Secondary SLP Service Delivery

Snow day in NC!!!! Thanks Leon!

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Today I thought I would take a detour from my typical blog posting about AAC and talk about the other part of my job (SLP for middle and high schoolers). Never in a million years did I imagine myself working at the secondary level – but now I can’t imagine a world in which I don’t work with adolescents! (at least some of the time)

Working at the secondary level has it’s unique challenges to service delivery. Here are two of the biggest challenges that I have come across, and how I’ve addressed those:

1. Secondary students have limited time. Once students hit middle school, they have classes that they are required to take. Often times, students spend a limited amount of time with each teacher, so teachers are not usually willing to let students miss a class period once/twice per week (not to mention time lost due to testing, assemblies, field trips and required remedial programs). How can you provide service delivery when students only have a limited amount of time in the day?

a. Schedule students in sessions per quarter (rather than sessions once/twice per week). Unlike many of my peers, my schedule is a fluid, ever changing thing. So when a teacher says, “Johnny can’t come to see you today because he failed his science test and needs to retake it.” I can say, “OK, I will catch him twice next week” to make up for the lost session. FLEXIBILITY is key! Scheduling times per quarter is also helpful when state mandated testing rolls around. In my experience, this is a horrible time for students and speech language therapy is the last thing on their minds. If I can avoid it, I do not schedule therapy on days students are testing. Remember though – you should not schedule students based on your convenience! The team decides what level of support the student needs to access his/her IEP goals – which you can translate into times per quarter.

b. Parent and elementary SLP education. The other secondary SLPs and I have done some brief inservices for our elementary counterparts to inform them of the unique scheduling demands of middle and high school. One of the biggest differences is that students are not with one teacher throughout the day – so if they miss that day’s lesson, there’s no making it up that day and the class will move forward without them. In my district, students at the resource level may get one small group resource class with a resource teacher per day. THAT’S IT! Student’s may get put into collaborative classes (resource teacher or teaching assistant in the class with the gen ed teacher) as needed. This means that the resource teacher has one period per day to preteach/reteach concepts, provide opportunities for test retakes, and help students complete assignments (not to mention any required remedial programs that must be provided). Once we lay this out for parents and SLPs, we can talk about ways the SLP can support the student within the secondary environment. Which brings me to my next point…

c. CONSIDER OTHER MODELS OF SERVICE DELIVERY. I think the biggest problem that I see is the Related Service Support Description (e.g. support plan) is considered a means to exit students from speech and language supports, or provide less supports. THIS IS NOT TRUE!!!! 

Let me explain: Sally is a 6th grader with a significant learning disability. She is reading independently at a mid 3rd grade level and writing is below grade level. She works hard and is turning in most of her homework (which she completes in her resource class with the resource teacher). Her homework completion is saving her grade, because she is failing tests (as you would imagine since her skills are not at the 6th grade level). Classroom instruction is moving much too fast and the gap is growing.

An 8th grade general education teacher asked me, “When students come to my class, I expect to lay the 8th grade set of bricks. What do I do when I have a student who does not have the 7th grade (or even the 3rd grade) bricks?”

Enter specialized instruction team! Wouldn’t it make more sense for the EC teacher to be able to spend more time with the general education teacher to adapt assignments to ensure that they are on Sally’s level (IN ALL CLASSES), so Sally can benefit from the instruction and learn? It also stands to reason that the speech and language pathologist could provide input as well to address language needs in the classroom. This way, Sally is getting that support throughout the day (not just in speech and language therapy sessions). Unfortunately, there is limited or no time for this collaboration throughout the day. Everyone’s schedule (including the kids’) is so jam packed, that we are relying on our predetermined times set on the IEP instead of looking at the bigger picture here. It’s like putting band-aids on a broken bone.

