in our schools when it comes to these kinds of things.

Marisha: And it's easy to be like, "Oh, yeah, of course, they know how to do this and that." But they don't, and we don't know those things until we're in the classroom with the teachers, we're modeling it, and then they're like, "Oh, I didn't think to do that."

Marisha: And it's amazing, because it has such a ripple effect. I love when I'm able to do something in the classroom, and then I'm walking by the classroom later in the week, and I see the teacher using that strategy. And it's so amazing, because then you know that it's impacting those students. But also, that's a strategy that she's going to have for the rest of ... She or he, will have for the rest of their career. And they'll be able to use that to help so many more students going forward.

Marisha: So it's just a really ... I don't think that's something that we talked about in the beginning, but that's such a powerful impact that we can have just by showing up in that way and supporting the teachers. And I feel like we learned from being in there too.

Lyndsey: Absolutely.

Marisha: And we can hear from the teachers, but it's just ... We all do better when we work together in that way. So I love that. And I love Dr. Erin's quote about language underpinnings. I reference that often, so I'm super excited that you shared that.

Marisha: Okay. Because we're running a little bit short on time, I want to ask like 50 more questions. You talked a little bit about data collection. Do you have any other tips that you wanted to share about that and making that work? Because you have some really inaudible questions about giving activities that the teacher can use, even when you're not there. So you can like use the results of that comprehension activity to have some data.

Marisha: And then you talked about, you don't always have to have that hard data, you can take soft data, and take some narrative notes. Do you use any other kind of strategies?

Lyndsey: I'm actually the queen of Post-its. I would probably say it's like my downfall. In 15 years, I am just the queen of Post-its. I'll put a Post-it on my leg. I sometimes pre-print on my Post-its, a grid of what I'm working on and I can just plus and minus with what my kids' goals are. And I know that and I just transfer that into my data binders, either later that afternoon or right after the session.

Lyndsey: If I'm not taking it from an activity that we're doing or I'm getting from an activity that I've left for the teacher and they're completing it, I'm using Post-its. And I find that, that's just a quick way and I can plus and minus without really taking the focus off of the therapy.

Lyndsey: Because I think, again, we focus so much on data collection, and we really need to think about what it is that we're doing. And I know there's been quite a few SLPs that I've talked about putting down the data binder and walking away from it. And I really think that is important for us to keep in mind that we don't always have to.

Lyndsey: And I think by just kind of having that Post-it with us, we can either jot down notes or do our pluses and minuses and get the data, that hard data that we need without being overwhelmed by the task of data collection.

Marisha: Yeah, that's super helpful. And then another question that we talked a little bit about before is, what about when it comes to scheduling this? How do you make that work?

Lyndsey: So I think scheduling is very ... It's probably the most critical piece to being able to provide classroom-based services. And you really do need the support from the top down from your administrators in order to be able to do scheduling because you as the SLP are not just the only one making those decisions.

Lyndsey: However, I will say where I am, we use the models based on the Florida Inclusion Network. So if you've never heard of it, it's a really great resource. It's called FIN, but Florida Inclusion Network. And they have tons and tons of resources about inclusive service delivery models and other types of resources that you can access. It's a free website.

Lyndsey: And again, I'll provide that as an additional resource. But we talked about flexible scheduling and about being able to look at the master board. So really looking about how we can build our master board and about ... It's a team approach, so it's not just one individual, it's about having your administration, your general education teachers, your speech language pathologist, your special education teachers and your ESL teachers as part of that team process.

Lyndsey: But what we do at my school is we actually use big chart paper and we use Post-its with our student names on it. And then we have the little round ... I think of them as like garage sale stickers, but the little round stickers that are colored, the round dots. They're all color coded based on the primary and secondary eligibility for the students' IEPS. And then we group them based on their needs.

Lyndsey: So my administrator will know, say in second grade, she's going to have two inclusive groups for that grade. We group our speech and language and our special education students into two groups. And then we schedule everybody else around them. So we actually schedule our speech and language and our special education students first, and then we scheduled the gen ed students around them.

Lyndsey: So this allows for multiple things and make sure that we are able to schedule for all of the services first and foremost, including occupational therapy, physical therapy, speech and language and special education. But it also allows us when we're building the classes to make sure that we have pure models, both academic models and behavioral models for those students within the general education setting.

Lyndsey: So we really work together to determine how to cluster the students, the needs students, the behaviors of the students, and how best that we can do this together. And it is a team approach. And we do this every single year together. So it really is helpful for us when we sit down and we look at this as a team to make sure that we meet the needs of all students.

Lyndsey: And then by doing this, when we go to our schedules, we know, "Okay. Well, I'm going to be providing services in within the language arts classroom." It varies by district and by state, but in my district, we have a 90 minute uninterrupted language arts block. We could not pull students out from that block, but if I'm going into that block, I'm not considered to be interrupting that time. I'm considered to be supplementing with that time.

Lyndsey: So we're able to provide services within that language arts block. But we are able to look at can we also provide services collaboratively like in the science classroom. I've done some math stuff. It's not my favorite, but I like to go into the science classrooms, because there's tons of vocabulary and comprehension and things that we can do collaboratively with our teachers.

Lyndsey: So there's a lot of different ways. But when our students are grouped together, we're able to better see how we can provide flexible service delivery to those students.

Marisha: Yeah. Like for your second grade group, do you always go into that language arts classroom and work with that teacher? Or would you switch it up and do language arts for a while and then switch to math once you make your schedule do you say in that class?

Lyndsey: So I stick with language arts, but I sometimes switch the amount of time. So I am not. There's no research to support really that two times a week for 30 minutes is the most effective. So I like to be very flexible. Like I mentioned with my third grade block right now, I'm in there for almost two hours.

Lyndsey: But last year, for example, I was in my second grade room for 30 minutes. I left and did an articulation pull out group for 30 minutes, went back into my second grade room for another 45 minutes. And then I had some planning time. And then I had my third grade group for 45 minutes.

Lyndsey: So my times are very varied, but because of in the second grade classroom last year, we also had special education teachers and intervention teachers in the room, and we couldn't all see the same students at the same time, so we had to be flexible. And I was able to be the most flexible.

Lyndsey: So I came and I left. And what it also allowed me to do was I did 30 minutes of whole group co-teaching, and then I did 30 minutes to 45 minutes of small group time with my students or some 30 minutes of small group, 15 minutes of individual within the classroom, depending on what they were doing.

Lyndsey: And I was also then in there for the reading part of the block and the writing part of the block, which allowed for a lot more flexibility with targeting goals as well.

Marisha: Yeah. No, super helpful. Thank you again for breaking that down. Again, it's really nice to hear someone who's in the trenches, just breaking this down and just saying how you do it. I think it helps us, like all of us who are listening, just imagine what that would actually look like. And so I super appreciate that. And let's squeeze in one more question.

Lyndsey: Okay. I mean, I could talk about this forever.

Marisha: Me too. I told you already that I was so incredibly excited as I was writing out these questions, because I just love learning about this. And I think it's so incredibly powerful. Because you talked a lot this all is based on working with teachers.

Marisha: I feel like this would have to be an entirely different episode about working with administrators and figuring out how to make that work. But let's just keep it small. Like I'm an SLP who's wanting to do this for the first time. I'm going to start small. How would you recommend communicating with the teacher to get started with this?

Lyndsey: So I would say my recommendation is always around the holidays or a holiday is probably the best time because it allows for you to kind of say like, "Hey, I have this really great activity. I think that I can really target a lot of goals with my students. Would you mind if I came in and co-taught a lesson with you? Or even would you mind if I taught the lesson and you helped and supported me with behaviors and whatnot?"

Lyndsey: A lot of times teachers are like, "Really? Wow, yeah, sure. No problem." I've really never run into a situation where a teacher has said, "Oh, heck no. Do not come into my room." It's rare. And so I think if you approach it from that kind of standpoint, and it's really about thinking about, "Hey, we're all in this together. We're here to support the students. I'm here to help you too."

Lyndsey: I think coming about it as, "Hey, I have this really great lesson." And then once you go into one teacher's classroom and do it, and if you say, "I was just in Mrs. Smith's room, and this lesson was so amazing." Or if Mrs. Smith is like, "Oh my gosh, [Dr. Surasky 00:57:26] just came in and did this lesson in my room. It was so amazing. You should have really been there for."

Lyndsey: And then it's kind of that trickle down effect. What happens is other teachers who have students of yours are going to want you to be able to either do that same lesson or, "Hey, is there another time when you could come in and do a similar type of lesson?"

Lyndsey: And then it sort of just goes from there. And I think just, again, that start small. Find one person that you can do it with, but I find around the holidays, or some sort of event would be a great way to get started. So that just start small piece, one lesson to get your foot in the door.

Marisha: Yeah. So I actually have reached out to a teacher, and she really did not want me to come into her classroom. So like that might happen. But that's okay, because we're starting small, and we're doing this to benefit our students and to support them, so she might not be ready for it yet.

Marisha: Just reach out to another teacher and that's totally fine. The worst thing that will happen is that they'll say no. Like I said, we can just go to a different teacher and then word will start to spread. I actually did that in that school and I just went to a different teacher. I did the unit. She raved about it. She loved it, and then that teacher ended up asking me if I could come into her classroom.

Marisha: So it's just really funny how that works. But don't be afraid of those knows, especially keeping in mind that this is to benefit the students. We talked about a lot of the benefits that we might see from giving this a try. And there's so many more kind of things that spin off of that as well. So before we wrap up, did you have any other just closing thoughts that you wanted to share?

Lyndsey: No. I just think it's like you mentioned, keeping an open mind. And I think just kind of getting out of your comfort zone. We all like to stick with what we know. And I think that is the hardest part is getting out of our comfort zone and just remembering that success is the state of mind.

Lyndsey: So if you feel like you won't be successful in the classroom, you're already setting yourself up for that. So you have to keep in mind that take that small step and get yourself out of your comfort zone. And just take that one baby step and keep in mind that it's how you think about it, it's your perception of it, and you want success to be your state of mind. You want it to be positive. And you want to keep in mind a growth mindset with it all too, because it isn't all easy from the very beginning.

Marisha: Yeah, but anything worth doing isn't going to be easy. And I love that success is a mindset. I want a giant poster that says that. That's such a good quote. So thank you so much for all of these amazing tips and strategies and just breaking things down for us. If people want to find out more about you and what you do, where can they go to find out?

Lyndsey: So they can head to my website speechtothecore.com. They can find me on Facebook and Instagram as Speech to the Core. And I have several articles on SIG 16 Perspectives. The inclusive first steps article, a growth mindset article that I've co-authored.

Lyndsey: And then there's lots of resources on ASHA's practice portal about service delivery models, caseload, workload, and there's so much more that we can talk about, about that. But there are so many amazing resources out there on ASHA's website and through the practice portal that everyone should make sure to check out.

Marisha: Okay, perfect. And then I'll be sure to do some research too and link to ... Well, it will be easy to link to your site and your social media accounts. And then I'll look up those articles too. So it's really easy for people to find those and the link to find that is slpnow.com/24. But thank you so much Dr. Lyndsey Zurawski and I can't wait to see what else you come up with. I can't wait for that research 10 years from now and everything in between.

