Anne Preddy graduated with her MA in Communication Disorders from CSULA in 2008. She now works as an SLP at the Long Beach VA Medical Center and came back to tell us about what she does every day at the VA.
SLPs at the VA do a little bit of everything and treat a variety of communicative disorders including speech, language, voice, dysphagia, cognitive disorders, and swallowing.
Anne’s job which was at first overwhelming has turned out to be a rewarding opportunity to pursue a career she’s extremely passionate about. She referred to SLPs at the VA as “jacks of all trades ” because in this setting every day presents new challenges and opportunities to use the latest technology in assessment and intervention.
Patients at the VA are veterans ages 19 to 99 that have served our country over the decades. Working in this setting has enabled Anne to provide services to this population and assist them in their return to their lives at home.
Since Anne started working at the VA about 2 years ago she has gained experience with a number of assessment and intervention strategies in a range of areas. Anne mentioned a number of different assessment tools that she has had the opportunity to utilize and gain valuable experience with on a daily basis. Working at the VA in her opinion is “heaven for a gadget geek” because there are so many opportunities to work with cutting edge technology. The VA setting provides valuable experience with the most current assessment and intervention devices and technology like fiber optic endoscopes, electrolarynx devices, TEP, AAC, oral motor exercises, Barium swallow tests, standardized tests, cognitive prosthetic devices and cognitive group therapy.
She has worked with a number of patients who have sustained injuries like TBIs from blasts, IEDs, and grenades. SLPs working at the VA use a multidisciplinary approach to treatment and provide a host of functional cognitive group therapy programs like College Connection and Brain Boot Camp that teach patients compensatory strategies and provide opportunities to learn to problem solve in a number of activities of daily living.
Working at the VA hospital provides SLPs with the opportunity to provide these brave veterans with the treatment and compensatory strategies they need to resume a life that in some ways resembles the one they had before going to war.
Anne’s Pros and Cons of working at the VA
Pros:
The positive impact you have on the lives of veterans
The opportunity to work with adults
Collaboration with other SLPs and medical professionals
The potential to participate in research projects
Access to cutting edge technology
Cons:
Longer work hours
Less vacation time
The “Yuck Factor”
Monday, March 29, 2010
Saturday, February 13, 2010
February 1 Minutes
Minutes of February 1, 2010 Meeting
Guest Speaker
Amber Hogan M.A., CCC-SLP with the Los Angeles Union School District (LAUSD)
Amber is an SLP working in LAUSD, the second largest public school district in the U.S. She is a consultant for Alternative and Augmentative Communication Devices and currently works with 71 clients ranging from ages 3-22.
Amber has over 70 students in her caseload and conducts consultations for AAC devices throughout the week. She works with a range of students in individual AAC consultations, individual and group sessions and classroom integration. Each day presents a new challenge that promises to be new, different and interesting. Visit her Blog and read about what life is really like as a school based SLP in LAUSD.
For more information on Alternative and Augmentative Devices (AAC) and other helpful resources please visit Amber’s Blog Corner at abc4slp.info.
Guest Speaker
Amber Hogan M.A., CCC-SLP with the Los Angeles Union School District (LAUSD)
Amber is an SLP working in LAUSD, the second largest public school district in the U.S. She is a consultant for Alternative and Augmentative Communication Devices and currently works with 71 clients ranging from ages 3-22.
Amber has over 70 students in her caseload and conducts consultations for AAC devices throughout the week. She works with a range of students in individual AAC consultations, individual and group sessions and classroom integration. Each day presents a new challenge that promises to be new, different and interesting. Visit her Blog and read about what life is really like as a school based SLP in LAUSD.
For more information on Alternative and Augmentative Devices (AAC) and other helpful resources please visit Amber’s Blog Corner at abc4slp.info.
Monday, January 11, 2010
Minutes of January 11, 2010 Meeting
Guest Speaker: Susan Simon, M.A., CCC-SLP with the Los Angeles Union School District (LAUSD)
Ms. Simon worked as an SLP for LAUSD for many years, and is now an administrator. She currently supervises 70 SLPs. LAUSD employs 400 SLPs, and is probably the largest employer of SLPs in the state. LAUSD covers 700 miles and includes 8 local school districts.
• LAUSD is the 2nd largest school district in U.S., with 640K students, 82,000 in Special Ed, and 28,000 receive speech-language services
• Urban & suburban experience, and everything in-between; caseload variety, curriculum based intervention
• LAUSD offers employees the opportunity to change to different position – not just SLP – e.g., opportunities to become administrator, or vice-principal, in smaller districts, this would not be possible not the
• For SLPs, the following is offered by LAUSD:
o CFY/RPW supervision, District Sponsored continuing education, Prevention & Intervention Services: focus on RTI, have to prove to a team that you have helped the child (help teachers), Leadership opportunities, Web based IEPs & daily documentation, District provide lap-top, Students with variety of disabilities ages 3-22
• Salary Options for SLP: with MA and CA License $61,433/$70,756 (Special Services pay scale – applies to SLP grads who have never worked as a teacher; however, $70,000 is probably not available for a CFY year), with a credential SLP salaries are $45,637 - $72,592 (based on teacher pay scale, not applicable to new SLP graduates)
o Work 180 work days with 10 weeks off at summer, 3 weeks off in winter, and 1 week off in spring
o By 5th year, SLPs can expect to earn up to $76,000 annually at LAUSD
• LAUSD SLP Employment requirements:
o Online applications
o MA in SLP or ComD
o Eligibility for CA SLP or SLP credential
o CBEST (take it now, your score will last forever)
o Successful interview
• Other requirements: Health & TB clearance, Fingerprint, Transcripts, Employment eligibility documents, Letters of Recommendation
• Other Benefits: 20 paid holiday, 10 illness/sick days yearly (accumulate if not used) can take them to other district in CA, District-paid medical, dental, vision, which includes spouse or domestic partner & dependents; District paid life insurance; STRS membership; Loan forgiveness; LA teachers mortgage assistance; Credit union
• Myth about LAUSD: get lost in such a big district – given your assignment
o Truth: are part of central office, assignments are made from there, and when first start, have intensive training for 2 weeks, when go to school site where you are helped w/scheduling your students
o And once per month, meet with all new trainer, and this goes on for 12 months – have meetings with your trainers, e.g., how to use an interpreter
o Every year, are given an assignment survey – and can ask to go elsewhere
For more information: Susan Simon 213-241-6200; email susan.simon@lausd.net; see also website: teachinla.com/speech
Currently offering $5,000 stipend for 2nd year grad students – if you know you want to work as a public school SLP, interview with LAUSD and, if offered a position (which would begin after graduation), agree to a 2 year work commitment, and you get a check for $5,000.
Guest Speaker: Susan Simon, M.A., CCC-SLP with the Los Angeles Union School District (LAUSD)
Ms. Simon worked as an SLP for LAUSD for many years, and is now an administrator. She currently supervises 70 SLPs. LAUSD employs 400 SLPs, and is probably the largest employer of SLPs in the state. LAUSD covers 700 miles and includes 8 local school districts.