 

2. Student Motivation – As students enter adolescence, they worry about “being cool,” yet strive to fit in with their peers. In my experience, pulling students out of class to work with me is the worst thing I could possibly do for their self esteem.  No amount of prize boxes or bribery can make up for that. I see VERY few students 1:1 for this reason. Over the last 2.5 years, I’ve worked very hard to build  positive relationships with my students and have done so with many of them. It has become clear that INCLUSION YIELDS THE BEST RESULTS.

a. INCLUSION. So there are many levels of inclusion (more on this later), but I hate going into the classroom and acting as support staff for a teacher’s lesson. I do not want to go into the classroom and walk around keeping students on task and “getting them through” the assignment. For me the best place to do this inclusion is by “pushing in” to student’s small group resource classes. Over the last couple of years, I have slowly built relationships with resource teachers, and they allow me to come into their classrooms once or twice per week to delver a lesson to the whole class (usually 5-6 students). We give it a jazzy name like “Writer’s Workshop” (haha). I create lessons that are targeting the language based needs of a couple of students in the class; however, the entire group benefits from the instruction. This set up gives me the best chances at student participation and allows the resource teacher to see what I’m doing so he/she can carry that skill over into other lessons. For example, I have been working on teaching my 6th graders how to write a paragraph using a 4 square graphic organizer. Now, when the student is asked to write a paragraph in Language Arts, the resource teacher in that collaborative class can refer back to the graphic organizer that students used in Writer’s Workshop (disclaimer: we call it Writer’s Workshop, but reading comprehension or other language based objectives can easily be addressed).

A good resource for this is Western Michigan’s (Go Broncos!) Writing Lab Outreach Project – found here.

 

All of this makes me wonder, what if we changed the traditional views of speech therapy? What if I primarily served as a consultant for teachers (both EC and gen ed) to address language based needs in the classroom? Would I still lead Writer’s Workshops and drive instruction through student data? – ABSOLUTELY!

 

How are others serving their students?

 

Rolling Out the PODD: STEP 1

Oh PODD… how I love you. You are a wonderful language based, low tech system that grows with students (check out my Pillars of PODD post to get the scoop). My dream is to have a lending library of PODD books in my district to use for assessment purposes – just another tool in the toolbox.

Yet, PODD is providing to be a good bit of work. Anyone who has spent hours trimming those tabs knows what I’m talking about… But there’s more to it than just getting the books made and distributing them throughout the district to all of the little boys and girls. In order to ensure that devices are used in the classroom, it is important to make sure that the classroom staff understand and feel comfortable with devices. Here’s where we are so far in the PODD roll out in my school district:

STEP 1

Student identified as possible candidate for PODD system – After a brief training for our district SLPs and EC teachers, many approached me asking if they could try PODD with a specific student.

Introduction of PODD to Classroom – Once a student was identified as a possible candidate, I brought the appropriate level of PODD over to the classroom. I did a quick “Pillars of PODD” training. DON’T FORGET TEACHING ASSISTANTS IN THIS TRAINING!

Full disclosure: Initially, I sat down with teachers and therapists in initial training thinking they would relay the information to the TAs. While intentions are good, in the hustle and bustle of the day, the information wasn’t always transmitted. TAs have asked to be included right from the get go. LESSON LEARNED!

Identifying Targets – I asked staff to think about the curriculum and the student’s communication needs to determine our first vocabulary targets. In order to keep it doable, I’ve asked staff to pick 3-5 to start with. This vocabulary can be from the core word vocabulary and/or “fringe” vocabulary deeper in the book. I always make sure that I am not dictating to the team what vocabulary to use. I am not an expert in the curriculum and the team knows the child much better than I.

Now what?

Next Steps:

Once the team has identified the first targets, I will come back for an additional training. This training will focus more specifically on teaching the targets the team has identified and integrating the PODD across the day – not just within specific activities. Data collection will be another story….

 

Is anyone else out there rolling out the PODD? How’s it going?

 

 

 

Inspirational (& functional) AAC Therapy

In honor of Dr. King, and all of the inspirational contributions he has made – I would like to share some  inspiring therapy I happened upon a few weeks ago. For those who don’t know, my mentor and blogging role model is Ruth Morgan of Chapel Hill Snippets.

I always learn from the many AMAZING therapists I work with in my school district. This is one example of some awesome therapy targeting FUNCTIONAL COMMUNICATION by the talented Ruth Morgan.