Lyndsey: Thank you.

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Filed Under: Podcast Tagged With: Curriculum-Based Therapy, Literacy-Based Therapy

#023: Techniques for SLPs to Improve Communication with Teachers

October 10, 2019 by Marisha Leave a Comment

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In this episode, we’re continuing our series about starting the school year successfully and talking about how SLPs can successfully navigate communicating with teachers, because they can be some of our best allies when it comes to our students.

This isn’t always an easy topic to handle, and I’ve heard stories from both sides of the spectrum — sometimes the relationship with a teacher is amazing, and sometimes it feels downright dismissive. But, I think it’s so important that we have these conversations and learn how to improve because our students will reap the benefits when their teachers and SLPs are on the same team. 💪

So grab your beverage of choice, put your feet up (or get your walking shoes on!), and listen in.

Key Takeaways

– How SLPs can show up in the school
– Get clear on attendance requirements for staff meetings
– Time integrity with students’ sessions
– Communicating schedule changes so there are no surprises
– Being visually present at the school
– Providing education
– Let the staff know what your role is and how you’re there to help
– How to share information in a way that actually sticks
– Reviewing the goal + target setting process
– Creating an IEP at a Glance
– Conducting IEP check-ins with special educators
– Using a red folder to ensure teacher compliance
– Making probe data fun
– Supporting goals that the teachers are working on
– Keeping the relationship going strong all year long

Links Mentioned in the Podcast

– Templates on Teachers Pay Teachers
– Using SLP Now for data organization

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Thanks so much!

Transcript

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Teacher communication. On a scale of one to five, one being you strongly dislike teacher communication to five you love communicating with your teachers, how are you feeling? Drop your number in the chat if you're here live or if you're listening to the replay, just do a quick memory check and see how you're ... do a quick check in on how you're feeling about that. Okay, awesome. So in the live chat we've got people who are feeling pretty good on lots of threes and fours and fives. So that's exciting. Let me know what's keeping you from being a five, like what makes it a little bit challenging for you or what do you feel like the hurdle is there. What would make it a five and just think about that too. And as you're doing that I will just share a quick story.

And I've had pretty successful teacher communication overall, but I've heard horror stories from other SLPs and so I wanted to kind of share that combined experience because it's so incredibly important especially if we're working towards that embedded practice. Like we really need them to let us be a part of their team to make the biggest impact for our students. But it can be a challenge because we're all very busy. Teachers have really large class sizes, we have huge case loads. We're running around, we have duties [inaudible 00:01:42] all of these different things that we have going on and the emotions can get pretty intense sometimes and especially if there's something that we don't totally agree on in terms of how to serve a student that can bring about some different tension. And I've heard of a lot of younger SLPs struggling just to be respected by the teachers. Like one SLP told me that some teachers would just turn their back on her and she was straight out of grad school and she looked a little younger and maybe that was part of it. I don't know. I wasn't there.

So it's hard to tell, but we can definitely come across some conflicts as we're navigating the schools and working with our teachers, but it's not a reason to give up just because we find or we come across a more challenging teacher or a more challenging administrator. We are problem solvers and we're not going to let that get in the way of doing what's best for our students. And I really think that's ultimately what motivates all of us. And sometimes we just have to find a way to get to the core of that and to make that happen. And if you are in a situation like maybe you didn't put your number down in the chat or maybe you weren't here live and you were giving that a one because you're experiencing more of those situations, my best advice before we dive into the specific strategies is to start small. So if you're meeting a lot of resistance for whatever reason, just start with one teacher. Start with the one teacher who seems to be the most receptive and start practicing your skills and implementing the strategies with that one teacher.

But if you're feeling like you're at a four or five, start implementing these strategies if you're not already and just keep improving and refining that process. And either way we're going to continue making progress and moving forward one step at a time. And we all have different things that we're working on and different strengths and weaknesses or areas for improvement. So yeah, hopefully this will give you some good strategies. So we've got five that we're diving into today and the first one is to show up. So I've come into a couple of schools where the previous SLP, according to the staff, I don't know what actually happened, but they felt like the previous staff person didn't show up or they had different feedback around that. And I think that, I mean, and it really varies if we are contractors versus district employees because I think one of the biggest differences was that as a district employee, I had to attend the staff meetings in one of the examples and the previous employee was a contractor and I don't think they were even allowed to attend the staff meetings. So that was one example. I think they kind of really honed in on that.

And that's something that they talked a lot about. But I think that ... I don't think we have to show up at staff meetings necessarily to show up as a speech language pathologist and just show up for our students. I think that the first thing is just to get our students at their assigned time. But you guys all know that. But that was something that the previous teachers mentioned, they don't always come get the students when they're supposed to and sometimes we wouldn't see them for a couple of weeks and we didn't know what was happening. So get your students during their assigned times and then if there's a schedule change, just communicate that and be present in the school in that way. And I think showing up in that way is huge and just communicating if there's a change in that. But then there's also just showing up around the school. So eating lunch in the teacher's lounge for example.

And sometimes that can be a little bit of a toxic environment but definitely feel it out and see if you can find a group of teachers there and just check in on your students. Even if you're not doing the social components, if you see the teachers in the hall and just say hi to them there and then take that as an opportunity to check in on the students because that's the best way to show that you care and that you're there for the students and you're really wanting to see them make progress and being able to report some changes that you've made based on conversations is incredibly helpful too. So then the next step is to provide education. Because I think with a lot of the teachers, they didn't understand my role or the role of previous speech therapists and they were missing a lot of important pieces and they didn't really understand even like which goals were supposed to be targeting or anything like that.

So you can do one on one ... Like education with teachers you can send out that handout for example. But I think it's most effective because if they get a handout they might glance at it, but they're not really going to retain that information unless you're just sending out quick little snippets over time, which could be a fun strategy. Like I saw one SLP who would send little snippets of information and she would attach a little treat to it. So that's a good way to get their attention. But I've had a lot of success presenting at staff meetings and all I had to do was ask the principal and all of the schools that I've been at they allowed me to do that. One of the principals was the little resistant and I had to explain why I thought it was important. And just be prepared when you go to ask be able to explain the why behind it. But as soon as I explained my rationale, she's like, “Oh yeah, of course that totally makes sense. We'll share five minutes with you.” And then I went into that and that made a huge difference because I was able to share education around the things that kept causing issues or lack of understanding.

So just like a quick overview of the goals that we actually target can be a good one on how the referral process works because that goes hand in hand with knowing what we actually target. So explaining how goal districts referral process works and what that looks like and just being able to explain it to everyone at the same time and making sure that everyone's on the same page and bonus points if you have a handout is incredibly helpful. And then it's just a really great time saver cause you're able to address everyone at once. And I have some different templates that I've shared in terms of different things that I've shared at staff meetings like that. So I will share that in the course notes as well. But providing that education is huge. And then I follow that up with the students' goals. So I like to create an IEP at a glance and all of the districts that I have been in have a ... the IEP system just has that built in where I can select all of my students and then just print the IEP at a glance.

If your system doesn't have that, there are tons of templates on teachers pay teachers to, or if you use a digital system, like with SLP now there's a way to print out your students' goals and any notes you would want to add or ... So you have lots of different options there. And then some things that I really like to include in that IEP at a glance are the students' goals. Because there's nothing worse than going to an IEP meeting and the teacher think, “Oh I have no clue what they've been working on.” And sometimes they'll actually admit that in a meeting, which is, that's always fun. So I want to list their goals and make sure they understand what the goals are. I list the accommodations, any other services that they're receiving.

In some schools I partnered up with the special education teacher and I would just go deliver my IEP at glances for the students just on my caseload. And then we would either go together or split up the goal or the IEP at a glances for the students that we shared so that we could have good conversations around those students with the teacher. And it's just like a really quick check-in. But yeah, so those are helpful things to include, the goals, accommodations, other services, the scheduled time and the different templates that you can find in the different systems will have that. And my strategy for success was because I did it one year and I just printed it out on regular paper and I gave it to the teacher, but I still didn't have quite the attraction that I wanted. The second year I tried this, I put it because this is technic or it is confidential information and it's actually our responsibility to make sure that that information is still secure and all of that with all the HIPAA rules and all that.

And so I put the information in a red folder and I wrote confidential on it and I had the teachers sign that they received the document and I told them that they would need to bring it to the next IEP or I would collect it at the end of the school year depending on kind of how the timeline fell. And so then that raises a flag in their brain for a number of reasons because they're seeing this red folder, it's confidential, they signed for the folder and then their attention is suddenly peaked. And when I'm explaining what the goals are and kind of having a discussion around that, it's just a much more meaningful conversation and I think it's more likely to register. And then in the future they'll see that red confidential folder and it'll just stand out and they'll keep it in a safe place and then if they ever need to reference it, then they'll know where it is. But that system has worked really well and it's just been a really great strategy to use with the teachers. And during that discussion I'm able to, because it is one on one, I can make sure that they're understanding and offer any clarification maybe even give some examples.

If I already collected the probe data, I can show them where they're at and that is such an amazing way to show up and make that happen. And you can make it fun. Like I'm all about bringing different treats and things because I want them ...I probably work too hard to get them to like me, but it seems like it works. I have had successful communication and have had really good teamwork so I don't know. There's always room for improvement, but I think that's a way to make it a little bit more fun, especially when they are stressed out and just to show that we appreciate them sharing their time. And then one thing that I like to do when I'm sharing the students' goals is that I offer support because a lot of times teachers have their professional learning goals or their professional growth goals and they have to ... if they're using the Danielson framework or any, I don't know what other frameworks there are out there, but they have to document different strategies that they've used and different communication and working with you can meet one of the requirements for their evaluation.

And they also have to document student progress towards those goals a lot of time so it can be a great way to partner with them. Like the example that I gave in one of the earlier modules was I knew that all of the third grade teachers were working on this math story problem goal and they were kind of stressed about it. So they were really excited when I offered support because the students that I'm working with are the students that need the most support and that they were the most worried about meeting that goal. So I was able to offer my expertise and offer support towards that goal in something that they were already working towards. So they were really motivated to share those math problems with me. Whereas the previous year I really struggled to get anything from my teachers. I really wanted to implement curriculum based therapy, but it was like pulling teeth.

So once I started aligning with what their priorities were, and of course it has to match up with what the student needs to work on too, but like in this case it was a perfect fit and they were ... we made a really great team in working towards that. And so that's just asking them and taking that like, okay, so we just shared the students' goals. Like I'm curious what are your professional learning goals? And if you're not familiar with that process, talk to one teacher that you're comfortable with and ask them if your principal requires your teachers to write goals like that and what that looks like. And maybe come up with a couple ideas on how to start that conversation depending on what your school's set up is. But I think that's so incredibly valuable and helpful and they all remember that and they'll want to be able to document that as evidence towards their goal. And if you're able to help it's a game changer.