• LAUSD is the 2nd largest school district in U.S., with 640K students, 82,000 in Special Ed, and 28,000 receive speech-language services
• Urban & suburban experience, and everything in-between; caseload variety, curriculum based intervention
• LAUSD offers employees the opportunity to change to different position – not just SLP – e.g., opportunities to become administrator, or vice-principal, in smaller districts, this would not be possible not the
• For SLPs, the following is offered by LAUSD:
o CFY/RPW supervision, District Sponsored continuing education, Prevention & Intervention Services: focus on RTI, have to prove to a team that you have helped the child (help teachers), Leadership opportunities, Web based IEPs & daily documentation, District provide lap-top, Students with variety of disabilities ages 3-22
• Salary Options for SLP: with MA and CA License $61,433/$70,756 (Special Services pay scale – applies to SLP grads who have never worked as a teacher; however, $70,000 is probably not available for a CFY year), with a credential SLP salaries are $45,637 - $72,592 (based on teacher pay scale, not applicable to new SLP graduates)
o Work 180 work days with 10 weeks off at summer, 3 weeks off in winter, and 1 week off in spring
o By 5th year, SLPs can expect to earn up to $76,000 annually at LAUSD
• LAUSD SLP Employment requirements:
o Online applications
o MA in SLP or ComD
o Eligibility for CA SLP or SLP credential
o CBEST (take it now, your score will last forever)
o Successful interview
• Other requirements: Health & TB clearance, Fingerprint, Transcripts, Employment eligibility documents, Letters of Recommendation
• Other Benefits: 20 paid holiday, 10 illness/sick days yearly (accumulate if not used) can take them to other district in CA, District-paid medical, dental, vision, which includes spouse or domestic partner & dependents; District paid life insurance; STRS membership; Loan forgiveness; LA teachers mortgage assistance; Credit union
• Myth about LAUSD: get lost in such a big district – given your assignment
o Truth: are part of central office, assignments are made from there, and when first start, have intensive training for 2 weeks, when go to school site where you are helped w/scheduling your students
o And once per month, meet with all new trainer, and this goes on for 12 months – have meetings with your trainers, e.g., how to use an interpreter
o Every year, are given an assignment survey – and can ask to go elsewhere
For more information: Susan Simon 213-241-6200; email susan.simon@lausd.net; see also website: teachinla.com/speech
Currently offering $5,000 stipend for 2nd year grad students – if you know you want to work as a public school SLP, interview with LAUSD and, if offered a position (which would begin after graduation), agree to a 2 year work commitment, and you get a check for $5,000.
Monday, January 04, 2010
NSSHLA meeting January 11, 2010
Guest Speaker: Susan Simon of LAUSD will discuss the benefits of working at LAUSD
Time: 3:15 p.m.
Place: KHB 111
Time: 3:15 p.m.
Place: KHB 111
Tuesday, November 03, 2009
NSSLHA Meeting November 3rd, 2009
NSSLHA MEETING 11/3/2009: AAC
Speaker: Adam Weiss from Zygo Industries
- his company produces voice output systems, alternative access, environmental control system
- AAC = augmentative alternative communication
- Why do you need voice output?
- Must prove that it is medically necessary to provide a voice output device
- SLP is the one who has to recommend a product for their client, need to document the need for it and choose which device or devices are necessary
- Provided handout about various devices and contact information
- Communication device can provide voice output through digital or synthezed speech.
- Macaw: digital recording device, vocabulary is recorded speech and use overlay to represent vocabulary that is stored on the machines. Symbols can be pictures, letters, graphics, words. Press on a cell and get recorded message that speaks out. Most of the overlays are pictures with text prompts. Can start off with overlay being just message, then increase the number of symbols until client can use many symbols on one overlay. All of the overlays don’t have to be the same layout (i.e. the same number of symbols). Macaw can sequence/combine two symbols to create additional messages. Can sequence up to 80 characters in a row.
- Windows XP tablet computer: dynamic display device. Make choices by touching the screen. Has a 22 GB hard-drive. Can fit more voice recordings and pictures on this device than the Macaw. Don’t have to physically change the overlay. It is cognitively more difficult than the Macaw and may not be appropriate for people who have cognitive impairments. Can plug in a tracking mouse or eye-gaze system if client can’t physically touch icons on the screen.
- PECS: can take pecs symbol and place it on the macaw overlay symbol that it matches and it makes the Macaw do voice output.
- can record various languages on the Macaw. Can use a single overlay but record two different languages for each symbol.
- Pollyanna (text to speech): person is cognitively intact but cannot be understood. Uses deck talk to transfer typed text into voice output. Had word prediction for word you are typing and for the proceeding word. ‘
- Medicare will pay for a dedicated communication device- means that all it is used for is the communication that the SLP recommends.
Speaker: Adam Weiss from Zygo Industries
- his company produces voice output systems, alternative access, environmental control system
- AAC = augmentative alternative communication
- Why do you need voice output?
- Must prove that it is medically necessary to provide a voice output device
- SLP is the one who has to recommend a product for their client, need to document the need for it and choose which device or devices are necessary
- Provided handout about various devices and contact information
- Communication device can provide voice output through digital or synthezed speech.
- Macaw: digital recording device, vocabulary is recorded speech and use overlay to represent vocabulary that is stored on the machines. Symbols can be pictures, letters, graphics, words. Press on a cell and get recorded message that speaks out. Most of the overlays are pictures with text prompts. Can start off with overlay being just message, then increase the number of symbols until client can use many symbols on one overlay. All of the overlays don’t have to be the same layout (i.e. the same number of symbols). Macaw can sequence/combine two symbols to create additional messages. Can sequence up to 80 characters in a row.
- Windows XP tablet computer: dynamic display device. Make choices by touching the screen. Has a 22 GB hard-drive. Can fit more voice recordings and pictures on this device than the Macaw. Don’t have to physically change the overlay. It is cognitively more difficult than the Macaw and may not be appropriate for people who have cognitive impairments. Can plug in a tracking mouse or eye-gaze system if client can’t physically touch icons on the screen.
- PECS: can take pecs symbol and place it on the macaw overlay symbol that it matches and it makes the Macaw do voice output.
- can record various languages on the Macaw. Can use a single overlay but record two different languages for each symbol.
- Pollyanna (text to speech): person is cognitively intact but cannot be understood. Uses deck talk to transfer typed text into voice output. Had word prediction for word you are typing and for the proceeding word. ‘
- Medicare will pay for a dedicated communication device- means that all it is used for is the communication that the SLP recommends.
Wednesday, October 07, 2009
NSSLHA Meeting October 6th, 2009
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Announcements:
- tote bags for sale $10 --> contact Bailey Duemmel to purchase.
- pay for dues for the quarter ($5) or the entire year ($20) ---> Pay dues to May Wu.
- First year graduate students apply for NSSLHA positions. Email Claire at CWbrownie84@yahoo.com
Speaker: Laurie Campbell
- speech language pathologist in hospital setting
- born in Panama, had an active childhood
- currently has Parkinson’s Disease
- her early symptoms were similar to the flu, felt achy
- had bad headaches, neck strain
- she started fainting
- first diagnosed with migraines, put on migraine medication and had a stroke from it
- she had a lot of difficulty getting doctors to take her seriously and properly diagnose her.
- Parkinson’s is a brain disorder that affects the substantia negra
- Caused by a lack of dopamine in the body
- Dopamine doesn’t cross the blood/brain barrier and the body can’t absorb dopamine
- Signs and symptoms: rigidity, slowness of movements, visible shaking/tremors, difficulty with balance, cramping, stiff facial expressions, muffled or slurred speech, depression, dystonia is a symptom for young onset of PD.
- Seeing more of young-onset cases because there is more awareness and research being done.
- PD usually affects people over 65 y/o, 10% of people with PD start having symptoms before 40 y/o.
- There is no test to diagnose PD, it’s a process of elimination
- Those with parkinsonism or the symptoms and signs of PD without the disease itself can be due to medications, drugs, or other disorders or injuries.
- 3 types of PD: young-onset, idiopathic parkinson’s, and secondary parkinson’s
- people with PD become depressed because serotonin levels are also lacking
- because the disorder is progressive, constantly need to change medication as the symptoms change and progress
- as an SLP, should ask at every session if patient with PD has had any falls, if they are taking their medication, what they are taking
- There are no cure for PD, can treat with medications and surgery.