Ruth was working with a student using an AAC device. She provided the student with several motivating activities, but did not provide all of the materials (e.g markers) so the student could complete the activity. Ruth modeled (aided language input) the target item on the device for the student, then helped the student go into to classroom and ask the classroom staff for the needed materials. The classroom staff provided the student with the needed materials and all was well. WOO HOO for natural consequences! WOO HOO for motivation! 

I think as a school based speech and language pathologist, I have the privilege to see students in several different contexts (in the class, at lunch, at recess, one-on-one…). I have access to so many team members, that I feel like I am prime to deliver some truly functional (best practice) therapy. Yes – it looks different from “traditional” pull-out therapy, but that’s good. Maybe we’ve been hanging onto “traditional therapy” for too long, and it’s time to really think about changing our models to promote best practice.

What do you think?

Camp for Individuals Using AAC

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I have THE BEST news: I have been accepted to intern at CAMP CHATTERBOX this summer!!!!!

Check out the website here: http://www.campchatterbox.org 

During the last ASHA conference, I had the incredible fortune to sit next to Joan Bruno – founder of this amazing camp (not to mention several other AAC tools, like the TASP) . We chatted on our way to our next session, and I was hooked. I came back from Chicago, and immediately applied to intern this summer. I’ve been officially accepted and I CAN’T WAIT!!!!

According to the website:
“Camp Chatterbox is a therapy camp for nonspeaking or severely speech-impaired children, ages 5 -16, who functionally use synthesized augmentative and alternative communication (AAC) devices. It is sponsored by the Children’s Specialized Hospital in Mountainside, NJ.” 

This is an AMAZING opportunity! If you know someone who would benefit (AAC user, family member, or therapist) – I highly encourage you to share this information.

Come join us at Camp Chatterbox. I know it will be a great time!

Who’s in?

Personalizing the AAC Device

Here is a form I came up with to help personalize AAC communication systems in my district. I really wanted a way to get parent input as to the best ways to customize devices to fit their needs. My hope is that this will help families “buy in” to the idea that AAC is meant to be with the child at all times and serve as that person’s voice.

I based this form off of the PODD system, but these questions could easily apply to any device. I refer to the AAC user as “student” because I’m in a school. The more collaboration you have (including the AAC user to whatever extent possible) in choosing vocabulary, the better.

There are a couple of questions that I wouldn’t typically include – for example asking whether or not a parent would want undergarments or religion included on their device – but because I work in a school, I want to make sure that I’m not making parents uncomfortable or crossing any legal boundaries. That being said, my true belief is that we should never omit words because they are uncomfortable (we can’t unteach that swear word to a toddler). Best practice says to keep them in.

Here it is – let me know what you think. Are there other tools out there to help customize vocabulary selection? AACPersonalizationForm

 

Pillars of PODD

I want to share another tool I have added to my district’s AAC tool kit. It’s called the Pragmatically Organized Dynamic Display (PODD) – created by Gayle Porter. Disclaimer: I have not been formally trained in the PODD system. This is information I have learned through attending various conferences and reading through the PODD Manual.

I’m not going into too much detail about the PODD, but I will say it’s a light tech, multi-leveled, systematically organized communication tool. Check it out here: http://www.mayer-johnson.com/podd

Here are some of (what I like to call) the Pillars of PODD:

* Vocabulary is systematically organized. It is key for individuals using AAC to have access to vocabulary that is always in the same place. This promotes motor memory and saves cognitive resources so individuals can focus on generating their message. This goes back to increasing Operational Competence for users (refer back to my post on AAC Assessment and Janice Light’s Theory of Communicative Competence).

* This is the student’s voice. I first learned about the PODD system when Linda Burkhart spoke at the 2013 NCACA conference in Durham, NC. During a question and answer session, someone said something like, “You can print off one book for home, and one book for school.” Linda Burkhart responded with a resounding, “No.” We have to value this as the child’s one, true voice. It goes EVERYWHERE with the student. Check out the PODD manual for more information on methods of access.

* Aided Language Stimulation is KEY. We cannot expect a person to just pick up an AAC device and start generating messages. We need to input the system for that person (think about how we narrate the life of a baby). We have to ensure that each person develops Linguistic Competence for his/her device. If you screw up – that’s ok!!! You should model what to do when you mess up (oops!). You are building that skill of Strategic Competence!