So it's really helpful. And then we'll want to check in with our teachers along the way. So it's not that we ... because we could start off super strong. We could have this amazing staff meeting where we provide amazing education and handouts for them. We share their IEP goals and we have an amazing discussion. We offer to support them with our goals and then if we just drop off and don't follow up with that, then that won't be setting ourselves up for success or our students or the team. So we want to make sure that we check in and there are a number of ways that we can set this up. If your school uses Google, there are some tools that you can send automated emails even, or you can just jot a note in your planner of like, okay, so on the first week of the month, I'm going to check in with the kindergarten and first grade teachers. The second week, I'm going to check in with second and third. And you can come up with a system for that or if you're good at just naturally checking in, then that's amazing. But if you need a little bit of extra support, definitely set that up. But I think a quick little automated note can be amazing. And I know the inboxes sometimes get pretty full, but if it's just something super short and sweet, you typically get pretty good responses with it.

So that's what I've got. But like I said, there's some different templates that I'll share in the notes with different resources that you can use there.

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Filed Under: Podcast Tagged With: Teacher Communication

#022: Parent Communication Strategies

October 3, 2019 by Marisha Leave a Comment

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This week, we’re continuing our series all about navigating the start of the school year successfully. 💪

We’ve spent the last few episodes talking about scheduling, setting up your caseload, and building those interpersonal relationships with our fellow teachers and paraprofessionals.

This week, we’re going to branch out beyond the school + classroom and talk about communication with parents!

Parent communication can seem like a “soft skill” or something that’s more of a bonus compared to treatment goals, but it’s a great area to consider working on because they spend an awful lot of time with our students. They are often the ones who know their children best, and they can be such great allies throughout the therapeutic process.

So, if you’re ready to do some work on your communication skills, grab your drink of choice (I’ll have a chai latte!), put your feet up, and listen in!

Key Takeaways

– Why we should spend time working on parent communication
– Five strategies that we can use to start navigating the process:
– Using handouts with parents
– Mapping out IEPs, and getting parents prepared
– Using technology to keep parents informed
– Having a central hub for information
– Keeping everything organized

Links Mentioned in the Podcast

– Communication apps
– SLP Now for communication logs
– My favorite handouts

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Bonus points if you leave us a review over on iTunes! Those reviews help other SLPs find the podcast, and I love reading your feedback! Just click here to review, select “Ratings and Reviews” and “Write a Review,” and let me know what your favorite part of the podcast is.

Thanks so much!

Transcript

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... to share some examples of that with you. Before we dive into all of the strategies for our parent communication, I think I'm preaching to the choir here, but I just wanted to take a second to think about why we would even spend some time working on this because we have so many things pulling for our attention, and it might not be the goal that you're working on right now and that's okay, but if you're trying to decide which goal to work on or which area of your practice to improve, I think parent communication is a really great areas to consider. They spend an awful lot of time with our students and they know our students best. They can really be our allies and help us reach maybe students who are a little bit more difficult or just help any of our students make progress.

If they can help with that generalization at home, that can make a huge difference in terms of overall progress and generalization to other settings, as well. If we have them on our team, it can be incredibly powerful and huge. So just a little bit of the why behind that. Like, I feel like there's so much research coming out lately that focuses on including parents and intervention. I mean, it's a little bit trickier for us to implement in the schools, but that's something that I'm really excited to dive into and see how I might be able to implement that with my caseload in the future and just implementing what the research is telling us. But there's some really great results coming out of that.

But for today, I have five strategies that we can use to start navigating this process a little bit. The first part is to make it easy, so I'll share some ideas that we can use to make it easier. We want to log our communication and we'll talk about why and how to do that. We want to communicate early, communicate regularly, and one super helpful strategy is to build a handout binder and I'll show you how I do that and what that looks like.

First thing is to make it easy. I confessed earlier that I had a really hard time sending home worksheets. It was just challenging for me to find, like put together the activities that would make sense for the student that matched up with what we're doing that were appropriate for their level that they could do. Because I was really worried about that errorless learning, especially when it came to articulation and I didn't want them to be practicing at the wrong level or practicing it wrong because that meant more work for us. And so there were a bunch of hurdles there just in terms of the time and just the logistics around implementation. So many times I found I would put together these beautiful worksheets and send them home, and then I would just find them crumbled up at the bottom of a student's backpack, and they like rarely got returned. That was challenging for me because I put so much work into it and it didn't seem like it was getting any results.

And I was doing some brainstorming and trying to figure out how I can make this better. I was talking to one of my teachers and everyone at this new school that I was at was using Remind, which is a communication app. They're all HIPAA compliant, they've got all the security in place, and it's really great if your school is already using a communication app, but if not it's something that would be worth looking into some. I'm not sure about the compliance of all of the other tools, but I know, for example, that Class Dojo is another example. There's a couple of Seesaw is another example of an app that I've seen other SLPs use, but I think it speaks to the making it easy component.

Maybe it's not that. I've seen other SLPs use, they set up a Google voice number and they text with parents through there, too. But it's so fascinating to me because when I was using Remind, but I was still kind of in the transition, I would try and call parents and I would leave them a bunch of messages to try and schedule their IEP or to chat about something or whatnot, and I would like call, and leave messages, and try and squeeze it into my schedule and it would just be crickets. Like nothing. Then I was like, "Oh I should try this sending a message on remind because we have that set up." I'd send them a message and they would respond within seconds.

And so I think, I don't know, especially in terms of how I like to communicate, I don't often answer the phone or check my mail. We just get so many notifications and so many things going on that a text is just really easy, low entry. I can be like, "Okay, sure I can respond to that." That's one thing that has made a huge difference for me. Parent communication started being much more doable once I made it easier, and that was just what happened to work best for my parents at that particular school. Different schools and different demographics and all of that will respond to different things, but that just worked out really well.

So think about what would be easy for your parents, and maybe those handouts, like Holly shared the example because her parents come into the session, a handout is probably the easiest thing there because maybe they sat in on the session, then they saw it happening, and then Holly can just share handout or a worksheet for continued practice because they were in the session, they saw it happen, they know what to do, and then they can take it from there.

And even if they weren't, she has the opportunity to check in with them and share a strategy that they can use when completing that activity. So for that example, the worksheet might be easier. So, just think of the different options available to you, whether it's phone calls, text communication apps, worksheets, folders, more regular meetings, whatever it may be, and what feels like it would be easier for you and easier for your parents, and that'll be the best way to maintain that communication and keep that working.

Then the next step, once we find something that feels easy, we want to make sure that we log the communication, because depending on your caseload size, you might be having conversations with over a hundred pairs of parents, and that's a lot. We want to make sure that we're keeping track of what we're communicating about and that we know that we can remember and keep things straight, so setting up a communication log right at the beginning of the school year is so huge. Then when I was using Remind, because you can copy and paste that information, I would, and you can just keep it in Remind and maybe just export it at the end of the school year if you're required to keep conversations, but if it was something really important that I wanted to reference when I was writing the IEP, I would copy and paste it into SLP Now. That's my digital system and that's where I would keep track of my communication logs, because it's just linked to the student's profile, so when I'm reviewing my data and updating my IEP, I can see all of those relevant notes.

I also use that, we'll talk about teacher communication in the next module, but I really liked having that central hub for all of that information. Then when the next time I was having a conversation with a parent or when I was preparing for an IEP, I could just see all of that in one place and feel like a rock star therapist because I can remember all the details.

The next step is to communicate early. I know that I get a little bit anxious when I'm on a deadline, I have to schedule this IEP, and I don't always do my best communication when I'm on a time crunch and when we just have to get this in because the deadline is coming up. That's why I map out my IEP dates well ahead of time and I start reaching out to parents well ahead of time as well so that we can get something on the calendar and make sure that they're prepared to come into the IEP.

Then start to bring up, maybe when I'm on the call with them, if we're going to be talking about any kinds of changes in the service delivery, or the goals, or anything that we might be talking about, I can get a feel for where they're at and we can kind of start moving towards that conversation instead of having it all be a really rushed conversation of, "Okay, let's get in, let's do this," and then the bomb goes off with all the changes that are happening. I think that's when the miscommunication comes in and that's when issues arise is because we didn't give ourselves enough time and space to have those conversations and just give them the time and space that they need.

Then the next step is to communicate regularly. If we're giving ourselves enough time, like if we go to schedule that IEP meeting, we can check in there, and then we can have a quick reminder or a quick Remind reminder using the app, or Google voice, or whatever you're using, but just having a way to check in in terms of scheduling the IEPs. But then when I was using Remind, I would just take a quick picture of the activity that we did in the therapy room. I was like, "Hey, we're reading this book this week," and then maybe the next week I would say like, "We worked on this skill," and just give an example. And so, I would give little snapshots of what we were working on and then I would take a quick picture.

Like if we did the story retell, it's like, "Hey, we worked on this story grammar organizer," and I could even share video and different examples of I could send like a quick voice memo showing how the story retell worked or share a quick strategy, but that was really doable for me to squeeze in those quick messages throughout the week. I wouldn't do it every week for every single student, but I would at least communicate, like, I would communicate way more frequently than I would if I just had the phone, and sending a quick picture is easy to do with multiple students in a group at once, and so that was just one way that I was able to communicate more regularly.

Then another strategy that's been a game changer is just building a handout binder, and I carry to any meeting that I go to with parents or teachers. I'll give you an example of some of the things inside, but I think it's incredibly important because we're really familiar with the IEP process, how special education works. We are really familiar with our content area and we have a good enough idea of what's going on with other specialists, but for parents, it's all new to them, and they're also bringing in all of the emotion that goes with that. They're overwhelmed, they're worried about their child, they're being bombarded with all these acronyms, all of this information. It just goes over their head a lot of the time.

That's why I really like to have these handouts ready to go, because it makes the conversation easier because we can refer to the visual and I can make sure that they're understanding it. So I'll explain whatever I'm explaining and refer to that, kind of like we do with our students, but then I'll let them take the handout home so they can refer to it and revisit it, and I might just like staple my car to it or whatever in case they have questions, but that's just increases their comprehension so much more and it makes the conversation that much more successful.

Here are a couple of my favorites, and these are all free, and there are more generic, but Jenna Rayburn, this is on Teachers Pay Teachers her what is an SLP handout, but I think it's helpful to explain this to parents when we're first starting out so that they know what we do and what we target. This is also especially important for teachers. This is more of a teacher-oriented handout as well, but it shows the expectations for the different grade levels and it's really helpful. This is by an Amanda Newsome from A Perfect Blend and that's also on Teachers Pay Teachers. I just had to plug in these observation checklists, because they are incredibly helpful as well.

But my favorite handout to use when I'm explaining evaluation results to parents because the standard scores and all of that don't make a whole lot of sense. It took me a little while in grad school and I know that some of my parents have no clue, so this makes it much more visual, it makes it much easier to explain, and it includes really nice descriptions of the different bands. I just love how it is visual and shows the number of students so that I can use more parent friendly terminology when describing it.

What I do is I use this in particular when we're going over evaluation results, but I'll pull the standard scores or percentiles from their different assessments and plot them on the bell curve. Then we get a really good overview of where they fall across the different skills. It just really makes a discussion that much easier and it's just really helpful. This is from Pacificcoastspeech.com/resources. It's also free and easy to find. Then if you're looking for more recommendations for handouts, I will also share that link in the blog post for this course.