- Exercise slows progression of the disease ---> shown by recent studies, a new phenomenon.
- Treatments don’t slow the progression of the disease, but improve motor function and quality of life.
- However, the benefits gained by these treatments decline as the disease progresses.
- Levadopa helps produce dopamine in the brain and it reduces slowness, tremors, and stiffness.
- Sinemet is an older medication
- Selegiline inhibits the enzyme MAO-B, which breaks down dopamine. Carries some anti-depressant effect.
- There are two types of surgery: Pallidotomy and deep brain procedures. Patients who receive the most benefit from surgery are people with good general health, normal intellectual/memory function for their age, and continue to have benefit from levadopa.
- Pallidotomy destroys a section of the brain and helps with tremors, rigidity, bradykinesia, and levadtop-induced dyskinesia.
- Lee Silverman voice treatment is used for people with PD ---> patient does treatment (talking really loudly) five days a week for an hour plus an hour of homework, 2 hours of homework on the weekends.
- Need to always be aware of what the goals are of the patient
Wednesday, May 27, 2009
NSSLHA Meeting Minutes May 4th, 2009
NSSLHA Meeting 5/4/2009
Speaker: Debbie Schram
- Announcement: Work for Hallmark Rehabiliation for one year after you graduate, and they will pay for your tuition or student loan. You can visit their website for more information at http://www.hallmarkrehabinc.com/
- She has been in recovery since July of 2007
- She progressed into state where she couldn’t communicate with anyone. She didn’t know what was going on.
- She struggled to find the words to use to say “I had a stroke.”
- Has left hemisphere brain tumor
- Gave her 4 months to live.
- She was given signs on paper so she could point to yes, no, right left.
- She had speech therapist that came to her house. She had worksheets for filling out phrases, prepositional phrases, sequencing steps.
- The speech therapy was helpful.
- Her and the speech therapist would have conversations.
- At 18th month, there was a period of spontaneous recovery- she was able to communicate much better.
- She would use content words and leave out all of the function words. At 18 months, she could use more function words so people could understand what she meant.
- Her comprehension is good.
- She participated in a cancer retreat. She was overwhelmed. She was aware of everything that was going on, but she couldn’t understand what was wrong with her and why she couldn’t communicate.
- She could write, but she couldn’t speak.
- She thinks others perceived her to be retarded, incompetent.
- Using gestures, the computer, facial expressions, yes or no questions work well for her.
- She has trouble finding specific words.
- Pictures work well, flashcards that have a picture on one side and word on the other are also helpful.
- DMV, police don’t understand what aphasia is. Using a card that explains her situation helps.
- One thing SLPs can do to help people with aphasia is help the families understand what the impairments are and what they aren’t, what the patient’s strengths and weaknesses are.
- Debbie is in a rehabiliation program at Coastline College for people with brain injuries. Debbie is in the language class. All of her classmates have good comprehension, but poor speaking abilities.
- Her sister, Marilyn, uses various strategies to communicate with Debbie – she can point to an option of 2 things, waiting for a response, not talking too much, not guessing/anticipating what Debbie is going to say, and to not push Debbie to talk.
- Writing is easier for her than speaking. Sometimes the same mistake comes out in the writing as it does in speaking.
- She is good at reading out loud. It is a little hard to pronounce some words.
Speaker: Debbie Schram
- Announcement: Work for Hallmark Rehabiliation for one year after you graduate, and they will pay for your tuition or student loan. You can visit their website for more information at http://www.hallmarkrehabinc.com/
- She has been in recovery since July of 2007
- She progressed into state where she couldn’t communicate with anyone. She didn’t know what was going on.
- She struggled to find the words to use to say “I had a stroke.”
- Has left hemisphere brain tumor
- Gave her 4 months to live.
- She was given signs on paper so she could point to yes, no, right left.
- She had speech therapist that came to her house. She had worksheets for filling out phrases, prepositional phrases, sequencing steps.
- The speech therapy was helpful.
- Her and the speech therapist would have conversations.
- At 18th month, there was a period of spontaneous recovery- she was able to communicate much better.
- She would use content words and leave out all of the function words. At 18 months, she could use more function words so people could understand what she meant.
- Her comprehension is good.
- She participated in a cancer retreat. She was overwhelmed. She was aware of everything that was going on, but she couldn’t understand what was wrong with her and why she couldn’t communicate.
- She could write, but she couldn’t speak.
- She thinks others perceived her to be retarded, incompetent.
- Using gestures, the computer, facial expressions, yes or no questions work well for her.
- She has trouble finding specific words.
- Pictures work well, flashcards that have a picture on one side and word on the other are also helpful.
- DMV, police don’t understand what aphasia is. Using a card that explains her situation helps.
- One thing SLPs can do to help people with aphasia is help the families understand what the impairments are and what they aren’t, what the patient’s strengths and weaknesses are.
- Debbie is in a rehabiliation program at Coastline College for people with brain injuries. Debbie is in the language class. All of her classmates have good comprehension, but poor speaking abilities.
- Her sister, Marilyn, uses various strategies to communicate with Debbie – she can point to an option of 2 things, waiting for a response, not talking too much, not guessing/anticipating what Debbie is going to say, and to not push Debbie to talk.
- Writing is easier for her than speaking. Sometimes the same mistake comes out in the writing as it does in speaking.
- She is good at reading out loud. It is a little hard to pronounce some words.
NSSLHA Meeting Minutes April 13th, 2009
NSSLHA Meeting 4/13/2009
Announcement:
WALK FOR AUTISM April 25th
Register at walknowforautism.org, click on register, create a team or join our team WHEELS ON THE BUS
For more information, email baileyslea@yahoo.com
Topic: AUTISM Speaker: Gwendolyn Meier
- Autism is a spectrum disorder (classic autism -→ high functioning autism -→ Asperger Syndrome)
- A behaviorally defined condition
- Neurological disorder
- Severe impairments in: socialization, communication, behavior and interests
- Need 6 symptoms from 3 categories in the Diagnostic Criteria (DSM-IV): Social interaction (2 symptoms), Communication (1), Restricted, Repetitive, & Stereotyped Behavior & Interests (1)
- Diagnosis usually happens at Regional Centers
- Kids with autism don’t play with toys in the way typical children do: they focus on a specific part of a toy, employ self-stimulatory behaviors
- Idiosyncratic use of language
- Need very structured, concrete activities
- If something unexpected happens in their schedule, they may have a tantrum
- Many will self-stimulate: touch, visual
- Core deficits in Autism: what areas you think are core deficits will determine what you treat in therapy
1.) Joint Attention – poor response to name, lack of showing and sharing; if child doesn’t follow where his/her parent is pointing to, child won’t learn what the referent is.
