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:)

It All Spilled Over

This blog post will be a monster post symbolic of the past few days. Everything has spilled over.

You know, life gets moving and so you start taking things and put them on the back burner to deal with, but before you know it, even the back burner is full. The past few days have been full of a whole lot of wonderful and a bit of stress. Most of it I managed to capture in pictures.

To begin, last Friday was Valentine's Day, as I'm sure every single one of you were aware of. Amazingly, my Facebook newsfeed was NOT flooded with a million pics of flowers men sent their perspective wives and girlfriends.

Hence the reason I feel comfortable showing you all this beautiful bouquet of roses and lillies that Jake showed up with at my door. The best part was the strawberry cheesecake chocolate sticks poised at random throughout. He did good.

Anyways, not to get ahead of myself, Friday was a therapy day that consisted of dessert Skittles articulation therapy and various Valentine's language activities. I was given a cupcake by a 3-year old that I professionally scarfed down with my bare hands like a savage immediately following the session. That red food dye does NOT wash off skin easily, P.S.

Here's a picture of my car mid-day Friday. Oh, who am I kidding. This is a typical home-health car, at least MY car typically. I guess I should note that my trunk is generally much more organized than my back seats. You can see I do not have children at the moment; where would I even put a car seat? I'd make room, though...just saying.

In the afternoon I did a bilingual penguin activity, which I know, is typically a January theme. But it was Friday and that's what I had. Here's the front and back, showing the way I used it to target basic verbs and subject-verb agreement:

Following therapy I headed back home to celebrate the evening with my handsome Valentine. We went to Torchy's Tacos, per my request. If you haven't been, you need to go. Just say, "2 Trashy Trailer Park's." Trust me, you'll be happy. 

                                                                Before Dinner


Those 4 evals I mentioned in my last post? I am just now finishing the fourth one. Like I said, everything began to spill over. I am feeling good about the month of March, however. As for now,
I am going to finish this last eval and begin working on a new pillow for the Etsy shop.

Also, stay tuned for a new therapy game in my next post! It is self-developed and has always been a winner with my preschool crowd. Target area: phonological processing goals!

I hope everyone had a lovely weekend and is finding productive ways of dealing with the stress that comes along with the workweek and life spilling over. :)

The Power of Words

Today I wanted to touch on one of the most important lessons that I think exists in regards to language. It has a little to do with vocabulary, or word choice. A little more so with pragmatics. But it has everything to do with heart. And intention. The power of words.

So often we SLPs are working with children whose verbal capabilities are struggling to keep up with their mental processes and desires to communicate. For these children, speech and language is limited. But we still try to teach them that there is power in their words, that their words AFFECT others. And affect themselves. Communicative intent, anyone? Point + cookie = receiving cookie. Mama + arm = Mama attending to a hurt elbow.

But why don't we start teaching this lesson explicitly, especially to our children who have age-appropriate and higher-level verbal abilities? And why do some adults seem to lack understanding or empathy towards this concept? That is, you carry a dangerous weapon with you at all times. One must be careful to wield the gift of speech and language carefully, because words are powerful.

One of my favorite quotes is by Taylor Swift. I know what you're thinking but hang tight with me on this one. It says:

"Words can breaks someone into a million pieces, but they can also put them back together again. I hope you use yours for good, because the only words you'll regret more than the ones left unsaid are the ones you use to intentionally hurt someone."

If there is anything I have learned in my journey as a speech-pathologist, is that speech and language is a gift never to be taken for granted. Those of us who have the ability to communicate must be taught that these words have amazing power:

They can:
- Compliment.
- Encourage.
- Comfort.
- Assist.
- Engage in debate.
- Give perspective.
- Accept.
- Reject.
- Communicate who we are as individuals.

Conversely, they can also:
- Criticize.
- Bully.
- Test.
- Highlight other's weakest points.
- Mock.
- Shame.

We are sometimes so concerned with communicating what's going on inside our heads that we pick the most effective and cutting words possible, for convenience sake. Instead of taking the time to use the right words, we say what we "feel". Because "free speech", right? The results are not pretty.

