Want Caseload Relief? Do Artic Differently

Sometimes in an effort to be extra helpful, we give kids a lot of help. On the karma-like rating scale of “Niceness,” giving extra help is super nice.

But in the reality of the school-based SLP, giving a lot of help to students doesn’t always equal remediation and dismissal. And when students are not remediating and being dismissed, caseloads are not going down.

So instead of giving more help, what would happen if we set deadlines as to when students should remediate their articulation challenges? What would happen if we set the expectation that service models should change as students made progress?

As it turns out, when we do those things, kids make growth. SLPs dismiss. Caseloads go down.

Most any SLP will tell you (and national data from ASHA indicate) that higher workloads often result in speech groups increasing in size. These larger groups result in longer remediation time for articulation disorders.  

Part of the reason remediation can be delayed is the struggle to individualize therapy in a group setting. During the Spring of 2012, a work group of speech-language pathologists set out to identify a more student-centered service delivery model to increase rates of articulation remediation. At that time, approximately 40% of these SLP's workloads related to students with articulation eligibilities. Increasing remediation and, consequentially, dismissal rates from special education, would significantly lower overall numbers of students on individual caseloads for speech pathologists.

SLPs in the schools can reduce their caseloads by doing articulation differently. Here's how.

But what does a “more student-centered service delivery model” actually mean? The study team of SLPs decided that it meant more individualized service in the area of articulation, with flexible service models that change as the needs of children change. Furthermore, they decided that . . .

  • Without complicating factors, students with articulation errors should make significant progress within one academic year (i.e., students will move from severe to moderate, moderate to mild, or mild to remediated).
  • Students are capable of making significant progress in articulation after 20-30 hours of direct intervention (5-18 months depending on service delivery model).
  • Articulation therapy efforts must be consistent across the school day and home environments for significant progress to be seen.
  • Best practice for establishing correct sound production is therapy with a 1:1 or 2:1  student:clinician ratio.
  • Once correct sound production is established, practice at the sound, phrase, and sentence level should be constant throughout the week. Students should be practicing their sound with multiple people in the school building, not just the speech pathologist or speech assistant.
  • Once correct sound production is established, students should have 75-100 correct productions per session, at any production level (syllable, sentence, etc.) or grade level. 

Here are a few examples of strategies the SLPs in the work group utilized to increase the rate of articulation remediation:

  • Increase direct service throughout the week
  • 1:1 therapy outside of the classroom (in the hallway) for 8-10 minutes every day by the SLP or SLP-Assistant
  • Combine a day of group therapy with a short drill session
  • Provide HW packets for parents to monitor and sign
  • Utilize classroom practice buddy (class peer; could be another speech student or a typical speech peer)
  • Utilize classroom vocabulary as articulation targets with the expectations for correct production in class.
  • Utilize a 60 day RTI or “in depth screening” to assess stimulability and level of support needed for remediation (i.e., does this student need specially designed instruction to identify and utilize correct sound productions) [either effort would involve parent permission]
  • Self-monitoring instruction is maximized when video, audio, and self-charting are utilized
  • Utilize personal iPhones for recording their speech (high interest activity for students)
  • Utilize a mirror
  • Monitor facial expressions for student awareness
  • Utilize other people in the building to support speech practice (teachers, parent volunteers, aides, SLP-Assistants, peers)
  • Include a visual representation of how sounds “look” inside the mouth for students to reference (great support for visual learners) [University of Iowa Phonology]  This can be tied to the LIPS program as well.

So what happened when these SLPs decided to do things differently for 40% of their caseloads??

They created their own magic. Kids’ speech improved. More people took ownership of student goals. More kids were dismissed.

Now, what would happen if every SLP decided to do something differently?

Sharon Soliday

Sharon loves to help people communicate more effectively. She has been a licensed speech-language pathologist for 18 years serving both young children, teens and adults. She has a passion for adolescent language, communication and social skills. Individuals with disabilities have benefitted from her services as well as individuals just wanting to refine and improve their skills. She has worked internationally and has been recognized on a national level for her excellent work.

