Monday, February 6, 2017

My Bag of Tricks in a Bin

Whether you are an SLP in home care, private practice, or school settings, one common ground remains constant: we all need a bag of tricks.  We need to have something readily available that aids in improving attention and interest in the speech and language task at hand.  This collection may be a combination of communicative tempters and sensory stimulating tools and/or visual reminders to stay on task.  In my private practice world, my bag is a bright, deep, red bin that matches my office decor and sits comfortably between my seat and a wall, making it difficult for clients to grab.  This bin holds my tried and true tempters and sensory items.  Allow me to dump out the contents and give you a closer look at what is inside.

First and foremost, I have your ever-fancy, re-purposed slab of cardboard covered in white contact paper and Velcro.  This board, which has saved many a speech sessions, is accompanied by a ridiculous collection of pictures stored categorically in a giant binder.  From toys to foods to letters and numbers, you name it and I have a picture of it laminated with a Velcro dot on the backside.  These visuals give several of my clients a better sense of what we will be addressing in our 50 minute speech and language session.  Once a task is complete, clients remove the picture and drop it in my dollar tree bin marked, "all done."  Using this system helps clients visualize and therefore comprehend how long he or she will be spending time with me working on all the hard stuff.

Next up in the bin are my son's old, monster feet.  These brightly colored feet are made of a thick, durable foam and attach to cords and a handle.  Clients take work breaks by stepping onto the feet and pulling up on the cords by the handles to walk about the room.  My OT colleagues have taught me that these feet give clients a better sense of where their bodies are in space, which in turn helps them organize and attend.  Monster feet come in handy during transitions into and out of my office space too.




Rolled up and folded in half is my two yard piece of stretchable, fabric sleeve purchased at Joann's fabrics.  I used a coupon and saved a little money on this fabric, so it only cost about twenty dollars.  A private practice OT, with whom I often collaborate regarding shared clients, suggested that I purchase this ready made fabric tunnel to assist clients needing proprioceptive input.  Unlike standing tunnels, this sleeve allows you to push and stretch while inside.  Clients sometimes crawl through this or step into it and push against the fabric while standing upright.




Not all of my goodies will fit inside my bin, so my fidget cushion rests just next to it.  I have had this particular cushion for so long that I cannot remember where I purchased it.  Like anything else, I am sure you can find one at Amazon.  I especially like my textured cushion because it works like a balance ball without risking injury.  It's not something that you would use throughout a 30 or even 50 minute session, but perhaps will come in handy for a 10-15 minute task.  One benefit in using this cushion is that it helps some clients reduce the need to move about the room for a gross motor break by letting them get their wiggles out while seated.




Now, let's talk about fidget toys.  I have a few in my stash that I use either as a reward choice for having completed a work task or as a fidget for keeping little hands busy while seated and listening to auditory bombardment of target sounds.  Koosh balls are always popular as are putty.  I am working towards having my AAC users request these items using descriptive words such as "big purple" for a large koosh.




Finally, it never hurts having some tempters nearby.  My favorites are wind up toys and poppers.  These come in handy at the end of a session when I am trying to finish calculating my data because they keep my little friends from pulling out toys on my bookshelf or hitting the buttons on my copier.  It's also good to have tempters nearby on those days when you need to quickly shift gears because that cute craft or sensory bin may not be doing it for the little one in front of you.




What about you?  What do you have in your bag/bin/container of tricks to assist your clients in attending during speech and language sessions?  Leave me a comment and let me know!


Monday, January 23, 2017

Telepractice- Your Questions Answered


This post summarizes my experience over the last six months working as an independent contractor for Presence Learning.  The opinions expressed here are solely mine without compensation.  If you would like to learn more about telepractice services at Presence Learning, then you can watch this link about the company.

A Day in the Life of a Presence Learning Telepractitioner

If you are like me and are a "hands on" learner and you want an opportunity to see a telepractice therapy room, then email me at nanettecote@gmail.com.

