Tuesday, November 25, 2014

Bridging the Gap between the Private and School Speech Worlds

Probably the most demanding, taxing job I had over the years in my speech world was working in the public school system.  Caseloads were always astronomically high and more kids were added to the roster with fewer discharges every year.  Then, you had to make time for report writing, evaluations, screenings, teacher collaboration, classroom lessons, therapy planning, documentation, decorating your closet space, and speech and language small group sessions. It makes my head spin all over again just writing about it!  Nowadays, there are these champion school speech pathologists that do all of the above and then go home and create products, write blogs, and somehow manage to eat and sleep before going back to work bright and early the next morning!  Even with all the challenges and stress, I wouldn't change a thing about my experiences and collaboration with so many heroes.  It made me the therapist that I am today and fueled my drive to pursue private practice.

When I set out on the private journey, I had three C's in mind:  Consult, Collaborate, and Connect.  I believe that these three actions help create a bridge between private and school speech pathologists working with the same client.

Before I can take one step forward, I need to get caregivers to obtain and sign school consents so I can begin connecting with school professionals.  Once the paperwork is complete, I typically send an email to the school SLP introducing myself.  From there, we work on scheduling my school observation which typically includes observing my client in action and setting aside some consult/discussion time with the school SLP.  In my private practice, I try to make this observation within the first few months of the school year so I can begin helping the team collaborate goals in all settings.  To date, I have found that all school speech pathologists have been very receptive to my visit and many appreciate the collaboration, especially when updating annual IEPs.  Caregivers are especially grateful of this networking because it gives them more information about specific activities targeted at school.  I have found that my presence at a client's school setting is far less intrusive and distracting than a caregiver's.  Most children hardly notice that I am there, which likely wouldn't be the case if mom or dad was visiting!

When I visit my client's school, I typically bring something that we have been working on in my practice.  While I do honor IEP goals, I also write some of my own based on my data collection, evaluations, and parent report.  In the past, I have asked parents to send a picture exchange communication book or highly motivating snack in preparation for my observation.  I have also brought pacing boards and oral motor tools like the Z-Grabber for demonstration purposes.  Sometimes, I don't bring anything.  Instead, I collect as much information as I can and follow-up via emails later with school staff.  Personally, I have found that I can obtain so much more valuable information during an hour observation as opposed to exchanging emails and phone calls with the school SLP.  It helps me to watch and listen to my colleagues because we all have our own unique styles and expertise.  Maybe it's because I am such a visual learner, but I make better connections when I see things happen in real time.

The final, most important step in my game plan is connecting my consult visit and collaboration with the school team to the client's family.  Sometimes, I write my SOAP note during the visit and leave a copy for families.  Most often,  I type out my chicken scratches at home and review the documentation with caregivers at the next clinical session.  I can honestly say that every visit that I have had to a school setting has been a worthwhile, successful trip.  I've seen changes made in a child's diet, increased use of picture exchange communication, and improved execution of voice output devices.

My hope in writing this post was to send a message to all the school speech pathologists out there that you are doing an AMAZING job with all your responsibilities.  As a private therapist, I want to help improve carryover and make the best impact that we can for the families that we are blessed to work with at school and home.  If you are reading this post and work in the schools or private sector, then I'd love for you to share your success stories in the comments section.  Regardless of your placement, what do you look for when collaborating with colleagues?  What would help you improve your service delivery model?

Sunday, October 26, 2014

Sorting by Object and Color and Sequencing, oh my!

True confession: I frequent the local Dollar Tree at least once a week, sometimes twice.  If you can't find me there, then check the Target Dollar bins;). I'm always on the lookout for mini object erasers and small figures for classification drills to add to my collection.  Luckily, my son was willing to part with the erasers that he got in birthday party favor bags a couple years ago.  His generous donation helped me begin my now expanding collection!  To date, I have assorted colored bears and bugs, mini sweets and treats, dinosaurs, vehicles, and three sets of colored apples.

Several months ago, I set out on a mission for a container and clear, miniature buckets for sorting objects by color.  I immediately fell in love with this two bin stacking case from Target.  It was a little pricey, but I liked how it can hold two levels of play and also store some sequencing cards to accompany the objects.

