There's More To This Brave Adventure

I'm going to be honest here, I haven't felt much like blogging the past couple days. I've been fairly overwhelmed with work and general feelings of apathy. If there's one thing I feel sometimes as a therapist it is isolated, or alone. Home health has its perks but the constant time to oneself can get old.

Yesterday I had 10 sessions planned for which I came up with 2-3 activities I could use for the majority of them. I decided to go with an early "summer" theme consisting of these adorable Articulation/Language Sandcastles from Crazy Speech World and Summer Pronouns card game, which is a freebie download over at Speech is Sweet. Thanks ladies for the great ideas!

Articulation Sandcastles

Summer Pronouns

I also brought my "Under the Sea" lacing cards for some integrated fine motor and language work. The kids loved all the activities tied together. Here's a picture of one of my kiddos showing off his activities:) My phone camera quality clearly leaves much to be desired.














In the afternoon I had to make a notably long drive to and from a particular session. As I mentioned earlier, the time you have with yourself as a home health therapist is great for introspection but can get you bummed out from time to time. No matter what people say, interacting with people via text and over the Internet is just not the same as face-to-face interaction. And while I appreciate being invited to activities after work, not many people understand that if will take me more than ten minutes to get there, I just won't go. I've been in the car all day! So catch-22.

Anyways, I had my iPod linked up to my car speakers and just as I was starting to let myself get down about things, a certain song popped up. A song that I listened to my first day of grad school. I remember putting on my cutest outfit for orientation, binders in hand, and pulling out of my parent's driveway while packing the goofiest smile, thinking, "I'm going to be a speech pathologist. It's actually happening." I was nervous but damn, was I excited.

May 2011 - Prepping for week 1 of SLP grad school 

In fact, here's me looking a little too excited. I'm one of those girls who gets excited about school supplies.

Anyways, I remember starting my first practicum with a fun, amazing group of girls and feeling those exact same feelings as we all stood there, waiting to see our clients for the first time, armed with bubbles and a visual schedule, which never really worked, but it made us feel prepared. We chased those kiddos around, analyzed our own behaviors, and by the time we got to closing circle time looked at each other with exhausted "omg" faces and smirking eyes that said, "Whew. Thank goodness that's over!" But we loved every single second.

As I listened to this song I was reminded of the passion I started this journey with, and that's something I never want to lose. I formed relationships back in grad school without knowing that eventually I would choose the home health setting and that these relationships would be invaluable. I have continued to form new relationships since grad school but the point is- I didn't go through all of that to be alone. I don't have to be. And I didn't go through all of that to let myself become preoccupied with things that aren't of primary importance, even this blog, for example.

I remember posting a Facebook status one day in the midst of my first year of grad school chaos that said, "At the end of the day, I just want to be a good speech language-pathologist."

And that's still true. Sometimes you just have to remind yourself to forget all the B.S., and remember why you started this journey.

"To The Sky" - Owl City

And here's the song that reminds me. So what if it's from an animated movie about owls. :)

Managing Bilingual Therapy: Part 3 {+ Spanish GIVEAWAY!}

Here we are, at the final installment of "Managing Bilingual Therapy". Time to talk treatment!

What language should I treat in?
Many people believe that once you've identified the child's "home language", or language of greatest exposure, you should be targeting that language in intervention. I believe this to generally true, for example, in the case in which a child primarily is exposed to Spanish during the day and hears English only via television shows, music, etc. However, in the case in which a child truly receives bilingual exposure to both English and Spanish, such as they hear both spoken in the home (with integrated codeswitching) or they a bilingual preschool or classroom, I will conduct therapy in both languages.

How does that work, conducting therapy in two languages? 
There are several ways to do this, however, my favorite way to do so is through an integrated child-led and adult-led approach. It incorporates several factors:

1) Beginning the session in the language which you would like to target language concepts primarily that day;
2) Codeswitching between languages as appropriate to aid in comprehension and carryover of learning from one language to the other;
3) Alternating between languages based on the child's desire to do so; for instance, if I ask a child a question in Spanish and they answer me in English, I will reinforcement their response in English. I may also repeat the answer in Spanish for good measure, but I never force the child to respond in only one language during the session. As a non-disordered individual and dual language learner they must learn that it is their attempts at communication that matter most to us, not their language choice, and that for bilingual speakers, real fluency is demonstrated in the ease of transition between one and the other.