Then the other things that I like to do to keep this organized, I put all of the handouts in sheet protectors. I think this is an example of sheet protectors from Walmart or Target. You can find them anywhere or in your school's office. But then I put the original handout and then some copies of the handout in the sheet protector so when I'm at a meeting, I don't have to rent in the copy machine, I can just pull one out of the sheet protector and I'm ready to go. I use a highlighter to put an X, a big giant X, on my original so I don't give it out. The magic thing about a yellow highlighter is that if you copy it, it doesn't show up on the copy. Because I don't want to give a parent handout with yellow highlight or all over it, so it prompts me to like go get another copy so I don't lose the original. But it's just a really nice way to keep them organized.

Then I use this ready index, and this is what I was talking about with the assessments, as well. I use already indexed to keep track of the different different sections of handouts so I can easily navigate to the ones that I need for any given meeting or whatnot. That works really well. And just another note, because I got extra wide ready indexes so I could still see the number of tabs stick out, because the sheet protectors are wider than a normal piece of paper, so if you're a super type A like me, you might want to look for an extra wide ready index to keep those organized, or just extra wide dividers so you can still see the tabs, or you can get little sticky note tabs to separate them out. But that organization is definitely a time saver so you're not just flipping through all of the pages trying to find the one that you need.

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Filed Under: Podcast Tagged With: Parent Communication

#021: Navigating the First Few Weeks of Therapy

September 26, 2019 by Marisha Leave a Comment

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Navigating the First Few Weeks of Therapy

I hope you’re ready to get an ear-full (in a good way!), because this week on the SLP Now podcast we’re going all in on tips, tricks, and practical strategies for navigating those (sometimes crazy and chaotic) first few weeks of school.

Hopefully you’re already actively doing a lot of the suggestions, and today’s episode delivers you a nice boost of confidence as you listen in thinking, “Yup, check. I’m doing that. Check, check, check.”

And, maybe there’s one or two things that you haven’t considered and could implement in your own therapy routine. You never know when you’ll glean some new ideas from the SLP hive mind, and can make some tweaks and adjustments to an already great process.

After all, we’re all here level up our speech therapy game together. 💪

So, grab your beverage of choice (it’s officially PSL season, right?), put your feet up (or hit the road ), and listen in.

Key Takeaways

– Top 3 priorities for the first few weeks of therapy, and strategies to make them happen.
– Practices that help students regulate + arrive ready to learn
– Using goal cards to check-in + review
– The importance of visuals to support
– Using authentic context in therapy
– Supporting students’ ability to access to curriculum
– Facilitating success and avoiding negative practice
– Scaffolding support
– RISE (Repeated opportunities, Intensity, Systematic support, and Explicit skill focus)
– Giving specific feedback and assigning homework
– Ways to get additional practice and help facilitate carryover
– Setting a group schedule + gathering data
– Organizing your visuals (in a way that is usable)
– Ideas for classroom activities that help the knowledge to stick (with examples of application)

Links Mentioned in the Podcast

– Free goal cards to check-in with + a template to implement
– Caseload at a Glance
– Contextualized Language Intervention by Ukrainetz
– SLP Now
– The Expanding Expression Tool
– Marisha’s therapy tote
– The Notability app
– Reading A-Z
– NewsELA

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✨ Bonus points if you leave us a review! ✨ Those reviews help other SLPs find the podcast, and I love reading your feedback!

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Thanks so much!

Transcript

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Feeling overwhelmed with all of, the different options navigating the first few weeks of therapy. So, this is one of our meatier topics. We've got a lot to dive into here, and our plan is to kind of, talk through the four main things that we want to get done and this looks different in every district.

I know some SLPs start therapy on day one, and they just start their sessions, and they're doing all the things. Some districts have a little bit more lead time. The first week is, you have time to get things setup and then you start therapy.

So, this plan that we're talking through is just, kind of, once you start therapy what that would look like. So, in the first week or two of therapy we really want to focus on establishing rapport with our students, establishing routines and expectations, and then we also want to make sure that we have baseline data.

So, those are my top three priorities in the first week or two, and we'll talk about different strategies to make that happen. And then in week two or three is when I'll start actually with ... Starting with the actual therapy. And then we'll talk about what that looks like too.

So, the first thing that we want to do, is we want to establish rapport, and it might seem like, "Why would we take time to do that?" But we all know if we have a doctor who is not welcoming, and he's just, kind of, rough our interaction with him is much different than with a doctor who's friendly, and nice, and helpful. And we're probably going to get better results with this more friendly doctor.

And so, just taking some time, there's a lot of research behind it, there's some citations in the references at the end of these slides and so, it is worth taking some time to make that happen.

And some things that we might be able to do with our students are, just to check-in, talk abour our summers, what did we do? And it's also a great way to ... Because we're always looking at different components, this could be an opportunity to collect a language sample too, so we're collecting some data as we're establishing that rapport.

But let them tell us about their summers. I would model first and tell a story about my summer, and then everyone in the group could go around and tell a story about their summer. That could be an example, or we could just have a conversation about what we did over the summer and look at the interaction skills there.

So, we're always kind of, listening and taking in what the student is saying, but we also can use this as a way to start collecting that data and figure out where we're at.

Like, if we were working on K last year, and they're talking about how they went to camp with their beautiful K sound, then that's something that we'll note, and we always have our therapeutic brain on as we're doing these things.

Some other things that we might do if we're brand new to a school and getting to know these students for the first time, we might talk about what their interests are. What are their favorite things to do? And I often jot down notes so that I can be sure to incorporate some of their interests into therapy, because if they're engaged they'll also make that much more progress.

I also like talking about what their goals are. And we'll dive into this a lot more as we dive into the actual therapy components, but what do they want to be when they grow up? Do they have any goals for this year? Do they want to join the track team? Or do they want to accomplish ... Do they want to do some project or go on some vacation? What are their goals and how can we support them with that?

And then ... Yeah, just kind of, show your personality. Show your quirks and your interests. What are you interested in? Are you really funny? Do you like telling jokes? Are you a good storyteller? Are you a crafter? Do you make things? Bring in some of your interests into the therapy session too, because it helps the students get to know you and then it also helps make things a little bit more enjoyable for yourself as well as we're kind of, diving into all the things.

So, it works for our students, and it also works for us. And if we have a happy therapist, we have much more, awesome therapy sessions. So, that's important. Then we also want to take some time to establish routines. And we can do this in a number of ways.

And I'd like to talk about the why, behind routines as well, because it might make it feel like we're being robots, and it's super robotic, but there's actually a lot of research behind incorporating these routines into our therapy sessions, and it can be really helpful.

It makes it easy to incorporate evidence based practice into our sessions, because we can use these general principles that have been shown to improve student learning and outcomes, and we can use those to infuse our therapy sessions with those good practices.

And then it also makes it easier for our students. It gives them the cognitive resources to learn, because they're not struggling to figure out what's happening. They know what's happening, they know what to expect, and they can focus all of their resources on figuring out what to do, and how to make the most of the session, and how to really implement those new skills that we're teaching them, because that's what we want them to do. We don't want them to have to figure out what's happening in the session.

And then it also helps us. So, it frees up our own cognitive resources to be more flexible, and to do more problem solving, and to figure things out. And I think it's kind of, like a road trip map. If we know where we're going, if we are ... We're starting in Phoenix and we're going to New York. We're taking a road trip there, and we know that's where we're going. And if we know where we are, and where we're going, if there's a detour somewhere, if they're doing construction on one of the interstates or whatnot, it's easier to make that detour because we know where we are and where we're going. And we can more easily navigate that journey.

Whereas, if we're just like, "Where are we? What are we doing? Where are we?" And then it's just, much easier and just, less chaotic when we're trying to navigate the challenges that inevitably come up.

And it just helps increase student attention, engagement. Like I said, it gives them the resources that we need, and the research really does support taking precious minutes out of our sessions to do these different things. And we already talked about one of them, which involves the introduction, checking in with our students, kind of, establishing that rapport. And then we'll dive into the subsequent three steps as well.

So, with the introduction I like to take some time to check-in with the student. So, this goes along with establishing that rapport, and if I know that they love ... They do go-kart racing or something, and then I know that they had a race on Sunday and I'm picking them up on Monday for their session I can ask them how that go-kart race went.

And then in that conversation oftentimes other things come up. And I also like to do just, a general check-in with how they're feeling, and I'll give some different examples of visuals that we can use to do that check-in. And then I also review the goals, the students goals and I do that with the student, and that can be incredibly helpful for a number of reasons. And we'll dive into that in just a second too.

But first with that check-in. So, Nicole Allison has a free clip chart in her Teachers Pay Teachers store, and she uses it for behavior management, but I think it can also be helpful just to kind of, get it ... You can use it as an emotion check-in, if the student is ... If they're calm and ready to learn, they're green, or if they're kind of, sad or angry, maybe we can put them ... They can put themselves on yellow and red, and I would model this for the student first.

So, "My cat is sick, so I'm feeling a little bit worried and sad today, and I'm putting myself on yellow." But if they are like, "I won my go-kart race, I'm the champion," and they're super pumped up, they might put themselves on purple, because they're super pumped up and energetic.

And with either of those spans we could do some things to help them regulate and be in a place where they're ready to learn. Because, neither of those examples are going to be ready to learn. So, some examples that we could do are just doing a quick breathing exercise to ground ourselves.

We can dim the lights, we can have them sit in some kind of, alternative seating. Whatever will help kind of, bring them down or help them feel more comfortable. I've had ... I don't know, sometimes this is silly as a student, because I live in Arizona and it's hardly ever cold, but one of my students didn't have a coat, and he was freezing. And he wasn't going to pay attention to anything I was going to say, because he was just, so distracted by the fact that he was cold.

So, we, on the way from picking up, we just ran by the nurse and borrowed a coat and then he was ready to learn. So, sometimes it's just a quick little fix, or just a quick acknowledgement, a quick note, just something really simple and easy just to get them back on track.

And if they are very dysregulated we might have to take some other steps. Like, maybe they need to go back to class, and we need to see them another time, or maybe we need to change our plan for the session and do something that incorporates some more movement. We can be flexible and take that into consideration.

And you kind of, you learn this over time, and you learn to read the students, and you learn to know what is going to work and what won't work, but I think if you're still figuring that out this can be a good framework to start putting those puzzle pieces together, because sometimes it's just, not going to happen, and we need to find a way. And if it's a quick 30 second fix I will take that.

Another strategy that one of my special education teacher, friends uses is a temperature check. So, this is the visual that goes with it. And this matches up with what I was talking about with modifying Nicole's scale. But she has her students come in, and she sees larger groups, and so when they walk in they just put up fingers for how they're feeling.

So, if they are having the worst day ever they'll walk in with one finger up, or if it's the best day ever then they'll put a 10. And usually there's a verbal response that comes with their number. And then she uses those strategies too, and because she has larger groups she might get some students to start working while she checks in with the student who's having a one day, or the student who's having a 10 day and she just, kind of, triage's it as they come in that way. So, that's how that works.

And then for goal awareness, because I said I like to check-in with my students goals as one of the first things in the session. So, there's different ideas here. So, I've created some ... And you could actually get these for free, and I'll share it in the blog post too. I'll see if I can pull it up real quick for you in the chat too.