Before I delve into my telepractice world, let me provide a little background about my life as a speech pathologist.  I began this fabulous career in 1995 as a speech assistant at elementary and middle schools and then earned my masters in December 1998 at Northern Illinois University.  Over the course of my career, I have worked in both public and private elementary and middle schools, a severe to profound system, acute and rehabilitative hospitals, and early intervention.  I know that seems like a big list, but my time in the hospital settings were per diem.  In the summer of 2012, I opened my private practice part time and then grew to full time less than two years later.  My cozy space is in my home and I run a one-woman-show, which means that I take intake calls, provide evaluations and therapy, and submit my own insurance claims.  Once I found my rhythm in private practice, I noticed blocks of time that were especially hard to fill with clients between the hours of 11 am and 2 pm weekdays.  Not only did I constantly have this down time, but I also noticed a dramatic dip in therapy attendance across the board when the new year began and insurance deductibles reset to zero.   I started researching telepractice services to fill those daily voids and provide a reliable source of income during those periods of frequent cancellations and low attendance.

Last February, I took some time to speak with three telepractice companies and decided to pursue working with Presence Learning.  With almost six months under my belt, I think that I have found my telepractice groove and filled those voids while enjoying predictable reimbursements.  Now that I paved the way for myself, I am happy to help my peers in their pursuit of this new world.  Below are some of the most popular questions that I am often asked about working in telepractice.

*How many hours a week do you work in telepractice?  At Presence Learning, I am required to work directly with clients for ten hours weekly.  In addition, I am compensated for time spent billing, consulting with parents, writing IEPs, documenting and planning sessions.  I am also paid if a client cancels with less than 24 hours notice or does not show for a session.  On average, I bill for 10-13 hours a week, which includes a combination of direct therapy time and some of the other indirect examples cited above.

*How many kids are on your caseload?  My position is a bit different than I expected it to be as I work with clients who are home schooled in virtual sites across California.  Many of my sessions are individual, but a couple are group speech.  In total, I have eleven clients right now, two of which are temporary coverage for RTI clients.

*How often are you paid?  I submit my bills on the last day of each month and then receive a direct deposit two weeks after invoicing.

*Do you need to find your own clients?  No, Presence Learning always assigns you clients.  This was important for me because I wasn't quite sure where to begin with telepractice.  I know that you can do telepractice on your own, but this was such a new world for me that I wanted to start with a reputable company and have them find my assignments.

*How does therapy work?  This is the most impressive part of working for Presence Learning: they have recently updated their therapy platform and it is AMAZING!  Clients meet me in "my therapy room" by following a direct link to my space.  We both need to use a computer (there isn't enough screen space to use an iPad) with a webcam to see each other.

One of the links that I am allowed access to as an employee is the library.  This "library" is loaded with lessons and activities that other providers like me have loaded into this storage space.  If I cannot find something I need in the library, then I can scan and upload documents or download activities on my computer and load them to the Presence Learning library.  I am always given the option to share things that I load publicly or keep it private for my use only.  This allows me to utilize those products that I love incorporating into therapy without infringing on copyrights.  I can also create my own flashcards and memory games using images stored in the library or my own uploaded pictures.

After searching and previewing documents, I began creating "queues" to store plans for articulation, language, pragmatics, vocabulary, and seasonal tasks right into my therapy room.  These queues appear condensed along the right side of my monitor so I can easily grab what I need for each session.  In addition to being able to load and store activities, I can collect data on client goals while in my sessions with a simple click of a button and even write SOAP notes.

Finally, there are tons of interactives in the therapy room.  During sessions we can activate a pencil to circle answers, play games using stamps as markers, add dice or spinners, display timers, and so much more!  I can reward clients for accurate responses with a quick, pre-stored animated video or search for a character of high interest such as Peppa Pig or Mickey Mouse to display a short animation.  Finally, I can load video contents into my queues to work on just about any speech/ language task that my little heart desires.  For example, I have stored a video of someone reading a seasonal book in a queue to work on answering WH questions.  Needless to say, clients are never bored!!  In fact, it is REALLY hard to say goodbye to them when time is up because many are so motivated by all of the features in the platform.

*Do you get holiday and summer breaks?  In my position, I have the same holiday breaks as typical school systems, such as MLK day and President's day.  I also had two weeks off at Christmas and will get a week off during spring break.  While I am not required to work in the summer, I understand that I may be offered an opportunity for ESY with any clients that are currently on my caseload qualifying for summer speech and language therapy.  This may vary from one contract to another though.

*Do you need to be certified in other states?  Yes, as of right now, I need to maintain my certification in the state that I live in, and Presence Learning will reimburse me for certification and renewal fees for licensure in states where my clients reside.  Since Presence Learning has a large client base in California, I was strongly encouraged to gain state licensure in CA to broaden my scope for a caseload.  It took a little work for me to complete this process, but Presence Learning fully reimbursed me and paid for time spent completing licensure tasks such as fingerprinting.

