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)

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!

Sunday Feels

It is Sunday. Let me tell you how Sunday feels. 

Sunday feels like a McDonald's medium french fry and ice-cold Coke.

Sunday feels like a very heavy, scratchy grey blanket that I don't want touching me.

Sunday feels like a humid room with a barely functioning oscillating fan. 

Sunday feels like an all-too hot bath that you were dying to get into but five minutes later are dying to get out of. 

Sunday feels like a song you started writing but quit when you got to the chorus.

Sunday feels like the comforter you put in the dryer that you will purposefully forget about.

Sunday feels like the mess on the floor that is better suited for Monday's sense of purpose.

Sunday feels like an empty playground punctuated by the sound of a clanging flagpole.

Sunday feels like the ball you attempted to play with that you accidentally kicked out of reach.

Sunday feels like the tea you set aside to cool down but is now too cool and must be reheated.

Sunday feels like the excitement of wearing flip flops followed by the let-down of a chilly breeze.

Sunday feels like the shirt you want to wear so badly but never lays just right.

Sunday feels like the talk you will have with that good friend filled with long pauses. Those muffins you made, they weren't very good, were they? People are unreliable, aren't they? You don't want tomorrow to come. 

Sunday feels better in my head than it looks on paper. 

Restore to me the joy of your salvation. - psalm 51:12