The Dollar Tree had the perfect, miniature container and even better, they came in stacks of three!  These bins have my colored bears and recently acquired assorted colored bugs, which are from a thrift shop find!

The colored bugs were part of a Discovery Kids game that included sequencing cards.  I quickly learned that the cards were flying all over the place during my session with a busy client, so I holed punched and ring clipped them together.

When the activity is complete, I can simply close the lid and store it for the next client.  I'm hoping to save some materials set up time by having several activities always ready to go in my handy, dandy case.  I hope that this post inspires you to put together your own sorting kit!  

Friday, September 19, 2014

Ark Therapeutic- Supply Review and GIVEAWAY

Thanks to social networking, I have been fortunate enough to learn more about Ark Therapeutic supplies for oral motor treatment.  Years ago, I used a Z-Vibe, that was purchased by the Early Intervention program that I worked for, with great success.  I saw the immediate benefits of providing this kind of stimulation when the little boy I was working with gained better control of his anterior loss of saliva by putting his lips together following just minutes of treatment.  Since then, several new items have developed and I had my eye on a Z-grabber.  When I reached out to Ark Therapeutic, they graciously offered to not only send some resources for my review, but also took the time to get details from me about my clinical needs.  This post will review how I have been using many of the items in my collection to date along with direct links to the products at Ark Therapeutic.  

For starters, I busted out the Z-Grabber.  This tool is a combination of a grabber and Z-Vibe in one and I immediately loved it!!  I have used it with two clients, both of which have low tone and significant difficulty with jaw stability.  Neither of these clients were huge fans of a typical grabber and in fact, refused these despite my best, speech tricks.  It appeared that the vibration element for these clients was a necessity in order to work on jaw stabilization, but that may not always be the case. My once resistive clients are now accepting some bite and hold exercises using the Z-Grabber and now that these families have given the Z-Grabber a try and have observed the benefits of using one, they have put this product on their wish list for the holidays.

One HUGE benefit to purchasing the Z-Grabber instead of just the Z-Vibe is that you are getting two tools in one!  As though that weren't enough, you can also get an array of tips to switch out on the Z-Vibe end.  The tips that I was fortunate enough to try are pictured below with a brief description of how I used each of these at my private practice.  Many thanks to my son for modeling and agreeing to once again be my guinea pig.

The Probe Tip  has three surfaces: bumpy, striated, and smooth.  I started out introducing the smooth side and took baby steps towards trying the textured ones.  I didn't notice resistance to any surface with my client; however, every child is different so I would follow your client's lead.  This tip is best used for providing input to gums, palate, lips, cheeks and tongue using gentle pressure with or without vibration.  It is recommended that when using this tip on a client's palate, that you refrain from turning on vibration as this can be over stimulating for some clients.  It was my experience that turning the vibration on for tongue tip elevation distracted my client as he reached for the probe with his tongue and not his palate.  We will continue using this probe during speech sessions because this client seems to benefit more from tactile cues than with verbal only directions.

The Preefer Tip was designed to roll along inner cheeks and/or lips to increase oral awareness.  I have been using this tip as a "wake up" option by stoking the outside of my clients cheeks in a downward motion before moving inside his mouth to target bite/chew and tongue elevation.  I think the ridged surface of this tip was a brilliant idea because it provides the perfect amount of stimulation without being overbearing.

The Fine Tip is far less invasive than using your chubby, gloved finger or tongue depressor to point out tongue placement.  This handy tool not only helps pinpoint locations for tongue placement, but it is also skinny enough to position along the sides of the tongue for stimulation of sounds such as /r/.  I tried this tip out with my client working on tongue tip elevation for sounds /t, d, n/ and preferred this tip over the probe for him.  I like that I can also use this for future clients working on /r/ who require stimulation to the sides of the tongue for cuing tension.