But I just have these little goal cards, and I have students write the goal in their own words, because I want to make sure that the student understands what their goal is. And sometimes we'll add ... It looks different for the different levels of students, but for some students we might add in a little bit about the why. Like, why that's important. I feel like all of, the middle school students that I've worked with want to become YouTubers, but that's convenient, because it works really well with a lot of our goals.

So, we'll just do a quick tie in, if they're working on story retell for example, that's important to be able to put together a good YouTube video. So, then we'll just make a quick tie in with that.

Another option ... So, I just print these out and just, cut little cards, and I store them in a pocket chart, and that's how I put that together. And I think this year I'll put them in the students actual folders, just in a little pocket. But both of those options could work.

And then they just grab that as they walk in the door, and then we review. And I usually just review one each time, like whichever one we're focusing on. And because they're paper clipped I can just shuffle them around. So, I can make sure that when we end the session the goal that we want to work on next is at the top.

But then we'll just check-in [inaudible 00:14:56] that goal and again, the student needs to know what they're working on for it to be effective, because otherwise they'll walk out of the speech room and say, like when someone asks them, "What do you do in speech?" Then they'll say, "Play games." But if we have this focus on the goals they'll know what they're working on. The research shows that it helps them make more progress and that awareness is so key, and so important.

So, here's the link to that. And so, there's just a quick, little, easy template that you can use to implement that. And then Nicole Allison also has some really cool common core posters. So, I did use this for a little while, I just made all of her posters and then I had the students grab the one that they were going to work on for the day.

I just thought ... Like, it just gets a little bit tricky, because then they ... I have to know what they're working on and then I have to help them find it, and it just took a little bit more time. And it wasn't personalized for their specific goal and their why. And so, I thought ... That's why I switched to more simple goal cards, but that's a really great resource too.

Okay. So, now we get to dive into teaching. So, we've done the beginning part of our session. We've checked in with students, we've helped them regulate, if need be, and then we help them ... We make sure that they know what their goals are.

The next component is to actually teach the skill. And this is one that I often skipped when I was first starting out, because I had ... It's not a focus in a lot of the things that you can purchase. If you purchase a workbook it's all practice, it's not teaching. And so, that's something that ... And if we're working on an articulation we obviously want to teach the placement before we have them practice it, because otherwise it's a disaster.

And so, that was one of my most common mistakes was that I would just skip that, and I didn't have the materials that I needed to really make sure that I could teach them well. Because a lot of these concepts, they're not super easy to explain. Like, we need visuals and things for students to look at.

Like, if I'm trying to explain past tense verbs just using my words the students get ... They get all the googly eyes, because it's not the most simple thing in the world, and I also don't want my students to depend on me and be ... Yeah, dependent on my verbal prompts and cues to be able to complete a skill. I want them to be more independent.

And that's where visuals come in. So, having a solid set of visuals for that teaching is key, because it helps break down the process for us, it helps us be more effective teachers of that skill, and then it also sets a student up for success and enables them to comprehend what we're talking about and make that happen.

So, we talked about this already, but I use the case load at a glance to break that down for myself, because it can be overwhelming to think about getting together visuals for 50 plus students who all have two, or three, or more goals, and navigating that process.

So, that's where the case load at a glance comes in. Just to find where the overlap is and to start building that library, and really getting the goals that we have ... The most common goals first, and then going from there.

So, that's a note on teaching. And then the next step is to dive into practice. And so, the research really focuses on using authentic context for therapy, and this is all ... it's all in our [inaudible 00:19:20] guidelines and there's a lot of research supporting the use of authentic context, and I think that it makes sense.

So, we want to make sure that we're supporting the student's ability to access the curriculum, like, to interact with peers, to participate in the classroom, because that's what our role is as school based SLPs, and the research shows that the best way to do that is to use context that naturally lend themselves to that.

So, if we want a student to participate in a social studies discussion we can bring some of that into the therapy room. And this is often referred to as curriculum based therapy, or literacy based therapy, because literacy is a huge component of the curriculum. And so, that's something that we want to think about as we're putting together that therapy.

And this could be a whole ... Like, I did a whole eight hour presentation just on this alone. So, we won't dive into all the nitty gritty behind that, but I just wanted to put that out there. And I'll share a quick example of just, how this ... Because I didn't always use this type of therapy, it was something that I learned to do over time.

But I was working with a student, he was in ... Yeah, he was in second grade, and he was making amazing progress towards his goals. I was so excited, and I went to tell the teacher like, "Look, Johnny is meeting all of these goals," and when I went to talk to her I showed her the goals and how he was meeting them, and she said, "Well, he doesn't do that in class, and he doesn't do that in class, and he doesn't do that in class."

And one of the examples was following directions. He could follow three step directions in my classroom, or in my speech room, but he wasn't following any directions in the speech room, or in the classroom.

And it was just, really ... And I observed him and I looked at some work samples, and there were some really, really simple examples of things that he totally should have been able to do based on what I was seeing in the speech room, but he just wasn't in the classroom.

And so, I was able to ... That was the big eye opener for me, and I was able to do some really little adjustments, like sharing some visuals with the teacher. One of his goals was working on WH questions, and they had ... So, this was in second grade, but they had simple questions with multiple choice visual answers, and it was just, a quick little quiz they did and he didn't answer any of them. And they were just simple WH questions. Something that we had been working on for a really long time.

And so, the teacher ... I just shared the WH questions visual that I was using in the speech room and then the teacher used that, and then we suddenly saw his performance increasing. Because I think they just, they don't always see how, what they do, especially for using drill cards and things like that, they don't see how that skill connects to what they're supposed to be doing in the classroom for some reason. I don't know, it's really interesting how that works.

But because I helped build that bridge he was suddenly starting to apply the concepts that he learned in speech to the classroom. And so, that was just, a really simple example, but it's just amazing the impact that I can have.

I could tell so many more stories of how just connecting what I was doing in the speech room to the classroom, how big of an impact that had for students. So, I know it's another thing to tackle, but if you're feeling good about this back to school stuff let me know and I'll share some resources there, because it's so huge.

Okay. And then another thing that we want to consider when we're providing practice is, that we want to facilitate success, we want to avoid that negative practice. If a student is constantly getting things wrong, then that motivation will start to tank, but then they're also not learning how to do it correctly.

So, it's kind of, a double edged sword there. And so, we get to use that prompting hierarchy that we're so incredibly good at, to provide students with the support that they need. And if we are pulling things from the classroom, if we are using text from the classroom those at a higher level than the worksheets that we might pull, or the decks of cards that we might be using.

So, we have to be especially mindful about the level of support that we're providing. So, we really have to step in and provide those different types of scaffolds and supports when we're using those more challenging materials in the therapy room, but we can do it. It works and it's totally doable.

So, one of the ways that we can do that, and just to make sure that we're being therapeutic when we're using these types of activity, is this framework by Ukrainetz, And it was in ... She describes it ... I'm sure there is other articles out there, but the best resource that I can share is her book Contextualized Language Intervention.

She does a really great job breaking down this framework and it's so helpful. And then it just ... I use it kind of, as a checklist to go through if I walk out of a session and I'm like, "Oh, that didn't go so well." I use this framework to figure out how I could improve, and to pinpoint what the issue was. And it works so well. It's amazing.

So, RISE, it stands for repeated opportunities. So, if we want to be therapeutic, we want to make sure that the student has repeated opportunities to practice the target skill.

So, if we are working on past tense verbs and we have them use one past tense verb one time, that's not enough repeated opportunities. They're not going to learn that one verb, and nonetheless all the other verbs that we need them to learn.

So, we want to have repeated opportunities. Then INTENSITY refers to what we decide when we set up their schedule or write their IEP in the first place. How often do we want to be seeing these students? And that's something that we, like I said, we decide as a team, usually on a yearly basis, but if they're really not making progress that's something we might want to revisit and look at.

And then the third section is systematic support. So, that's what we were just talking about. We want to make sure that we're providing those visuals, the verbal cues, those prompts and all of, the different scaffolds.

So, one example of a different type of scaffold could be reading something out loud for a student, or it could be working on a skill in a quiet room one on one, versus in the classroom.

And so, those are just, some different things that we can modify to set the student up for success and make the task more attainable. Then E stands for explicit skill focus, and that's what we ... We've got that covered with our goal cards.

So, when the student walks into a session they know which skill they're going to be targeting that session, and I typically focus on one skill and just focus on that. And maybe, if they're starting to master one we might incorporate more, or if we're doing an [inaudible 00:27:20] activity we'll do a little bit more.

But typically it's just, mainly focusing on one skill at a time, then we might jump between different skills or whatnot, but that's typically how that works. And the student just needs to know what they're working on at any given time to be able to check that box.

So, it's just, a really great framework. It's super helpful if you're diving into more of that contextualized practice, because it helps us ... It just makes sure that we're being stellar therapists. Rockstar therapists. And that's what we need to rock our school year, right?

So, then once we've gone through all of those different steps of the therapy process we want to recap the session. So, we can review performance, and we want to give them specific feedback. And it might be on actual task performance, or it might be on how hard they worked and giving that really specific feedback. Like, "I loved how you kept trying on the grammar game, even though it was really hard." And it's just, giving that specific feedback, instead of, "Good job," is really helpful.

And then for older students we can talk about how we might reflect on how the session went for us using our little framework, we can do that with older students too, and work on kind of, that self-awareness and that can be really key when it comes to generalization.

And then, we may do this on our own, or we may involve the students in the process, but the end of the session is a great time to make a plan for next time. Like, "Based on how things went what can we do next time, and what makes sense there?"

And we might also assign some homework and give them some extension activities to work on. And then just, any connections that we can make. If we worked on something that is related to what they're doing in the classroom we can have a mini ... We can just make a quick plug there. Like, "Hey, we worked on this vocabulary and this is what you're going to use later today in your reading class." Or, "Hey, we just worked on ..." For some of my students it was ... Like, my third grade teachers had a professional goal to ... I forget what the goal was called, but their group goal was to achieve a certain percent mastery on these really challenging word problems that they had to do, and that involved a lot of language.

And when they were talking about it, it was like, "Oh, that would make sense for all the students that I was working with in their classroom." Because it involved their different vocabulary, and syntax, and comprehension types of goals, because it involved understanding the math word problem and then explaining their reasoning, which is so good for language.

I never thought I would do math activities in speech, but I did. And so, we were able to ... Sometimes we worked on the actual word problem, and sometimes we worked on the component skills, but we always connected it back to, "Okay, so we did this type of thing, and this is going to help you in this way."

And so, we just, kind of, helped to bridge that gap. And maybe, even make a plan for how they could use their strategies. If I taught them a specific strategy, if I taught them a strategy for using context clues like, "Next time you see ... The next word that you see, that you don't know in your whatever textbook, then do this." And we would make a plan and sometimes they don't do it, but at least we're planting that seed.

And then I just mentioned this briefly, and we'll talk about homework more in the parent section, but additional practice can be really important for carry over and continued practice. And I will be the first to admit this is something that I struggled to put together, so I'm excited to share some different ideas and strategies in the parent communication section, but we have lots of different options.

We can send home worksheets, we can send home folders, we can use communication apps, or we can send home monthly handouts. Whatever it may be. We can get creative, but as long as we have ... Or we can reach out to parents and have phone calls every so often, but I think that extension piece is really important, and if we can get parents on board then that is always a win.

