Monday Musings

Good morning, guys!

It is the beginning of a new week and I am trying to find some motivation to get up and work out before my day starts. It is the last day of the month, and even though this day is usually cray-cray for us home-health girls I'm actually not too stressed. Kind of like I've done all I can do and now just have to let the chips fall where they may.

A few things I'm pondering this morning:

How true is this comic. I can literally see the horror in some patient's eyes when I try to "excitedly" introduce flash cards. Here's a tip: half of them can see past your fake enthusiasm. The other half, however buy in and I'm like, MUHAHA. You fools. You believed me! This is going to the most boring 10 minutes of your life.

I'm all out of this tea and oh so sad. I drink it every morning for the healthy caffeine and antioxidants and I suppose I could go to the store for more but...yoga pants. 

Speaking of yoga pants, these Nike ones (well I suppose they're technically sweatpants, but whatever) from Academy are my JAM. They were a birthday gift from the boyfriend and beyond comfy. 

In other news, I wanted to touch on my current love-hate relationship with Teachers Pay Teachers and the whole materials-making spree everyone and their Mom is on these days. I, too, have been attempting to make some products that are useful for not only myself but other SLPs but lately I have been completely overwhelmed by all the product sharing and giveaways I see on Facebook. 

Don't get me wrong, I LOVE all of the amazing products my fellow professionals are pumping out (that phrase is awkward and is going to bother me, I know it) but I simply do not have the printer ink as a home-based SLP to support this habit. I guess Staples is the answer? I don't know. My other issue is that I really do not use many paper-based activities with my kiddos, as most of them are under 5. My plan for future products includes mostly bilingual and lesson-plan resources that incorporate real-life objects along with visual supports. I think this will be what is most useful to me and other preschool SLPs.

If you are preschool SLP, what kinds of ready-made products would you like to see in my TpT store for download? I'd love to hear your thoughts. 

Have an amazing last day of March, everyone!

This Week as an SLP and Otherwise Regular Human Being

Alright, I swore up and down to steer away from personal posts and focus on speech-only blogging. But honestly I have nothing new to tell you guys, speech-wise! No wisdom (cough) to impart. Only maybe a few highlights of the work-week and musings of this speechie's brain.

I think I often get caught up in the fact that I'm not "the best". Therefore, everything I do "doesn't count." Does this ring true for anyone else? I don't have any great new speech units I'm employing or comprehensive Home Exercise Programs I'm implementing...I am honestly just doing my job. Still loving it. But wondering when I will get that burn again to stay up all night printing, cutting and organizing. Maybe when I have a real work space? Who knows.

Here's a peek into this past week:

1) A whole lot of driving to far-away clients. Like an hour away. Four days this week total, as of tomorrow. Here's a hint...the farther you have to go to see clients, the less sessions you will actually DO. I did take advantage of the existence of a Smoothie King on my drive today...Apple Kiwi Kale Smoothie, you won me over!

2) My first real peds feeding eval. You know you always expect in grad school and during your CF that any feeding evals that get thrown your way will most likely be sensory-based and you'll give the ole' chaining method a try. Then the parent mentioned something about a swallow study done a year ago indicating esophageal phase dysfunction and inwardly I just:

I want a new swallow study done. I wanna see if we're got any premature spillage going on here before I'm ready to hear that noise.

Anyways. Moving right along.

3) I got back in the groove of clean eating and working out! Let's all cheer for my attempts at not treating my body like the human equivalent of a dumpster. My go-to workout is this bad boy:

If you haven't done her "30 Day Shred" series, it's on Youtube and you should do that one first. That was the series of workouts I used in 2012 to get my body back after a long-term relationship in which I consumed far too many Dr. Peppers and stuffed-crust pizzas during Netlflix marathons. All good and and fine things in and of themselves. But turns out you have to move your ass to not put weight on in the process. Go figure. Anyways, "Ripped in 30" is a great in-home, 30-minute workout that truly kicks my butt and makes me feel strong. It combines cardio, weights, and abs for a total body training experience. I'm starting to sound like an infomercial. I just love Jillian Michaels. #sorrynotsorry

4) I started organizing my therapy materials by goals. Seems odd but not really. Sometimes I really just need to be able to reach into a file that says "body parts", "prepositions", etc. and pull out an activity or list of activities. Therefore I am making that happen. The sad part was I forgot that I needed file folders and everything just ended up in criss-cross stacks on the side of my wall. Sigh.



