Using Spaced Retrieval/Delayed Imitation to Foster Learning in Pediatric SLP

If you're a geriatric/adults SLP, you're probably familiar with the concept of "spaced retrieval". Even as pediatric SLPs, however, we sometimes use this technique (most often unconsciously) to develop a child's ability to independently respond to questions. Most frequently, it just looks like drill or repetition of a concept:

Ex.:
SLP: "Where is the frog swimming?"
Child: No response.
SLP: "In the water!"
Child: "In the water."
SLP: "Where is he swimming?"
Child: "In the water."

So the child is exposed to the question and then answer, after which they are typically able to answer "independently", although the truth is they are answering in delayed imitation. Which is fine, totally great! I wanted to explain how I used the technique of spaced retrieval/delayed imitation for a 3-year old today who has been unable to name objects on command for quite awhile, despite the fact that she responds appropriately to directions to interact with said items and her imitation skills are intact. It's almost as if her short-term memory or retrieval abilities are somewhat delayed. Typically, or previously, our verbal interactions looked like this:

Me: "What's this?"
Child: "What's this?"
Me: "Cow."
Child: "Cow."
Me: "What's this?"
Child: "What's this?"

Working on vocabulary development with animal friends.

As you can see, this interaction is different from above in that she was not able to hold onto the semantic content long enough to respond appropriately to my question. I should note I'm making this assumption based on the fact that she is not "echolalic" in the true sense or in any other context as well as the fact that I know her comprehension skills are much higher than her expressive language abilities. Today, I utilized the technique of spaced retrieval/delayed imitation. Essentially, we repeat the question/answer format 2-3 times, quickly. Any significant pausing will impact her ability to respond correctly in delayed imitation.

Me: "What's this? (quickly) Cow (stressed). What's this?"
Child: "What's this?"
Me: "Cow."
Me: (quickly) "What's this?"
Child: *thinking* "Cow!"
Me: "Cow!" (pat on the back, visual excitement/verbal reinforcement).

We did this exchange for the majority of our noun targets today. I found that as time went on, we only had to go through the question/answer sequence about 2 times, and at this point, I started using more spaced retrieval to encourage her to hold the word longer in her short term memory. It looked like this:

Me: "Cow. (stressed) What's this? (quickly)"
Child: "Cow."
Me: pause 1-2 seconds..."What's this?"
Child: *thinking* "Cow!"
Me: "Cow!" (pat on the back, visual excitement/verbal reinforcement).

My hope is that the longer we continue using this spaced retrieval format, I will not have to go through the question/answers more than 1X (as in the example at the top) and can gradually add time to my second prompt to increase her semantic memory until finally she *learns* the name of the object and is able to label independently or following a WH- question.

Tell me: do you see delayed imitation skills as part of the learning hierachy for vocabulary? Have you used "spaced retrieval" with kids on your caseload recently? Chime in in the comments below.

Until next time,
L.L.

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!

Spring-Time Thoughts and Therapy

Well guys, we are officially immersed in the Spring season! I'm sure lots of you are waist-deep in theme-based therapy involving bugs, flowers, etc. All I can think about right now though is that it is the end of the month!

No reaction? I know my fellow home-health speechies know what I'm talking about. Two more days and the therapy world will reset essentially and I'll have a full 31 more days to get in all 9 of my kiddo's monthly visits. This time of the month can feel like a race to the finish line, and let me tell you, I am running...but it's taking me multiple Frito Pies and blended Dr. Pepper blended floats to get there.

Anywho, I've got a couple new therapy things ready for you all, in case you're looking for something to spice up your sessions. I recently made these Spring-time picture scenes that are primarily made to target "who" and "where" questions but are equally capable of targeting prepositions and sentence structure. This download is only a buck and comes with 4 picture scenes and two sentence structure prompts with visuals for each prepositional concept.

This is such a flexible therapy tool for the month of May and I'm planning on using it for all my preschool-aged kiddos!

Spring Grammar Scenes

Also, here's a non-themed freebie for you guys, perfect for group-based and/or elementary articulation students. Fill in or let them fill in their target words on these Articulation Tic-Tac-Toe boards and them let them go at it in pairs! Perfect for working on peer or self-monitoring, too.