And the best part is, once you say something, it can NEVER be taken back! Isn't that fun, I tell my kids. Sure, you can apologize, and hope that person forgets. But that ship has sailed. So live in the pause. And think about the power of your words, before you just go swinging that thing around willy-nilly.

Words are capable of expressing an infinite number of emotions, thoughts, and ideas. But the way in which we choose to wield this sword says a lot about who we are.

Please consider taking a moment listening to this song. It summarizes all of the above.

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Also, speaking of teaching our little ones, I would like to hook you guys up with one of the BEST general ed teachers I know and one of my oldest and dearest friends, Shannon, over at The Diary of a Nerdy Teacher. Her posts are full of of cute and practical classroom and curriculum ideas, many that I have thought would be great to integrate in a speech room, as well.

Check her out and some of her awesome freebies in her Teachers Pay Teacher's store!

Encouraging Strong Social-Emotional Development

Today I'd like to bring to you a list of some of the best parenting articles and links that I have found in regards to encouraging strong social-emotional development, also tying into behavior management. I find many of these tips helpful for me as a pediatric professional as I work with many children who lack a strong sense of self and are not able to communicate their inner thoughts effectively. This list will be added to as time goes on.

1) The Twin Coach: The Power That Words Have: Strengthening Your Child's Inner Voice

2) Effective Parenting 101

3) Public Discipline/Shaming

Getting the "Talking Train" Moving: Tips for Working with Nonverbal Toddlers

Hey, everyone!

Lately I have been working with several toddlers who demonstrate moderate to severe expressive delays and have played around with numerous techniques to get that "talking train" moving. I've finally compiled a list of what I find to be the most useful techniques that I have self-employed and expressed to parents.

1) Encourage vocal play.

This includes squeals, animal noses, syllables/syllable repetitions, and onomatopoeia, in general. A good way to do this is by demonstrating play in front of the child using objects you have at least 2 of, so you can act out an action w/ a corresponding sound and then pause for the child to do the same. My favorite game is to take farm animals and have them take turns “eating” hay (“mm-mm-mm” or “mumumumum”). Integrate the sounds the animals make, and then when they are “done’ eating, push them away and wave, “bye bye!”

2) Use predictable play sequences with consistent sound usages.

For example, in the play routine I described above, I have about 5 animals at my disposal. I do the same play routine with each animal so the child learnsthe routine and therefore anticipates what will happen next, and eventually, hopefully, will chime in imitatively or spontaneously, perhaps with some pausing. 

The routine looks like this:

1) Pick up animal - expressively give animal sound: “MOO!”

2) Make animal eat hay - “mumumumum”

3) Push animal away - wave + “bye bye”

Once the child begins to master/participate vocally within this simple sequence, you can expand on it. For instances, I bring in a bed and we put each animal to sleep and say, “night night!” after they’re doing “eating”.

3) Keep in mind early developing sounds when choosing target syllables/words to approximate.

Use 1-2 word models that contain EARLY sounds.

For instance, I will generally encourage a child to say, “moo” before encouraging “cow”, because /m/ is a target sound at this point and /k/ is not. Once the child will imitate syllables and/or is attempting word approximations, you can start expressively labeling with greater precision. I will usually start introducing the animal, for instance, as “COW! Mooooo.”

4) Integrate play routines that prompt the child to say the same syllable or approximation multiple times at the BEGINNING of the session.

This means using a syllable or word approximation that the child uses semi-consistently to get the TALKING TRAIN GOING.

For instance, I often use a shape sorter for this kind of thing. We sort the shapes and after each one, say “done” (usually “duh”). There are enough shapes to get at least 15 approximations in a relatively short amount of time. This gets the kid talking EARLY in the session. In other words, I like to start with activities I know the child will participate verbally in before integrating new vocal play or verbal play routines.

This is certainly not by far an exhaustive list but just some things that I have found significantly productive.

What I want to know is: what are some of your favorite tricks for getting those nonverbal kiddos to begin vocalizing?

Leave a comment down below and let's get talking.