I didn't really do any "Spring" therapy things this week other than introduce the book, "Happy Easter, Biscuit!" which amazingly entertains even my kids up to 5 years old. They love opening the flaps to find the eggs with Biscuit.

Overall I am just trying to get in as many sessions as possible as it is the last Medicaid week of the month and for all of us in home health, the busiest week of the month. Thankfully we're getting an extra day Monday to get in those visits.

I hope you all have had a fabulous week! Do you have any recommendations for a feeding eval in which the end result turns out to continually be esophageal dysfunction? I'll take all the advice I can get. :)

Psst...my Abstract "Where" Questions download is free right now in my Teachers Pay Teachers store...I'd love if you snapped it up and left me some feedback!:)

Things I Accidently Taught Myself While Teaching Kids

There are a lot of times during speech sessions I will be working with a child and make a passing statement to them that causes me to think, "Man. I think I meant to tell myself that."

Here's a list of semi-profound statements I have accidentally made while working on some kind of mundane puzzle that made me stop and think.


"That piece doesn't go there. You can't force it to fit. If you push too hard, the whole thing might break apart."
Say hello to the queen of, "I am going to force this to work and if it doesn't, I will just keep trying."

"You're not using your thinking brain." 
When am I ever using my thinking brain?

"You need to wait."
Why wait when I can exhaust myself by doing anything in my power to force something to come to fruition?

"Just because we are scared of something doesn't mean there is something to be scared of."
I am the adult version of the little girl who is scared to use the other toilet in the adjoining room because one time it made a really loud noise that scared me sh*tless. No pun intended.

"Sometimes friends don't want to share or play with us, and that makes us sad. That's okay. We can find something different to do that is just as fun."
It's okay to be bummed out when people don't share our passions for things. Do your own thing and the people who think you're super awesome will support you in what you love.

"I need you to calm down and then use your words, please."
The best way to be heard: express your needs simply and concisely when you achieve a moment of clarity following an emotional experience.

"What's important in this picture? Is it this tree? Or this person in the middle."
What's really important in this situation you've somehow managed to blow out of proportion? Are you focusing on a tree in the background when the main idea is right in front of you?


We all still have lessons to learn as adults. I'm sure I heard these very things at one point in my childhood. I'm just thankful I get to hear them again, because they still make me stop and think.

Is there anything you say to your kids that you are really saying to yourself?

Concrete vs. Abstract WH- Questions

So here's the dealio.

I learned something during my final semester of grad school internship in a Spanish-only Early Childhood Education school that I still think about on a daily basis.

And I wanna break it down for ya'll.

And when I say break "it" down, I mean this WH- question business.

Now I'm sure this is old news to most of you, but somehow I managed to get through almost the entirety of my SLP education thinking there was only one type of WH- question and one way to write these goals.

"Child will answer WH- questions with a complete sentence with minimal verbal/visual cues and 80% accuracy."

Or if you wanted to get really fancy:

"Child will answer 'what' and 'where' questions with a complete sentence and minimal verbal/visual cues and 80% accuracy."

Most therapists are familiar with designating the appropriate type of WH- question depending on the client. I'm not working on "WHY" questions per say with my 3-year old's, per say.

However, I was encouraged back in grad school to think of targeting "questions" within a different kind of hierarchy; that being:

1) YES/NO questions to accept/reject ("Do you want the car?");

2) YES/NO questions to affirm/deny ("Is this a car?" or on more advanced level, "Do we fly cars?");

3) Concrete WH-questions ("What is this?" "A car."); and finally,

4) Abstract WH- questions ("What do you ride in to get to school everyday?" "A car.")

As much as I love Super Duper and Linguisystems and all the products they churn out, every time I download an app for targeting WH- questions they all seem to target the more abstract spectrum of questions and geared more for the elementary crowd. As I am primarily a preschool/early intervention therapist, I needed to find some materials that brought things back down a notch to the emerging abstract level for my little guys.

So I made this. So fancy. So excite.

Abstract "Where" Question Cards for Pre-K

This is a set of 15 "WHERE" question cards with matching realistic photo prompts to allow you to provide as much assistance as desired or needed. They're sitting over in my Teachers Pay Teachers (TPT) store if you'd like to take a look. 

