The “Poetry” of our Parent-Professional Partnership

Mom's the Word: Pamela Aasen

I often wonder if the professionals that work with our children really know the impact they have on our lives.

I have two boys with bilateral cochlear implants. Within the cochlear implant world, I have been so fortunate to work with therapists, audiologists, social workers and doctors that have treated my children like their own. All these professionals played a role in guiding my husband and me on the journey of helping our boys with hearing loss to hear, listen and talk.

The skills taught to me by the professionals who worked with us have become invaluable and will be with me for life. The team all made their appointments fun and through them I learned how to help my sons without it seeming like I was doing “work”  I think of them often and their words and methods are close by when I need them.

A few examples come to mind:

Recently, one of my sons asked me what it meant to ‘not be able to hit the broad side of the barn’. I knew what to say and do to help him understand the idiom without it seeming like a lesson. The boy’s Auditory-verbal therapist and Teachers of the Deaf/Hard of Hearing have provided me with those tools to help my boys improve their speech clarity or language without them feeling like they’ve made a mistake.

Their audiologist made MAPping sessions enjoyable. She helped them to realize that they are key partners in the cochlear implant adjustment process by asking them questions about their hearing abilities and needs. asking for feedback during MAPping sessions, and involving them in any decisions regarding management or recommendations. Now, the boys, themselves, will suggest when they think they need to see the audiologist and can effectively advocate for their hearing needs.

They couldn’t wait to see their ENT as they looked forward to his magic tricks.

A trip to their social worker was a great opportunity for them to talk about themselves, reflect upon and feel proud of their accomplishments.

Occupational and Physiotherapists made their exercises fun and helped them develop a love of physical training so that they look forward to it and have made it a part of their daily lives.

Every member of our “professional family” was more
than someone who 
worked with my children once a week.
I know they will always be there if and when I need them.

Pamela and her sons

I am blessed to have found a group of professionals that have become a part of our family. This does not happen automatically. There were many things we had to consider when we were looking for the “right” professionals. Along with wanting the best , we needed to customize the team to meet the needs of our family. It was important to me that the boys enjoyed their various therapy sessions and looked forward to going rather than feeling like it was work and having them resent that time. I couldn’t do it alone. I knew that my expectations and my approach would influence the relationship my kids had with their many therapists.

About a year ago, my husband and I had to make a decision whether or not to move our family away from all that is familiar and comforting. It was almost unthinkable and our decision to leave was incredibly difficult for many reasons. We would be leaving our professional family, our friends, and our own extended family members who had been a huge part of our family’s journey.

Recently, in our new home, I had a moment that made me realize that the professionals will always be a part of our lives because they were instrumental in who my children have become and who they will be in the future.

My oldest son had an assignment for his Language Arts class that required him to read the poem “Still Here” by Langston Hughes.  After he read it, he was asked to think of a time when he was faced with a challenge and choose a line from the poem that would relate to that moment.

First, he said to me, “But Mama, I can’t think of a moment when I was faced with a challenge.”

Well, I was blown away.

You see, both he and his brother have Usher Syndrome Type 1. Along with being born deaf, he has problems with balance and he is losing his vision. To think of all the years of therapy and the challenges he has faced in his young life, I couldn’t believe he couldn’t come up with one challenge to write about.

At that moment, however, I felt so profoundly grateful for all the people who had helped him face his challenges along the way. My son loved visiting his auditory-verbal therapist, occupational therapist and physiotherapist, the hearing health professionals of the Cochlear Implant Program, and the vision health professionals of the Department of Ophthalmology and Vision Sciences. He never really thought that these appointments were a hardship in his life; he enjoyed them immensely. Those people projected the attitude that anything was possible for my sons. That attitude was infectious and my sons caught the bug.

So, next I had to convince him that he indeed, had faced challenges and I talked to him about his cochlear implant surgeries, the MAPping appointments, the therapies to address his skills in balance, listening and spoken language, and finally the appointments for his eyes and vision.

“But Mama, I don’t take them as challenges,” he responded.

So then I explained to him that other people would think they were challenges so he could talk about any of those for his assignment.  He seemed relieved that he would have something to write about but was still a little perplexed about how to begin.

He then had to find a line in the poem that would relate to him.  I read the poem to him and he chose the line, “But I don’t care!” because he thought it best reflected how he felt about his challenges.

Then he was ready to do his assignment. It was the end of the day and he was fatigued, even though he has many accommodations provided at school.

Here is his assignment entitled, But I don’t care!

Life has given me a lot of challenges. Some I was too young to remember, but I don’t care.  I have always needed to use an FM System since I can remember. My eyes started to affect the way I worked in school when I was in grade 4. I have a lot of things that make me different, but I don’t care. I have always been thought of differently than normal people, but I don’t care. I have a lot of challenges that I will face in the future, but I don’t care. I choose to live my life the way I want it to be. I will always work hard to do the things that I want to do. The only thing that will ever really stop me is my disability, but those are for reasonable reasons like safety. But, I don’t care. I will find other things to do.”

As I read this I thought of everyone who had been a part of his life and how everyone has contributed to this view he has of himself. These people have been an important part of my family from the time my children were born.

The professional members of my family were all invested in the process of helping me and my husband nurture our boys into brave, strong, confident children, who would overcome all the challenges they face, with dignity and determination.