Hello Live: Connecting Assessment Results to IEP Goals - Are You Doing It Right? with Heidi Peters, MA, CCC-SLP

Join Kelly and Heidi as they talk about how SLPs can connect their assessment results to their IEP goals!

Are you looking for strategies to connect your language assessment results to IEP goals?  Do you ever wonder how other clinicians do it and what best practices are?  Join Heidi Peters, MA, CCC-SLP as she shares guidelines and tips to help you improve what you've been doing so that you can easily write great goals that are measurable, realistic, and functional for your students.  In this podcast, she addresses what 6 steps you should be following from assessment to goal, 4 things you should never do when writing goals, and results from a recent survey she did asking other SLPs for their input into this topic. Be sure to scroll down to the bottom of this post for her great handout to accompany the podcast. 

And once you've listened to Heidi's formal talk, take a listen to our little conversation about our unique window on the wide world of IEP goals and how I don't know the difference between The Pottery Barn Rule and the Girl Scout motto. 

Harnessing the Power of Flashcard Apps

Talk to almost anyone who has done articulation therapy, and at some point they have enjoyed the convenience of a deck of cards. Flashcards offer pre-selected targets with a visual representation, and great opportunities for repetition and practice. Given a batch of articulation cards with words containing your target sound, it’s easy to scaffold from practicing an initial sound, to words in phrases and sentences, to more conversational tasks. 

So what does technology have to offer us in the way of flashcards? Actually, quite a bit! 

Though an app requires some investment in technology (e.g. an iPad), flashcard apps offer some significant advantages over traditional decks of paper cards:

  • Individualized Practice - Many flashcard apps allow you to create your own content or search for and download shared decks of flashcards that others have created. If you download a shared deck, you can usually go in and further customize the deck to your needs by adding or deleting specific cards
  • Generalization Support - In the same way that you might send a homework page home with a student, many flashcard apps allow you to “share” the electronic deck with other users. Your students might be able to review decks or exercises they have already mastered in class or at home! If a parent installs the free app on their phone, speech sound practice could happen in the car, as a break between homework assignments, or over breakfast! If your student has access to an iPad at school, they may be able to practice their speech sounds when they’re done with their work, during a choice activity time, or for a moment during transitions! As a bonus, reminders and verbal cues can be added as “cards” in the deck (e.g. “Remember to keep your tongue behind your teeth”), helping teachers, aides, and parents know what words to use.
  • Novelty - Students enjoy working on an iPad, and novelty can go a long ways in encouraging frequent practice. In addition, decks can be changed quickly and easily, so that practice doesn’t get boring! 
  • Cost and Space Efficiency - A free app like Bitsboard that allows you to download shared community decks is a great deal when you don't have a big materials budget! And you can download and carry around on your iPad as many decks as you can organize and keep track of. 

If you are interested in playing with the idea of flashcards within an iPad app, here are some we recommend: 

Bitsboard - My personal favorite for creating custom flashcards, the app makes it easy to create, find, download, modify, and share decks of flashcards. I love the option to email a parent, teacher, or SLPA with a direct link for the custom deck I just created! The free version is quite robust, though pro upgrade offers multiple user profiles and the ability to search the web for images from within the flashcard maker.

Smart Baby Touch - The free version downloads with a couple of play mode, and allows you to use the same deck with different users. There are no sharing options. 

Picture card maker - This app is a great option if you want to be able to print out your cards or make picture-exchange style cards (e.g. to use on a sentence strip), though there are not as many adjustable settings as other flashcard apps. I recommend the paid version (Picture Card Maker Plus), as the free version has a lot of clickable ads. 

Keynote/Powerpoint - Both of these presentation apps are available as iPad apps, allowing you to create a "deck" of images at your desktop computer and then swipe through them on your iPad. Easy to share with other users, you can even create games using hyperlinks embedded in the pictures! 