How do you know which goals to target?
Typically, I look what is most functionally important in both- the ability to request, comment, use basic verbs, present progressives, pronouns, etc. Typically, if a child is truly bilingual, at least one of their main caregivers (or teachers) is bilingual as well, and so if they master a concept in one language, they can at least use that for communication purposes, regardless. I do not target each goal to mastery in both languages, unless it is a skill that it is functionally non-negotiable. I expose my kids to vocabulary in both, and with little guys ages 3 and under, I am always choosing the word that is use most often in the home. If the child's milk is always referred to as "lechita", I will use and target this term exclusively. That being said, if the choice is up to me, I will typically choose the word that is most articulatory "saliable" if that makes any sense- that being words that start with early sounds (bilabials, alveolars, etc.) and contain less syllables than their translated counterparts. For exmple, I am much more likely to teach a bilingual child the word "head" than "cabeza", although I will always provide the translation just in case the child surprises me and latches onto that one instead.

What if the child switches preference for their dominant language?
I once had a bilingual child that although he received bilingual exposure at home, demonstrated a strong desire to use English-only with me. One day, after six months or so of services, I came to see him and was shocked to find him running off at the mouth in Spanish only, after starting preschool in a bilingual classroom only a few weeks earlier. And I ran with it. Switched to Spanish in treatment, while providing supports in English as needed and to check for bilingual comprehension and expression skills. That being said, bilingual treatment is often like bilingual assessment, in that you begin with a target language in mind but you allow room to move in and out of both languages as necessary.

What are some useful bilingual treatment tools, i.e. websites, games, etc.?
Some of my favorite resources come from none other than Super Duper and Linguisystems, but also I've found a plethora of great downloads for Spanish resources on Teachers Pay Teachers and even just simple Google searches for, "Spanish preschool worksheet (target skill). Some of my most beloved apps include:

1) "Llama Llama Red Pajama" Story App- translated in both Spanish AND English! Great for Early Intervention through kindergarten.
2) "Five Little Monkeys Jumping On The Bed" App- English only, but simple enough to be translated back and forth.
3) "My PlayHome" App- a realistic, functional app in which kids can create families and make them do fun things like eating food, playing outside, taking a bath, etc. Great for language treatment no matter what the language.
4) "Bunny Fun: Head, Shoulders, Knees and Toes" App- Sings the classic song in FIVE world languages.
5) "Peek-a-Boo Barn" App- Farm animals in both English and Spanish...the ultimate farm animal app in my opinion. I also use it target early vocabulary such as "bye", "night night", "open", etc. Just get it.

Almost anything you use for English language therapy can be used for Spanish and bilingual therapy, unless you plan on using written materials or providing Home Exercise Programs (HEPs) for parents in a language other than the child's dominant language. Right now I have a great HEP Packet available in my TpT store with multiple recommendations for carryover activities in English; would anyone be interested in the Spanish counterpart?

That being said, I wanted to finish this off this series by doing a giveaway for you awesome speechies out there doing bilingual or Spanish therapy!

Enter the Rafflecopter below for your chance at winning a brand-new copy of "216 Fold & Say 'WH' Question Scenes" by Super Duper! 

I know. Super awesome.

Giveaway ends next Friday, May 16th!

a Rafflecopter giveaway

K.I.S.S. + {Flower Power Superlatives freebie!}

We've all been there. Planned an amazing activity while playing out the session in our minds- the light bulb finally clicking and you beaming with the pride of a job well done.

However, that's not the way the universe always works. Instead its more like, "LOL." - The Speech Pathology Universe.

That's what happened yesterday. I brought two of my newest activities to therapy today, along with a new one I'm putting together- my Spring Grammar Scenes and Information Detective Game.