I am super excited to start learning how to make more of my own therapy products that fit my individual needs as a therapist. Let me know if you decide to try these cards out yourself and if you find them helpful. I also plan on creating other WH- question card sets for "WHAT", "WHO", etc. so if anyone is interested in those too give me a shout-out.

I mustache you a question: WHERE do you like to go for your WH- question targeting needs?:) 

Home-Health vs. Private Therapy Settings: A Review

Good morning everyone!

I am back with a monstrous headache today, that as the SLP part of my brain identified, is running from my frontal lobe all the way to my left temporal lobe. The weekend was just a little too crazy (in other words, non-routine) and I think my brain spent most of Monday trying to integrate everything and re-orient to the usual schedule. Man, change really screws me up. Sometimes I really identify with some of my kiddos in that way. :)

Anyways, as I have been fortunate to have been able to dip my toes into several SLP settings thus far, I wanted to give you all a short "review" of home health and compare it to a clinic or private setting if you are curious about switching to either.

First just let me say, I love home-health. But I truly believe (like any setting) that the company, district, or management makes all the difference. It is definitely possible I would not be quite as happy working for another home-health company. And as we all know, every setting has their horror stories. The company I work for, however, is extremely ethical, caring, and an advocate for their therapists on a professional and personal level. I have been with them since my first semester of grad school starting out as an SLPA, through my Clinical Fellowship, and now as a certified SLP. I am blessed to be a part of the work they are doing. We offer ST, OT and PT, but the majority of our therapists are SLPs and SLPAs.

Pros:
- You can set your own schedule.
Only want to work 4 days a week? Only want to work mornings from 8-1? You got it. Provided you stay within the guidelines set by insurance (some require 2 sessions per week from day Y to day Z, cough cough, TMHP) and work with parent schedules, you can make clients fit into your preferred work hours.

- You can work as little or as much as you want to.
This is ideal for therapists who have children or want to split home-health with another setting. You can take on a part-time or full-time caseload depending on your availability. Full-time caseload is currently around 15 kiddos in my world. You can also pick up evaluations for extra money in nearby locations for treating therapists who do not have time to evaluate for whatever reason.

- You can choose to accept or decline a client (within reason).
Even if you choose to evaluate a child, you may be able to decline accepting them onto your caseload if you feel your caseload is too heavy or time restraints currently make it difficult to fit them in.

- Sessions are typically shorter.
In my experience, I found that while all my home-health sessions lasted 30 minutes in length, often my private setting sessions lasted up to 45.

- Compensation rates may be higher, depending on the company.
This may be relative on a case-by-case basis, but I hear many home-health therapists agree with this statement.

- You can target goals in the child's natural setting.
To me, this is one of the biggest pros. I love being able to show a parent how to integrate HEP (Home Exercise Program) into activities using the child's own toys and environment.

- Scrubs.
One word: comfy.

- You can stop at Starbucks in the middle of the day.
Self-explanatory.


Cons:
- You're in the car. All. The. Time.
Sure, you get to have some great car dance sessions, and you better believe I've had the time of my life during the summers belting out some Blink-182 while sipping an Icee on the way to sessions. But believe me, it gets old, and when your friends/boyfriend/husband mentions driving somewhere after work, even if it's 20 minutes away, you'll feel like bursting into tears.

- Some companies may not reimburse you for gas or travel expenses.
My company does not. However, I do believe my session rate is higher to compensate for this. I also use my personal vehicle for visits which obviously puts me at a greater risk for traffic violations, accidents, etc.

- You may not have access to a wide-range of materials or more expensive programs such as Boardmaker, like you would in a clinic.
Seriously, I am dying to get my hands on a copy of Boardmaker.

- The rooms of your home and backseats/trunk of your car will be filled with toys.
As I tell my boyfriend, I am a traveling preschool. I miss having an adult bedroom.

- You are isolated from other therapists/adults.
One thing I definitely miss about the private/clinical setting is daily interaction with other therapists, including OTs and PTs. Home-health can be lonely and you will have to make the effort to stay in contact with friends and other therapists so you don't get too bummed out.

- Parents may take advantage of the fact you are coming to them instead of the other way around.
I have experienced more cancellations in home-health than in private settings, in general. Because my company works with Medicaid only, I believe some families take advantage of the "free" nature of the evaluations, sessions, etc. and will cancel moments before you arrive.