Many people have asked how we have adjusted to our move and I think my son’s assignment answers this question beautifully.

I was so worried that he would have difficulty being around new people who hadn’t grown up with him and been used to his differences.

I am not worried anymore.  He is not worried and he will figure it out as he goes along.

This is what I want everyone who has ever worked with him to know.  This is the child they helped me raise. There are still many years to go but he has an incredible foundation to build on.

‘Thank you’ just does not seem like enough.

My Top Ten Tips for Parents:

  1. Determine desired outcomes for your child and choose the intervention approach and professionals who will help your family achieve them.
  2. Clearly state the family’s goals and expectations to every professional involved, so everyone is on the same page.  At the same time, be open to new ideas.
  3. When visiting a clinic, walk its halls, saying hi to everyone on each visit, not just the professional being seen that day.
  4. Turn appointments into an adventure and plan something fun to do that day after the appointment, especially if you are traveling.  If an appointment that is close by, get a special treat afterwards.
  5. Give respect if you want respect back.  Be timely and polite, not demanding.  Also, be personal and ask about family.  Encourage your child to do the same.
  6. Inform professionals of the extra-curricular activities in which your child is involved enabling them to develop an intervention plan that can be incorporated into those sports/activities. Professionals may also chose to use extra-curricular themes in their therapy plans.
  7. Include and involve school professionals in the intervention process by sharing goals and expectations.
  8. Share important events/successes/accomplishments with each member of the intervention team, helping the professionals get to know your child.
  9. Help your child develop self-advocacy skills by having professionals direct questions to the child from an early age. Make the children the focal point of appointments – after all, he/she know themselves best.  Also involve your child in his/her ‘Identification, Placement & Review Committee’ (IPRC) meetings.  This will help your child gain confidence and greater understanding of his/her strengths and needs.
  10. Become involved in professional training, advocacy and fundraising organizations focused on your child’s needs. This will further develop the child’s and family’s self-advocacy skills.

***
We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/pam-aasen-the-poetry-of-professional-partnerships), as being the originator of the content.

It All Starts With Play…

Rebecca Siomra



Children need the freedom and time to play.
Play is not a luxury. Play is a necessity.
– Kay Redfield Jamison

When I came across this quote, it made me stop and think.

Play is a necessity. Interesting. Necessary for what? The importance of play for everyone has gotten a lot of attention in research and literature in recent years. In adults, play means something different to different people – playing hockey, painting a landscape, singing show tunes, training dogs, going for a morning run or even building a deck! In childhood, play has a very special and important role. Play affects just about every area of a child’s development, and impacts brain development. Play makes us feel good and it can motivate us and help us learn.  In discussing play in children, I’m not talking about the need for mountains of trendy, expensive toys or electronics, but just ‘play’, pure and simple.

Why would I care about play? I specialize in speech and language. Speech-Language Pathology isn’t only about talking and understanding, it’s about communicating and interacting with others, and those skills begin to develop from day one through daily routines, and through simple play.  The way we bounce, rock, tickle or sing to a baby are all early play activities. When we see how babies do (or don’t) respond to these activities, we start to know more about their personalities, or how they might be feeling that day. The way that we respond in turn helps that little one to learn that what they do (or don’t do) has an effect on others. They learn that making a noise or smiling will bring on another tickle, or round of ‘Twinkle Twinkle’, and so communication begins.

In my practice, the first step in a therapy program for a young child often starts with very simple interactions. I want the parents that I coach to really understand that play is a child’s work; encouraging play and joining in play is a parent’s work. Play allows a child to learn about themselves, their environment, other children, adults and how they should and should not behave with other people. In a wonderful coincidence, when we play with a child, we also learn about them and, if we’re lucky, about ourselves too.

I think it’s incredible that so many important
life-skills can be learned through play.

When we use the term ‘child’s play’, we usually mean something that is ‘easy to do’, or ‘without significant challenge’. I have the opportunity to work with very young children every day, and my experiences lead me question that generalization. A child’s play is fun, absolutely, but without challenge? I’m not so sure the little ones would agree with that!  Remember, this is their work, and they take it very seriously!

Boy working with building blocks

Watching a toddler tackle stacking blocks or a shape sorter for the first time, or try to sort out how to make a toy bus sing its song again, reminds me just how important it is to reset my perspective. So many skills are second nature to me as an adult, but are brand new to the children I work with. Every little step in developing early play skills requires patience… practice… learning. Think about it, when babies are really little, they learn to grasp something in their hand, then to lift it up, then their hand gets tired and, oops, it falls out.  Now what?

They try again, and again, and again. Perseverance is a life-skill; how amazing is it that it can begin to develop at such a tender age. As an adult, our role may be to stay close by and to let them keep trying, to allow them the opportunity to learn. Babies and young toddlers may dump anything and everything out of containers, but putting something back into a container requires hand-eye coordination and control of grasp and release. What happens when the task becomes too frustrating?

The child needs to figure out how to communicate so that someone will know to come and help; one more skill to add to the to-do list. Wow, this ‘child’s play’ stuff is a lot of work!  Fortunately, it’s also a lot of fun, which encourages these little ones to keep practicing.  They certainly are motivated to learn!

Over the years, I’ve collected charts and lists detailing developmental milestones. What I find fascinating is watching the points from those lists coming to life, first in what children do in their play, and then  in their everyday routines.