Flashcard apps are an easy way to create your own content on the iPad. And when you are using your own content, students are supported exactly at their level with individualized materials! How do you use flashcard apps in your practice?

To Teach and Be Taught: Reflections on My Clinical Fellowship Year

All through my undergrad and graduate coursework, I longed for the day I’d begin my clinical fellowship. I did not expect to have all of the answers, or all of the knowledge, or really any idea what I would be doing, but I knew I’d be well-equipped in gathering resources and finding the answers and knowledge I’d need. I thought I would be giddy, motivated, and excited and never miss a beat. I figured this would be the most informative nine months of my life, and boy oh boy, was I right - about most of that.

I indeed do not have all of the answers. I definitely know how to seek out my resources (particularly my wonderful THF team). I often feel as though I have no idea what I’m doing. My giddiness ebbs and flows (depending on how much paperwork is piled up), my motivation changes day to day, my excitement seems to be a function of my motivation, and I definitely feel like I miss some beats. And, I was absolutely correct – this has been the most informative period of my life.

Brianna Brown reflects on her Clinical Fellowship experience

The past nine months have taught me so much more than any formal education could have ever attempted. I have learned what it means to work on an interdisciplinary team without a syllabus outlining duties, without an instructor or supervisor guiding us, and without any real idea how to solve some of the …”social communication barriers” I may face or observe with colleagues. I have also learned that this sort of team work is absolutely necessary, and though we all may have varying communication styles and/or agendas, the topic of utmost importance is the students and their goals/needs/well-being. I have learned to be a flexible team member as well as a diplomat. I often find myself attempting to mend communication breakdowns in the moment between colleagues and then planting seeds of positivity regarding team members during personal conversations. I have learned that what I want more than anything in this job is to see the students – not just mine, all of them – succeed, or at least do their best at trying to, and that without their educators collaborating effectively and selflessly, it’s much more difficult for them to do so.

During my formal education, I knew my CF would deliver a lot of knowledge regarding speech and language intervention, assessment, goal writing, IEPs, etc. etc. etc. When I got to the “real world”, I discovered an entirely new realm of learning. I have learned (and will continue to learn) SO much more than I could have ever expected, including:  how to manage outrageous and undesirable behaviors, how to share power with children to build trusting and respectful relationships, how important having that sort of relationship is, how to manage groups of kindergarteners and keep them interested in the activity, how to take meaningful data that will not take away from my therapy session, how to make a functional schedule for 50 kiddos without interfering with core instruction time in the classroom, how to collaborate with teachers to incorporate curriculum-based topics and/or vocabulary, how to efficiently and effectively get through an IEP meeting without digressing into irrelevant (or relevant, but off-topic) conversation with the parents, how to kindly and gently let a parent know their child is presenting with some common signs of high-functioning ASD, how to kindly and gently let a parent know that their child’s communication is severely negatively impacting their access to education and would benefit from an AAC device (but that it will not inhibit their verbal language growth), and so much more!

While I have learned an incredible amount about how to survive as an SLP in the school setting, I know there is still so much to learn. At the beginning of the school year, the thought of how much I had to learn and how little I felt like I knew tormented and totally overwhelmed me. I didn’t feel like I had enough room in my brain to put more information without it popping. I also felt like my mind was so overloaded that I could not access any relevant information. At this stage in my career, however, one month away from completing my CF (!!!!!), I am at a point where I enjoy learning again; it doesn’t scare or overwhelm me. The thought of learning a new therapy approach or working with a new student on a goal I’ve never even heard of before is absolutely thrilling. My focus is no longer on myself, my stress, my caseload, or any of that. Now, my focus has shifted to the students, their success, and their comfort in the speech setting. I want to respect and be respected, I want to teach and be taught, I want to grow and see growth. If there is one thing I can say particularly about my CF and the learning experience therein, it’s that I have shifted my focus from constantly worrying about myself, my stress, and whether or not I was capable of this work, to the students, their needs, and knowing that I am not only capable of this work, but I’m made for it. I love my job, I love my field, I love my students, and I love my team. I love seeing growth and getting feedback from parents and teachers about how much they’ve seen their kiddos’ speech and/or language grow. My CF, though quite challenging, has solidified every feeling I thought I’d have about being a speech-language pathologist; I am absolutely in love with this field and cannot imagine myself doing anything else. I now thrive on the idea of learning more and growing more as a clinician, a colleague, and a person.