- Every home is different in terms of cleanliness and overall atmosphere.
I have been in homes where I have fought off roaches while reading a story as well as homes that are nicer than those in North Dallas. It really is hit or miss. You just have to be willing to deal.

- You may have to fight the urge to stop at Starbucks in the middle of the day.
You don't need a grande Java Chip frappucino with no whip and extra drizzle every day after that session with Little Johnny but by golly yes you DO.

So there you have it. For me, the pros definitely out weight the cons currently in home-health. I know at some point I will attempt the schools again (I only did my internship there in grad school) but for now I am happy right where I am.

What setting are ya'll a part of right now? I'd love to hear along with a pro/con or two:)

Little Bit of Real Life

"Real life" is a great thing. It's different than the imagined version of our lives we create in our minds where everything is beautiful because it's perfect. "Real life" is beautiful because of its simplicity...at least for me. The things that aren't a product of me "doing" anything. The little things. Yesterday was a little bit of real life for me. And it felt really good.

I didn't have sessions in the morning so I took my time making organic chicken/maple sausages and my Zen green tea. I enjoyed them post-folding laundry and watching re-runs of Teen Mom 2 with my kitty nearby. Oh yeah. I have a kitty. She became part of the family about two weeks ago, around Valentine's Day. Meet Ava. That's her handsome Dad, behind her. ;)

Afterwards, I turned on Spotify and ran a bubble bath (I use Fair For Life: Everday Shea Lavender Bubble Bath from Whole Foods) while I let my new hair color sink in...finally I am a dark brunnette again! I have been an auburn color for awhile now but it hasn't really felt like me. While in the tub I enjoyed the book, "The Honest Life" by Jessica Alba. Lots of great info regarding all-natural living.

Once my hair was done and I invested in a spray tan, I wrote up some therapy notes, made some phone calls and headed out to a session about 40 minutes away. I decided to stop at my parent's new home also, which is in the general area. I have been concerned that their new home won't feel like "home" to me...but I was surprised to find that all I wanted to do when I got there was lay on the couch I had never seen before and listen to my Mom unpack boxes. God really quieted my fears in that moment. There is nothing like the calmness of home.

I completed my session (which was largely focused on attention) and then went back to my parent's house where I picked up my sewing machine from my Dad (I need it to make my Etsy products). While in the process of loading it into my car, my Dad decided to try and pass off some other boxes they've been keeping for me; you know, boxes of memory items from highschool and college. I spent the next couple of hours just pouring through old journals from as early as age 8 and college acceptance letters from my Senior year of highschool. Man, if I had only known the journey I was about to embark on.

One of my favorite finds was this great work of fiction I wrote in 2001:

"A STORY ABOUT ALCOHOL" LOL. Yeah. But I got a 100 and man did I deserve it with all those colored illustrations.

After leaving my parents, I treated myself to a little birthday ice cream at Coldstone Creamery at the harbor nearby. Appropriately I chose "Birthday Cake Remix". I'm pretty sure the "remix" is that afterwards you feel like dying, on your day of birth. But it was yummy none the less.

I enjoyed my treat in front of this gorgeous fountain just soaking up the Texas sunshine. I have missed the sun SO much and it was great to feel the heat "beating" down at 75 degrees.

That was about the end of my excursions for the day. I MAY have stopped at Garden Ridge on the way home for bags of Popcorn Indiana Dark Fudge Chocolate Chip Kettlecorn...but you can't prove that, can you? CAN YOU. Haha.

Overall, it was a wonderful, relaxing day. I am about to head off to some sessions during which I will be jamming to this amazing new album by Jillian Edwards, "Daydream":

It is perfect, breezy Spring-time singer-songwriter-ness.

I hope you all have a wonderful Tuesday.

I will leave you with this embarrassing relic from my childhood.

10 Things To Do With a Page of Artic Pictures

There have been many days I forgot to throw my iPad in my car for therapy or just did not have the toy I planned on using for a given session. Those days I usually have at least a page of artic pictures on hand, like these ones from Mommy Speech Therapy.

Here are some go-to ideas when you just have to make it work:


1) Skittles Artic Therapy:

A summer favorite. Child produces a target word 3X each in accordance with their particular goal (word, phrase, sentence, etc.) and then receives a Skittle to place on the word.