*Is your compensation similar to private practice?  While I am not authorized to discuss salary and reimbursement, I will say that Presence Learning was the only company willing to negotiate a starting rate.  Having worked as a contract therapist before, I knew the reimbursement rates would be lower in comparison to my private practice charges.  My intent was to fill a 2-3 hour daily void with clients and provide a reliable source of income during those periods of frequent cancellations and low attendance.   Thus far, my position at Presence Learning has fit both of those bills.


Thursday, December 8, 2016

TOYS!!!!

This post contains some affiliate links.  No compensation was received for sharing my opinions about these products.




'Tis the season for talking about toys.  Besides the most obvious reason for buying toys at this time of year, I'm cashing in on the deals and updating my therapy closet.  Let's be honest though, I don't need a sale or holiday to buy toys because I pretty much shop all year round.  The toys that catch my eye typically have three things in common:

1) They make HARDLY ANY noise.  I'm probably not the first SLP to make this comment and I surely won't be the last!  Bottom line is that I/we want the kids to do the talking.  Sometimes that talking is a noise or part of a word and sometimes it's a word/phrase/sentence.  It's nice to be able to hear these moments without interruptions.  Now, having said that, a good, old fashioned single, noise making toy never hurt anyone.  For example, the Elefun makes a whirling sound when activated and I'm ok with that because it motivates kids to request "more", "go", and "stop."  You The bottom line is: I steer clear of those toys that kids get trigger happy with and all you hear are a million sounds and words all at once.  Not fun.  Personally, I avoided noisy, talkative toys when my son was little and I have lived quite happily in my SLP world for a couple decades without all the noise.

2) They fit right in with my theme.  Herein lies my year-round shopping problem.  I'm always looking to add materials to my theme units.  I can't help myself.  I have to admit that I love bringing out the Fisher Price Thanksgiving sets and Holiday train, Learning Resources camp fire sets, and Super Duper magnetic fish.  When these toys are only available for a short amount of time, I think you get more bang for your buck from them.  It's the same concept of rotating toys in your home so the old ones feel like new when you cycle through them.

3) They stand the test of time.  This rationale is two part: durability and traditional.  I like a toy that can take a beating and clean easily, so I reach for the plastic Velcro foods and walk right by felt food.  If I can't clean them fast with a Clorox wipe, then I can't have them in my therapy closet.  While there are always cute, new toys being released, I stick with traditional themes like Mr. Potato heads to work on learning about body parts.  Another great option is any toy that is alphabet-related.  Two of my favorite hits for kids in my private practice aged 2-8 years old are my wooden ABC puzzle and alphabet soup.  What better way to work on letter-sound recognition than with toys?!

Now that you know what I look for in a toy, I'd like to leave you with my top 20 favorite toys (in no particular order) in my speech and language therapy room.  Hopefully, this list will help you when shopping for someone you love this Christmas.

ABC puzzle (I especially like the puzzle with objects in the shape of the initial alphabet 

letter)

ABC soup by Learning Resources 

Camp set by Learning Resources

Melissa and Doug magnet puzzles

Mr. Potato heads

Lift the flap board books

Zingo


Velcro fruits and vegetables

Lego ice cream cones

Gymboree bubbles (they last for a few seconds and don't leave much residue)

Storyteller Writing Box by Lakeshore 

Foam magnetic fish by Super Duper Publications

Monster feet

Elefun

Nesting boxes (I have a SUPER cute touch and feel one with animals from Eric Carle's book: Polar Bear, Polar Bear, What do you Hear?)


Portable Vet Clinic

Klip Klop Princess Play sets

Playdough

Melissa and Doug sticker collections

Learning Resources Magnet track


Thursday, October 13, 2016

Targeting /s/ blends through Literacy activities

Like most of my slp peeps, I am a planner!  I have theme-based lessons and materials that I have treasured over the years, so prepping for my private sessions is fairly easy.  Every once in a while though, I decide to gather some new materials to target common articulation, phonological, and/or language delays.