A baby who has been putting her fingers, then toys, in her mouth comes to realize that she can also put bits of cookie in her mouth – brilliant. One big step to independence!! The young toddler who has been playing peek-a-boo with his parents realizes that when they disappear around the corner to answer the phone they’re still there and will come back, and he doesn’t need to be sad – marvelous!

In Auditory Verbal Therapy, we coach parents to make ‘Learning to Listen Sounds’ for their babies while playing with toys, singing or looking at books. The big moment comes when, one day, that little one looks at the airplane and says ‘ahhhh’, without even realizing that she has learned how to attach a label to an object. Even more astonishing, all of that practice of making those funny sounds back and forth with any adult who will play, one day turns into first words!!

Play gives children a chance to practice what they are learning.
– Fred Rogers

Ah, those first sounds… first words. Music to every parent’s ears.  What comes next?  We want to hear those words again, and again of course! As adults, we can create endless opportunities for young children to practice new sounds and words through games or books.  We want them to feel confident and to want to try again. When we build all of this ‘work’ into play, a child will be motivated to keep trying, to keep learning.

The repetition of songs can help children learn about body parts, actions, animals or even what the parts of a bus do!  They learn how to listen and wait for the pause in a song when they can happily fill in the ‘E-I-E-I-O’ with gusto! They learn how to take turns by pushing a car or ball back and forth.  They learn how to ask for help by handing the container of bubbles to a parent while looking between the two expectantly. The countless rounds of peek-a-boo, driving that blue train around the track one… more… time. So many opportunities for children to learn from us, and all we have to do is have fun – really? Amazing!

As a Speech-Language Pathologist, I may guide a parent in how to adjust play routines, or the language they use, to match their baby’s learning needs, but it really still boils down to play.

Laying the ground-work for early play and communication development opens so many doors… like the one to the land of make-believe, but that’s a thought for another day!

***
We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/it-all-starts-with-play), as being the originator of the content.

What comes first? Short-term Objectives or the Toy?

Karen MacIver-Lux

I’m a toy enthusiast. Luckily for me, as an auditory-verbal practitioner, toys are the tools of my trade and I can share my love of toys with the children I work with and their families.

I have to admit, however, that toys have gotten me into trouble at times. Not trouble of the financial kind; the goal setting kind.

In other words, I have sacrificed appropriately set goals (short-term objectives) because I loved the toy and stubbornly thought that I could make it work for the child and parents/caregivers (family). The trouble was that short-term objectives ended up being adjusted to suit the toy or theme and not the child, resulting in an activity that was either too easy, too hard or not relevant to the child and family’s culture, interests or daily routines. 

As you can imagine, the child was forced into an unfair situation and responded accordingly (e.g. crying, refusal to engage in play, etc.), and the family went home with unrealistic expectations of the child (e.g. inappropriate short-term objectives), and both the child and the family began to lose confidence in their therapy experience.

One of the toughest lessons I had to learn early on in my career were:

  1. Appropriately selected short-term objectives primarily guide the toy/theme selection process.
  2. The child’s interests and family’s environment, culture and daily routines play a supporting role in the toy/theme selection process.
  3. The primary purpose of the session is to guide and coach parents/caregivers/family members in ways to play so that learning opportunities in listening, spoken language, critical thinking, and literacy development are bountiful. The toy/theme is a tool, to be used as a means to an end.

Many therapists would state that they can apply appropriately selected targets to any toy or theme. That may be true in some cases, but I find that I only do this during the session when short-term objectives have been adjusted due to changes in the child’s listening and spoken language abilities, or if the child has brought in his/her toys from home for “show and tell.” The mark of an effective therapist is one who plans well and is prepared to adjust to changes in the original plan.

Toy Montage

Selecting short-term objectives

As a rule, short-term objectives are planned before choosing the toy for the following reasons:

  1. Some toys and themes are better than others at fulfilling all of the short-term objective and engaging the child’s interests. Therapists owe it to the families to choose the toy (or theme of play) that addresses all of the child’s short-term objectives within the time frame of the therapy session. In order to do this, the therapist needs to know what the short-term objectives are first.
  2. When families don’t own the same toys at home that the therapists used, they may feel the need to go out and buy the same toy so that they can do the homework required. Therapists need to guide families in learning how the short-term objectives (homework) can be incorporated into the child’s daily environment, routines and play activities. At the end of each session, the therapist and parent should review the short-term objectives. Asking, “How do you think you can help [name of child] learn to understand and use [short-term objective] within their environment (or playtime with their toys)?” helps parents plan ways that they can create meaningful, age- and stage-appropriate listening and spoken language learning opportunities for their children daily.
  3. Short-term objectives often influence which strategies are going to be used by the therapist to facilitate ease of learning. For example, a short-term objective for a child who has a high frequency hearing loss might be to “demonstrate understanding of morphological marker for plurals( -s).” The therapist must be prepared to check the hearing technology (e.g. hearing aid and personal FM system) to ensure that the child has auditory access to “s”. The therapist determines which strategies would make the “s” acoustically salient to the child, using techniques such as whispering the target word or elongating the “s” sound. The therapist must be prepared to explain why these strategies were used and when to use them during daily routines. When the family gains understanding of, and proficient use of, these strategies, the child will gain improved access to the listening and spoken language opportunities that naturally occur during the family’s daily routines and environment.

