Tag Archives: Speech-language pathologist

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.”

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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.

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’.

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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.

Do You T.H.I.N.K When Providing Intervention?

Karen MacIver-Lux

Auditory-verbal therapists spend a lot of time coaching, providing feedback and engaging in collaborative discussions with parents. Speech-language pathologists, audiologists, teachers and other early intervention professionals (professionals) are no exception. Effective communication is recognized as a priority across the health care continuum because it directly affects the quality of patient care, safety, medi-care outcomes and patient satisfaction (1995).

Occasionally, professionals may need to deliver news or feedback that can difficult for a parent/child (client) to hear. Some professionals dread having these conversations because, despite their best intentions, the information gets lost in translation and clients can end up feeling unnecessarily frustrated, discouraged or even angry. As a result, rather than putting into action a plan for care, valuable time can be spent recovering from the shock of the news.

In her book The Now Impact, Elisha Goldstein describes the T.H.I.N.K. strategy, which can be used when preparing to provide feedback or information so that the message is clear and concise. This strategy can also be used when communicating and engaging with young clients, particularly during behavior management.

Before engaging and communicating with clients, it is a good idea to T.H.I.N.K. by asking ourselves if what we’re about to do or say is:

True

When discussing treatment plans/options, try to ensure that the information shared is accurate and current. When sharing observations, try to accurately describe what was observed, remembering to include multiple examples/evidence. When the answer is unknown or unclear, say so. Then work together with the client to find the answers. If the client requests additional information about a topic or intervention approach we’re not familiar with, refer them to the appropriate source(s) or professional(s).

During my years working with children, I’ve learned to say what I mean and mean what I say. Body language and follow-through are as equally important as the message.  If I say I’m going to do something, I need to do it.  When working with clients, I need to walk the talk, truthfully.

Many years ago, I saw Jack (not his real name), an adorable three year-old boy who noticed every delicate décor accessory in the clinic. Jack would have these in his hands before his mother or I can move them out of reach.  One day, he looked at a flower vase, and reached out to touch it.  I smiled cheerily and said in the nicest voice I could muster, “No, no, Jack. Don’t touch the vase! If you touch it, it will break!” Well, guess what? Jack touched the vase and it didn’t break. My voice and body language did not match the message and the verbal consequences I presented didn’t make sense. Nor was it the truth.

The next time Jack walked by the vase, he reached out to touch it and looked back at me. This time, I didn’t smile and I used a quiet but firm voice and said, “No, Jack. Don’t touch the vase. If you touch the vase, I won’t be happy and there will be no bubbles.” He touched the vase, so we didn’t play with the bubbles during our session.

The next time Jack walked by the flower vase, he didn’t touch it and as a result the beloved bubbles stayed in our session plan. My body language matched the clear boundaries I set and the consequences were realistic and truthful.

Helpful

As professionals, we are accustomed to providing recommendations and suggestions and we expect the children and their parents to follow them. At times, however, due to a family’s circumstances, the recommendations may be easier said than done.

Consider the following case of a family whose baby, Molly, was fitted behind-the-ear hearing aids one month prior. During their follow-up visit with the audiologist, the parents reported that Molly had adjusted well to the hearing aids and is wearing then during all waking hours. Upon reviewing the data logging, however, the audiologist noticed a discrepancy that suggested that the hearing aids were only being used four hours a day.

Although tempted to question the parents about the discrepancy, the audiologist refrained. Instead he said, “I see that your baby is getting an average of four hours a day of hearing aid use.  This is a great start!  Our goal is to have the hearing aids on during all waking hours. How do you think we can achieve this goal with Molly? Is there anything I can do to help?” The parents showed surprise and responded that they are certain that the hearing aids are being used at all times except during rides in the car, bath time and sleep .

After the audiologist waited for a few minutes allowing time for self reflection, the parents suggested the possibility of the hearing aids not being used while Molly was at daycare. Later that evening, the parents discovered that the daycare staff were uncomfortable handling the hearing aids and were fearful of losing or breaking them. In addition, the other children were pulling Molly’s hearing aids off and placing them in their mouth. As a result, fearful for all the children’s safety, the staff weren’t always diligent in putting the hearing aids back on.