The last tip that I tried out was the Bite-n-Chew.  It was a great option for my client who had a hard time starting with the Z-Grabber because the later is less flexible and harder to bite.  This Bite-n-Chew tip is smooth and somewhat flexible.  You can place it either vertically or horizontally on molars depending on your client's needs.  I have been using both this one and the Z-Grabber to stimulate biting with a client who prefers chewing on his left side.  I will continue using these tools immediately before snack time in our session as I have seen a dramatic increase in biting when foods are placed on his right side.  Prior to trying the vibes, this client would only take bites using his front teeth or left side and protest assertively when food was presented on his right side.  He no longer protests and will readily accept presentations on both sides now!

If you do invest in a tool that can provide vibration, I highly recommend purchasing the Tips and Techniques for the Z-Vibe, DnZ-Vibe, and Z-Grabber because it is a fabulous resource for specific exercises and stimulation techniques for using these tools.  I have mine tabbed with client names on pages with exercises that I want to continue testing and using in my practice.

In addition to the Z-Vibe family, Ark Therapeutic sells regular grabbers to assist with jaw stability, biting, chewing, and tongue coordination.  There are several different types to meet your client's needs from those with smooth narrow parts that suit tiny oral cavities to those with harder textures for older clients.  There are even options to purchase scented grabbers to motivate those less willing to accept presentations of these tools.  While I have not yet tried all of the grabbers, I have a decent assortment in my toolkit.  In the past, I have found that chilling grabbers or dipping them in foods tempt some hesitant clients to open wide.  For now, my clientele are moderately to severely involved and require maximum stimulation opportunities via vibration.  

Just prior to contacting Ark Therapeutic, I had purchased: Tips and Techniques for the Grabber Family from the Ark catalog.  Like the tips booklet for the Z-Vibe family, this handy how-to companion will give you step by step instructions for using grabbers for a variety of purposes.  Since a copy of the same book was included in my materials package from Ark, I decided to raffle off the donation to my followers!  I'm also adding a textured grabber for your oral motor toolkit.  You can enter the raffle for these must have items in the Rafflecopter at the end of this review.

In addition to the grabbers, the remaining items in my box of goodies were directed towards improving straw drinking: the Bear Bottle, a lip blocker, and one way valve.   Earlier this year, I began private services with a two year old who has a limited verbal repertoire and insists on drinking from a bottle.  He seems to be using this for soothing purposes and reportedly likes to carry the bottle using just his teeth.  While his parents have been working very hard on transitioning to straw and cup drinking, they definitely needed more ammunition.  Enter, the Bear bottle from Ark Therapeutic.  First and foremost, I liked this option for my young client because it's adorable and novel for kids.  We have been calling it his new "bottle" since he started using it.  At first, he pushed it away, but now he takes successive sips before drinking from his old bottle.  He has even named it: B and accepts drinking from it more often than he refuses.  I call this success!  While Ark Therapeutic was kind enough to include a lip blocker and one way valve, this client did not need these supports.  However, I noticed another client having difficulty sustaining a suction while straw drinking and the one way valve worked wonders for him.  This valve traps the fluid in the straw rather than let it drop back to the bottom when the suction is released.  One thing that I did notice about the lip blocker was that it would appear to stay in place on the straw after multiple uses and washes.  It is made of hard plastic and fits snugly into a straw.   There are five types of blockers sold by Ark which allows for graduation as your client improves his or her ability to position musculature for drinking without tactile feedback.

If you have any questions, Ark Therapeutic has a contact link on their website that you can access.  I am so thankful for their products and personal attention to details, both of which made my testing trial such a positive experience for myself and my clients.

Disclosure:  Ark Therapeutic generously donated supplies for this review.  No other compensation was received in exchange for this summary.  All opinions expressed here are unbiased and solely mine.
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9/22/14 UPDATE:  Ark Therapeutic is providing the coupon code SPEECH2ME for my followers for 15% off site-wide through the end of October!

Sunday, September 14, 2014

Speech and Language Pirate Sensory Bin

Ahoy Mattes!  I'm here to share a quick treasure that you can put together for your early elementary students just in time for national, "Talk like a pirate day" on Friday, September 19th.  This fun activity should surely keep you from walking the plank!  Arrrrrrr!

I picked up the rocks, blue beaded necklaces, and measuring cups at my local dollar store; mini treasure chest at oriental trading; and miscellaneous jewels and coins from my son's stash.  Anything shiny that you have at home should get the job done!