2.) Symbolic Skills- coming up with the concept for the language referent; symbolic skills are apparent in language and play
- Estimates of incidence of Autism has changed a lot in recent years → could be due to population growth, data collection, investigators, change of diagnostic criteria, migration to CA, change in categorization
- Estimates of incidence of Autism are: 1 in 150 (Autism Speaks, 2009)
4-5/10,000 (prior to 1985)
- Etiology and Suspect Factors: genetic link, comorbid medical issues (GI concerns, sleep problems, allergies/infections), NOT caused by parenting, multifactorial cause
- Possible Triggers: Exposure (in utero, after birth, toxins), immunologic, metabolic, MMR vaccine debate (jury is still out)
- Evolution of Treatment: 40’s and 50’s: removal from home, 60’s and 70’s: behavioral teaching/operant conditioning, controlled settings (food deprivation, aversives, poor generalization), 80’s 90’s and 00’s: “naturalistic” behavioral approaches, natural reinforcers, daily settings, motivation, self-initiation, connection between communication and problem behavior, amount and type of stimulation (debate)
- No definitive evidence for any one treatment approach over another
- SLP Assessment: standardized measures look at language FORM and elicited responses, primary deficits lie in pragmatic USE of language/FUNCTIONS, initiation, and rate of communication, few resources aid us in evaluating pre-intentional, pre-verbal, and nonverbal communication
- Visual schedules: organizes the child’s day, establish routines, predictability, expectations
- Aided language stimulation/visually cued instruction: make language input visual and intransient, provides language model
- PECS: provides means to make requests
- For more information, visit autismspeaks.org
Announcement:
WALK FOR AUTISM April 25th
Register at walknowforautism.org, click on register, create a team or join our team WHEELS ON THE BUS
For more information, email baileyslea@yahoo.com
Topic: AUTISM Speaker: Gwendolyn Meier
- Autism is a spectrum disorder (classic autism -→ high functioning autism -→ Asperger Syndrome)
- A behaviorally defined condition
- Neurological disorder
- Severe impairments in: socialization, communication, behavior and interests
- Need 6 symptoms from 3 categories in the Diagnostic Criteria (DSM-IV): Social interaction (2 symptoms), Communication (1), Restricted, Repetitive, & Stereotyped Behavior & Interests (1)
- Diagnosis usually happens at Regional Centers
- Kids with autism don’t play with toys in the way typical children do: they focus on a specific part of a toy, employ self-stimulatory behaviors
- Idiosyncratic use of language
- Need very structured, concrete activities
- If something unexpected happens in their schedule, they may have a tantrum
- Many will self-stimulate: touch, visual
- Core deficits in Autism: what areas you think are core deficits will determine what you treat in therapy
1.) Joint Attention – poor response to name, lack of showing and sharing; if child doesn’t follow where his/her parent is pointing to, child won’t learn what the referent is.
2.) Symbolic Skills- coming up with the concept for the language referent; symbolic skills are apparent in language and play
- Estimates of incidence of Autism has changed a lot in recent years → could be due to population growth, data collection, investigators, change of diagnostic criteria, migration to CA, change in categorization
- Estimates of incidence of Autism are: 1 in 150 (Autism Speaks, 2009)
4-5/10,000 (prior to 1985)
- Etiology and Suspect Factors: genetic link, comorbid medical issues (GI concerns, sleep problems, allergies/infections), NOT caused by parenting, multifactorial cause
- Possible Triggers: Exposure (in utero, after birth, toxins), immunologic, metabolic, MMR vaccine debate (jury is still out)
- Evolution of Treatment: 40’s and 50’s: removal from home, 60’s and 70’s: behavioral teaching/operant conditioning, controlled settings (food deprivation, aversives, poor generalization), 80’s 90’s and 00’s: “naturalistic” behavioral approaches, natural reinforcers, daily settings, motivation, self-initiation, connection between communication and problem behavior, amount and type of stimulation (debate)
- No definitive evidence for any one treatment approach over another
- SLP Assessment: standardized measures look at language FORM and elicited responses, primary deficits lie in pragmatic USE of language/FUNCTIONS, initiation, and rate of communication, few resources aid us in evaluating pre-intentional, pre-verbal, and nonverbal communication
- Visual schedules: organizes the child’s day, establish routines, predictability, expectations
- Aided language stimulation/visually cued instruction: make language input visual and intransient, provides language model
- PECS: provides means to make requests
- For more information, visit autismspeaks.org
Tuesday, March 03, 2009
NSSLHA Meeting Minutes March 3rd, 2009
NSSLHA Meeting 3/2/09
Anne Preddy
- Works at the VA Hospital in Long Beach → doing CFY
- Sees in-patients and out-patients
- Cognitive evaluation and treatment – see many veterans with mild TBI. Does cognitive therapy and compensatory strategies training
- Swallowing evaluation and treatment – bed side swallowing evaluation, modified barium swallowing test, and FEES (flourscopic endoscopic evaluation of swallowing)
- Speech evaluation and treatment – do standardized and informal assessment, compensatory strategy training, recommends oral prosthesis, electro-larynx
- Voice evaluation and treatment – functional and organic voice disorders, standardized testing and informal assessment, compensatory speech strategies
- Language evaluation and treatment – aphasia from stroke, brain tumors
- AAC and cognitive prosthetic devices- help with speech, memory, organization
- A perk of working at the VA is that there aren’t the funding issues that you normally have to deal with at other hospitals → can get expensive devices easily
- Train families and collaborate with them
- Why work in a hospital?
- great variety
- can work with children and adults, depending on the setting
- colloboration → team of SLPs, interdisciplinary tea, VA hospital system
team
- have flexibility of patients you would like to work with
- learning opportunities and continuing education
- challenging, never boring
- rewarding
- Why not work in the hospital? Long hours, not as much vacation, “yuck” factor
- Email: Anne.Preddy@va.gov → for questions and/or if you want to shadow
her
- What is the paperwork like? Taking her a while now because she is new at it. Everything is computerized. It’s a lot of paperwork.
How much individual vs. group therapy do you do? 80% individual, 20% group. Have stroke group, teaching how to use palm pilots for patients with cognitive deficits.
Blanca Hatim
- works at a highschool in Alhambra
- she likes working at a highschool because the kids can stay still, can have a conversation with them
- can work in public or private school
- district or agency paid
- not hard to find a job → when you do your externship, you will be offered a job
- find jobs at edjoin.org → helpful to start looking now so you get the hang of it
- sign up for Advance magazine → have job postings
Why School?
- kids, competitive salary, 10- month contract, extra pay for summer work, decent work schedule (7 or 8 hour day)
- all student holidays off, full health and medical benefits, retirement benefits, union support, peer support
Downsides?
- school budget cuts → conference and supplies, caseloads (state avg. 55), paperwork, reports (about the same as CSULA clinic)
- paperwork isn’t that bad for her since her caseload is 37 students
- variety of needs → MR, down syndrome, autism, Aspergers, specific learning disability, etc..
Variety of Needs
- work on semantics (vocabulary building), syntax (grammar, sentence structure), morphology (internal structure of words), pragmatics (social skills), voice, articulation, fluency (stuttering)
1st Year Requirement
- called CFY or RPE year
- requires supervision by licensed SLP
Anne Preddy
- Works at the VA Hospital in Long Beach → doing CFY
- Sees in-patients and out-patients
- Cognitive evaluation and treatment – see many veterans with mild TBI. Does cognitive therapy and compensatory strategies training
- Swallowing evaluation and treatment – bed side swallowing evaluation, modified barium swallowing test, and FEES (flourscopic endoscopic evaluation of swallowing)
- Speech evaluation and treatment – do standardized and informal assessment, compensatory strategy training, recommends oral prosthesis, electro-larynx
- Voice evaluation and treatment – functional and organic voice disorders, standardized testing and informal assessment, compensatory speech strategies
- Language evaluation and treatment – aphasia from stroke, brain tumors
- AAC and cognitive prosthetic devices- help with speech, memory, organization
- A perk of working at the VA is that there aren’t the funding issues that you normally have to deal with at other hospitals → can get expensive devices easily
- Train families and collaborate with them
- Why work in a hospital?
