Times are Changing

Well…it’s that time again. All of my colleagues in Chapel Hill are preparing their classrooms and offices for the start of another school year. I write this with a heavy heart because I will not be joining them. 

Over the summer, my little family and I packed up and moved to Michigan. We wanted to be closer to family for our baby and a job opportunity came up that was too good to pass by. 

I am now a SLP specializing in AAC in outpatient pediatrics at the University of Michigan Hospital System. 

It hasn’t been an easy switch. I feel like a CF again! In NC, I had all of the processes and paperwork down. In MI, I feel like I’m starting from scratch. It’s been quite the learning curve figuring out insurance and how to navigate such a huge system. Everyone says it will get better. 

I’ve been there for less than a month and I’ve already gotten my hands on some pretty cool devices. I’m learning how to program a lot of different systems and navigate insurance funding. On Wednesday, I had two separate families ask me if I knew of Dr. Karen Erickson. They were thrilled to know that I actually do know her and had the distinct pleasure of working with her in the schools. 

I miss NC like crazy, but I’m trying to stay open to the possibilities that UofM has to offer. I can already tell that I’m a better clinician after this move.

Who knows what’s next? 

For now, I’m going to try not to mess up the documentation too bad, enjoy treating a broad range of patients, and focus on my AAC eval and treatment skills. 

Good luck to the staff and students returning to CHCC this fall! 

“I’m going to Carolina in my mind…”

AAC Devices: Tip of the Iceberg There’s More to Good AAC Implementation Than Meets the Eye

By Ruth Morgan M.S. CCC-SLP  and Ashley Robinson M.S. CCC-SLP, ATP

 

How often have you heard this?:  “I saw XYZ new device and I think it would be great for my student,” or “Last night I saw XYZ device on tv and it was a miracle!”

High tech AAC devices are just the tip of the iceberg of things that need to be in place to make students successful communicators. Here are 10 other key components.

iceberg

Image by Ruth Morgan. Use but PLEASE CREDIT

    1. Systematically organized core and fringe vocabulary. Here are some examples:
    2. Peer language models. This doesn’t even have to be other device users. Kids need to see other kids using language.
    3. Opportunities for functional communication (including commenting, asking questions, greetings/salutations, requesting, and rejecting). Not just making choices
      • The Communication Matrix is one of many tools that allows you to see a range of communicative functions
    4. Data collection methods
    5. Lite Tech backups should always be in place for high tech devices. Batteries tend to die at the most inopportune times.
    6. Room for growth. Students need to be able to combine symbols to make more complex language. Always be thinking ahead.
    7. IEPs with SMART goals
    8. Training and planning time for staff. This is crucial!!!
    9. Adult modeling of AAC use.
    10. Stakeholder support (including parents and administration) for funding of devices and implementation of all of the above!

 

If teams focus solely on the device (the tip of the iceberg), then you may very well end up with a really expensive book end or fancy choice board.  What’s underneath the surface is vital to successful implementation.

 

Author Bios:

Ruth Morgan is a full-time speech language pathologist at Ephesus Elementary school and author of Chapel Hill Snippets. You can find her materials on Teachers Pay Teachers.

 

Ashley Robinson splits her time between providing speech language pathology services at the secondary level and working as part of the district Assistive Technology team. 

 

2015 NCACA Conference Handouts: Building Classroom Communities to Support AAC Users

I had the distinct pleasure of presenting at the 2015 NCACA Conference in Winston-Salem NC (my first time ever!). It was an honor to be a part of a conference with people that I truly look up to and see the great work they are doing all over the state.

During my presentation, I outlined the training process I have been using in my district this year. Basically, I am working to help classroom teachers build a foundation to support AAC users in the classroom. This is not where I’m going to end up, but it’s a start.

Check it out!

NCACA 2015 Conference

Blank AAC Training Plan

Completed AAC Training Plan

THANK YOU

It’s that time of year to stop and reflect on what we are thankful for. Today I got some WONDERFUL news and I want to thank those who made it possible.

The grant I wrote was funded!!!!

Thanks to the generosity of the Public School Foundation and A Better Image Printing in Chapel Hill, all system level teachers in my district will have resources to support the instruction of our low verbal and nonverbal students. It’s actually happening!

 

THANK YOU THANK YOU THANK YOU!!!!

 

Stay tuned for Phase 1…

Feeling Happy…

This evening, I had the honor of watching my mentor (Ruth Morgan of Chapel Hill Snippets) receive an award for her many contributions to the practice of serving students who need alternative or augmentative communication. It was a much deserved award and her passion for her work was evident.

A WONDERFUL organization called the New Voices Foundation sponsored the event in honor of an amazing individual who used AAC – Laura Jane Parker. They awarded four individuals who have dedicated their careers to serving students with physical and communication needs. Check out their website to see more of the awesome work that they do – I could go on all day!

It was a true honor to be in this room, surrounded by some amazing professionals, celebrating the work of our peers. I will admit that prior to this event, I was feeling kind of low. Political agendas (both state and local) had gotten me down. But sitting in that room – I felt the love.

The folks behind New Voices truly care about individuals with communication needs and for the professionals that are working to serve those individuals. That’s something I haven’t felt in a while. I left with a renewed spirit.

The field of AAC is dynamic. This is the time to be innovative and to collaborative! Tthings aren’t great in the NC public school systems, but there are people out there fighting for us to get the tools and support we need. I hope to work with New Voices in the future.

It’s time to get out of my funk and focus on the good – believe me there’s a lot of good. It’s an exciting time to work in AAC!

What do others do when you start feeling low about your work?

 

Tis the Season…for Job Interviews

As many of you know, I have the privilege of working with an enthusiastic and hard working graduate clinician this semester. It’s been a true pleasure to work with her and I know she will go on to be a great speech language pathologist. In a few short weeks she will be graduating and looking for her clinical fellowship position. I remember these days, and how nerve wracking the job interview process can be. Luckily for me, a fellow speech language pathologist – TJ Ragan from “The Gladdest Thing Under the Sun” wrote this AMAZING blog post with job interview questions to practice. Click HERE to find the link to those questions.

This was my bible when I was interviewing, so I asked if I could share this on my blog. I hope others find it as useful as I did. Good luck!

Does anyone else have any interesting job interview questions to share?

 

 

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)

Screen Shot 2014-02-02 at 12.39.41 PM

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!

Image

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?

 

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?