Articulation Tic-Tac-Toe

Happy End-Of-The-Month! Please let me know if you enjoyed any of these downloads or what you're loving for therapy right now in the comments so I can steal your ideas. :) 

Managing Bilingual Therapy : Part 1

One of the things that I know SLPs struggle with in today's world is how to approach and manage the increasing presence of bilingual clients on their caseload. I know this can be tricky for not only monolingual SLPs but SLPs who consider themselves bilingual but were not dual-language learners from birth and/or doubt their competency in this area. I have, like many people, four years of high school Spanish under my belt and minored in Spanish in college, and despite lacking some higher-level linguistic skills, finally do consider myself bilingual. But it wasn't an easy road getting here, and I still experience that feeling of incompetency from time to time.

That being said, I wanted to share with you all some tips, in the form of a blog series, from my journey slowly transitioning into bilingual therapy as an SLP in hopes that it might give those of you considering making this transition a bit more confidence and remind you- we are all just doing the best we can out here! That being said, here is my first tip, or opinion rather:

#1: Never let your lack of "perfect proficiency" deter you, but be able to admit when your skill set prevents you from completing an assignment ethically or effectively.

For instance, the fact that I still have trouble using past subjunctive tense or higher-level grammatical forms does not really affect my ability to work with preschoolers with speech and language disorders or evaluate their linguistic abilities. That being said, however, I do realize the limitations of my Spanish fluency and do NOT accept monolingual Spanish evaluations for children older than 7, generally speaking, nor do I attempt to treat higher-level Spanish language skills as I recognize I lack competency in some areas that could affect my ability to accurately assess and treat. So the point is simple: Do what you can, with what you have! Recognize your own strengths and abilities and be willing to refer to another therapist if necessary.

According to the ASHA Code of Ethics (and I quote loosely), you should employ the assistance of a bilingual therapist to translate or a trained interpreter when attempting assessments and intervention if you are not personally competent in the language being assessed. Meaning, you cannot do what we ask many children to: request, comment, judge whether a sentence is grammatical or not (based on the child's age), etc. For example, I know how some conversational French but I would not assume competency in judging a bilingual French speaking-child's articulatory skills in French. And the reason this is significant is that true articulation and phonological disorders are typically present across sound systems in bilingual children, and it is important to be able to identify whether sound substitutions are really errors or just dialectal influences.  That brings me to my next point:

#2 Educate. Educate. Educate yourself on differences in speech and language development in Spanish-only as well as bilingual language learners. 

I know many monolingual SLPs are put in the tough position of having to implement Spanish assessments and resources for children who are assigned to their caseload, but it is important to be educated on what it is you should be looking for exactly. For example, I can't tell you how many times I've seen goals for voiced and voiceless /th/ written for a Spanish/English bilingual child. And it drives me crazy, because this is a classic case of disorder vs. difference, and unless there is education happening to teach therapists the differences and warning signs of true impairment we are wasting a whole lot of time on goals that are not even valid. And telling parents that their child has errors when they truly do not. Again, this kind of goes back to the principle of realizing your limitations, but once you've identified those limitations, stretch to push yourself beyond them!

A great website with resources for assessment and treatment of bilingual speech and language disorders is Bilinguistics.com.

#3 Easy in slowly.

My jump for monolingual therapy was not immediate. I am lucky to live in a state where many children are bilingual and are happy/willing to let me test out my Spanish with them and honestly, make errors! Before I went in full-force with a Spanish-only child, I worked with an English-speaking child whose family members were bilingual and I knew would probably be responsive to me incorporating some Spanish into our sessions. I played around with my own skills; a direction in Spanish here, a vocabulary word there...and when I saw the pleased looks on both the child's face and the family members that I was attempting to incorporate even a small part of their bi-cultural identities, I was hooked. 

I also kept tabs on what I felt comfortable expressing as well as my comprehension. There were times I noticed real gaps in my vocabulary or realized the family used a colloquial term I wasn't familiar with, but these were great entry points for learning and made me a better therapist. For example, often preschool therapists use farm animals as a popular starting point for vocabulary and play. I had no idea walking into some of my first bilingual sessions that some animals make different sounds in Spanish than they do in English! Or that in Spanish "oveja" is a very formal term for a "borrega", or sheep. These are things I did not learn through my formal Spanish education.

Beyond this, I started my transition into bilingual therapy by administering Spanish assessments, such as the PLS-5 Spanish, where I had the prompts/translations there for me to read if I needed them. After that, I began translating for a monolingual SLP in gathering case history information and soon felt at least moderately competent in administering a complete eval in Spanish independently. 

#4 Analyze pre-made Spanish materials, i.e., apps, flashcards, etc. closely for accuracy and functionality before implementing them.