With this information at hand, the audiologist and the parents developed a plan of action to help ensure that the hearing aids would be worn during the baby’s entire time at daycare (e.g. a pilot cap and an in-service for the staff on the handling and care of the Molly’s hearing aids). Adopting a helpful attitude and supportive language is what often sets the stage for progress.

Inspiring

When I was 13 years of age, I decided that I wanted to become an audiologist.  It did cross my mind, however, that given the severity of my hearing loss the job may be difficult to do. How would I be able to do listening checks on a hearing aid? Was my speech good enough to do speech discriminations tests?

The list of questions grew longer and my dream drifted further and further away until I met Jeff Float.

As team captain in the men’s 4×200-meter freestyle relay, Jeff Float was the first legally deaf athlete from the United States to win an Olympic gold medal. Impressed by his story and example, I realized that if he could start a relay race, then so could I.

Meeting Jeff Float gave me the inspiration to pursue my dreams with dogged determination.

When parents are faced with their child’s diagnosis of a communication challenge, they are usually uncertain of what the future holds. In all honesty, so are the professionals.  Professionals however, have the advantage of having the skill set and knowledge to develop an intervention plan to help the child reach his/her highest communication potential. It’s important for  professionals to remember that parents not only need a plan of action, but that they need some inspiration as well. The same goes for young children, teenagers and adults with communication disorders.

  1. Arrange appointments so that clients have the opportunity to meet other others with similar communication challenges. Partner “new parents” with parents who have been through the process.
  2. Present opportunities for children with communication challenges (e.g. hearing loss, dysfluencies, cerebral palsy, auditory neuropathy spectrum disorder, etc.) to meet adults with similar communication challenges.
  3. Encourage children and young teenagers to join peer support groups of similar communication challenges (e.g. LOFTHitIt, etc.).
  4. Use language that is respectful of other professionals and communities who have embraced alternative communication approaches.

A good dose of inspiration goes a long way for those who have communication challenges and paves the way for the achievement of dreams and beyond. Encourage clients to aspire by introducing them to those who inspire.

THINK

Necessary

When my mother found out about my hearing loss when I was four years old, the doctor firmly told her that I would never hear or be able to speak.  He also added that I would never go beyond grade three, and that I would be severely limited in my vocational choices. He explained that it was necessary for my mother to adjust her expectations of me because of my mild to profound hearing loss. He then left the room to attend to another patient. Did my mother adjust her expectations? No, but she did feel devastated by his words and it took her some time to recover and move forward to find out what I really was capable of.  She later discovered that the doctor not only provided inaccurate information at the time (e.g. I could hear her voice even without hearing aids because I have a mild to profound hearing loss) but I also achieved outcomes beyond his expectations. To this day, my mother remembers his words and is still angered by them. Unfortunately, similar interactions still occur today unnecessarily causing parents grief and aggravation.

Each case is unique and professionals need to gauge the type and amount of information to provide. It is best to avoid making predictions about outcomes. Instead, listen to the parents’ dreams and desired outcomes for their children. Professionals should provide research data on outcomes and variables that can be controlled (e.g. hearing technology). Parents should be directed to resources so that they can do their own research. When parents’ dreams for their children have been heard and understood by professionals, parents will be more open to developing a plan of action in a collaborative fashion and following it.

Be mindful of when and how we share information.  Is it necessary to call a parent on a Friday afternoon to recommend a cochlear implant candidacy investigation when your next appointment with them is on Monday? Is it necessary to tell a parent of a one year old child to work on producing “s’ in words?  Is it necessary to provide parents of a newly diagnosed infant with a thick binder of information on hearing loss?  Is it necessary to tell a child that he’s a good boy when he hears a clock ticking?

When we take the time to consider the necessity of the information we provide to parents and children, chances are they will be more open to listening and moving forward with a plan of action.

Kind

Kindness is not just about being polite or generous; it’s also about having and demonstrating empathy.

Unfortunately in today’s world, kindness and empathy are sometimes regarded as signs of weakness. Often, the perception is that kind and empathetic professionals are either too timid to be effective or that they rely on their “niceness” in place of knowledge and the ability to effectively treat or impact clinical outcomes. Additionally, there seems to be a fear among some in the “helping” profession that empathy will lead to “burn out” early in their careers, and they develop a persona of polite indifference to protect their mental health and livelihood.