Language targets/ following directions:
Big, medium, small
First, next, last
Color identification
Shape concepts (i.e., Find something round)
"Put in" the treasure chest

Speech targets:
Dig, scoop, in, out
Naming colors
Labeling sizes/ shapes
First practice 25 speech targets, then dig for 25 treasures

Wednesday, September 3, 2014

It's a Bird, It's a Plane, It's Superheroes Week in Speech!

Every Fall, it's the same drill for me.  I anxiously take out all my apples and pumpkins plans the first week in September and delve into one of my favorite seasons.  Inevitably, three weeks pass and I am tired of apples and I have run out of pumpkin ideas to make it to Halloween.  This year, I think I have learned my lesson because I have decided to keep my Fall motif packed away for a couple weeks while we delight in superheroes.  Thanks to my blogger friends, a dash of my own creativity, and my son's Dollar Tree super hero figures, I have a pretty comprehensive collection for lesson plans.

First up, I have not one, not two, but three Batman and Spider-Man units from the incredible Jenna at Speech Room News, who incidentally is a superhero herself in the speech community.  You can grab all of these freebies from Jenna at this link.

I love that I can target following 1-2 step directions with Batman-

Comparing and Contrasting with Spider-Man-

Positional concepts and Speech Articulation with Spider-Man-

Moving right along, yet another speechie superhero, Jenn from Crazy Speech World put together this freebie using adorable graphics of Batman and Robin for word association play.  Snag Jenn's freebie here.

This was a good start, but I needed more materials for my younger clients so I took a drive to my local thrift shop and found a superhero memory game for language lessons.

I also snagged a giant, three-segmented flip book to create silly superheroes.  I love these flip books for working on concepts: top/middle/bottom and first/next/last.

After the thrift shop, I went two doors down to a Dollar Tree and found a Teenage Mutant Ninja Turtle number puzzle and sticker collection.  I will probably use these to work on sequential concepts, making patterns, and descriptive story telling.

I saved the best for last- my superhero figure guessing game cup.  I made this using an empty food container and my Avengers duck tape.  I wanted to be sure that the kids could not see through the cup so I cut an opening in the shape of a comic strip BOOM/POW star-like image and colored one side black.  I made sure that little hands could reach into the container via the cut lid without getting scratched by rounding off sharp edges. To play this game, we will first look at a picture of an action figure and use descriptive words to highlight costumes and traits.   Next, we will try and use our hand to dig into the container and retrieve the correct match.  I will probably add some recall to the activity by challenging clients to remember the order of superheroes drawn from the cup without looking at the figures lined up on the table.

You can find more lesson plans at my Pinterest Superheroes board.  I hope that you are all having a great start to the school year!

Tuesday, August 26, 2014

My Happy Space- A Peek Through the Keyhole Edition of my new, Private Speech Practice

When I first started working as a Speech-Language Assistant, I was 23 years old and Pinterest, TpT, and blogging was far from existence, so I made my materials using construction paper and the school laminator.  Over the years, I added to my resource collection by hunting down clearance sales at toy stores and utilizing board maker programs at my school placements to make interactives.  Fast forward to today where I print, laminate, cut, and copy materials weekly, some of which are my own creations while the majority are from masterminds like Crazy Speech World, Speech Room News, Speech Snacks, and The Peachie Speechie to name a few.  I still seek clearance sales at Target, Walmart, and Meijer and even occasionally allow myself to enter local Goodwill and Dollar Tree stores, given I can muster some self control.

As you can imagine, I have quite the collection.  I've hauled my lot to client's homes during my Early Intervention days and schools in Rhode Island, Massachusetts, and Illinois.  I've lived out of my trunk, school closet spaces, and the teacher's lunchroom.  My materials have been stored at home in basements under a staircase, kitchen pantries and cabinets, my son's toy closets, under beds, in laundry rooms, and jammed into a decent sized bedroom closet. 