¡Ecuador 2015! The Crucible

So, it’s been a long little while since I blogged about Ecuador. Lo siento. I don’t really have any good excuses . . . save for, you know, Life. I don’t quite remember where I left you, perhaps at a meeting in Heather’s apartment on a cold and blustery day? We have had 2 meetings since then, one of which I was unfortunately not able to attend, and many, many,  many virtual conversations. A sidebar here to say that the degree to which we are using technology to plan this trip is so much greater than what we used for our BiH trip. Likewise, I remember the members of Costa Rica team remarking on just how much more tech we were using for the BiH trip than they had used for their trip. Makes me wonder what it will all look like next time around ;-) 

Anyhoo, our team has been spending the bulk of the last 2 months chewing on and pounding out a service model for the trip. I love this part of the group process, little bits of time in the crucible that serve to strengthen our bond as a team. It's not altogether pleasant 100% of the time, but the sweat that forms when of a group of committed, passionate people grind toward a common goal is deeply powerful stuff. There are still details that remain to be seen, and it won’t be until we walk in the door of Esperanza para todos that most of them will be ironed out. And that’s another thing that, for me personally, is such an integral part of the journey. I’m such a planner and organizer that it is somehow freeing (if not a wee bit painful at times) to simply surrender to the process.

The Hello Foundation is going to Baños, Ecuador in 2015 (and Kelly won't be doing this swing)

At this point, that process has lead to our mini-teams being formed, our schedule and plan being outlined, and our little expedition generally inching ever closer to being ready to go. We’ll be doing more “teaching” on this trip than we have on previous trips, so figuring all of that out is taking up a fair amount of mental real estate right now. We just this week ironed out the details of our lodging (not for nuthin’, but I am over the moon at the prospect of hot showers), and we’ve had some fun kicking around ideas for our “expedition” day (I am so totally not doing that swing-thing there in the photo, thankyouverymuch). Passports are being renewed, plane tickets are being researched, drivers are being hired, travel plans are coming into focus. In other words, this is, like, so totally and completely HAPPENING. In 4 months. That’s quatro meses in Español.

And how is my Español coming along? Well, gee, I’m glad you asked. Because it pretty much issn’t. I mean, it was, but again, that whole Life thing happens and you find yourself flat on your bum straight outta nowhere for a while, and you just sort of have to sit there and regroup for a bit. So that’s what my Spanish is doing right now. Regrouping. My general mental preparation is coming right along, though. I have excited days and anxious days and frightened days and exhilarated days. I talk with my teammates and we wonder about what will it feel like to walk in the door and meet new kids, and new staff. What will the food taste like? What can we do to have the most long-lasting impact for the most people? What will I do the first time I see a gigantic bug in my room? 

I have a photo of our BiH team that hangs on my bulletin board above my desk. Whenever I feel anxious, I take a deep breath and look at it -- the sun shining on our smiling faces, our practical shoes on the ancient cobbled street, the storied Stari Most bridge behind us -- and I am flooded with pure joy at the memory of it all, and at the prospect of doing it all again. That crucible I mentioned up there? It's helping me to get to know my Ecuador teammates a little bit better every day. The thought that I’ll have the same sort of bond with them as I have with my BiH teammates is so, so, so profound. We don’t know what we’ll see, where we’ll go, what we’ll feel, but what I do know, what we are slowly learning together, is that we have each other.


ecuador.JPG

This post is the latest in our series documenting our forthcoming international service trip to Baños, Ecuador. You can read our past entries here, and be sure to check back often for future updates.