So, that's the overview of what we want to do with our therapy routine, and hopefully that gives you some different ideas. Hopefully you're doing a lot of these already, and so it's a confidence boost of like, "Yep, check. I'm doing that. Check, check, check." And then maybe there's one or two things that you might want to implement in your own therapy routines. Some new ideas or some tweaks and adjustments that we can add to just, keep stepping things up.

And just one note here is that, this isn't always a parallel, or just a nice, little cycle. Some sessions, we might have to spend a lot more time in that check-in phase. And sometimes we'll spend almost a whole session teaching. Sometimes we'll just get to dive, quickly run through those in a matter of seconds, and spend our whole session with practice and just a quick wrap up.

And so, it just, really varies. And sometimes we might start with a check-in, we might start teaching and do practice, and then have to go back to check-in. And, so, we're constantly adjusting and it's not like, "Okay, first three minutes are check-in, then we do our teaching for three minutes, and then we practice, and then we wrap up." It's not always going to be the same, and that's okay.

And it shouldn't be exactly the same each time, because our work dynamic, our students are dynamic, our sessions are dynamic, and their brains are learning and adjusting. And so, it's not supposed to just be a perfect little cycle. And so, I think that's helpful to consider and know in case you think it is supposed to be that way.

And then it also might not apply perfectly to all types of students. So, some students might need a slightly different routine, and they might need different components in the session to help them be successful.

And so, we can use the data and use that RISE framework, and all of those different components, use our problem solving skills to figure out if something's not working, and if we need to make a change.

And that's why we're spatially rich pathologists, and not speech robots, because we get to make those decisions and really analyze what we're seeing in our sessions to make the best decisions, and adjustments for our students.

Okay. So, now we got through the routine and we're diving into some baseline data. So, this is something that ... So, I went into quite a bit of detail on the routine, and we just want to kind of ... We want to just, establish some of, the expectations around that. And our initial sessions might not include ... Well, our very first session with a student might include a check-in and it might include some of that.

Maybe it will include some teaching, and instead of teaching a specific skill we'll be teaching about the routine, and then we'll practice different components of the routine.

So, you could look at it that way, or you could just, like with older students you can explain, "Okay, so, when you come in you grab your goal cards and then we kind of, get ready for what we're going to practice today. And we just do some teaching, and then we actually practice it, and then we're going to wrap up."

And you can talk about it in student friendly terms, kind of, how I just went through it. Or you can just teach it in action and not have as many words around it. So, there's just, different ways to set that up at the beginning of the school year.

I saw one SLP who had ... She made four pieces of colored paper for the four steps of the routine. And she just ... I think she used a paper clip or something to move through the different sections for her students, so they knew what to expect. And then I imagine as they came in being like, "Okay, so, we're going to do our check-in and then we're going to ... We're doing some new things today, so we're going to spend more time teaching and we'll just do a little bit of practice." And maybe she used it that way.

So, there's just, some different ideas depending on what you're group need. But before we dive into all of, the therapy, we want to have an idea of where we're starting. And I think it's important to first build that ... Establish that rapport, build those routines, but then we also want to know where we're starting, like I just said.

And so, you can do this in a number of ways. It really depends on what your schedule is, and how quickly you're starting therapy. For some of my schools I would have to wait for all of, the other schedules to be put in place, and sometimes it took a really long time and I didn't have my official therapy schedule until a week or two into the school year. I think one time it even took longer than that. I'm not sure though.

But I didn't have my set group schedule, so I decided just to start pulling students individually and gathering their baseline data that way. So, I'd just run through my probes and just, update that, so then when they started coming together in groups it was just, really easy, I knew exactly where everyone was, and I didn't have to deal with trying to take data while managing other students.

And I think that's ... If you have the option to do that, that's really amazing and you could just have your probe week, and it's a good opportunity to check-in with students individually. If some of them are more shy, or just, maybe they're more likely to open up if they're not surrounded by their peers.

So, that's one option, if that works for you. I really liked using that in the past, but another option could be to ... Because if you're doing this in a group you might just have some different activities going on that are related to establishing that rapport or even diving into some skill practice right away.

So, you could set up stations, if you're going to do a book unit maybe you can have one station where the students are doing probes with you, and then another station has where they're doing ... They're listening to the book on audio and that can be a station where they're going through that.

And then another station can be where they're doing a pre-story knowledge activation and you can just have them move around, or you can have a back to school themed activity. So, there's different ways that you can set this up if you're not able to see students individually, but I think that's ... It's just, a really good use of time to get that figured out right from the start.

And then in terms of organizing this, on the goal cards that I showed you guys I just started writing the number ... A number that corresponds to that goal, and I just have a massive binder that has all of, the different assessments in it that I want to use.

So, then when I pull up a student's goal card I can see what number that is, and then I just flip to that tab, because they have super cool, mega number tabs and I just flip to the tab, give them the assessment that corresponds to their actual goal, and that measures it in the way that it needs to be measured. I just collect that data and enter it into my online system, and I don't keep all the paper sheets, I just have the template that I run through, and that's how I organize that.

But you can ... If you want to have data sheets, probe sheets for each student you can put that together too. There's all the options in the world to make this work. So, those are my tips for gathering baseline data, but I would strongly suggest that you revisit the students IEP goals and make sure that the probe matches up with how the goal is written, otherwise Parker's report time will not be very fun.

And I think it's a really good habit to make sure that you have probes or assessments for the goal when you put it into the IEP going forward, and that's just an action step that I add to my checklist to make sure that I'm getting that set up so that I am totally set up for success and ready to go.

And that prepares us for therapy. And we have got a really good start already. The students know their goals, we have a routine around our session, we have a way to collect data, we know where we're starting and hopefully, if we did like that case load at a glance, we have the visuals that we need to teach the skill and then we just need to find something ... Once we have those pieces together we just need glue for the session. We need something to piece it all together to work on all of those different skills.

And this is more of a logistics type of course. We won't be diving into too much detail on how to do all of, the contextualized intervention and all of that. Like I said, that would be a whole other day seminar, but hopefully we'll be able to walk away with some quick, actionable tips to make this happen in the meantime.

So, we talked about this quite a bit already in terms of the SLPs curriculum. We don't have a textbook or anything, but we have a built in set of strategies and you are your best therapy tool, or your best therapy resource. All of, the strategies and the knowledge that you have in your brain are what help your students make progress.

Sure, it's nice to have a great activity, but you have ... Your brain is what is driving that change with the students. So, that is incredibly important. How we structure our sessions, and what we're doing in the session really matters.

But it can be helpful to have some additional supports, and visual supports are huge and there's some really nice research behind that. We've talked about it a little bit, but some of, the ... It can help us structure our therapy, it increases student independence, because we don't have to talk as much. We can refer to the visual, instead of going into a whole spiel explaining how something is or how it works ... Sorry about that.

And then it's also easy to fade the use of the visuals. So, when we start introducing a skill we can hold it right in front of the student, we can point to it, we can talk through it, we can reference it all the time, and then as they start to understand the skill we can maybe, just point to it without using any words, or we can just put it on the student's desk and not point to it.

And so, it's really easy to gradually fade the use of that and just, kind of, as the student makes progress we can back off, and it's just, really easy to do that with a visual, because we have more [inaudible 00:44:30] there.

And then we can also ... Like I shared in the story, it's easy to share that with teachers to help with generalization, if we have a visual that's really working for a student we might print a mini version and put it on their desk, or we might put it in their binder, like, in their math binder and so, when they open up to do that crazy math word problem they'll have whatever strategy I taught them to make that ... To help them be more successful with that.

So, that can be a really great strategy. And then, it can be time consuming to create this, but that's why we have that case load at a glance, and we just tackle it one by one. We can conquer anything, just one little step at a time.

And so, just taking the time to build that up is a really, really great use of time. And we can find these materials in a number of places. So, sometimes the best visuals are a Crayola marker and a white piece of paper, and we just knock it out in the session.

And sometimes that's all we need, and sometimes those are the best visuals, because they're made specifically for the student. We can pull ... Sometimes teachers will have really great visuals, and it's nice to be able to pull from what they're using in the classroom to help bridge that gap.

Sometimes that doesn't do the trick though, and sometimes they need something a little bit more specific, or the teachers don't always have the best visuals to explain how certain skills work.

So, we can also go to Teachers Pay Teachers. There's lots of options on there. And then I have the SLP Now Membership, which includes lots of different visuals as well. So, that's another option to find some of those visuals.

And here are just a couple examples to give you some ideas. So, these are some of my favorites. The Expanding Expression Tool, which I'm sure most of you, if not all of you have heard of. It's a really great multi-sensory tool. I think students just connect with it right away, and it's a nice way to build on some describing skills, and that's a nice example of a different type of visual. It includes the sensory element as well.

Nicole Allison does a really great job with her intervention binders. She does a great job of breaking skills down for our students, and she has some really nice examples there. I have created a bunch of different sets of visuals as well. I have these, just, little strips that I used to hang on my therapy wall, and they just include super, super, super quick, simple explanations of different skills.

Since then I've moved to bigger visuals that go into a little bit more detail, and that helps scaffold different parts of the skill. And I just store them in a file tote in this roller bag. I think it's meant for ... It's from Michaels and it's meant for sewing machines actually, but it fits my visuals perfectly. So, I just put this file tote inside and then I label all of, the different skills that we're working on, and then you can see that I also have my assessment binder in there.

But I like this system because I can just wheel it close to my therapy table, and then if I go into the classroom or if I go to a different school it's just easy to transport my most used therapy materials, and it just works really well.

If students get familiar with a system and they're able to just pull their visual for whichever skill we're working on, and that works really well. And I just print and store them in sheet protectors, because I feel like ... Well, that's the fastest way to get started, because we don't all have a ton of time on our side.

And it works well, because we can easily make copies and we can use dry erase markers to right on the sheet protectors, and it's just, really easy and simple. So, that's my motto, "If it can be easy and simple we can go with that." So, those are some examples.

Here are some more. So, this is how I used to organize my skill packs too. I would put the little manipulative cards in a little pencil pouch, and then I would put the visuals, and assessment, and practice pages in a plastic portfolio folder and that, I would just have a folder for each skill and then I would pull that. So, that's an option if you like focusing ... If you like everything for one skill to be in the same place.

And then the tote here, it's like a deconstructed version of that. And I thought that just worked a little bit better with my workflow, but I wanted to share the other example in case that's helpful.

And then this, I used to have this cart and I would store the different folders up top, and I just used a binder clip and just cut out a little piece of sticky labels to label the different skill packs. So, if you're looking for ideas to organize those, that's one idea.

And I kept this close to my therapy table, because it just had the stuff that I used most often. You can see it has some books in there, and some different worksheets and activities. I have my iPad right there, because I like to pull up some different activities on the tablet too. So, that's one option.

This is just showing on the left, we have an example of the different visuals hanging on the wall, and then another option could be to use one of these carts with all the drawers in it to organize the different visuals as well.

So, just throwing some ideas out there in case one of them gets you particularly excited. And so, we've got a really great system going. We've got our routine, our data, a plan for our visuals and now we just need something to piece it all together.