Weekly, I challenge myself by picking short-term objectives for various age groups (1, 2, and 3 year olds) and choosing toys or themes that are best suited for each age group. I then think about how I can use these toys to accomplish my short-term objectives.  I often consider the culture and interests of the children and families on my caseload and assess the appropriateness of the toys/themes chosen. I recall strategies that, when used, make the short-term objectives in listening and spoken language easier to hear, learn, say, read and write. This is usually done as a mental or an exercise/conversation with colleagues.

By firstly becoming a short-term objective enthusiast and a toy enthusiast second, I am better able to focus on providing the best quality intervention I can, in hopes that I can help the child and family meet their long-term goals in an timely manner.  By prioritizing short-term objectives I have found that I have become more confident in my practice as an auditory-verbal practitioner.

So, take a moment and reflect. Are you a toy enthusiast or a short-term objective enthusiast? We would love to hear from you!

***
We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://www.soundintuition.com/blog/short-term-objectives-and-toy-selection), as being the originator of the content.

Literacy is important to speech development

Rebecca Siomra

Parents involved in speech therapy sessions with their children may expect to take part in games and imitation tasks during visits. They may be curious about, or frustrated by, time spent looking at books and reading stories during the precious time they have set aside for their child’s therapy sessions with their Speech-Language Pathologist (SLP).

It is well-known in the Speech-Language Pathology community that children with speech and language delays are at risk for challenges in their literacy development. Because of this, SLPs often include literacy activities, or with very young children, emergent literacy activities, in their therapy sessions.

Emergent literacy skills are those that develop before the more formal reading and writing tasks that typically come to mind when we think of literacy. Exposure to environmental print such as the logo on a storefront or a neighbourhood stop-sign, and learning the routines associated with books (e.g., how we hold then, turning pages one-by-one and talking about the book as we do so), are both part of emergent literacy development. Becoming aware of and interested in print and its many purposes at an early age is important for all children, but even more so for children who have speech and language disorders and delays.

Early childhood literacy specialists encourage parents and caregivers to read books with their babies, toddlers and preschoolers every day. In fact, many suggest that we read to our children for at least fifteen minutes every day.

When an SLP assesses a child’s speech and language, he/she is able to identify which skills are not developing as expected, as well as which ones that child may be ready to work toward improving. These suggestions can be carried over in to daily activities, such as book-reading, to help a child move forward in his/her speech development.

When a child is demonstrating speech errors beyond what is considered developmentally appropriate, exposure to print and books is very important. These children are at risk for challenges in reading development, and academic development as a result. In addition to the enjoyment of exploring stories, and spending quality time with a parent/caregiver, and building those literacy skills, ‘book-time’ offers the opportunity for some low-key speech sound bombardment and informal speech practice.

Auditory Bombardment

The Foot Book; Whacky Book of Opposites

The Foot Book; Whacky Book of Opposites – Dr. Seuss

When an SLP has identified a speech sound, or group of sounds, that a child needs help to develop, one step in repairing this error is for the child to become more aware of that speech sound – what it sounds like, looks like and when/where it is used. This will be the ‘target sound’ in this strategy. Auditory bombardment helps to improve the awareness of particular speech sounds. We can help a speech sound stand out and become more obvious to the child by making it a little louder than usual, longer than usual if possible, or by pausing just before we say it, while maintaining the natural rhythm and intonation pattern of the words. An example from a popular children’s book by Dr. Seuss (‘The Foot Book’) is, ‘Left (pause) ffffoot, left (pause) ffffoot, left (pause) ffffoot, right. Ffffeet in the morning and (pause) ffffeet at night’.

When you choose a story with a character’s name or series of key words that contain the target sound, you create an opportunity for your child to practice listening to the target and become more aware of it.

speech-development-rebecca

Target Word or Phrase Practice
Many children’s books have a word or phrase that is repeated many times throughout the story. After you say the word/phrase that you are targeting, you can pause to wait expectantly for the child to repeat it – without creating pressure/expectation. Once a child is familiar with a book, the adult reading the book with him/her can start to pause before saying the repeated word/phrase and wait for the child to fill in the blank. When you are working with an SLP, he/she will provide you with the speech sounds that are appropriate for your child to target. With this information in mind, you can seek out a book that matches your child’s speech goals. Some examples are ‘Where is green sheep?’ by Mem Fox (for ‘sheep’), ‘I was so mad’ by Mercer Mayer (for ‘mad’, ‘so’, ‘was’), or ‘The Very Busy Spider’ by Eric Carle (for ‘spider’ and ‘web’, or ‘spinning her spider web’). A quick internet search can lead you to many suggestions for children’s books that can be helpful to you.

When we read books with children we nurture their imaginations, build literacy skills, share information about the world and spend quality time together. If we plan ahead a little bit, and choose books with care, this wonderful opportunity can also support a child’s speech therapy programming in a relaxed and fun way.

***
We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/literacy-speech-development), as being the originator of the content.

Realizing the Potential of Group Therapy

Margot Pukonen bio

Many administrators and clinicians think of group therapy as a means of increasing the number of children in service.  This is true to a point but it will not increase numbers exponentially.  There is a limit to the number of children a clinician can effectively treat at any one time due the planning and documentation requirements associated with service delivery.  After many years of running speech and language therapy groups at The Speech and Stuttering Institute, we’ve come to the conclusion that the value and power of group therapy lies in the quality of service it offers.

