Components of my AAC Evaluation

Spring is here!!!!! Well… spring break that is. This winter was a busy one, but it’s time to get back on the blogging wagon. I have a deep respect for those professionals who are working full time and keeping up these blogs as a “hobby.”

I’m looking at you praacticalaac.org

I recently finished a comprehensive AAC evaluation. As I made my recommendations, I kept asking myself “Why?” I think that if I can convey why I’m recommending a certain device or accommodation, then I’ve done my job.

AAC assessment is an iterative process. I’ve found that it takes me a great deal of time and gathering information from multiple sources.

Here are the components of my AAC assessment:

1. File Review – Gather all information you can. Check IEPs, progress reports, notes/data from therapists, and TALK TO MEMBERS OF THE TEAM! I’ve found in some cases, the buck stops here. Often I have quick recommendations that the team can put in place, but if more information is needed – we proceed with the assessment.

2. Observations – In MULTIPLE settings. I sit as unobtrusively as possible in classrooms, therapy sessions, or anywhere else that will wield good information. Not only does this provide information on how the student is functioning within the typical day, but I can analyze the environment as well.

3. Data – I like to have some objective information to support those gut feelings. This can be done through trials. There are more and more tools coming out. Here are a few that I’ve been using recently:
AAC Evaluation Genie App (I especially like the visual discrimination subtest)
AAC Profile from Linguisystems (This follows the format from Janice Light’s research. You can find more information on that in this previous post
TASP (Created by the Joan Bruno – creator of Camp Chatterbox)

4. Feature Matching – Once I have identified the needs and areas of strength, then I can try to match the best technology for that student.

5. Summary and Recommendations – I like to use simple tables in this section to bring it all together. In my first table, I summarize areas of strength and areas that were identified as challenging. Next I make recommendations. It is important to clarify that I only make recommendations. It is up to the IEP team to meet and decide what, if any, of my recommendations should be implemented in the IEP. My recommendation table includes three columns: AT currently in place, AT tools to consider, and AT recommendations.

What are you using for AAC assessment?

Inclusive Practices

In a recent post I wrote about my work as a secondary SLP (check it out here). In that post I talked about how I primarily serve students through inclusive services. I do this for a variety of reasons that I won’t get into now, but here is some information I stumbled upon this past week that talks more about what inclusive practices look like (found in the ASHA Leader February 2014):

http://leader.pubs.asha.org/Article.aspx?articleid=1830636#.Uw0k-NbehWA.email

I really can’t say it better than Ms. Dixon does in this article. Basically, it’s not a one size fits all approach. Personally, I’ve had the most success using the supplemental teaching method working in conjunction with resource teachers – but I’ve been heavily advocating to my principal that we need time to collaborate together so we can deliver some team teaching lessons.

If you want more info on this topic, I found this Considerations Packet that has lots of good info and resources for implementing inclusive practices. As a school based speech language pathologist, I feel like I am uniquely set up to deliver inclusive services within the classroom (the place where kids spend the vast majority of their day).

Some of the benefits I see everyday include:

– increased student motivation (once students hit middle school, they hate anything that might mark them as “Different” so pull out is a no go)

– increased teacher carry over of what I’m doing: I LOVE when teachers ask me for my materials OR when they hand me materials they know I will be interested in

– teachers in my schools KNOW WHAT I DO!!!!!

– goal writing has become so much more collaborative between myself and teachers  (with a focus on goals that address the curriculum)

– students are making progress (even students that aren’t on my caseload)

 

Is anyone else using inclusive practices? How’s it going?

Communication

How many of our daily problems could be solved with better communication?

This week I have had several reminders about how important it is to communicate with other team members – and I mean ALL team members.  Communication is the foundation of trust.

One thing I  love about working in the schools, is how many team members I easily have at my disposable. Just start typing their names into my school email account and BAM! – quick email sent to the OT/teacher/behavior therapist/autism specialist…

However, the communication needs to extend beyond the school’s four walls – especially when you are dealing with implementing AAC. Many students with complex communication needs have teams that extend beyond the school based personnel.  When you combine all of the people who are working with this student, we end up with some REALLY big teams!  Team members usually  come from multiple agencies and backgrounds.

Here are some important tips to keep in mind when communicating with other team members:

It’s always safe to assume that everyone on the team is there to help the student and doing the best he/she can; so, keep an open mind when you enter into courageous conversations.

Just because someone is doing something different from you – do not assume that it is wrong.

On the same note – DO NOT get offended when someone asks you, “Why did you think/do/choose that?”  We all bring unique talents to the table and we aren’t going to agree on everything, but if you have information to back up what you are doing/recommending – it’s much easier to get others on board.

If you find yourself thinking, “I should call/email _____, but I don’t have time,” then make time. It’s so difficult to carve out times in our jam packed schedules to make the time to communicate with each other – but it’s so critical to building trust. Keep on keeping on!

I’ve made communication mistakes, and I’m sure I will continue to do so; but, I’ll keep trying.

Here are some quick(ish) ways to communicate among team members (with parent permission of course):

– emails

– shared google docs/forms

– video taping what you are doing

– sharing of evaluations/progress notes

– private blogs to provide quick updates

 

How do you communicate amongst team members?

 

NC Paperwork for the New Clinician

I have the distinct pleasure of working with a graduate student clinician this semester. I am so excited to have her and she is doing great. I look forward to seeing her implement her ideas and I know our students will benefit from working with her. This is her last semester in grad school and she is looking for jobs (hopefully in the schools…)

During the hustle and bustle of the day, I don’t always get to sit with her and talk her through all of the paperwork. When I first started my job at the schools, I did not realize how much my supervisor was doing behind the scenes (e.g. many forms exist other than the IEP). So, I’ve created a graphic to help explain what paperwork needs to be completed (in NC) for initial evaluations and for re-evals. I’ve highlighted paperwork the SLP is responsible for completing in green. Hopefully these are helpful!

Initial Evaluation: (find the form Initial Evaluation Paperwork)

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Re-Evaluation: (find the form Reevaluation Paperwork)

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In my district we are so fortunate to have Program Facilitators, who facilitate (go figure) much of this process. These wonderful individuals handle forms like the Dec 5  (Prior Written Notice) and Dec 6 (Informed Consent for Initial Provision of Services). The link to all of the forms can be found here. Many districts are moving to web based platforms to complete these forms – which comes with it’s own set of pros and cons.

In any case, paperwork is a necessary part of our job. I like to think of it as a system of checks and balances to ensure that proper steps are followed for all.

My last piece of advice: It’s so easy to use acronyms and technical jargon when completing these forms. Remember: these should be accessible to all – event those who are not familiar with school based terminology. When in doubt, explain everything.

Did I miss any steps? How does your district handle paperwork?

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?