And so, I've just got a couple examples for you, and then we'll dive into the next module. So, the first thing is, this is an example of how I worked on narrative skills, or story retell using a book called The Gingerbread Man Lose in the School.

And I really like this one around the holidays. A lot of times they'll do some ... Usually in the younger grades they'll do some fairytales, but this book is appropriate too for the older students, like if they're doing anything related to gingerbread, stuff in the classroom I take any chance I get to pull this one, because it's like a cartoon.

So, the older students are receptive to it, and it's just, it's a nice ... It's an easier read, but it still has really great vocabulary and different targets. And great for compare and contrast, and comparing and contrasting to the original story and all of that good stuff.

So, that aside, when we were working on story retell, this is just a snippet of a small activity that I did. I typically have a month long unit where I dive into a book, into a lot of detail and we work on all of their different goals in the context of the book.

And the story retell activity is one of the things that we do later in the unit, because it's a great way to integrate a lot of different skills.

So, there's so much research on there. I did a presentation on vocabulary a couple months ago, and there was so much research on using story retell as meaningful opportunities to practice vocabulary targets.

We're creating sentences in our story retell, so it's a great opportunity for embedded grammar practice. It's a great opportunity for perspective taking. I just talked to a social language expert and she uses narratives and story retell in her social language group, specifically because it's such a great activity for that.

So, there's so many great activities that we can ... Or great skills that we can target in the context of a book like this, and story retell just incorporates so many of the goals in one, nice activity. So, this is an example of how I did that with The Gingerbread Man Lose in the School and I just used some of my different story cards to help scaffold their retell of the story.

I also have sets of visuals that students could use to match the appropriate story grammar element, but with this group of students they were a little bit more advanced and they didn't need the visual support, we could just fill in the graphic organizer.

And as you can see we did a very, very simple version, because the goal is for them to retell the narrative, and I just wrote down enough for them to be able to retell this story.

So, it's not like, writing out the whole sentences necessarily, unless that's a support that the student working on syntax for example, need it. It's just, a really great way to combine all of these different skills.

And then this is an example of what that looks like for Little Red Riding Hood. And this is just the example of the interactive activity. So, all of these are little, interactive pieces and I used sticky tack to attach them to the organizer, and then we can move them off, we can stick them to the board, we can stick them in pages of the book. Lots of different options there.

And then I also have the vocabulary cards and the WH question cards. I just store those, it's kind of, hard to see, but this is a little pocket from the Target dollar spot that I use to store those little cards.

So, that's just an example of how I put that together. And again, like I was talking about with The Gingerbread Man Lose in the School, we go through an entire five step unit where we start with pre-story knowledge activation, because a lot of our students are missing some of that background knowledge that they really need to comprehend the unit.

And of course, this is customized and adjusted for each student, in each group depending where they are. So, we know, as clinicians we can use that clinical decision making to figure out what makes the most sense for our students, but we start with some pre-story knowledge activation, then we read the story, we do comprehension activities.

Which a lot of times does include the story grammar activity sheet, because it includes a lot of comprehension. They have to know who is in this story? When did this story happen? Where did it happen? What was the problem?

And so, that involves a lot of initial comprehension and then once they're comprehending it, then we can move onto really specific skill practice and diving into all of those components. And then we work on integrating, practicing those skills, and then integrating them in the subsequent steps of the unit.

And so, that's a super, super quick overview, but if you're interested in learning more, like I said, happy to share different resources there.

And then this is an example of what we could do with a narrative organizer without printing it out, if you're just trying to do some digital therapy to get yourself started.

So, I pulled this into an app called Notability and I will share these names in just a second. But Notability is an app that you can use to ... You can take a picture and draw all over it, you can import a PDF and draw all over it, you can add pictures to PDFs, like I'm doing here.

So, with this one the students needed more support, and so we took a picture of the character in the book and used it to fill in the organizer. And then afterwards we can print it out or do whatever we need to do to support the students there. But it's just, a really great way to add additional visual supports, if they need those.

And then just a couple more ideas, and then we'll move onto the next sections. So, now just one other idea for following directions. If we're sticking with The Gingerbread Man unit and we're just needing some different extension activities to work on following directions, in general I would target directions in the context of therapy.

And so, if they have a goal to follow directions I would identify what's causing them to struggle with those directions. Like, if they're missing some of, the vocabulary that they need to understand the direction, I would target that, or if it's more of a attention or kind of, executive function strategies we can dive into those and target those in the context of the session.

So, I would give them additional directions and give them visuals to work on those strategies, but sometimes we just need a little to really hone in those specific strategies, we want to dive into some more of the specifics and give them lots of repetitions in one go, so they can really understand and use this strategy.

So, one example of doing that is, I have different visual instructions for different crafts, and I don't know if there's anything else quite like that, where they have the different pictures of the crafts, but you can find YouTube videos and take screenshots of different steps and any kind of procedure.

But then I just cut out the different steps of the cards and then I'll verbally give the directions as I show it and pair it with the following directions organizer. So, if one of the things we're working on is syntax, then I definitely want to use something like this, because I want to get them more meaningful exposures to the different directions.

So, the directions with, after in the middle, actually have a reversal and that's so confusing. So, if I say, "Dance after you laugh," the student has to laugh first and then dance, and it's just out of order and it's like [inaudible 01:00:19]. I am sure you guys know with out of order directions.

So, with this type of activity we can do something that's related to what we're working on, all the other students can still use the different vocabulary that we've been working on, but the student working on following directions has the opportunity to practice using this more complex syntax and we can manipulate the pictures and move them around. And I can give him directions as he makes his craft, or if there's another student working on it, maybe she can give the directions to the other students and then she has the opportunity to give the directions to multiple students in the group.

So, those are just a couple ways to work on that. I am trying to share as many ideas as possible, but then still staying on track with the time. So, let me know if you're wanting any other specific ideas, but I just thought I'd throw that out there.

And this works with older students too. So, I was reading an article about forensic science with a group of middle schoolers, and you might be thinking, "Oh, those are Fisher-Price animals. Why did you do that?" But that was all that I had in the therapy room at the time that would work to navigate this different vocabulary.

And it actually ended up being a really amazing lesson, but we used the same framework where we go through the five steps of doing pre-story knowledge, activation of reading, comprehension, specific skill practice and all of that.

But with these students when we're working on vocabulary there's some research to show that pre-teaching the vocabulary is very helpful, and I was just learning this when I was working with this group of students.

So, I didn't do that initially, and we just read the article and I did the comprehension activities, and they didn't comprehend any of the article. Like, the vocabulary. Detective, evidence, victim, suspect, criminal. That was really tricky for them.

And so, we were able to go back, and we changed the order a little bit. It was like, an example of what I was talking about with that graphic. We changed the order and we started working on the vocabulary first, I taught them those words, I gave them tons of exposure, tons of meaningful exposures to those vocabulary words, and then we read it again and did the comprehension and were able to dive into all of those activities and comprehension just, it went through the roof.

And they even retained the words when they went into the classroom. So, this works with older students. I know I gave some more examples with the younger ones, but we can use the same framework and maybe not use Fisher-Price animals, maybe we should have just printed out pictures of ... Like, it would have been so fun to have pictures of people in magazines or something. That might have been a little more appropriate, but it worked for this example and sometimes you just use what you have.

But some really helpful sites are Reading A to Z. That's where I got the forensic science article. And that was ... A teacher was using that and I decided to support what they were doing in the classroom. That was really great. News at ELA is great. They offer leveled articles. So, that's really nice if one of your teachers happens to be using Newsela, and your students are at a lower reading level you could pull the same article at a lower level and still use that in your instruction.

And that is a really nice way to scaffold and support students, and then when they go participate in the discussion they still have an understanding of the basic concepts, which is really helpful. And then ReadWorks is one of my favorites too. And I actually started creating month long units around some of their articles. So, if you're looking at implementing this and want some materials I'd love to share some examples of that with you.

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Filed Under: Podcast Tagged With: Therapy Plans

#020: How to Set Up Your Caseload

September 19, 2019 by Marisha Leave a Comment

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In this week’s episode of the SLP Now podcast, we’re going to continue with our 6-part series all about how to rock your school year and talk about setting up your caseload. 💪

I’ll be honest with you here. I’ve tried so many different data collection systems that I’ve lost track — I spent a lot of time searching for a “perfect” solution, but (spoiler alert!) I don’t think there is one right solution for all SLPs.

There are, however, a lot of really great options for data collection out there. So, what we have is the opportunity to get creative and put together a caseload system that complements our unique strengths and quirks. 🙌

That’s the angle we’re taking on today’s episode, so grab your beverage of choice (I’ll have a chai latte!), put your feet up, and listen in.

Key Takeaways

– Things to consider as you set up your data collection systems
– Creating systems based on your strengths
– State and district requirements
– The value of data checklists
– Different styles of data sheets (so you can choose which is right for you)
– A simple hack for goal tracking
– Using a paper planner
– Digital solutions to track progress

Links Mentioned in the Podcast

– Data sheets that you can download that for free from TpT
– The data sheets that I used to use (but would always struggle to update)
– Quiz: What’s your ideal data collection system?
– Natalie Snyders’ weekly data sheet
– SLP Now student progress graphs

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Transcript

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And it's done. So that's the process. Let's dive into more of the logistics about how to set up your case load, because we have that basic student information, we have our schedule now, we have things that... like a good starting point and the next big hurdle is figuring out data collection and therapy and all of that. So this will set us up for success with those components. I have tried so many different data collections systems I have lost track, but I was really searching for like the perfect solution and I don't think that there's one perfect solution for all SLPs. I think it really depends on the dynamics of our caseload. It depends on our personal preference and just... I don't know. From year to year it might change for any individual SLP as they move through different settings and all of that. But these are some questions that I think are helpful, because like I said, I've tried a lot of systems and gone through a lot of changes, I've talked to a lot of SLPs trying to figure out the best data system for them.

Some things to consider are what are you most comfortable with? Do you hate technology? Can you... Like do you not like using a computer? Then if that's the case, you probably don't want to use spreadsheets for your data or if you really struggle with mixed groups or if you are always behind with Medicaid billing or if your district requires you to create graphs, think about solutions that will... Because data collection is so closely tied to what you do in a mixed group, it's so closely tied to billing Medicaid, because we need that data to do the billing. It's so closely tied to tracking progress and to creating those graphs. So think about the things that you need that you struggle with most that you would like to make easier for yourself and try and come up with a system or look for a system, I'll give you lots of ideas here, that meets those needs.

We definitely want to consider our state and district requirements. I know some districts or states require you to graph progress and so if that's a thing that you have to do, you might want to try and find a solution that makes that easier so you're not always pulling your hair out when you're doing that. We want to think about a system that will flow with us throughout the entire year, because we always have to update goals and we want it to be easy enough to set up an update so that we're not... so we don't get behind, so we can actually stick to our system. Because I know... I use these, I'll show you the data sheets that I used to use, but I would always struggle to update them after the IEP meeting.

So one solution could be to update them right after the IEP and just have that be part of the IEP checklist, or maybe the hassle of finding the student's digital file for this data sheet, then updating it, retyping the goals, like maybe that's not a good idea. Maybe I just need a blank template and I need to write in the goals or whatever it may be. Maybe I need to keep my goals on a separate sheet of paper and not put them on the data sheet. Whatever works best for you, consider that. There's not one right answer for everyone.