Group therapy provides a very rich therapy environment and offers learning opportunities that are not present in individual therapy.  Groups provide peer learning opportunities.  Clinicians do not have to directly teach and reinforce all the skills a child may need to develop since the children learn by observing each other.  Group activities also provide opportunities for children to practice new skills in more naturalistic conversational exchanges which support generalization into contexts outside the therapy room.  An additional benefit is that children learn how to participate in a group setting.  They develop skills such as maintaining a group focus of attention, taking and waiting for turns, responding to questions and comments, sharing information and asking questions.  This experience will serve them well in school since most teaching occurs within groups.

Group therapy is a good intervention option when children have developed the behavioural and self regulation skills to wait for turns, delay gratification and follow adult directions.  If these skills are not established, the clinician will spend more time supporting the child’s participation rather than addressing actual speech/language targets.  Children in junior and senior kindergarten are typically ready for a group therapy approach.  A group of two is an excellent starting point for clinicians who have not run groups before.  Groups of three are ideal since there are enough children to create group dynamics yet children don’t have to wait too long for their turn.  At this stage of development, children lose attention quickly if they have to listen and wait for any length of time.  In terms of the child’s skill development, his/her therapy goals should be emerging and can be elicited through verbal or visual models or requests to imitate.  Individual therapy is a more appropriate option when skills need to be established and the child requires consistent clinician support to elicit an appropriate response.

Clinicians may be intimidated at the thought of running groups because of concerns about behaviour management and/or the ability to meet each child’s individual needs within the group context.  These challenges can be managed when clinicians understand two key concepts about group therapy: “the group” is a client and groups evolve.

Clinicians should view “the group” as one of their clients.  For example, if there are three children in the group, “the group” is the fourth client and the clinician needs to plan for and support its functioning when planning and running therapy sessions.  In fact, “the group” should be viewed as the primary client because when the group doesn’t function, it is challenging to meet the needs of the individual children.

An understanding of how groups evolve will provide clinicians with a set of strategies they can employ to support group development as well as an understanding of their role in facilitating the process.  Children’s therapy groups undergo the stages of forming, storming, norming, performing just the same as adult groups (Tuckman, 1965).  Children’s needs and abilities are different at each stage of the process so the clinician needs to provide the appropriate supports in order to guide the group to higher and more productive levels of group functioning.

Realizing the Potential of Group Therapy

At the forming stage, children are new to the group.  They don’t know the others in the group, what to expect or what will be expected of them.  The clinician’s role is to provide them with information about what will happen, when and how as well as what they are expected to do.  This is achieved by providing a well-organized environment so the children know where to focus their attention, where to move and where to keep or find materials.  Visual schedules help them understand and predict what will happen next and when the group session will end.  Desired group behaviours or “rules” such as waiting for a turn, making transitions and positive peer interactions also need to be clearly explained, demonstrated  and reinforced.  Providing visual cues that can act as reminders of the target behaviours as well as reinforcing group members who demonstrate the behaviour facilitate the process.

Once children become more comfortable in the group they often start “storming” and push boundaries and challenge the clinician.  This is when all of the structures and visual supports introduced in the forming stage become very helpful.  The clinician’s role at this stage is to remind children of the rules and expectations or negotiate by referring to visuals and group rules (e.g. first we ….., then you can…..).

During norming, the children come to understand and accept the boundaries and expectations.  As a proactive measure, clinicians continue to review rules, refer to visuals and reinforce desired behaviours.

The group is performing once children are managing their own behaviour fairly independently and the focus of the group shifts to working on specific speech-language goals within the group activities.   These goals may have been introduced earlier but were often of secondary importance as the clinician focused on developing the group structure and processes.

It takes time for a group to reach the performing stage and it is natural for groups to move between storming, norming and performing within and across sessions.  If the therapy block is too short, clinicians will spend most of the time guiding the group to the performing stage and then disband just as it reaches its maximum potential.  Based on our experience with junior and senior kindergarten children, we recommend a ten to twelve week block at a minimum.  It often takes at least 6 to 8 sessions to reach the performing stage and then children can focus their attention on practicing and generalizing individualized targets during weeks 8 to 12.

Groups are a rich and motivating intervention context for children.  For clinicians, they are a more complex form of service provision because they require planning for several children as well as the group.  By establishing a predictable group structure, routine and rules and guiding children through the process of learning how to participate and learn within a group, the potential of group therapy can be realized more consistently and successfully.

Reference: Tuckman, B. (1965). Developmental sequence in small groups. Psychological Bulletin 63 (6): 384-99.

***
We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/realizing-the-potential-of-group-therapy), as being the originator of the content.

 

A Paradigm Shift in Practice

Becky Clem

Do you ever have someone inquire, “Why did you decide to become a Speech-Language Pathologist (SLP)/Audiologist (Aud.)/Teacher of Children with Hearing Loss/Deafness (TOD)?”  I love to share that my dad’s profession as a reconstructive and plastic surgeon led me to speech-language pathology.  His work with children with cleft lip and palate and his belief that SLPs played a critical role in his patients’ speech and language development influenced my career decision early in high school. I loved meeting his patients, learning about the surgeries, and seeing his beautiful reconstructive work on these small children. He frequently remarked that the SLP’s role was essential in helping these children have excellent speech and communication quality without social and emotional challenges.