* Implement the PODD within a natural communicative context. Linda Burkhart said, “What fires together, wires together.” So, make sure that individuals using AAC have opportunities to practice in real world environments. Interactions must be genuine and provide natural consequences. You’ve got to make sure communication is functional!

There are many, many more and this post is not meant to be an exhaustive list of all of the key points of PODD.

We started implementing the PODD with several students in my school district. I am excited to see how this rolls out and I’ll keep you posted.

Is anyone else out there using this system? How’s it going?

Assessment and Communicative Competence for the AAC User

Lately, I’ve been thinking a lot about AAC evaluation. What makes a good AAC eval? How can you sift through all of the apps and devices out there to feature match the best device for each individual client? There’s so much to consider and there’s no one size fits all tool.

I want to share what I’ve found to be most helpful so far:

1. The AAC Evaluation Genie app for iPad

*This app has 14 subtests that measure different skills like: visual identification skills, visual discrimination skills, vocabulary, category recognition and other skills. At the end of each session you get a nice summary that you can print out and add to your assessment report. While I think AAC assessment is largely a qualitative process, it’s nice to have some “numbers” to support the recommendations I am making.

2. Janice Light’s Framework of Communicative Competence for individuals using AAC (Light, 1989).

*This article is a good one – easy to read and really seemed to set the stage for how people think about competence in using an AAC device. It’s worth a read, but here are the highlights that I want to keep in mind for future AAC assessment:

There are 3 components to the definition of communicative competence:

1. Functionality of Communication = Is the system functional for the individual? This will change based on the context. Yesterday, I was working with a student during a craft activity. He needed more glue, so I modeled asking for glue using his communication notebook. He followed my model and I handed him a crayon (my ultimate goal was to expose him to “different”). He happily began to color on his paper. Palm to forehead – I did not make this communication opportunity functional for him (or very motivating for that matter). He didn’t care about the glue or the crayon. Functionality of communication is ever-changing – make sure to look at the different environments and communication partners in addition to the person you are evaluating.

2. Adequacy of Communication = This means the student can adequately communicate what he/she needs in any given environment, at any given time. Adequacy does NOT mean mastery. Does anybody really have mastery over language?

3. Sufficiency of Knowledge, Judgement, & Skill in using the device = This component has four subcomponents to evaluate.

a. Linguistic competence = I think of this as the form and content of language. Don’t forget that an individual using an AAC device not only has to master the language of their device in order to express themselves (more on this later), but they also have to master the language that others are using around them (probably spoken) to understand what others are saying. That’s an important point to keep in mind…

b. Operational competence = can the individual operate the device? Some devices are pretty comprehensive and tech heavy. My AAC professor explained that we all have a set amount of cognitive resources. If you are devoting a lot of resources to just working the device, then you have less resources to devote towards using existing language skills to generate a message. For example, I cannot figure out how to type in this blog and carry on a conversation at the same time – just not happening.

c. Social Competence = There are two prongs to this one.

*Sociolinguistic – The use of language (pragmatics)

* Sociorelational – I will admit that I need to be reminded of this. Light (1988) states that these skills are important to the sociorelational characteristics of someone using AAC:
– positive self-image
– interest in others
– desire to communicate
– active participation in conversations
– responsiveness to partners
– ability to put partners at ease

I, for one, definitely need to look more into this, but it’s obvious that confidence is key.

d. Strategic Competence = If you’ve ever been to a country that you do not speak the language, you know this feeling. You don’t know how to say what you need to say, so you mime, give single words, and just do whatever you can to get the point across. It’s important that individuals using AAC are able to make the best of what they can do.

Whew… One last point – these skills CANNOT happen in isolation. A student may be able to whiz through a device, but if they are not functionally communicating with it – they are NOT a competent communicator.

I’m curious to hear what others are using for AAC assessment. Please share!

References:
Light, J. (1989). Toward a Definition of Communicative Competence for individuals using augmentative and alternative communication systems. Augmentative and Alternative Communication, 137-144.

Light, J. (1988). Interaction involving individuals using augmentative and alternative communication systems: State of the art and future directions for research. Augmentative and Alternative Communication, 4, 66-82.