Oh dear. You know that look on a kid's face where you realize you're losing them? Eyes glancing side to side, trying to find an exit out of this activity that you've incorrectly assumed is appropriate for their skill level. Even after you trying to simplify the activity, they're still stressing and you feel like a big, fat failure.

Well, I'm not a failure. And neither is anyone else in my position. I just got a little too excited and tried to make something work that was not meant to work. Or just needed some modifying.

Now that I've implemented these activities, let me just say- I love them both. But in all honesty, here's what I learned:

"Information Detective" should be used with kids first grade and older and ideally with children who have basic reading skills. My pre-kindergardener had a hard time without visuals for the "clues" in the game, and has a difficult time with auditory memory which made the activity that much more difficult.

In using the "Spring Grammar Scenes", it may be helpful to separate the preposition visuals from the visual sentence structure. My kiddos had a little bit of difficulty finding the object on one page, then identifying the preposition visual and then plugging it into the sentence structure. Slight modification needed.

Moral of the story is, it is okay if your kid got more excited to color in a picture of a flower you took two seconds to print off than the extensive arts and crafts project you had such high hopes for. That's the nature of children. They like SIMPLE! They like cut and dry. I need to stop stressing out so much and trying to make things complicated.

In other words, K.I.S.S- Keep It Simple Stupid. :) And have fun!

Here's the activity I used yesterday that actually did hit a home run- I call it "Flower Power Superlatives"! It works great for targeting shapes, superlatives (biggest square, smallest square, etc.) and following directions. I would recommend it for late preschoolers onward.

It's free in my Teachers Pay Teachers store now!





Today I am linking up with Speechie Freebies again, be sure to check them out for more great downloads from awesome speech bloggers!

Happy Sunday! {what I'm loving & new expressive language game!}

Oh this weekend. I've been literally going non-stop, I don't know what has me so full of energy but I'm going to roll with it. Maybe it's my morning green tea but something's pumping through my system making me want to be productive. Who would've thought?:) Maybe it's my #slp bracelet...

I bought this customizable bracelet (made by BCBG Generation) from Macy's in December. It comes with a bazillion gold letters and symbols that you can arrange in any way you'd like; I decided to rep SLP life. I've worn it off and on to sessions but I've been wearing it this weekend and getting a kick of motivation out of it. So cute, right?

Yesterday my roommate and I ran a few errands and then I kicked out a re-eval report, all before 12pm. This is not my usually way. I am the hugest procrastinator but I think I'm starting to realize that that method doesn't do me any favors. Afterwards I got a workout in and did some grocery shopping at Whole Foods. My favorite find was the fajita meal combo they have going on right now- buy the fajita meat and get the veggies, salsa, and tortillas for free! So that's what we cooked up last night. I also tried out a new flavor of kombucha, Green Apple Ginger by holykombucha:

Yum. I actually blended that up with a bit of the that delicious coconut-pineapple juice next to it, added some ice and made a kombucha-rita with a pina colada flair! It was a great addition to our fajitas.

I'm really feeling coconut lately, that's probably why I love this shower cream from The Body Shop.

It is not a "soap" and therefore not drying; instead it's incredibly creamy, moisturizing and has me dreaming about a beach vacation.

Later that night my roommate and I just kicked around and I decided to get to work making a new game for some of my older language kiddos:

"Information Detective: Wh-at's Missing?"

I have a few kids who continue to struggle to provide crucial and relevant information in their discourse, or who use imprecise language such as, "I went there and then played that game," without giving me the head's up of actually where they went or who they were with. I get no context for their stories. This game puts you kiddos in the role of a detective who has to listen to a friend's statements about their weekend and decide what information is missing. They can then work to devise a wh- question to find out the missing information. A table is also included for them to fill in what they know and what they still need to know. 

What are you guys loving this weekend? Do you like kombucha or do you think it's the grossest thing ever? Most people fall on one side of the spectrum or the other, haha.:) 

I'm a dysphagia expert...just kidding.

Good morning guys!

If you know me at all, you know that my favorite area of speech path is phonological processing and articulation disorders, closely followed by our dear friends receptive and expressive language. However, I did, like most people, get exposure to pediatric and adult dyspagia assessment and treatment in grad school and in the back of my mind have always hoped for a feeding kiddo to pop onto my caseload.