Along my career journey, my passion for children with hearing loss and deafness developed.  My graduate school, Wichita State, required all SLP graduate students to take the maximum number of audiology courses possible. We did extensive hearing tests; used giant audiometers by today’s standards, made earmold impressions, debated the pros and cons of Aural-Oral and Total Communication at a monthly dinner, and fully integrated our thinking into the world of hearing.   One of my first clients was a homeless adult diagnosed with neurological deficits. As it turns out, he had an undiagnosed moderate to severe sensorineural hearing loss. Once fit with hearing aids, he began to explore the world of sound with joy and abundance.

Beginning the journey towards certification as a Listening and Spoken Language Specialist with Auditory-Verbal Therapy Certification was nothing less than an upheaval to everything I thought I knew about working with children with speech, language, and hearing disorders. From the beginning of my career, I wanted to work with children and only children in the field. In the field of LSL, the focus is guiding and coaching parents. LSL intervention was not taking the child to the therapy room for 30 minutes, 2 times a week, leaving the parent in the waiting room reading, watching TV or perusing the Internet! Parents would be in the sessions fully participating? How would I teach parents? Instead of using the SLP requisite mirror and photo cards for articulatory mouth positions, we would be teaching speech through listening only!  How was that possible?

There was a monumental paradigm shift in practice from my role as a speech-language pathologist to an LSL Cert. AVT speech-language pathologist. That shift changed my practice as an SLP for all my patients with communication disorders.

What did I learn along the way? I learned to:

  • Be open to learning something totally new and different. Learn with a clear mind and open heart.
  • Be willing to try new skills and methods even when they are not comfortable.
  • Be willing to have someone else evaluate your clinical skills. Be willing to have them evaluate and help immediately in the moment. As a clinical supervisor myself, it was rather humbling to have someone else evaluate my clinical skills in therapy sessions.
  • Be more concerned about learning and improving than what it might look like to the parent/family to have someone help you during the session.
  • Engage parents and family in therapy sessions, as full participants. The results in patient progress will be far beyond therapist-child only sessions.
  • Have the parent participate even in ‘the child does better without the parent’ situations.  How can we expect progress without the parents’ involvement in the session learning and practicing strategies?
  • Be willing to make mistakes. It’s okay!
  • Practice AVT strategies and techniques in as many situations as possible with children who have other types of communication issues.
  • Read current research about how we learn to talk by what we hear – not by what we see.
  • Ask questions of other disciplines who work with children with hearing loss.
  • Ask audiologists and TODs to teach you about what they do.
  • Be respectful of what others do in the profession of paediatric hearing loss.

A Paradigm Shift in Practice

What changed in my own practice as an SLP? I now try to practice by:

  • Involving all parents of my speech-language patients fully in therapy sessions had a dramatic impact on the child’s outcomes.
  • By teaching parents specific strategies for carry over and helping figure out ways to carry over in a functional way at home, results in faster discharge from therapy.
  • Growing my skill set to include how to teach to various adult learning styles.
  • Developing my skills in mentoring and coaching for parents and professionals could positively affect the outcomes for children with hearing loss.
  • Teaching children speech through listening instead of through vision and articulatory placement cues (exclusive of those children with motor speech disorders) leads to more natural sounds speech at discharge.
  • Evaluating suprasegmentals and vowels as part of articulation testing and conversation evaluation changed my starting point and goals for intervention.  Goals target errors in suprasegmentals and vowels before error consonants.
  • Being open to constant changes in the hearing technology field and learning how it could improve access to speech through listening for my patients.
  • Collaborating with other professionals within my own program and outside led to failures and successes. Learning from all encounters and using that information for future collaborations provided some key changes in my thinking and practices.
  • Partnering with families of children with speech, hearing, and language disorders is not exclusive to the field of LSL-AVT and paediatric hearing loss.  The principles especially related to “guide and coach parents” and “parents are the primary language model” became part of all my therapy sessions – became part of my professional personality and mission.
  • Parents want to be part of their child’s success. By guiding and coaching them to be their child’s primary language model and teacher at home and in the community, successful outcomes for children with communication disorders of any type are possible.

I am joyously passionate about pediatric speech-language pathology and pediatric hearing loss!  Speech-Language Pathology is a marvelous profession.  Megan Hodge, a speech-language pathologist at the University of Alberta has a perfect quote for my thoughts in closing:  “….a career in speech-language pathology challenges you to use your intellect (the talents of your mind) in combination with your humanity (the gifts in your heart) to do meaningful work that feeds your soul.”

***
We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/a-paradigm-shift-in-practice), as being the originator of the content.

Why we believe in continued education

Stephen Owen

Growing up I learned that one can get great lessons from parables. What may appear, at first blush, to be just a simple tale can many times have a profound impact on its hearer.

Allow me to share one such story that I think encapsulates why, at SoundIntuition, we do what we do.

A very strong woodcutter once asked for a job with a timber merchant, and he got it. His salary was really good and so were the working conditions. For that reason, the woodcutter was determined to do his very best.

His boss gave him an ax and showed him the area where he was supposed to fell the trees. The first day, the woodcutter brought down 15 trees.

” Congratulations,” the boss said. ” Carry on with your work!”

