In the Community - iCan Bike
“Do it badly; do it slowly; do it fearfully; do it any way you have to, but do it.”
― Steve Chandler
In the Community - iCan Bike
This week we'd like to recognize iCan Shine and Crimson Center for Speech-Language Pathology for organizing an amazing opportunity for children with special needs to spend a fun-filled week learning how to ride bikes independently. The summer camp style program iCan Bike (formally Lose the Training Wheels), focuses on helping local children become life-long independent bike riders. Special recognition, of course, goes to the amazing volunteers who spend their week running back and forth alongside the campers while they practice, and the donors who help make it possible. Its amazing what can be done when a group of people come together for a common cause. We look forward to watching it be a success again next year! Click here for information on how you can support or participate in this program.
“Do it badly; do it slowly; do it fearfully; do it any way you have to, but do it.”
― Steve Chandler
Interprofessional Collaboration - Why And How
Speech-language pathologists (SLPs) work alongside a plethora of allied professionals across medical, private practice, research, home care, and school settings. Due in part to existing systemic structures and impacted curricular programs, service providers have historically worked parallel to rather than in tandem with each other. Recently, there has been a cross-disciplinary initiative (initiated by the WHO) to provide better health services through collaboration. We at Inspired*In*Speech believe that this is a critical movement that will ultimately benefit patients as well as providers across the board.
Why is this so important?
In the traditional health care model, practitioners are trained to adopt the social and educational perspectives of their chosen discipline. Each disciplinary perspective incorporates a unique set of theoretical and practical principles that shape clinical practice (D’Amour, Ferrada-Videla, Rodriguez, & Beaulieu, 2005). Highly trained and skilled professionals may be aware of but not truly knowledgeable about other disciplines that serve a shared population of people. Moreover, many work environments are not conducive to wide-scale coordination. The unfortunate result is a segmented system that has been proven difficult to reform (D’Amour et al., 2005). On a more concrete level, this lack of synergy has resulted in may problems that directly impact the people who we are all trying to help:
If this is such a big problem, why haven't we already fixed it?
There are significant challenges that practitioners face when it comes to implementing true collaborative practice.
One substantial barrier is the current model of reimbursement. The fee-for-service reimbursement model has worked sufficiently for parallel service delivery, however time spent co-treating and meeting with professional collaborators is not always compensated (Rodgers & Nunez, 2013). This reduces incentive to prioritize collaboration, and even sparks competition to earn what compensation is available (Rodgers & Nunez, 2013). In my experience with private clinics, most insurance companies will not reimburse for collaborative sessions because the professional to client ratio would be 2:1. This is unfortunate, because many children could maximize their response to treatment if dually treated (such as occupational and speech therapy).
There are also a number of less structural but equally robust barriers to allied treatment. Functionally, it is difficult to coordinate schedules, especially when coming from different locations of service. There are also social caveats that obstruct progress. For example, the lack of intimate knowledge and/or respect of different professional contributions can lead to perceived hierarchical standings. For example, a doctor, nurse, and SLP in the hospital all have different but critical roles in their patient's recovery. The doctor’s extensive medical knowledge, the SLP’s expertise in swallowing, and the nurse’s intimate knowledge of the client must all be valued equally and incorporated into the treatment plan. If any of those team members feels devalued, the triad of care is compromised.
What can we do to support progress?
This is clearly an issue that requires global coordination towards systemic change. Fortunately, there are a number of things that professionals can do right now to promote better collaborative practice.
Constantinidou F., Wertheimer J.C., Tsanadis J., Evans C., & Paul D.R. (2012). Assessment of executive functioning in brain injury: Collaboration between speech-language pathology and neuropsychology for an integrative neuropsychological perspective. Brain injury, 26(13-14), 1549-1563.
D’Amour, D., Ferrada-Videla, M., Rodriguez, L.S.M., & Beaulieu, M.D. (2005). The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks. Journal of interprofessional care, 19(1), 116-31.
Ewashen, C., McInnis-Perry, G., & Murphy, N. (2013). Interprofessional collaboration-in-practice: The contested place of ethics. Nursing Ethics, 20(3), 325-335. doi:10.1177/0969733012462048
Johnston, J., & Truluck, C.A. (2011). Writing & research. Interprofessional Collaboration. Radiologic Technology, 83(1), 97-99.