Just recently, I polled my colleagues on Facebook and searched my Pinterest boards to create a list of books for preschoolers that target /s/ blends.  Much to my surprise, I had several of the books that I needed on hand.  I only needed to order three of the seven books to complete my /s/ blend library. Here is the criteria that I used for my collection:
  • Short readings with no more than 2-3 sentences per page/picture
  • Repetition of early /s/ blend targets (i.e., stop, small)
  • Appropriate for children aged 4-6 years old
  • One book for each /s/ blend target
  • No more than two /s/ blend targets per book to meet cycles approach 
  • Seasonally appropriate books (I am a theme girl)
Now that I have my books on hand, I can use each in my session with my clients working on improving both listening and expression of /s/ blends.  Since the books are mine to keep, I wrote the /s/ blend target in permanent marker on the cover and I used a highlighter to mark the /s/ blend words in the books.  You can likely find any of these books at your local bookstore, library sales, or Amazon.  Maybe you have some already in your materials collection!!  I will close this post with a photo gallery of my Fall and Winter books.  Next Spring, I hope to compile my warmer weather collection.



























Tuesday, September 6, 2016

Crack the Books by Mobile Education Store {{SEPTEMBER SALE}}

This post summarizes my experiences with using Crack the Books during speech and language sessions.  The unbiased opinions discussed below are solely mine with no other compensation other than redemption codes for these apps for trial and review purposes.  

The Crack the Books series by Mobile Education Store (MES) is such a favorite among my upper elementary and middle school clients and why wouldn't it be with all that it has to offer?!  Here is a great description of this product quoted directly from the MES website:

"Crack The Books™ is an multiple award-winning, state of the art, interactive book series for upper elementary students. Developed in collaboration with top universities, scientists, educators and specialists, Crack The Books™ is the first standard based, core curriculum aligned digital book series that includes both interactive enhancements and universal design accessibility features. Designed for all students, from children with special needs to students who are academically gifted, Crack The Books™ gives educators a powerful new teaching tool to help students of all academic skill levels meet state standards for reading comprehension."
The best thing about these books is their versatility.  You can adjust reading levels for 1st through 8th grade to suit the reader's ability with a simple click all while maintaining content.  This adjustment makes it possible for all students in one classroom to participate in a unified curriculum regardless of their reading ability.  The icing on the cake for a private practitioner is that you can target 3rd to 5th grade science and social studies core curriculum in your clinical settings.

This summer, I had some time to look at all the new updates and was delighted to see additions of coloring pages, activities, word searches, memory matching, and puzzles which include vocabulary and visuals from each of the subjects featured in the apps. What a great way to carry over curriculum vocabulary in a leisurely way!  Like the series, you can even adjust the difficulty levels during word searches, memory matching, and puzzle play so it can be fun, yet challenging for a variety of children.


COLORING PAGE 

LESSON PLAN

WORD SEARCH- 12 LETTER GRID

MEMORY MATCHING- MEDIUM DIFFICULTY

PUZZLE GAME- EASY LEVEL

In my opinion, the interactive interface in this series is what captures the attention of my clients.  One of my favorites in the Grassland series allows you to adjust temperature and rainfall and then visualize what the terrains would look like under specific parameters.  Many of my private clients ask to review these visuals long after we have completed reading chapters.  I believe that the interactive links and high resolution images and videos enhance learning and assist in retention of new information.






If you fancy the ability to navigate around the Earth's biomes, then you can find 3D interactive globes filed in the video gallery for each book.  These videos are incorporated into the chapters; however, if you want to find one quickly for review, then you can go directly to the index.  Again, I have found that using these models along with text enhances learning, especially for clients that I work with in private practice who need to visualize information and see images on a wider, dimensional scope. 





ROTATE AND ZOOM THE GLOBE FOR 3D

One of my middle school clients will make all kinds of bargains with me when she needs to read aloud during our comprehension drills, but she NEVER wants me to take a turn when it comes to reading a Crack the Books topic!  Just yesterday, she commented that the author is "funny" and she made sure that I connected with her mother about purchasing these apps for her home iPad.  This particular client also delights in exploring "Fun Facts" and quickly hearing how new words are pronounced via links in the text.  



CLICK ON THE FUN FACTS FOR TRIVIA

QUICKLY HEAR WORDS PRONOUNCED AND READ DEFINITIONS

I cannot wait to see the additional series that Mobile Education Store promises to release in the future!!  Right now, these five titles are HALF off for the month of September.  You can purchase them for $5.99 each or buy the bundle for $14.99 right now. Happy Learning!!