You can both be a different color of Skittle and attempt to get the most "correct" productions while incorporating auditory awareness and self-monitoring or the child can attempt to fill in the entire page himself.

2) Tic-Tac-Toe:

You and the child take turns placing X's and O's on words produced correctly __ number of times. Whoever gets a row first or the most number of rows by the time the page is completed wins.

3) Wh- Questions:

Who makes the sound "meow"? (/c/at); "What do you put on when it's cold outside?" (/c/oat). Great way to incorporate drill into a language-based activity. Using the phrase, "I spy something that..." is often more well-received by kids as you're tricking them into thinking you're playing a game. Like always.

4) Hide-N-Seek:

Cut pictures apart (or tear them apart if you're really unprepared, like me sometimes ;)) and hide them in various places around the room or child's home. Having fun targeting prepositions, past tense verbs, artic drill at the same time! Works great for phrase or carrier phrase-level work ("I found a _______!", "I saw a _______!")

5) Accordion Drill:

Fold paper up like an accordion so there is only one row showing at a time. Let child pick a favorite color marker and mark through each picture with a shape of their choice (heart, circle, x) as they produce in X-number of times and then "unfold" the paper as each row is finished. Great for kids who are intimated by a huge sheet of pictures for drill and like fine-motor activities such as coloring).

6) Word Hunt:

Search for each object in the child's room or home (parent permitting). Talk about each object's function or if it is an abstract object or idea such as "hot" you might talk about it simply through conversation.

7) Sound Hunt (does not need pictures):

Great for auditory awareness. Move throughout the room and label objects with a single word, asking the child to identify the presence of their target sound with a "thumbs up" or "thumbs down".

8) Thumbs Up/Thumbs Down: 

Produce each word picture both correctly and incorrectly (but not one following the other). Ask the child to be the teacher and identify your productions as correct or incorrect with "thumbs up" or "thumbs down".

9) Go-Fish/Matching:

Print off two pages of said artic pictures and cut them up to form a quick and easy matching or Go-Fish game.

10) Something Blue/Red/Green, etc.

Target colors while identifying target words and incorporating drill. May need to fold up the page of pictures to reduce the number of possibilities so the child is not overwhelmed.

What is one of your go-to activities for artic drill?

There is nothing wrong with you.

I am going to try and tie this post into something speech-related so it makes sense in the context of this blog; however I believe this applies to the much bigger picture we're all familiar with known as life.

There is nothing wrong with you.

Ah, perfectionism. Being a perfectionist has its pros and cons.

The pros include always striving for the best version of yourself and striving to view yourself analytically.

The cons include always striving for the best version of yourself and striving to view yourself analytically.

Yes, these are both good and bad things in my opinion, simultaneously.

I grew up in a household that sought to make me feel accepted and loved for who I was, but at the same time never hesitated to point out where I feel short. Constructive criticism, you may say. But it instilled in me a very real sense that unless I attempted to alter myself in certain ways, I would not be deserving of love. Or support. Or acceptance. This is an exhausting, mental juxtoposition, one that the Christian faith attempts to soften with the concept of grace.

Society tells us to love ourselves for who we are but to never stop striving to better ourselves. When are you, as is, enough?

All I ever needed to know was that even if I didn't change, even if I didn't do this one thing, I would be loved and life would not cease to be fulfilling.

I had a youth pastor growing up who said something to me that has always remained lodged in my heart and has been a comfort in the face of such pressure.

He said, "There is nothing you can do to make God love you more than he does right now."

My friends, there is nothing wrong with you.

You are a human, and being human is hard. We have not been put here not to torture ourselves with internal and external pressures but to rest in the grace that God offers that says we are enough. 

We beat ourselves up for lack of achievements but hey, you are still living! You are still working at this thing called life! And God has not forgotten you.

I'm not saying there is anything wrong with formulating and working towards goals. That is an integral part of my life as an SLP.

But when those goals become so significant that they cloud our ability to appreciate ourselves for who we are today, I think it's time to sit back and rest in the knowledge that you will never be the best. Or the worst. And no one expects you or thinks you to be either. It really doesn't matter.

Happiness matters. You matter. So before you internalize outside pressures or expectations, sit back and remind yourself that the only one putting that pressure on you is you.

I am seeking to live life in balance. And I believe remembering that regardless of whether you got that workout in, or felt like you blew that evaluation or session, you are simply human. Which is nothing to be ashamed of.