- great variety
- can work with children and adults, depending on the setting
- colloboration → team of SLPs, interdisciplinary tea, VA hospital system
team
- have flexibility of patients you would like to work with
- learning opportunities and continuing education
- challenging, never boring
- rewarding
- Why not work in the hospital? Long hours, not as much vacation, “yuck” factor
- Email: Anne.Preddy@va.gov → for questions and/or if you want to shadow
her
- What is the paperwork like? Taking her a while now because she is new at it. Everything is computerized. It’s a lot of paperwork.
How much individual vs. group therapy do you do? 80% individual, 20% group. Have stroke group, teaching how to use palm pilots for patients with cognitive deficits.
Blanca Hatim
- works at a highschool in Alhambra
- she likes working at a highschool because the kids can stay still, can have a conversation with them
- can work in public or private school
- district or agency paid
- not hard to find a job → when you do your externship, you will be offered a job
- find jobs at edjoin.org → helpful to start looking now so you get the hang of it
- sign up for Advance magazine → have job postings
Why School?
- kids, competitive salary, 10- month contract, extra pay for summer work, decent work schedule (7 or 8 hour day)
- all student holidays off, full health and medical benefits, retirement benefits, union support, peer support
Downsides?
- school budget cuts → conference and supplies, caseloads (state avg. 55), paperwork, reports (about the same as CSULA clinic)
- paperwork isn’t that bad for her since her caseload is 37 students
- variety of needs → MR, down syndrome, autism, Aspergers, specific learning disability, etc..
Variety of Needs
- work on semantics (vocabulary building), syntax (grammar, sentence structure), morphology (internal structure of words), pragmatics (social skills), voice, articulation, fluency (stuttering)
1st Year Requirement
- called CFY or RPE year
- requires supervision by licensed SLP
Monday, February 02, 2009
February 2nd, 2009 NSSLHA Meeting Minutes
Speaker: Rebekah Taylor (SLP at a private practice)
- announcement about paying dues, signing up for email, registration
- announcement about free magazine called “Advanced for Speech Therapist” – sign up online or on phone
- Walk for Autism on April 25th →sign up on walknowforautism.org
- look on ASHA website for skills you need to obtain during CFY, gives focus on what you want from the experience
- pay attention to change in supervisor rules →supervisors need to take a class to become a supervisor
- must do everything in BLUE ink for forms for California State Board
- she did CFY in private practice
- environment completely different than what she expected
- works with 2 year old kids
- she felt like she suffered through it
- impossible to get all the information you need in a 2 year program → don’t go into your first year feeling like you have to know everything
- observe as many people as possible to get ideas for therapy
- don’t forget your sense of self, have confidence in yourself
- professionalism isn’t knowing all the answers, but knowing how to find them
Questions:
1.) What should we look for in a CFY? Figure out what you want first, where you want to work, which age group. Ask classmates about the hospitals or schools they work in. Garner relationships with SLPs, network.
2.) How much supervision did you receive? She didn’t get that much. Definitely talk about it with your supervisor beforehand. She had weekly meetings with supervisor, but didn’t have much actual observation. Don’t be afraid to ask for help.
Private Practice
- works at Briggsan Associates.
- Assessment, recommendation, treatment
- Parents are in the room during therapy
- Teach parents how to do therapy/strategies at home
- Work with the family, community in a team
- Initial assessments done as a team →2 people (one person records and interviews and one examines)
- Don’t give formal assessments, very play-based
- Best way to figure out a child is to figure out how they interact
- Giving a test doesn’t really give you an idea of what is going on with a child
- Sometimes give formal tests if school district requires it
- see kids birth-5 years old
Questions
1.) Can you choose the population you want to work with? Can’t get so specific with a specific disorder you want to work with; can choose age range you want to work with. Once you get into a CFY, you can request to your supervisor that you want clients with a specific disorder.
2.) What are the differences in load of paperwork, hours between private practice and school? She works 33 hours. She has 1 on 1 50 minute sessions with the parents. Out of the 33 hours, she has 27 booked with clients. Need to write notes at end of every session. Progress report every 6 months. All private pay; work with regional center, so don’t have to deal with insurance companies.
3.) How much vacation do you get? Vacation is based on hours worked. Get about 2 weeks off. Medical benefits not as great as working in a school.
4.) What is reverse swallowing? Babies stick out tongue to swallow. Can be a problem when you do this after infancy. In same category as tongue thrust.
5.) What problems do 18 months old have? Looking at where they are developmentally. Can work on getting their mouth moving, saying any sounds. Think about what they can do and start from there.
6.) What kind of diagnoses do the kids have? Developmental delay, dyspraxia
7.) What are the symptoms of developmentally delayed kids? Delayed in milestones for speech and language. Ask if they are receptively and/or expressively delayed?
- announcement about paying dues, signing up for email, registration
- announcement about free magazine called “Advanced for Speech Therapist” – sign up online or on phone
- Walk for Autism on April 25th →sign up on walknowforautism.org
- look on ASHA website for skills you need to obtain during CFY, gives focus on what you want from the experience
- pay attention to change in supervisor rules →supervisors need to take a class to become a supervisor
- must do everything in BLUE ink for forms for California State Board
- she did CFY in private practice
- environment completely different than what she expected
- works with 2 year old kids
- she felt like she suffered through it
- impossible to get all the information you need in a 2 year program → don’t go into your first year feeling like you have to know everything
- observe as many people as possible to get ideas for therapy
- don’t forget your sense of self, have confidence in yourself
- professionalism isn’t knowing all the answers, but knowing how to find them
Questions:
1.) What should we look for in a CFY? Figure out what you want first, where you want to work, which age group. Ask classmates about the hospitals or schools they work in. Garner relationships with SLPs, network.
2.) How much supervision did you receive? She didn’t get that much. Definitely talk about it with your supervisor beforehand. She had weekly meetings with supervisor, but didn’t have much actual observation. Don’t be afraid to ask for help.
Private Practice
- works at Briggsan Associates.
- Assessment, recommendation, treatment
- Parents are in the room during therapy
- Teach parents how to do therapy/strategies at home
- Work with the family, community in a team
- Initial assessments done as a team →2 people (one person records and interviews and one examines)
- Don’t give formal assessments, very play-based
- Best way to figure out a child is to figure out how they interact
- Giving a test doesn’t really give you an idea of what is going on with a child
- Sometimes give formal tests if school district requires it
- see kids birth-5 years old
Questions
1.) Can you choose the population you want to work with? Can’t get so specific with a specific disorder you want to work with; can choose age range you want to work with. Once you get into a CFY, you can request to your supervisor that you want clients with a specific disorder.
2.) What are the differences in load of paperwork, hours between private practice and school? She works 33 hours. She has 1 on 1 50 minute sessions with the parents. Out of the 33 hours, she has 27 booked with clients. Need to write notes at end of every session. Progress report every 6 months. All private pay; work with regional center, so don’t have to deal with insurance companies.
3.) How much vacation do you get? Vacation is based on hours worked. Get about 2 weeks off. Medical benefits not as great as working in a school.
4.) What is reverse swallowing? Babies stick out tongue to swallow. Can be a problem when you do this after infancy. In same category as tongue thrust.
5.) What problems do 18 months old have? Looking at where they are developmentally. Can work on getting their mouth moving, saying any sounds. Think about what they can do and start from there.
6.) What kind of diagnoses do the kids have? Developmental delay, dyspraxia
7.) What are the symptoms of developmentally delayed kids? Delayed in milestones for speech and language. Ask if they are receptively and/or expressively delayed?