  • Pines to Vines- The Forest Biome
  • Blades- The Grasslands Biome
  • Seashores to Sea Floors- The Ocean Biome
  • Parched Planet- The Desert Biome
  • Aquatic Earth- The Freshwater Biome




Wednesday, August 24, 2016

Category Game Bags- A Perfect Activity to Start the School Year


As many of us embark on a new, school year, I wanted to take this opportunity to wish you all a fabulous, stress free speech life!  With that, I would like to share a quick and easy lesson plan for your classroom, small group, or individual sessions that will take you just minutes to put together. This game was my "go to" activity for classroom instruction at the beginning of the school year and it is sure to earn you the reputation as the "fun" professional while at the same time build vocabulary and speech skills with your clients.

I had the good fortune to work with some exceptional Speech-Language Pathologists early on in my career.  During one of my observations, I watched students play a lively, category game using just brown paper lunch bags and small sheets of paper.  This game can easily be adapted for students in 1st through 5th grade.  If your clients are younger and have a hard time reading, then you can always put pictures on the bags in place of words.

Before you begin, get at least 10 paper bags and write the names of various category groups on each one.  Then, make a list, using a small piece of paper or half of an index card, of 4-5 group members.  If you need to use pictures instead of words on the bags, you will need to create those and attach them to your bags.  You can make groups like Colors even more challenging for your upper elementary students by listing members such as African violet and Fuchsia instead of naming primary colors.



Wednesday, August 3, 2016

Using Pool Noodles to Support Speech and Language Development


Buon Giorno!! It's late morning on the train ride from Rome to Florence and with my coffee in hand and family in tow, I thought I would write some blog posts!! Just prior to the start of this fabulous, long getaway, I completed my second summer speech and language pool group session. This year, my participant size doubled from last summer with nine registered children between the ages of two and seven years old. Once again, I was surrounded by smiling faces and lots of gestures and vocalizations with a side order of splashing.

This group has been a passion of mine from early on in my career and despite my best attempts at planning, I always stumble upon a creative idea during the group. A couple weeks into this year's session, I walked by a container of pool noodles at our facility and asked each child to pick a color. My intent was to help position participants on their bellies for some kicking and splashing during our opening "wake up" routine of Motor Boat, but the noodle served an even greater benefit for many little ones and their caregivers.

Keeping Roaming Nomads close to Caregivers
While most children stay close to their caregivers, some enjoy exploring throughout the group. Having had a toddler who NEVER stayed with me during mommy and me group times, I understand the need for those "motivated to move" in order to fully attend. Given that the majority of my participants were working on generalizing skills into group settings and socializing with peers, I didn't want to allow for constant escape from social opportunities to play in the water alone. That's where the pool noodle came in quite handy! Caregivers wrapped the noodle around their child and then positioned themselves directly behind little ones. I'm no expert, but this arrangement may have given my little swimmers a better sense of where their bodies were in space which reduced the need to move. The most active children ceased movement and appeared content, not restrained. Those who remained near caregivers without the noodle, protested having it wrapped around them for the entire 30-40 minute group, so we simply put the noodle aside for them.

Body Wake-Up with Increased Water Resistance
After a couple quick rounds of Motor Boat go so slow/fast, I typically extended some body wake-up time with the song: The Wheels on the Bus. I really like this song for three reasons. First, just about everyone knows the words to it. Second, kids DELIGHT in being lifted up and down in the water when we sing about the windows and kids on the bus. Third, there are several opportunities for using water resistance to stimulate attention and alert our muscles. In all honestly, I happen to use the pool noodle while singing this song by accident when I realized it increased water resistance. Everyone loved swishing the noodle underwater to make waves during the sequence about the wipers on the bus and it was fun trying to motor plan using the noodle ends to spin like the wheels on the bus. With all this water resistance, our bodies were alert and we were ready to make some noise!

Pretend Play
Originally, I worried that having a noodle handy throughout the group would lead to children hitting others with them while swinging them around. Thankfully, I didn't see anyone start this particular trend. What I hadn't intended was that I could use the noodle for symbolic play. Once again, during the Wheels on the Bus song, I curved my noodle and positioned it into an arch over my head to pretend it was a building in a town. I encouraged others to imitate this new action by building their own homes in our town and the crowd loved it. I yelled out greetings to Mason in his town and Riley in hers and children responded to hearing their names by looking and attending. It occurred to me while writing this post that I could have used the noodle as a log during the song about the frogs that sit on a log and then jump into a pool or maybe made the noodle into a bridge for children to circle "under" during the motor boat song. Oh well, there's always next summer!