Well, my dreams have come true, and I have my first pediatric feeding client right now who is working on behavioral strategies to manage the size and appropriate mastication of a bolus as well as timing for the swallow. This client is younger than 3 but is very with it cognitively and has no concomitant speech and language delays. 

That being said, I made this nifty little placemat for her to color that we are going to laminate and use during her "feedings". When cleaned prior to eating, it has spots to place an appropriate amount of food (if it doesn't fit in the circle, it's too big to go in their mouth) with visual cues to take a sip of a drink following each swallow to wash away any additional residue or food particles. It also features visuals for us to use when describing the process of chewing and swallowing. It is my hope that as this patient gets a little older they will be able to gradually decrease using the visuals and demonstrate carryover, like always. My suggestion would be to print this on cardstock.

Here it is for download if you are interested!

Feeding Placemat (Color-In!)

Today I am linking up with Friday FreeBEES at Speechie Freebies! Check 'em out. :)

-Ing Words

Time for more of a lifestyle post. I borrowed this from Erin over at Living in Yellow with the excuse that it's basically a bunch of present progressives. And therefore perfect for an SLP blog.

Making: a mental list of where I want to go shopping tonight. Target. Bath & Body Works. Actually, I'm making several mental lists at the moment.

Cooking: I cook-ed my turkey meatballs and organic pasta for dinner. It's a pain in the ass to watch over on the stove but it's hearty. It hit the spot.

Drinking: nothing because I have yet to go grocery shopping, and rural Texas tap water will most likely kill you.

Reading: my Twitter feed.

D

Wanting: someone to hang out with. It's quiet around these parts.

Looking: for motivation to get super super pumped about my fitness and nutrition efforts. For now, not wanting to die every morning and not falling asleep in morning session will do.

Playing: Uno with my therapy kiddos under the guise of "functional language instruction". 

Wasting: my time trying to figure out when and how I will feel better.

Wishing: someone would show up at my door with dark chocolate Justin's peanut butter cups and watch Teen Mom 2 with me. This is an ugly confession.

Enjoying: the fact that tomorrow is FINALLY payday.

Waiting: to gain some perspective on certain situations.

Liking: the fact that my roommate and I are spending more time together.

Wondering: if I should lighten my hair back up or keep it dark (black).

Ginger LD, circa October 2013.

Loving: my annoying baby of a cat, Ava.

Hoping: I have the strength to not let my emotions dictate my actions.

Marveling: At how quickly life can do a 180.

Needing: $$$ in the bank account.

Smelling: the odor-less air of the living room. What, my nose is stuffy.

Wearing: bright green scrubs.

Following: Nadine @ Back East Blonde and Jenna @ Speech Room News, among other lovely bloggers.

Noticing: that I'm incapable of letting my nails grow long enough most days to merit paying for an actual manicure.

Knowing: that everything will be fine.

Thinking: about what time the bank closes.

Feeling: lonely. Yeah yeah I know, don't let me get all 11th grade and emo on you.

Bookmarking: nothing, but continually re-posting the Dr. Cate Crowley's video on bilingual language development on Youtube.

Opening: up to a bunch of strangers. 

Giggling: about the fact that a sweet kiddo of mine practically pooped his pants during a particularly long administration of the PLS today. Whoops.

Feeling: like I am stronger than I give myself credit for. 

Managing Bilingual Therapy: Part 2 (Assessment)

Wow. I'm not going to lie...suddenly I feel slightly ill-equipped to write this next portion of the series- assessment. My world just got rocked by these videos by Dr. Cate Crowley on second language acquisition and factors influencing bilingual language development. So before you continue reading this post, I highly suggest you check out both of these videos.

Normal Second Language Acquisition

Factors Influencing Bilingual Development

Now, why do I say these videos have me questioning whether I'm well-equipped to handle this topic? Mostly because she denounced essentially the main point of this post, and that is the idea that typically a child can be correctly identified as having a language disorder based on delays in L1 and L2.