Monday, December 01, 2008
Professional collaboration and referrals
Notes from NSSLHA meeting, 11-17-08
Guest speaker: Dr. Maryann Abbott
CCS (California Children’s Services) provides medical, OT and PT services for children aged birth to 21, as well as durable medical equipment, with Medi-Cal dollars. Doctors who identify children with physical impairments should refer to CCS. They cover equipment such as wheelchairs, bath chairs, splints, braces, and communication devices. CCS needs SLP referral for communication devices, as well as written permission from doctors. SLP must refer with proof of medical necessity. CCS covers medical aspects—e.g. helping children to walk. The OT/PT at school provides services for access to the curriculum, so the eligibility is a little different than CCS eligibility. A student may potentially be eligible for one (CCS or school services) but not the other. OT’s, PT’s, doctors and case workers work for CCS, so they need to go through a private SLP, a non-public agency or a school to get speech-language reports.
The Regional Center is state funded. Depending on where you live, you are covered by a separate Regional Center. Each is a separate entity and may provide different services. Anyone can refer to the Regional Center for disabilities birth to 3. After the age of 3, services are taken up by the school district. If there is a cognitive or physical impairment, the Regional Center services are life-long. They provide services that are mostly related to daily living, such as diapering. They may cover respite care. They also pay for one conference a year for parents to go to, and after-school activities such as swimming lessons. This may even include transportation.
If a child has a disability, we have to go through CCS, which uses MediCal dollars, to get something like a communication device. If a student has either aged out of CCS or is not eligible for other reasons (e.g., undocumented) the Regional Center may provide services. Neither of these services employs SLP’s directly. It’s great to collaborate with specialists from the Regional Center (e.g., behaviorists) if possible, and have them come to the IEP meetings.
Low incidence disabilities includes: severe orthopedic, vision and hearing impairments. Some federal money is allotted for these students, so larger school districts may be able to purchase devices for these students. For students with autism, we may need to depend more on MediCal dollars or private insurance to cover communication devices. This works the same way as going to the doctor, including co-pay, deductible, and whatever else isn’t covered by insurance (e.g., 20% of cost).
Referrals: We might refer to OT’s if students are having trouble forming letters but can spell. Young children should be sitting independently by 6-7 months. Some children crawl late. Most children are beginning to walk by 12-15 months. Young children rake things in that they want, then use palmer grasp, then pincer grasp. Many children don’t get a hand dominance until the age of 5 or 6 years. There are some good developmental milestones online, but look at the Department of Health, National Institute of Health, or another reputable source. With autism there are usually referrals to OT for sensory integration or motor planning. However, some problems may be due more to attentional problems or sensory overload. Attention spans should be your developmental age, minus one (e.g., four minutes for the age of five), and it is also affected by interest level. If OT’s try something with them but it doesn’t make a difference for their attentional level, it’s probably not a sensory integration issue.
Make sure that you keep within your realm of practice and expertise. If we don’t, we breach ethics and may lose our license. OT’s work on tasks that require physical manipulation, motor planning or sensory integration. In the schools, it’s OT’s (not SLP’s) who provide swallowing services. Physical therapists work on range of motion. On a school campus, they may look at whether students can travel over different kinds of terrain and keep their balance, or whether they need equipment such as walkers or helmets.
Guest speaker: Dr. Maryann Abbott
CCS (California Children’s Services) provides medical, OT and PT services for children aged birth to 21, as well as durable medical equipment, with Medi-Cal dollars. Doctors who identify children with physical impairments should refer to CCS. They cover equipment such as wheelchairs, bath chairs, splints, braces, and communication devices. CCS needs SLP referral for communication devices, as well as written permission from doctors. SLP must refer with proof of medical necessity. CCS covers medical aspects—e.g. helping children to walk. The OT/PT at school provides services for access to the curriculum, so the eligibility is a little different than CCS eligibility. A student may potentially be eligible for one (CCS or school services) but not the other. OT’s, PT’s, doctors and case workers work for CCS, so they need to go through a private SLP, a non-public agency or a school to get speech-language reports.
The Regional Center is state funded. Depending on where you live, you are covered by a separate Regional Center. Each is a separate entity and may provide different services. Anyone can refer to the Regional Center for disabilities birth to 3. After the age of 3, services are taken up by the school district. If there is a cognitive or physical impairment, the Regional Center services are life-long. They provide services that are mostly related to daily living, such as diapering. They may cover respite care. They also pay for one conference a year for parents to go to, and after-school activities such as swimming lessons. This may even include transportation.
If a child has a disability, we have to go through CCS, which uses MediCal dollars, to get something like a communication device. If a student has either aged out of CCS or is not eligible for other reasons (e.g., undocumented) the Regional Center may provide services. Neither of these services employs SLP’s directly. It’s great to collaborate with specialists from the Regional Center (e.g., behaviorists) if possible, and have them come to the IEP meetings.
Low incidence disabilities includes: severe orthopedic, vision and hearing impairments. Some federal money is allotted for these students, so larger school districts may be able to purchase devices for these students. For students with autism, we may need to depend more on MediCal dollars or private insurance to cover communication devices. This works the same way as going to the doctor, including co-pay, deductible, and whatever else isn’t covered by insurance (e.g., 20% of cost).
Referrals: We might refer to OT’s if students are having trouble forming letters but can spell. Young children should be sitting independently by 6-7 months. Some children crawl late. Most children are beginning to walk by 12-15 months. Young children rake things in that they want, then use palmer grasp, then pincer grasp. Many children don’t get a hand dominance until the age of 5 or 6 years. There are some good developmental milestones online, but look at the Department of Health, National Institute of Health, or another reputable source. With autism there are usually referrals to OT for sensory integration or motor planning. However, some problems may be due more to attentional problems or sensory overload. Attention spans should be your developmental age, minus one (e.g., four minutes for the age of five), and it is also affected by interest level. If OT’s try something with them but it doesn’t make a difference for their attentional level, it’s probably not a sensory integration issue.
Make sure that you keep within your realm of practice and expertise. If we don’t, we breach ethics and may lose our license. OT’s work on tasks that require physical manipulation, motor planning or sensory integration. In the schools, it’s OT’s (not SLP’s) who provide swallowing services. Physical therapists work on range of motion. On a school campus, they may look at whether students can travel over different kinds of terrain and keep their balance, or whether they need equipment such as walkers or helmets.
Tuesday, November 25, 2008
Alumni Spotlight: Kristin Reisch, MA, CCC-SLP, Class of 2007
(full article)
1. Where do you work, and how long have you been there?
I work at Presbyterian Intercommunity Hospital (PIH). I completed my externship at PIH and was then hired on as a full-time SLP. I began working as an employee in July 2007. I received my CCC’s last month!
2. Where did you work during your CFY? What is/was like, and how much support (from supervisors, fellow alumni, former professors, etc.) did you receive throughout that time?
I completed my CFY at PIH. It was a challenging experience. Going from being a student to the professional provided some new stresses in my life. Even though I always felt responsible as a student for the decisions I made, the ultimate responsibility lay with my extern supervisor. As a CFY (and now SLP with my C’s) the sense of responsibility for decisions made and their impact on patients was stressful.
3. What is a typical day for you?
Typical? What’s that? In the hospital setting we don’t really have typical days. I work in all areas of the hospital (critical care, intermediate care, acute care, transitional care, acute rehab, and outpatient) and on any given day I may see a patient from each area. The priority of each day is always new evaluations, followed by patients who are NPO, followed by patients on restricted diets, and then patients on less modified diets, with the speech-language/voice patients mixed in. If I have an outpatient he/she will take priority during their appointment time and then I will be back to in-patient care.
One of the benefits of working in a large hospital is the great diversity experienced almost every day with both population and disorder. One of the challenges is not really getting the opportunity to specialize and become an expert in one area.
4. What are the pros and cons about your job?
Pros:
· Educating patients and family re: their impairments; their prognosis, their plan of care, etc.