There is nothing wrong with you.

"...i mean really. what is the the thing you are good at? what's your thing? what's the thing you use to make you feel like you're great? take it away, do you still think you're great? because you are." - jillian edwards chapman (http://ifyoufeellikereadingit.blogspot.com)

"Turtles and Tails" Final Consonant Deletion Game! {UPDATED}

Today I am bringing you one of my absolute favorite preschool activities for targeting phonological processing goals; specifically, final consonant deletion. Say hi to...

This is a matching game I use to target phonological awareness and self-monitoring in kids working on final /t/. It incorporates a visualization of final sounds "tacking on" to the ends of each word that my kids really seem to get and I find that this game is great way to get "drill practice" in in a not so drill-like fashion. 

Basically, there are five turtles and tails, each with matching final /t/ stimulus pictures on the back:

Here's how we play:

1) We flip all turtles and tails over with photos facing down.

2) The child and I alternate turns looking for "matches" between turtles and their tails. Every time we turn a turtle or tail over we attempt to say the word pictured, regardless of a match or not.

3) When we find a match, we get SUPER excited and put the turtle's tail on!

I like to then flip the tail back over to the "t" and visually bring the turtle and tail together while pausing to add on the final /t/ verbally. I will produce each word 5X each and then let the child. As the child gets more proficient in adding the final sound, we might say the words faster. I try to make sure the child produces the final /t/ sound simultaneously with the actually "attaching" of the tail to each turtle, to mentally and motorically solidify the process that is happening. 

4) After all turtles have "found" their tails we might go through each turtle-tail match one more time for extra practice. 

Another fun way to use this game is to hide the tails in different places around the room at make matches that way, while simultaneously targeting prepositions or following non-routine directions.

Anywho, I wanted to share this game with you all because I have been using it lately with great results.

The updated version of this game (effective February 2016) now includes turtles with solid coloring- no "coloring-in" necessary! Here's an example of what you can expect:

You can find this Turtles & Tails game over in my SpeechLoveTexas Teachers Pay Teachers shop HERE or on Etsy HERE. 

Thanks for stopping by!:) 

How To Get Your Motivation Back (Therapy-Wise)

Across my adult life thus far, since graduating high school, I have struggled with continuous low-grade depression. It affects me to varying degrees daily, and often I feel like my attitude towards work and life and general can be affected by things as insignificant as whether the sun is literally shining or not. I'm working on this.

One thing I continually come back to the drawing board on is how to re-gain my motivation in regards to work. Some people may find this strange; after all, you went to the effort of getting a Master's degree in your field, you must love your job! And I do. But home health can be very isolating; you have a lot of time to yourself to think; a.k.a., ruminate on your problems. Long drives between sessions become pressure cookers for insecure thoughts. Or Britney Spears karaoke sessions. It really is either or. Anyways, this isolation and time spent driving can lead to a monotony that slowly drives you insane. I am sure there are plenty of home health therapists that travel very short distances between clients but I am not that SLP. My closest client is 8 minutes away and my furthest is an hour and fifteen minutes.

However, there are a few things that help me find the joy in what I do on days when I just don't know if I can handle another 30 minutes working on past tense verbs again with the little guy I have seen for several years straight. When 30 minutes seem like the longest 30 minutes of my life. One of them is telling myself that I'm a badass. A la Leslie Knope.

On top of that, here are some of my go-to strategies:

1) Take 10 minutes to print out a new themed cut/paste activity and make enough copies for all clients. Check out Teachers Pay Teachers and bring one new activity or toy to therapy today. 

Seriously. Stop using that same deck of Super Duper cards that only makes your kids cry and you want to hit your head against the wall. Even typing in "preschool March cut/paste" into Google can give me something quick to print out so I don't have to face the monotony of my usual go-to materials.

2) TREAT YO SELF.

Bring a new snack (aka bribe yourself with food, usually works for me) or stop at Starbucks for a midday pick-me-up. Being able to look forward to a treat or something relaxing in the midst of a busy day will help carry you through. I like to download The Jillian Michaels Show podcasts. New podcasts automatically download every Tuesday and therefore every Tuesday I actually look forward to my long drives so I can listen to this show. 

3) Emotionally re-invest in your clients.