I did make a little quiz if you guys want to check this out and it helps navigate through some of those questions and give suggestions based on those answers, so that quiz will also be on the page for this course. But then let's just dive into some examples.

So like we talked about already, there is a lot of different options that we can use. There are five million different data sheets that we could use, but we're going to talk about some different styles of data sheets and maybe one of those will be a good fit for you. Maybe a planner is a good fit for you or maybe it's a digital kind of solution.

So we'll just talk about some different options here. Data sheets, like this data sheet on the left, is what I used for a very long time. It's a free editable data sheet so you can like move things around if you don't like one of the columns or if you just want to add in your student's information, you can view that. You can download that for free from Teachers Pay Teachers, and how it works is I just put in like the important caseload information and then I list the student's goals, and one hack for me was that I numbered the goals and then when I was taking data, I could just write the number of the goal and I wouldn't have to write out the whole thing, which sounds like a little thing but if you're working with a mixed group and you have like four students you're taking data on, those couple seconds for each student are very valuable.

So instead of writing answer what questions, I would just say goal one and I just wrote who because we were focusing on the who questions in this example. But then I use the little boxes to keep track of the accuracy and then I could also use that to make any notes, I use that for planning purposes sometimes and that worked well enough. It's a little bit tricky to maintain, so I always had just blank data sheets that I was filling in with updated goals. But if I hadn't had a good system to update... because they were in a PowerPoint so you can easily just duplicate the slides and update the goals and reprint it real quick. So that's totally doable. And that's if you want just one student on one sheet of paper.

Another option, this is from Natalie Snyders, and she puts her whole caseload, well not her whole case load, but a full day of students on one sheet. Like you can see, she sees Joe from 8:10 to 8:30 and she makes a note of which classroom they're in so it's easy for her to find them, which is helpful. That's smart. Then she has shorthand for all of their goals and then she just circles the goal that they're working on and then she takes data in those boxes. So it doesn't give her a ton of room, but it's nice because it can be helpful for planning your day of sessions. Like you could jot down notes in the boxes with the students' names, like we're going to do this today, and so you could use that for planning and data in one sheet. That's a pretty nice option there.

Then the only thing is that like it makes it nice for Medicaid billing if you bill on a daily basis because then you can just go through and look at the notes and then enter that and then be done, so that's one other pro for that one. But then it does make it harder to see how students are progressing over time. You'd have to flip through a bunch of different data sheets and find a way to organize that effectively because you... like you might see Joe on Monday and Tuesday and so you'd have to figure out like where all those data sheets are, where all his spots are, so that makes it a little bit tricky. But there's lots of pros for that one. Then it's great for mixed groups because it's all on one sheet. Then kind of the reverse apply to the single student data sheet.

So just consider all of those components before you pick a system and just figure out what is most important to you. We likely won't find one thing that addresses everything that we could possibly need, but hopefully we get pretty close.

Another option that I don't necessarily recommend, but it would be like a similar version of what Natalie was doing, but just in a planner. So they have teacher planners out there. The biggest problem with this is you get the benefits of the planner... or the data sheet that Natalie uses. You can easily flip between pages. It's all in one nice little bound thing and then you know, okay I see Johnny in this spot, he's always going to be in this spot and you can just like flip to the last couple of pages so that's nice, but it would involve a lot of work to fill that in every time. At least with Natalie's system, you can just print a couple copies of that and have that ready to go.

But with the paper planner you would have to write in a bunch of those different components. Maybe you want to make your own planner like this that has all of those boxes, that's an option. But when I did a poll in the Facebook group, a couple of people mentioned this, so I thought I would share it, and it is very pretty. That would be fun to use.

Okay. And then another option is digital data. This allows you to set up your schedule and so you just set up all of your students like you can see in this little calendar and then you can plan your sessions and attach them there. So that helps with not having to flip through a bunch of different pages and you can just quickly access that and enter your data there.

A lot of digital data collection solutions help save time with documentation and billing, like this one has a templated summary. So if I enter... Sorry, I think the GIF is cutting off a little quickly, but if I enter data for the session and then I click load template, it makes a Medicaid friendly template that pulls in my student's name, what we did in the session, their data. So I can just type in the accuracy, like 80% that's how we did and then load that template and then at the end of the day I can just click through and enter those components, so that is a nice benefit for that. It also makes it easy to review student progress.

A lot of these digital systems will graph your data for you, so with SLP Now you can see the student's progress within the session and each one is set up a little bit differently. So all of them have the graph within the session, but a lot of, pretty much all, digital solutions will have a way for you to view student progress on a graph, which if your district requires that, that might be a nice nudge in that direction.

But like I said, there's not a perfect solution for every SLP. Like, I can't say everyone needs to do this. It really depends on what your needs are, and I hope that quick helps you narrow it down if you're feeling overwhelmed with all of the different options.

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Filed Under: Podcast Tagged With: Organizing Digital Resources, Organizing Therapy Materials

#019: How to Navigate Scheduling

September 12, 2019 by Marisha Leave a Comment

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This week is Part 2 of rocking your school year as an SLP. We’ve already talked about setting up your data collection + caseload, tackling some potential mindset trolls, and other strategies for success in your first week, so today is about how to navigate scheduling. 😍

This episode is a quick listen but it’s jam-packed with strategies + suggestions for creating a therapy schedule that a) works, b) keeps you sane, and c) leaves everyone happy.

Yes, it is possible. 🤓

So, grab your beverage + footwear of choice and listen in! (I’ll have a chai latte and my cozy socks!)

Key Takeaways

– Marisha’s four-step process for planning a scheduling party
– Using a poster board + sticky notes
– Creating groups of students
– Inviting teachers + helping them prepare
– Having the party!

Links Mentioned in the Podcast

– Scheduling templates

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Thanks so much!

Transcript

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Dive into all things scheduling. The basic premise of the scheduling party is ... So I was starting as a first year SLP, in the schools and I had zero experience in the schools whatsoever. I was starting with a completely blank slate. I decided last minute that that's where I wanted to work. That was where I needed to be, but I had all medical experience before. And I knew how big of a headache scheduling could be, and so I reached out to the SLPs of my district. And one of them ... It was her last year, she was about to retire. But she was like, "Marisha, you have to do a scheduling party. I've been scheduling this way for years. It works wonderfully," and she was right. I've shared this with so many SLPs since then because it's fun. It's easy. It just starts the school year off on a really strong note and it's just ... I don't know, it just works so well.

I've tried it in different schools and different states. All the teachers have responded well to it. I've been in a variety of schools, like I've always been ... It's been like title 1 and all sorts of different things, but it works well across all of those settings. And I don't know as much because this has been with like single teachers, like elementary school. Some people have tried it with middle and high school, but I haven't done that personally so I can't speak as much to that. You might want to adjust the approach a little bit. But the premise is that I draw out a big poster board calendar, and I just put all of my time slots and I use sticky notes to block off the times that I know that I'm going to be working with certain students. So like in my first year, I was working in the autism preschool and I needed to have blocks of time to be in that classroom.

So I just went ahead and blocked that off. I also blocked off ... Like I gave myself a lunch. I didn't always take the actual lunch, but I wanted to at least give myself a chance to have that. And then also I just had been some of like my built in blocks of time, and you can decide how much paperwork time you need or whatever, but you can build that into this calendar. And it's nice because then it's transparent for the teachers. Then they see, Oh, because we usually give ourselves less time than they get for planning. So it helps with that transparency of like, "Oh, my goodness. You just take like 30 minutes in the morning," or you only take a couple hours a week. And then there's a little bit of understanding behind that. So, but then what I do is I create sticky notes for all of my different groups, and you can color code them or get as fancy as you want.

I just kept it simple. I just had one pack of sticky notes and I used that. But then I wrote the student's names on ... Like the students that I wanted to put in a group, they went on one sticky note. So I prepped those sticky notes ahead of time, and I picked the size of sticky notes that matched with the amount of time that I needed to see the students. So like the sticky note was the same size as the 30 minute block of time. So, you'll just want to make sure that you adjust that as you're setting that up. But then I put all the sticky notes together, and I sent the teachers a letter saying like these are the students that I'm seeing from your classroom. I would like to see ... Please bring your plan book, and think about some times that you would like me to see your students ... And then we would have a scheduled time to do the scheduling party.

And I always did this before school. I just brought some donuts and coffee. I had a strict rule like if I said 8:00, no one puts a sticky note down until 8:00. And that was just to avoid the teachers that would try and come in at like 7:45, just to make it fair. But then at 8:00 the teachers would get ... They'd come prepared, they know what times would work for them and they were ready to go. And then they would just put their sticky notes on the spot that they wanted and then they would go. And like it was always done in like three minutes time. It was super fast. They'd just go stick, stick, stick, and then schedule is made. Everyone's happy. Everyone got to pick their time, and that was it. So easy. So simple.

Not a big deal at all. So I will share the template here, and so you can take a look at the different components. I think I can switch the share here. Actually, I will let you guys look at it because I don't want to mess anything up. But, yeah. If you go to the page for this course, you'll be able to see the handout. And then for those of you live, it's in the chat. But I gave like a mock up of what the poster board would look like, I just had the days of the week at the top and then the times that students weren't in school as another column. And then I would just make sure that the slots were big enough for the sticky note. And if I had smaller increments of time, I would just cut the sticky note.

And one thing that I tried to do was I would try to group students in the same classroom, but if that didn't work, like if I needed to group across classrooms, I just made a note on the template letter saying so-and-so is coming with the student from so-and-so's class, connect with her before the party to pick a time. And I did that several times, and that always worked out well. They just had to share that sticky note and it worked fine. They were able to figure it out. And they're typically in the same grade level, so they had similar schedules. And because I'm right there, we can do some troubleshooting. Like, I've never really had to do much troubleshooting. It was always really smooth. But that could ... We can figure it out. We're problem solvers. But yeah. Then the template just includes a letter that you can send to the teachers.

There's one that just tells them what's going on, and then there's another one that has more detail. I usually send that like a couple of days before the scheduling party. Like I will notify them as soon as I know that I'm doing it. I'll send out that notification, and then I'll follow up with their actual student's names and groups because it takes a little bit of time for all of that to fall into place. So, that's how that works. And it takes me ... I don't know, because I don't really count the time of pulling together my caseload because that's something that I would have to do anyway to get prepared. But it takes me ... Like I always use the same poster board. So I drew it once, and then I reused it year to year. And then it takes me a couple minutes to write out the sticky notes, and figure out who I want to group together.

And I do that after I look at the student's goals, and kind of look at what makes sense and then ... Yeah. Then I put that together. The teacher picks the time that makes the most sense to them, and we're done. So that's how that works. Let me know if you have any questions, and then I'll just do a quick recap. So it's four step process for scheduling. First, create the poster board. Dry it out, make sure the sticky notes fit. The second thing is to create your groups and write the student's names on the sticky notes. And then I give those to the teacher when they come to the party. Then the third thing is to send out those invites just so they have time to prepare and bring their plan book and make sure they can be there. And then the fourth thing is to have the party and schedule out, and the teachers mingle and put their spots on, and then it's done. So that's the process.

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