· Diversity in caseload, e.g., aphasia, dysphagia, apraxia, TBI, RHD, etc. In the hospital I get to see a wide variety of disorders most days.
· Good benefits/pay
· 4 day work week (10 hour days; the days are long but I have an extra day off during the week)
· For the most part the SLP’s at my hospital are well respected by the physicians, nurses, and other staff
· Patients and family who really appreciate the efforts we make to help them improve!
Cons:
· Working weekends and holidays
· Schedule changes throughout the day – so I might start with two evaluations and five therapy sessions, but if new evaluations come in or the patient I want to see is with PT or out for an MRI, etc. the therapy gets bumped – so it is hard to plan the day into a set schedule. (This is typical of acute care, so just comes with the territory.)
5. How long did it take you to feel comfortable/confident with your work?
I have been working at the hospital for about 11 months and am just starting to feel pretty confident. Although to be honest, I still have days or sessions when I feel like I am still a complete beginner. But I can say, after about a year, it does get better!
However, one thing you must always do in any setting is project confidence, regardless of how you feel! Our patients and their family members look to us as the experts and we must present ourselves as such. This does not mean to make stuff up when we don’t know, but to give the best information we have (and we really know more than we might think at first) and then go back with additional information as needed. If we don’t look confident our patients and family members will doubt our skills and expertise and be much less likely to follow through on our recommendations. So always, always, always project confidence!!
6. What is the most memorable moment of your career so far?
The day a former in-patient’s daughter called to thank me for always introducing myself to her dad and for always explaining why I was there. She was so genuinely appreciative of all I had done to help her dad go from NPO to oral gratification.
I treated him for probably about two weeks and each time I would introduce myself to him and his family. I just make this as a habit for each patient and sometimes think they must think I am wacky because I always re-introduce myself. However, patients are exposed to so many therapists, nurses, doctors, etc. in just one day we cannot expect them to remember us. In addition to telling him and the family who I was I always told them why I was there (e.g., “to work on your swallow,” or “to see how you are doing with eating,” etc.).
This daughter’s phone call helped me to know I was doing the right thing in constantly re-orienting the patient to his therapist and the purpose of my visit. Now I never doubt the need to tell them why I am there.
7. What do you wish you learned in grad school before hitting the real world?
I think ultimately I was as prepared as I could be. However, one thing to realize is that in grad school we typically learn all about textbook cases and theory. In the real world, people and their disorders rarely fall neatly into one specific category (e.g., only Wernicke’s Aphasia), but often have components of several impairments. Somehow this surprised me. Real people are much “messier” than the people in the books, be prepared to have to really mix your knowledge base up and blend!
8. Do you have any advice for the COMD students of CSULA (e.g., things to focus on, clinic advice, praxis tips, shout outs, etc.)?
· Buy a good penlight! I am not kidding, spend the $20.00 and get one with batteries that is well made and bright! It is well worth it and far, far, far superior to the cheapie free ones you collect from conventions, etc.
· Use the blue book and the accompanying CD for the Praxis; consider buying a 30 day (or so) subscription to : http://www.nespaexam.com/index.shtml (I really think this helped me), do not study the night before instead eat a healthy and yummy dinner, go to bed early, get to the test sight a little early (not too early!), and relax! You will find you are more prepared than you thought! After it is over, go out to lunch to celebrate!
· Remember grad school is only for two years, your career will be many, many years. You can do it! Team up with your classmates to study and relax together (our class started knitting together!). You are all in this together! Make the most of it!
1. Where do you work, and how long have you been there?
I work at Presbyterian Intercommunity Hospital (PIH). I completed my externship at PIH and was then hired on as a full-time SLP. I began working as an employee in July 2007. I received my CCC’s last month!
2. Where did you work during your CFY? What is/was like, and how much support (from supervisors, fellow alumni, former professors, etc.) did you receive throughout that time?
I completed my CFY at PIH. It was a challenging experience. Going from being a student to the professional provided some new stresses in my life. Even though I always felt responsible as a student for the decisions I made, the ultimate responsibility lay with my extern supervisor. As a CFY (and now SLP with my C’s) the sense of responsibility for decisions made and their impact on patients was stressful.
3. What is a typical day for you?
Typical? What’s that? In the hospital setting we don’t really have typical days. I work in all areas of the hospital (critical care, intermediate care, acute care, transitional care, acute rehab, and outpatient) and on any given day I may see a patient from each area. The priority of each day is always new evaluations, followed by patients who are NPO, followed by patients on restricted diets, and then patients on less modified diets, with the speech-language/voice patients mixed in. If I have an outpatient he/she will take priority during their appointment time and then I will be back to in-patient care.
One of the benefits of working in a large hospital is the great diversity experienced almost every day with both population and disorder. One of the challenges is not really getting the opportunity to specialize and become an expert in one area.
4. What are the pros and cons about your job?
Pros:
· Educating patients and family re: their impairments; their prognosis, their plan of care, etc.
· Diversity in caseload, e.g., aphasia, dysphagia, apraxia, TBI, RHD, etc. In the hospital I get to see a wide variety of disorders most days.
· Good benefits/pay
· 4 day work week (10 hour days; the days are long but I have an extra day off during the week)
· For the most part the SLP’s at my hospital are well respected by the physicians, nurses, and other staff
· Patients and family who really appreciate the efforts we make to help them improve!
Cons:
· Working weekends and holidays
· Schedule changes throughout the day – so I might start with two evaluations and five therapy sessions, but if new evaluations come in or the patient I want to see is with PT or out for an MRI, etc. the therapy gets bumped – so it is hard to plan the day into a set schedule. (This is typical of acute care, so just comes with the territory.)
5. How long did it take you to feel comfortable/confident with your work?
I have been working at the hospital for about 11 months and am just starting to feel pretty confident. Although to be honest, I still have days or sessions when I feel like I am still a complete beginner. But I can say, after about a year, it does get better!
However, one thing you must always do in any setting is project confidence, regardless of how you feel! Our patients and their family members look to us as the experts and we must present ourselves as such. This does not mean to make stuff up when we don’t know, but to give the best information we have (and we really know more than we might think at first) and then go back with additional information as needed. If we don’t look confident our patients and family members will doubt our skills and expertise and be much less likely to follow through on our recommendations. So always, always, always project confidence!!
6. What is the most memorable moment of your career so far?
The day a former in-patient’s daughter called to thank me for always introducing myself to her dad and for always explaining why I was there. She was so genuinely appreciative of all I had done to help her dad go from NPO to oral gratification.
I treated him for probably about two weeks and each time I would introduce myself to him and his family. I just make this as a habit for each patient and sometimes think they must think I am wacky because I always re-introduce myself. However, patients are exposed to so many therapists, nurses, doctors, etc. in just one day we cannot expect them to remember us. In addition to telling him and the family who I was I always told them why I was there (e.g., “to work on your swallow,” or “to see how you are doing with eating,” etc.).
This daughter’s phone call helped me to know I was doing the right thing in constantly re-orienting the patient to his therapist and the purpose of my visit. Now I never doubt the need to tell them why I am there.
7. What do you wish you learned in grad school before hitting the real world?
I think ultimately I was as prepared as I could be. However, one thing to realize is that in grad school we typically learn all about textbook cases and theory. In the real world, people and their disorders rarely fall neatly into one specific category (e.g., only Wernicke’s Aphasia), but often have components of several impairments. Somehow this surprised me. Real people are much “messier” than the people in the books, be prepared to have to really mix your knowledge base up and blend!
8. Do you have any advice for the COMD students of CSULA (e.g., things to focus on, clinic advice, praxis tips, shout outs, etc.)?