It's amazing to me that many expensive, well-researched Spanish assessments such as the CPAC-S as well as Spanish Super Duper products use vocabulary that is outdated or non-colloquial. The problem with this is then that you must prompt the child to say the word the test is looking with creates a validity issue. I have had so made of my Spanish kiddos laugh at words or pictures on a worksheet, or better yet, laugh at something in an app that to them, is just a silly way to say something in their native language. Therefore, my recommendation is that to the best of your ability, try to double-check vocabulary and resources with a native speaker or colloquial source so that you can assess and implement speech and language intervention that is both functional and relevant based on the child's dialect. I say "gorra", you say, "cachucha"...if you say that means "hat", I'll say "cachucha" then, too. 

I also have on occasion double-checked a vocab word with a parent in terms of, this is the word I use for this object or verb, is that what you would use in your home? For example, I had been correcting a Spanish-speaking child who was saying (in a literal sense), "I'm painting," whenever he was coloring. The verbs are different in Spanish. However, I noticed that this was a trend amongst all my Spanish-speaking kiddos and I thought, this just might be difference and not an error. Sure enough, after checking with a couple parents, they said that verb usage was pretty typical. So I stopped correcting it.

#5 Invest in a Spanish dictionary app or website on your phone that you can use in a cinch. 

This is a simple tip but one that has been very essential in my work in those moments when a child asked me, "Que es eso?" while pointing to a completely random object that is not part of my everyday Spanish vocabulary. Once you say the word you've looked up, you can usually pretty quickly gauge by the look on the child's face whether that word is acceptable to them or not, haha.

That is all I have for you guys for Part 1; stay tuned for Part 2 of this series in which I will be discussing my tips for Assessment! 

If you currently work with bilingual children on your caseload, what have you found to be the most challenging aspect of assessment/intervention? Please share in the comments below!

Ladybug Artic

Hi, guys! This is just going to be a quick post while I sip my green tea and listen to Ava (my cat) cry in the kitchen because I won't let her eat leftover pizza. It's a hard life.

This week (lol "week", it's Wednesday already) I'm going to start a ladybug theme. I only have three kiddos this morning so I wanted to find a quick printable for this and found it.

Bilingual Ladybug Worksheet

I'm planning on using this for artic today two ways:

1) Having the kids glue on spots for productions; and

2) Placing pennies on top of their spots afterwards for a fun "cover-up" game.

Yes folks, gettin real fancy with the therapy activities today. Sometimes simple is best!

Hope you all have a fabulous Wednesday. 

"Sometimes you just have to put on lipgloss and pretend to be psyched." - Mindy Kaling

What A Crazy World

Good morning, guys!

It has been a crazy week so far and I am starting my day a bit later today, albeit with green tea in hand, like I always do. I was pleasantly surprised to get on Blogger this morning and see some surprising traffic on my dear blog here and it warmed my heart. So thank you!

Today I'll be going to see my most furthest away kiddos and ironically, they all are toddlers or younger, so many of the Easter activities I've been using lately just won't cut it. I'm mourning the loss of a couple pieces of Mr. Potato Head's body but the kids don't seem to care. I think this is maybe the fifth Mr. Potato Head that has been a part of my traveling therapy circus since 2011. :)

Anyways, yesterday was one of those days that I didn't have anything *new* for therapy really but I was proud to be able to make a few things "work" for my kiddos in a new way.

Take the cult favorite, "Articulation Chipper Chat" from Super Duper- I used it with a kindergarten friend who is working on an odd goal in my opinion, word-finding. We played a version of "I Spy" in which she both had to work at using descriptive terms to help me find objects and vice-versa, and then had to name all of the objects suggested. I purposely picked non-everyday vocabulary in each photo scene. Yes, it is struck me as very odd that I have found myself using some of the same strategies I used in grad school for my adult Wernicke's patients with a 5 year-old and it's actually been working. I might do a little more research into this as time goes on.

For the rest of my kiddos, we played with the Articulation Easter Basket Hunt game again, this time looking for the carrots. I'm for real, this game has been a hit and I can't believe I've already gotten 2-3 sessions out of it. I even was able to use it for grammar and language goals.

I also decided to make a visual for one of my kids working on using appropriate volume at home...it has a picture of a "loud lion" and "quiet mouse" to help them learn to self-identify their own vocal behaviors. You can get it for free right now for download in my Teachers Pay Teachers store!

                                                         Mouse/Lion Voice Poster 

I just want to encourage you guys, wherever you are, to keep doing what you can, with what you have, where you are, to quote one of my favorite sayings. If you are anything like me, your heart may be feeling a little heavy right now, but it is not anything you are not equipped to handle, no matter how much you may feel otherwise. Dig in your heels, do some killer therapy, and worry about the rest later.