Highly motivated by the words of his boss, the woodcutter tried harder the next day, but he only could bring 10 trees down. The third day he tried even harder, but he was only able to bring down 7 trees.

Day after day he was bringing lesser number of trees down.

” I must be losing my strength”, the woodcutter thought. He went to the boss and apologized, saying that he could not understand what was going on.

” When was the last time you sharpened your ax?” the boss asked.

” Sharpen? I had no time to sharpen my ax. I have been very busy trying to cut trees…”

Continued education is key and it’s why we offer this blog, it’s why we provide training and it’s the driving reason behind the conferences we host. We believe that good is not good when better is expected. We believe that sharpening our skills from time to time is the key to success.

**
The origin of the quoted parable is unknown.
***
We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/continued-education), as being the originator of the content.

Register for the October 30th WESS conference in Toronto

2015-WESS-header

Friday, October 30, 2015

Registration: 7:45 a.m.
Conference: 8:45 sharp – 4:00 p.m.

Location: Gibson Ballroom of Novotel (Hotel)
3 Park Home Avenue, North York M2N 6L3 Toronto, Ontario, Canada

2015-WESS-price

register


*$275 (+HST) for professionals; $175 (+HST) student rate with code;
HST is already included in the price on the registration page


Get to know our speakers:

Dale Atkins     |    Dave Sindrey    |    Karen MacIver-Lux

[table id=1 /]

Click to download .pdf of conference poster


Dr. Dale AtkinsDale Atkins, Ph.D. 

The author of several books, textbook chapters, and articles in popular and professional journals, “Dr. Dale”, as she is widely known, is a highly regarded motivational and keynote speaker who lectures worldwide at business, health, educational, and social service venues. With a special gift for presenting complex psychological, sociological, and educational research in understandable terms she appeals to a wide variety of audiences.

Dr. Atkins frequently comments on NBC’s Today Show and CNN’s Headline News about social / relationship issues. Additionally, she is a consultant and on-screen expert for several award-winning documentaries, news programs, and educational training films. She serves on the Boards of several non-profit local and national organizations and educational institutions whose foci are literacy, tolerance, wellness, community action, and child protection. An active volunteer, she and her dog are a certified “dog therapy team.”

Dr. Atkins earned a Ph.D. at the University of California at Los Angeles in Educational Psychology (Early Childhood Education); an M.A. in Special Education (Deafness) from Teacher’s College at Columbia University; and a B.S. from New York University. She has a private psychology practice in New York City.

register

Dave SindreyDave Sindrey, S-LP, Cert. AVT

David has published numerous workbooks and resources to help children of all ages learn to listen.  He is both the author and illustrator of the material he produces. Some of those include Listening Games for Littles (1997, 2002) and the Cochlear Implant Auditory Training Guide (2004). Mr. Sindrey has also developed several online resources including the the ListeningRoom at Advanced Bionics,  Speechtree, Listeningtree, and Actividades de Audición for Programa Infantil Phonak in Spain. His listening activities have been translated to Dutch, German, Spanish, French and Korean.  Since 2012 he has designed and illustrated 9 apps on iTunes that help develop and/or assess listening skills for children with hearing loss. Mr. Sindrey is currently working on completing a combined Masters of Audiology and PhD in Hearing Science at the University of Western Ontario, in London Ontario Canada where he lives with his family.

Karen MacIver-LuxKaren MacIver-Lux, Aud, Cert. AVT

AVT® is the president of SoundIntuition where she oversees the development of online training programs and products for professionals engaged in serving individuals who have communication disorder(s).

Karen has held the position of Lecturer in the School of Human Communication Disorders at Dalhousie University, and is currently a consultant to WE Listen International Inc. She has given numerous presentations internationally, and provides mentorship to professionals.

From 1997-2007 Karen worked as an auditory-verbal therapist and coordinator of clinical services at the Learning to Listen Foundation (LTLF), North York General Hospital in Toronto. In addition, she worked as a clinical audiologist for several years.  She also served as a director of the board of Auditory-Verbal International, Inc.  Karen has a congenital severe to profound hearing loss and is a graduate of LTLF.

Karen was honored by Maclean’s magazine as one of the Top 100 young Canadians of 2000 and received the Who’s Who in Students of American Colleges and Universities Award in 1993.

Karen has made contributions to the literature including: How the Student with Hearing Loss Can Succeed in College (2nd ed.) (1996), 50 FAQs About AVT (2001), Songs for Listening! Songs for Life!(2003), Listen to This! – Volume I (2004), The Listener (2000, 2005), Listen to This!-Volume 2 (2006), Auditory-Verbal Therapy and Practice (2006), Perspectives on Audiology (2009), 101 FAQs of AVT (2012) and Cochlear Implants (2014).

register

Download .pdf of poster here

Help! Teachers Can’t Understand My Child’s Speech

Rebecca Siomra

In my time working as a Speech-Language Pathologist, I’ve come to believe that our ability to effectively and efficiently communicate with anyone we meet can have a great impact on how we feel about ourselves and the people around us. Our ability to communicate can also have an impact on how others perceive us.

In my clinical work with toddlers, preschoolers and even school-aged children, parents often report to me that they aren’t able to accurately judge the clarity of their child’s speech because they are accustomed to the way their child speaks.  True enough!  This is why it is so important for parents, caregivers and teachers, whether it’s preschool or elementary school, to foster open lines of communication.  Teachers are valuable, often new, observers of the student and should be seen as an extension of a child’s support team.

