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?

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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?

 

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?

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?