The only things I can really control are my songs, and my behavior. The rest? If I focused on it, that would lead to insanity.” — Taylor Swift, in Glamour UK

I'm in a love/hate relationship.

I'm torn, Medicaid.

I love you, but I hate you.

I love your reimbursement rates, but I hate the way you don't listen to anything I say.

Doesn't matter how good my narrative is, you'll glide right over all that functional implication talk and zero in on my standard scores.

I mean, aren't I more than a number to you?

All I want is a little validation here.

The biggest complaint I have is your wishy-washy ways. You change the rules of our relationship faster than I can say compliance.

I guess the biggest elephant in the room would have to be a little something called...Home Exercise Program (HEP). You want me to implement one, document it constantly, and if I don't change things up frequently enough, you get bored with me and slap me on the wrist.

I need a solution. I'm not saying we need to break up...I just need to simplify the process so I can find "me" again.

That being said, here's my new plan:

This 11-page .pdf includes parent/caregiver hand-outs for seven common goal areas for preschool and early receptive/expressive language skills.

I also created a HEP Data Log that can be filled out by you and the caregiver on a session-by-session basis to track weekly HEP implementation. 

These hand-outs include practical suggestions for functional, in-home HEP activities for the following goals:

- Requesting
- Body Parts
- Clothing 
- Early Prepositions (in/out, on/off)
- Advanced Prepositions (under, behind, in front of, next to)
- Vocabulary (Nouns)
- Descriptors (Adjectives) 

All you have to do is make a copy of the data log for each child, give the parent a corresponding hand-out, and circle an activity.

Voila- simplified HEP implementation.  Check it out HERE. 

Please let me know if you check out this hand-out packet or have any questions!:) 

Bunny Body Parts + A Sad Tail (I Mean Tale)

I'm going to start this post off with a sad tale.

When I was 11, I had a German lop-eared rabbit named Nibbles. She was my pet and parent's answer to me and my brother's severe fear of dogs following the trauma of a dog attack. I fed her spinach, chocolate rice-krispie treats, and included her in family home videos over the course of a year together. 

We were a good fit.

One day, she got spooked by a cat outside and attempted to make a break for it through the closed door of her wire hatch, which didn't go so well. Nibbles paralyzed herself from the neck down and spent the remainder of her days watching me from pillow where she could only wiggle her little brown nose and gaze up at me adoringly.

Nibbles had a short life but a good one, despite a freakish and unfortunate demise. 

Moral of the story: you can't rehabilitate a paralyzed rabbit. Also, rabbits are good companions and fun for children.

They're cute, they're cuddly, and they're also an endless source of inspiration for April-themed speech and language activities. 

That being said, this morning I decided to get creative and put together a new printable activity called "Bunny Body Parts"! You can find in my Teachers Pay Teachers store here.

I chose to use this today to put together puppets with my kids to target some of the following goals:

Age 2-3:

- Receptive/expressive body parts

- Imitation of gross actions (pointing to body parts in imitation, placing corresponding picture to body part on self, actions such as "hopping")

- Requesting 

- Imitation of single syllables/words

- Spring vocabulary

Age 4-5:

- Articulation: /f/ in initial position of words ("Do his eyes go on his /f/ace or body?"); drill to receive each body part; received an "egg" for the bunny for each page of drill completed

- Possessives: "Who's eyes are these? His eyes." 

- Expanded sentence structure: "I want to glue the __________."

- Verbs/actions

- Pronouns: pick a verb card: "I jump. Do you jump? Do bunnies jump? They jump." 

Here is the final product also seen with some Spanish verb cards I used to target expanded sentences and actions. The kids thought it was hilarious to imagine bunnies doing some of the things we identified only people do, such as driving. 

I also brought along Play-Doh and Spring-time cookie cutters for a corresponding sensory/language activity. 

This download comes with all the pieces you need to make a puppet along with three bonus Easter eggs and a carrot for further reinforcement or activities.

You could also make each piece into a magnet and make a fun cookie sheet activity, too.

A couple things I should have done in advance to prep this activity:

a) Cut out all the pieces in advance and put them in baggies (unless your kids are older and can help, there are several body parts and the process is too time-consuming), and

b) Limit the number of body parts for little ones (i.e., only necessary parts such as the nose, eyes, etc.) 

Over all, these puppets got big "wow's" from all my kiddos. I used .39 cent white bags from Michael's which paired with the light/pastel coloring in the document made the activity very-cost effective.

Feel free to check out "Bunny Body Parts" and leave me any feedback if you decide to use it! 

Also, do you have any sad or strange Easter pet stories?

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!:)

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:)