Parents have reported to me that they become stressed when their child’s speech is judged by others to be difficult to understand; especially when it’s coming from their child’s teacher.  Parents know that, no matter what the child’s grade or level in school, success can be impacted by the effectiveness with which a student and teacher are able to communicate with one another or how they can be understood by each other. On the other hand, many teachers have reported that it’s not easy for them to share their concerns about a student’s speech and language skills with the student’s parents.  When parents let teachers know that they are open to communicating about their child’s development — either out of concern or praise — new opportunities for collaboration are created.  When both parties begin to trust that the other is working in the child’s best interest, the conversation can become less stressful and more productive for everyone.

Before I get to the heart of the matter, let’s have a quick refresher on some common speech and language challenges in children and how it affects their communication skills.  Even children who are very verbal may be extremely difficult to understand. Some children may do beautifully in formal speech testing, which usually consists of single words, while in conversation they may speak so quickly that their motor planning is unable to keep up with their thoughts. This can lead to decreased clarity of speech. Speech production relates to the sounds that we use when we talk and how we move from one sound to another to form words and combine those words together into phrases and sentences.   In addition to having some errors in their speech production, other children may have a very weak vocabulary.  Some children, when they want to share information and are unsure of which word to say next, may fill the gap with a nonsense word or even a mumble.  This certainly can have a negative impact on the clarity of their message. This is not necessarily due to speech production difficulties, but rather, language production.  Language production refers to which words we choose to use and the way we organize them into phrases, sentences and stories.

Tips to Facilitate Dialogue and Effective Collaboration

When a teacher or parent approaches one another to express concerns about a child’s speech and language, there are a few tips to consider that will facilitate open and collaborative dialogue which may lead to positive change and outcomes for the child.

  1. We live in a society in which the majority of communication is through e-mail and other forms of technology, but live communication can feel more personal and a child’s communication skills is a very personal matter! Arranging a face-to-face meeting with the parent or concerned teacher, or at the very least, having a conversation over the phone is a wonderful way to communicate!
  2. Be ready to ask the concerned parent or teacher questions about the child’s communication effectiveness.  Questions such as, “How much of what the child says does the teacher/parent understand?, Is this difficulty impacting his or her ability to have their needs met though the day?, Can the teacher effectively evaluate/assess the child? and, If not, can the parent suggest other ways for the teacher to get the information they need?”
  3. Ask the teacher or parent how the child is coping at school or home when they have a difficult time conveying what they want to say.  Some children are very easy-going about repeating themselves and clarifying what they say, while others may become frustrated or may even withdraw.  If the child is struggling emotionally or socially, they may need a little extra support to cope as they continue to work on their speech or language production.
  4. Share information about services available to the child. What services is the child receiving?
    Explore the effective (and ineffective) strategies that are being used within the home and classroom that help the child develop clearer speech and spoken language. A communication book that can go back and forth between the parent and teacher is one way to effectively share information and continue a collaborative partnership.

Clarity of Speech

Tips to Facilitate Improved Speech and Language Production 

Parents and teachers jointly share the responsibility of helping the child reach his/her highest spoken communication and academic potential. Here are a few tips that can help bring about positive changes in the clarity of child’s speech and language.

  1. Even though the primary concern is the child’s level of speech clarity, arrange for a referral to a Speech-Language Pathologist for a speech-language assessment AND with an Audiologist for a hearing assessment. A hearing assessment provided by an Audiologist will let the parent and teacher know if the child has good hearing access (auditory access) to spoken language (primary speech signal). If auditory access to the primary speech signal is weak or inconsistent, speech and language development will be at risk. Even a minimal hearing loss (e.g. ear infections) can cause sound to be muffled to the child.  Within a noisy setting such as a classroom, in order to learn effectively, children need the primary speech signal (teacher’s voice) to be significantly louder than the background noise. Even if the child has already passed a hearing screening test, it is recommended that the hearing is screened annually. Hearing thresholds (levels) can change over time, and a child may hear differently today than they did a year ago.
  2. Ask ‘yes/no’ or choice questions to ease communication stress.  When answers are limited in this way there is a greater chance that the response will be interpreted correctly and clearly understood.
  3. Ask the child to ‘show’ you what he/she is talking about.  This can create a way to clarify a message that was not understood.  Some ideas are:  pointing to a picture, photo, person, or object or using gestures and facial expressions.
  4. Have the child write the message. For those children who are old enough, they can write/type out a message, when the teacher needs clarification.
  5. Get down to the child’s level and ask him/her to ‘say it again’.  It is important for children to know that what they are trying to say is important.  The parent or teacher may catch the message the second time, or the child may rephrase in a way that is easier to understand.  Keep in mind that not all children will tolerate this strategy, and even if they do, they may only tolerate it to varying degrees.  Some children will be comfortable repeating once, and become frustrated with future repetitions while others will happily try over and over again until their message is understood.

When parents, caregivers, teachers and other professionals in the community reach out to one another and work together as a team to uncover and find solutions for a child’s communication challenge, they may be opening up new doors for that child and their future.  Communicating effectively and easily, gives the opportunity to develop friendships, learn, or tell others about ‘that funny thing that happened today’.

***
We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/teachers-cant-understand-my-childs-speech), as being the originator of the content.