At least that's what I was taught in grad school. These videos mentioned several aspects of second language acquisition such "silent periods", formulaic utterances, and the fact that many sequential bilingual children demonstrate attrition of L1 when L2 is introduced with large exposure. Now, that is not to say that all of our assumptions regarding simultaneous delays in L1 and L2 and language disorders are incorrect; however, I believe the point is that we need to be looking at multiple factors beyond black- and-white syntax and vocabulary deficits to correct identify these children, and in turn, not over-identify them. 

That being said, my tips for this post regarding assessment are a little less intense in nature in regards to the above disclaimer. These are just some things that have assisted me in my evaluations as a bilingual therapist and I hope will give some of you just starting out in this endeavor more confidence.

If You Are a Monolingual SLP...

I know it is nearly impossible to avoid, but it is my general opinion that only bilingual therapists should be attempting bilingual evaluations and treatment due to the fact that correct identification of the presence of disorders is hard enough without calling into play the fact that you are unfamiliar with the language of the child you are working with. This makes writing appropriate goals for language AND speech development very difficult, and treatment even more impossible as typically interpreters are not available in realms outside of home health. 

If a child is Spanish-speaking only and you are asked to administer services in English, we all know this is a direct violation of ethics. Printing out Spanish verb pictures or articulation pages from the Internet may sometimes be the only choice you have as a monolingual therapist, but is not always the most ethical route nor will it be the most effective. In terms of preschool therapy, much of the session is based on spontaneous language and play interaction, something very hard to do through an interpreter. If you have the ability as a monolingual SLP to recommend transferring Spanish-only or bilingual clients to a bilingual therapist or other bilingual intervention resource, I recommend doing so, not only for the sake of the child but for your professional ethics. Otherwise, do your best to gather reputable resources and use an interpreter to communicate with the family how they can support you in your efforts with a great Home Exercise Program (HEP). 

General Strategies for Bilingual Assessment:

1) Pre-determine the child's general language dominance before you attempt the evaluation by talking to the parent. 

You might need to do a little re-con in terms of asking specific questions such as: 

a) What language does your child hear majority of the day?

b) In what language does your child attempt to communicate primarily?

c) Can your child follow directions in Language A/B or identify common objects?

d) Does your child attempt to use both Language A and B in the home?

You're looking for what language the child has both the most exposure to and demonstrates the strongest receptive/expressive language abilities at this time. On several occasions you will prompt items in both languages, but it is good to know if the child may be a bilingual language learner or whether they are only exposed to one.

2) When in doubt, bring the test that is NOT in English.

By this I mean, bring the PLS-5 Spanish. The items are there for you translated in Spanish, and you are familiar enough with the test to prompt items in English should the need arise. If you only bring the PLS-5 English, you will not have the Spanish prompts if you need them.

3) If a child misses an item in their L1, recast in L2.

Give a child a chance to demonstrate whether they possess a skill in either language. If it is present in one or at least L1, chances are it is not delay but rather a matter of language acquisition.

4) If you are using an interpreter, remind them to not prompt beyond what is called for. 

Majority of interpreters, while highly skilled in what they do, are not SLPs and do not realize that just by adding a word or two they may be prompting Little Johnny enough to score a 1 when he really scored a 0 on a receptive language item. Speak with your interpreters ahead of time as well as parents to remind them what is necessary to ensure a valid and reliable assessment.

5) Keep in mind that many children will have alternate, more colloquial terms for test-based items. 

In terms of an articulation test, you may have to prompt the requested word using hand-covered mouth or delayed production approach to get all of your scores. It's always a good idea to write these colloquial terms down also for future reference. 

5) In interpretation of scores, score the test based on the "dominant" language being assessed, but in goal writing, keep in mind where the most functional deficits lie.

In writing my goals, I often assign them to be mastered in both languages if the child is a simultaneous bilingual language learner. 

These are only a few of the things I consider when administering a bilingual speech and language evaluation. Have any of you encountered any particular issues or questions during a bilingual eval that I did not touch on? Let me know in the comments. 

Coming up- Part 3: Treatment!