Stop thinking about that one client as the 3-year old who's been working on past tense verbs for like forever. Instead, sit down and make a new game plan. Imagine this child finally mastering their goals and becoming functionally communicative in the way you want them to be. Remember their names. Enjoy their personalities. Think about them as if they were your own children before you scold them for scooting around the living room every second of the session. Love on them. 

4) Come up with a new game plan. 

In grad school when I was an SLPA and had only 3-4 clients, I used to come home and think through each child, their deficits, and formulate how I could use very effective activities to get them in and out of therapy fast. I had a lot more time on my hands, obviously. Regardless, consider coming up with three new activities to target goals you're just over, so you can feel more effective during therapy and break up the monotony.

5) Clean out your car. 

Home health speechies, I know you feel me on this one. Hey, who knew you had these auditory awareness dry erase worksheets in there?! It's amazing what you can forget you're lugging around after weeks of dragging toys in and out of your trunk and backseat. Pull everything out, take an inventory, make sure you're carrying only what you need, and then replace worn-out toys and activities with new and exciting ones. 

Also throw out all those Starbucks cups and fast food wrappers. That will be helpful in maintaining your sanity. 

I hope some of these ideas help shake things up for you. And when you're all alone in your car, drinking an Icee and eating another bean burrito from Taco Bell, driving an hour to your next session...know I'm here for you, girl. 

Lindsay

So You Want Full Auth

Most evaluating speech therapists are familiar with the struggle to obtain authorization for their clients. Personally, I operate in home-health, and deal with Medicaid only. As is widely known, different providers operate under different guidelines for authorizing speech therapy services which continually change. Some of the trends that I have noted as a therapist include:

- Minimal to no authorization for stuttering therapy;

- Denial of clients with standard scores lower than 75;

- Denial of clients whose scores appear to "regress", although they have celebrated a birthday since their last re-auth and now fall into a new bracket of standard scoring;

- Partial auth approval with high emphasis on implementation and documentation of a Home Exercise Program (HEP); and/or

- Partial auth approval (1-3 months) with request to re-evaluate with the same standardized test.

This can be frustrating as a therapist, especially when you have a client who performs well on formalized items but falls apart in carryover or whose true areas of deficit are difficult to test formally. 

While I still am forced to deal with my own share of partial auth's and denials, there are a few things I am careful to include on all evaluations in attempt to win at this game we call "authorization."

1) Magic Words:

"Medically necessary."

"Spontaneous recovery is not likely based upon..."

"Implementation of a HEP."

"Cannot communicate wants and needs in a age-appropriate manner."

If you want to get the attention of providers, you have to speak their language. Make sure to include key terms in your summaries that readers look for when approving evaluations. I like to especially note that a child's errors are NON-developmental and therefore spontaneous recovery is unlikely, as many people still hold to the "they'll grow out of it" theory, especially when standard scores walk the line around low average to moderate. 

"Medically necessary" is a funny term. You can mention that in relation to a formal medical diagnosis or towards aspect of their deficits that is more specialized and requires formalized instruction, such as apraxia or hearing loss. 

For children under 3, you might need to highlight why Early Childhood Intervention may not be preferable to private or home-health services, if you are operating under that sphere. I like to note the difference in frequency of services between the two settings and whether or not the parent is specifically requesting home-health or private services.

2) Highlight informal implications of the child's deficits, such as an inability to communicate on an age-appropriate level with peers or safety implications.

Personal safety is always a good argument towards working towards communication skills.

3) Mention whether this will likely be the last period of authorization requested for the child, based on expected progress. 

This is obviously not possible for every child, but for children who I have had on caseload for a while and/or plan to discharge, I might note this if appropriate.

4) Include informal speech samples whenever necessary.

Seems obvious, but taking a short, paragraph-length speech sample can bring out aspects of the child's speech that was not noted through formal items. Personally, I have a child that struggles with word-finding on common vocabulary at times. Informal speech samples can bring these types of errors to light.

5) If standard scores are near or above 75, consider re-testing with a less sensitive yet appropriate test.

For example, the GFTA-2 is often too sensitive for my little guys 4 and under. If they score below 75, I will often follow up with the CAAP. For the PLS, the CASL or CELF can be a good follow-up since it uses subtests. 

And there you have it! Some of my favorite authorization tips and tricks. 

Let me know in the comments what you've found works for you!