Lee, A., Pettigrew, C., O’Sullivan, C., Henn, P., & O’Flynn, S. (2008). Strategies for Interprofessional Education in Health and Social Care. Powerpoint presented at the Speech-Language Hearing Association
Oandasan, I., & Reeves, S. (2005). Key elements for interprofessional education. Part 1: The learner, the educator and the learning context. Journal Of Interprofessional Care, 1921-38. doi:10.1080/13561820500083550
Prelock, P. (2013, June 01). From the President: The Magic of Interprofessional Teamwork. The ASHA Leader. Retrieved from http://www.asha.org/Publications/leader/2013/130601/From-the-President--The-Magic-of-Interprofessional-Teamwork.htm
Prelock, A., Beatson, J., Bitner, B., & Broder, C., (2003). Interdisciplinary Assessment of Young Children With Autism Spectrum Disorder. Language, Speech, and Hearing Services in Schools 34, 194-202. doi:10.1044/0161-1461(2003/016)
Rodgers, M., & Nunez, L. (2013). From My Perspective: How Do We Make Interprofessional Collaboration Happen? The ASHA Leader. Retrieved from http://www.asha.org/Publications/leader/2013/130601/From-My-Perspective--How-Do-We-Make-Interprofessional-Collaboration-Happen.htm
Pronouns With Splingo
Splingo, the speech and language alien, has a serious of apps that can be excellent supplements to traditional therapy. The apply titled Pronouns With Splingo ($2.99) offers a fun way to practice a variety of different pronouns (he, him, his, she, her, hers, they, them, theirs, I, me, mine, we, us, and our, to be specific). Before starting, the clinician/adult can select or deselect targets to customize the session.
In a variety of virtual settings, two different people or groups of people stand on opposite sides of the screen, each behind a table. At the bottom of the screen is an item as well as a written command (which is also presented auditorally). Commands are simple, such as "The cookie is hers", or "He would like the balloon." The idea is for the student to drag the item to the correct person/people. When not done correctly, there is an auditory "hu-uh" and the item returns to where it started. When the item is dragged to the correct table, it remains there and verbal praise is given.
Periodically, the student is given a reward/break. The scene changes to a child's bedroom and the student is prompted to choose 3-items to add to his room. Once placed in the room, the items animate and remain for future breaks.
* Things to think about: Some children do well identifying pronouns but have difficulty using them receptively. In these cases, the clinician might withhold the device to have the child repeat the phrase out loud before being allowed moving the item. Another, more advanced, option would be having the child answer a question that uses a different pronoun for the same person. For example, if the prompt was "Give the cookie to her," you might ask who wants the cookie (she does). I have also had children who like to repeatedly pick up and immediate drop the item, resulting in a cacophony of huh-uhs and efficient task avoidance. You may want to have a contingency plan ready for the kids who need the behavioral support. Lastly, in order for we and us to make sense in the game, the child must understand that Splingo is the one talking. You could give an introduction, or just deselect those items before starting.
We hope you love Splingo as much as we do!
Valentines Day Fun
Some fantastic ideas for February and Valentine's Day from around the internet.
Check it out!
Happy project hunting!
Tools for Middle and High School
Making the jump from a pediatric outpatient clinic to a middle/high school setting was a big adjustment for me. I had all the tools and trick I needed for preschool and early elementary aged kids, but was in a whole new ballpark with high-schoolers. Admittedly, my background in behavior management and AAC didn't exactly give me a lot to work with when it came to social skills groups with my 15 year old boys! These are just a few of the resources I've found to help me along in my journey.
1. This book has been such a life-saver for me. In the last few months I have had quite a few things come up in my interactions with students (when is teasing mean teasing vs. friendly teasing, who can you trust with specific information etc.) and every time this book has a lesson and worksheet that totally fits the bill. While some of the information is not appropriate for my students (e.g. romantic relationships) I think this is an awesome resource for anyone working with teenagers and young adults.
2. This game is like a social think-tank for my students. You show the prompt card and everyone votes on what level they feel the behavior falls into. It has sprung many discussions where the students are actually coaching each other on appropriate behaviors which, in my opinion, is so much more valuable than me coaching them through why we act the way we do.
3. In conjunction with the game I also snagged a copy of this book. It has been really helpful for some of my students who are able to tell you the social rules and know them inside and out in therapy, but struggle to monitor their behavior in class or with peers. The scales serve as a visual prompt and, if necessary, offers appropriate solutions to the problem they are facing.
4. This last one is pretty specific to my middle school and early high school girls, but The Smart Girl's Guide (every time I talk to the other SLP at our site about using these books I want to call them the Girlfriend's Guide- another Bravo addicts out there?) is a fantastic series of books written for young adolescent girl's about a huge range of topics. I love the way the information is approachable and interesting to the girls!
What are some of your favorites for teaching social language?
Some of you may be familiar with Story Grammar Marker as a tool used to increase narrative comprehension and oral expression. There are different characters, representing various parts of a story. These serve as a visual guide, and there is a manipulative, for students to remember and include the different parts of story grammar (e.g. characters, plot, setting).
Admittedly I have not had the opportunity to use the physical tool-kit, however I have used the iPad app frequently in therapy. Here's why I love it!
Once you have selected the appropriate narrative for your student the page will open up with the corresponding characters on the left. Here is where the fun really starts! You click on the character and the app opens to a page that allows you and the student to brainstorm by: typing, adding a photo, adding a picture, or drawing a picture of your own.