Last summer, I launched private therapy sessions in my home office with five weekly sessions, four of which I continued during the school year while working part time at an amazing Catholic school placement.  This summer, I tackled 15 private sessions weekly in our new home with an office space that I could create to fit my needs, materials, resources, and clients.  With so many private clients to service, I had to let go of my time in the school systems and find a permanent home for all my worldly, speech treasures.

The first order of business in our new home was arranging for a handy man to remove the glass French double doors that lead into our family room and then replacing the doors with a wall.  I already had another single door entry into the space, which we switched out from another glass French door to a standard door.  With boxes filled with materials stacked near the wall to allow plaster to dry and keep little hands away, we moved into phase two of the project with scheduling two more sanding visits.  Then, I closed the office for two weeks while our family traveled to Europe for the first time.  While we were gone, I had the stained, dirty cream carpet replaced with a deep blue/ gray rug and the mustard yellow walls were painted a light, bright lemon sorbet.  That completed the room projects, next up was creating a closet space.

The only downfall to my new office was that there wasn't a closet as with the last home office space.  But this negative quickly became a positive because for once in my life, I didn't have to squeeze my materials into a space, but rather build a space around my collection.  I spent some time laying out everything, and I mean every game, bin, bucket, file box, bag, and basket to take inventory.  

After a very, very, long day at Ikea, and an insane ride home with my Equinox filled to the brim with wardrobes, shelves, bins, and doors, I had everything I needed to make a storage space and move towards phase three:  operation storage.  All I needed was a big, strong man to build it.  Luckily, my amazing husband stepped up to the challenge and after a couple days, three, giant structures were built, doors were hinged, shelves and rods were installed, all units were anchored to walls, and some fancy, smancy handles were drilled into place.

I took things one step further and decided to get rid of all but one of my office totes so I could open wardrobe doors and see everything better and stop digging for stacked items crammed into totes and bins.  During that long visit to Ikea, I found deep, white containers for $4 each (lids sold separately) that were large enough to hold a decent category of toys and games.  I picked up 12 of these babies and enjoyed sorting materials into them just a little too much. 

Then, I dumped out my bin of bagged literacy units with manipulatives, clipped each clear Ziploc bag onto a pant hanger and hung them in my corner wardrobe. 

Last, I got sticker happy and typed and wrote out labels on everything. 

While I was at it, I spruced up my materials collection on one of my original bookcases thanks to Allison's Speech Peeps and her colorful, editable binder labels.

At last, my work was complete!  Take a look at my home office space now with my new storage cabinets and previously purchased bookcases and work table from a local Land of Nod outlet store.....

Puzzles individually bagged and stored in a milk crate

Now, just about all of my speech materials, including office supplies, client binders, and resources are in one room.  I kept my large play sets on a shelf in the laundry room next door since I rarely use these right now.  I was so excited about the organization that I went ahead and planned out my themes for the next year!  If you would like your own, editable Theme Therapy Sheet, then head on over to see the fabulous Jenn at Crazy Speech World.  

While I will miss working in the schools and collaborating with teachers and support staff, I am thrilled beyond measure to have a space to call my own and a growing, private speech practice!  Now all I have left to do is Keep Calm and Speech On!

Thursday, August 14, 2014

Back to School Raffles: Successful R Therapy by Pam Marshalla

In my last post, I blogged about Pam Marshalla's book: Successful R Therapy that was the inspiration for my speech tackle box game plan.  Since that post, I have been busy putting Pam's advice to work with two of my private clients and the immediate progress has been beyond remarkable!  I mapped out my game plans using Pam's strategies and started two clients on the path to success.  I also put together a couple clinical tackle boxes and just love having everything at my fingertips!    After sharing all my excitement on social media, I was contacted by Pam Marshalla, who graciously offered to donate not one, but THREE of her books to raffle for THREE of my lucky followers!!!  I can't think of a better way to start off the school year, than with your own copy of Successful R Therapy!  You can enter for your chance to win in the Rafflecopter below and I will pick THREE winners at the end of next week!

Disclaimer:  The three copies of Successful R Therapy were donated for raffle purposes.  No other compensation was provided for my reviews and feedback about this manual.  Any thoughts expressed in my blog posts were solely and unbiasedly mine.

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