Clients who engage with professionals who behave with indifference, understandably, lose trust in the professional and their treatment plan, and progress for positive change is disrupted or grinds to a halt (2014).

Kindness and empathy is demonstrated by adopting body language that clearly shows that the professional is truly listening and by providing feedback the professional confirms that the client/patient was heard and understood.

It’s important for the professional to remember, that they need to move quickly from empathy toward developing a plan of action in collaboration with the client/patient.  Such collaboration will lead to the client/patient acquiring greater knowledge, trust, and motivation during the intervention process.

Remember Molly’s audiologist?  Her parents were given the opportunity to take the time to think about why her hearing aids were not being used as often as they thought. How?  Making sure to keep his arms uncrossed and open, leaning forward and providing good eye contact, making sure that his legs are uncrossed as the audiologist waits and allows the parents to self-reflect. Adopting such body language conveys that he is open to hearing whatever they have to say and that he’s open to being helpful.

When planning your next session, celebrate your professional strengths and challenges and T.H.I.N.K. before doing and saying. When we T.H.I.N.K., communication and collaboration will lead to better understanding, collaboration, client satisfaction and outcomes.

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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/do-you-THINK-when-providing-intervention), as being the originator of the content.

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References

Stewart, M. (1995) Effective physician patient communication and health outcomes: a review. Canadian Medical Association Journal. 1995;152(9):1423n1433. 261
Back, A.L. & Arnold, R.M. (2014). “Yes It’s Sad, But What Should I Do?”: Moving from Empathy to Action in Discussing Goals of Care. Journal of Palliative Medicine 17(2):141-4.

You are so much more than ‘just’

Stephen Owen

I once attended a local small business networking event that was based on the concept of speed-dating. I was sent to a table where I met another business person. I had thirty seconds to give the other person my business card, state the name of the company I represented and what I did there before my table companion did the same in return. It was then expected that we’d engage in three minutes of dialogue which was to include finding synergies and how we could work together or at least refer someone else to use each other’s services. The bell would ding and we’d move on to explore the next business ‘dating’ experience.

To this day I remember the gentleman who sat at my table on rotation number two. I remember him for a number of reasons. He was extremely quiet, had a weak handshake, handed me his business card almost apologetically and seemed to be uncomfortable with eye contact. But he really stands out in my memory because of his first words to me.

When he said, “I’m just a plumber” my trained networking brain screeched to a halt and started twitching uncontrollably. This man had absolutely no idea.

He had no clue that a few weeks earlier a plumber had saved my basement from destruction due to a busted water pipe that jetted water at an alarming rate.

This man had no idea the respect I had for plumbers and the service they provide. To me, this man was not ‘just’ a plumber at all.

Needless to say, following our conversation, when the event was over, my new plumber friend was sitting a little taller in his chair, was holding his chin higher and happily talking about his trade with a new-found enthusiasm.

Corporate People Having a Business Agreement

Conversely, I recall meeting a woman at a conference recently. I recall my introduction to her very differently. Her handshake had exactly the right firmness to it, she proudly presented her business card to me (face up, text towards me) and pleasantly told me what about the work she was involved in.

There was no ‘just’ in the way she presented herself. She was who she was and was very comfortable and proud of what she did in her chosen career.

When you meet someone for the first time or are talking to another professional or parent please don’t ever present yourself as ‘just a therapist’, ‘just a social worker’, ‘just a communicative disorders assistant’ or ‘just a teacher’.

The term ‘just’ devalues yourself and the care you are involved in. It is perceived as lacking confidence and conviction that the role you play is an extremely important one and that you have something integral to contribute to the assessment and intervention process.

Believe it or not, you’re someone’s hero.
Whether you know it right now or not, 
your influence is changing someone’s life.
They don’t think of you as a ‘just’ and neither should you.

I challenge you to straighten your back, walk taller, lift your chin a bit and ‘Do Differently’. You’ll be surprised how much happier in your career you become when you do.

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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/you-are-not-a-just), as being the originator of the content.