Once you hit "done" your notes become part of the outline for the whole story. Serving as a visual prompt when your student begins to tell his or her story.
The next step is to give your story a title and start recording.
Your student can then listen to their own voice as they tell the story. So many options here for auditory feedback. This is a great tool not just for narrative language but for articulation at the conversational level and fluency monitoring as well.
For your own records you can email the story or save it in the app.
At 24.99 it is definitely at the top of my typical app budget, however I certainly use it enough to justify the price!
Happy Holiday Monday,
My Mommy Said It's Raining
If you haven't seen this video clip of a little boy arguing with twin girls over whether it is raining or sprinkling, then you should do yourself a favor and watch it right now! At 1:38, the most adorable turn of events will make your "hawt" smile <3.
Here's the gist, for those of you who can't watch it immediately:
Boy: "My mom said it is raining"
Twin A: "My mom told me it's sprinkling" (picking nose)
(repeat first two quotes many times)
Twin A: (Pokes boy on the cheek, to really make her point about the rain)
Twin B: "Say sorry to him"
Boy: "My Mom told me it is sprinkling"
Twin A: "No it's not, its raining"
(More repetition, with some adorable sister support)
Boy: "It's just raining" (seems to have changed sides but is equally passionate)
Twin A: "Because it's raining" (slightly thrown by Boy's twist, but not willing to back down)
Boy: "No, you're pretty. You're not real, I'm real" (???????)
Twin A: (Pokes Boy on his chest)
Boy: "You poked my hawt" (in a sad tone that no text could ever do justice to)
Twin Problem-solver B: "It ok. Turn around, I gonna get hind you" (stands behind him and holds part of his t-shirt like a tail- all better!)
...And that is why kids are the best!!
A while back, Larissa and I were chatting about how we can make pronouns stick for kids who don't acquire them naturally. Some children just need explicit instruction, others need lots of practice with consistent verbal feedback. It seems that a few kids, however, have difficulty with this even when given a high level of initial support and frequent practice. We concluded that the key is to find a way to increase the value of accuracy. For example, if we could have two people holding edible items (one highly preferred, the other disliked), then it might matter to the client whether or not the correct person was referred to. Since live stand-ins aren't available to us, we came up with these as an alternative.
I've already used these in a lot of different ways to work on he, she, him, her, his, and hers... Place an item of value (bingo chip, crayon, whatever) in front of one of them and ask the child who has it, or who you gave it to; hide an item under or inside one of the boxes and either tell or have the student guess 'who' has it; sort items by asking the child to give specific objects to each 'person'; play hide and seek by having the student cover their eyes while you place the items around the room - the options are endless.
Here's how you can make your own
Step 1 - Get your box/s ready. I used a long tissue box and had to cut it in half. I have been saving square boxes to make more that will have a fancy insert where the tissues normally come out. You can use whatever you have lying around, just make sure you think about where you need hard surfaces and openings ahead of time.
Step 2 - Print images that are an appropriate size and match your personal criteria. For mine, I wanted to have similar looking styles of clip-art for my boy and girl. Make sure you know about what size will fit onto your tissue box.
Step 3 - Place the picture on the tissue box, where you want it to end up. Then, run a pencil along to edges to mark where they are relative to the picture. Cut the picture out, about 1/2-1 inch outside the pencil line.
Step 4 - From each corner of the paper, make a diagonal cut directly to the corner of the nearest pencil mark. Make a crease along the pencil marks, folding the trimmed corners back.
Step 5 - Place the picture back onto the box, lining up the creased pencil marks with the edges of the box. Folding the paper around to the sides of the box, tape each side of the paper as it lays on the box. This is similar to how you would wrap the ends of a rectangular gift.
Once you have all of the sides taped, you are ready to go! I completely covered the pictures with clear packing tape, because I have had too many materials ruined in past sessions.
Have fun with your recycled pronoun boxes - we'd love to hear about your favorite activities for helping kids who just don't seem to grasp pronouns!
Our Pinterest page, "Inspired Speech", has a number of different themed boards that we add to on an ongoing basis. We find a lot of inspiration on the internet through google searches, and also through following Pinterest boards of people with similar interests and styles. For ideas about apps and technology, check out our board AAC * Apps * Tech - we pin posts from this blog, as well as ideas from the people/boards that we follow.
Fun Crafts and Games for January!
Now that the holidays have passed here's what we are looking forward to this winter.
Pair these activities with a great story about a snowman, penguin, owl or eskimo and you have a great- and fun- lesson for your kiddos!
Let us know what your favorite winter-time activities are!
Molly and Larissa are speech-language pathologists in San Diego, CA, who are looking to share inventive, inclusive, fun ideas for developing communication. This is also their platform for highlighting the many amazing people and resources in the community.