· Buy a good penlight! I am not kidding, spend the $20.00 and get one with batteries that is well made and bright! It is well worth it and far, far, far superior to the cheapie free ones you collect from conventions, etc.
· Use the blue book and the accompanying CD for the Praxis; consider buying a 30 day (or so) subscription to : http://www.nespaexam.com/index.shtml (I really think this helped me), do not study the night before instead eat a healthy and yummy dinner, go to bed early, get to the test sight a little early (not too early!), and relax! You will find you are more prepared than you thought! After it is over, go out to lunch to celebrate!
· Remember grad school is only for two years, your career will be many, many years. You can do it! Team up with your classmates to study and relax together (our class started knitting together!). You are all in this together! Make the most of it!
Sunday, October 26, 2008
Susan Simon- Los Angeles Unified School District
(Notes from NSSLHA meeting, 10/20/08)
Benefits of working in LAUSD
• 700 square miles, 670,000 students aged 3-22 with a wide variety of disabilities, 300 SLP’s
• Urban or suburban settings
• Second largest district in USA, after NYC, which means that they can be cutting-edge in some ways with research in conjunction with local universities.
• Caseload variety; normally SELPA pools resources (e.g., DHH students in one district), but LAUSD is its own SELPA, so assignments may be arranged in many different ways depending on your area of interest
• Innovative programs, e.g. 3:1 model therapy:non-therapy, RTI intervention without IEP’s
• New therapist support—this is one of their strengths and one of the most important things for a new clinician. This is more than just CFY supervision, which may be very minimal. LAUSD provides good-quality master clinicians, professional development events, and 3 SLP’s who have part of their job away from the caseload, working with new therapists beginning with intensive training for a few weeks, and continuing supervision all year long. Additionally, you have CFY supervision as well as an administrator who does ongoing evaluation and support.
• Opportunities for advancement
• Good pay, starting at $61, 433 (180 workdays)/$70,756 (210 workdays) with master’s degree and CA license (special services pay scale). With credential (teacher’s pay scale), starting at $45,637-$72,592.
• District sponsored continuing education, where professionals are brought in to the district.
• Prevention and intervention services, following IDEA—to combat the “wait to fail” model, the focus is now on RTI (Response to Intervention) model.
• Web-based IEP’s and daily documentation
• LAUSD-provided laptop
• District-paid medical, dental, vision and mental health for you, spouse and children, as well as lifetime health benefits, life insurance, and STRS (state teacher’s retirement system) membership, which is a powerful pension fund.
• Paid holidays and illness leave—10 days of sick leave each year that rolls over if not used. Districts often don’t tell you that you can take sick leave with you when you leave a school district; it transfers with you to the new district.
• Loan forgiveness programs—up to $17,000 of Perkins Loan forgiven.
• Set of new materials and tests.
Employment requirements: online application, master’s degree, CBEST, letters of recommendation, health/TB clearance, fingerprint clearance, 2 sets of transcripts, etc.
For more information, contact:
Susan Simon, 213-241-3325, susan.simon@lausd.net
Wililam Hatrick, 213-21-5200, ext. 29176, william.hatrick@lausd.net
www.teachinla.com, recruit@lausd.k12.ca.us
Q and A at the meeting:
You can’t request a particular region to work in LAUSD. Assignments are partially based on seniority. If you’re brand-new, you need to stay in one school for at least 2 years. After that, LAUSD tries to give you one school that is based on preference (e.g., region, assignment) and the other is need-based. You will not be asked to drive more than 20-25 miles or sit in a car for too long. They try to keep therapists within the local district within LAUSD or the next one over.
LAUSD no longer hires clinicians on waivers, unless you are currently within a master’s program and that you can demonstrate clinical experience with diagnostics and therapy.
Caseload size- you are part of the union (UTLA) as an SLP, which is pretty powerful. Caseload is protected by union contract under class size. It’s capped at 55 with teacher’s salary, and 68 with SLP’s salary. If you want to take more, LAUSD will pay for it with teacher’s salary table. This is in your employment contract. To handle workload, LAUSD is moving to 3:1 model to help provide some down time.
SLPA’s- there are only 700 SLPA’s in California, but LAUSD is now in the process of hiring them. Because there are so many uncovered schools, children accrue compensatory time that SLPA’s will cover.
Benefits of working in LAUSD
• 700 square miles, 670,000 students aged 3-22 with a wide variety of disabilities, 300 SLP’s
• Urban or suburban settings
• Second largest district in USA, after NYC, which means that they can be cutting-edge in some ways with research in conjunction with local universities.
• Caseload variety; normally SELPA pools resources (e.g., DHH students in one district), but LAUSD is its own SELPA, so assignments may be arranged in many different ways depending on your area of interest
• Innovative programs, e.g. 3:1 model therapy:non-therapy, RTI intervention without IEP’s
• New therapist support—this is one of their strengths and one of the most important things for a new clinician. This is more than just CFY supervision, which may be very minimal. LAUSD provides good-quality master clinicians, professional development events, and 3 SLP’s who have part of their job away from the caseload, working with new therapists beginning with intensive training for a few weeks, and continuing supervision all year long. Additionally, you have CFY supervision as well as an administrator who does ongoing evaluation and support.
• Opportunities for advancement
• Good pay, starting at $61, 433 (180 workdays)/$70,756 (210 workdays) with master’s degree and CA license (special services pay scale). With credential (teacher’s pay scale), starting at $45,637-$72,592.
• District sponsored continuing education, where professionals are brought in to the district.
• Prevention and intervention services, following IDEA—to combat the “wait to fail” model, the focus is now on RTI (Response to Intervention) model.
• Web-based IEP’s and daily documentation
• LAUSD-provided laptop
• District-paid medical, dental, vision and mental health for you, spouse and children, as well as lifetime health benefits, life insurance, and STRS (state teacher’s retirement system) membership, which is a powerful pension fund.
• Paid holidays and illness leave—10 days of sick leave each year that rolls over if not used. Districts often don’t tell you that you can take sick leave with you when you leave a school district; it transfers with you to the new district.
• Loan forgiveness programs—up to $17,000 of Perkins Loan forgiven.
• Set of new materials and tests.
Employment requirements: online application, master’s degree, CBEST, letters of recommendation, health/TB clearance, fingerprint clearance, 2 sets of transcripts, etc.
For more information, contact:
Susan Simon, 213-241-3325, susan.simon@lausd.net
Wililam Hatrick, 213-21-5200, ext. 29176, william.hatrick@lausd.net
www.teachinla.com, recruit@lausd.k12.ca.us
Q and A at the meeting:
You can’t request a particular region to work in LAUSD. Assignments are partially based on seniority. If you’re brand-new, you need to stay in one school for at least 2 years. After that, LAUSD tries to give you one school that is based on preference (e.g., region, assignment) and the other is need-based. You will not be asked to drive more than 20-25 miles or sit in a car for too long. They try to keep therapists within the local district within LAUSD or the next one over.
LAUSD no longer hires clinicians on waivers, unless you are currently within a master’s program and that you can demonstrate clinical experience with diagnostics and therapy.
Caseload size- you are part of the union (UTLA) as an SLP, which is pretty powerful. Caseload is protected by union contract under class size. It’s capped at 55 with teacher’s salary, and 68 with SLP’s salary. If you want to take more, LAUSD will pay for it with teacher’s salary table. This is in your employment contract. To handle workload, LAUSD is moving to 3:1 model to help provide some down time.
SLPA’s- there are only 700 SLPA’s in California, but LAUSD is now in the process of hiring them. Because there are so many uncovered schools, children accrue compensatory time that SLPA’s will cover.
Dr. Susan Downey, plastic surgeon: cleft palate surgery in third world countries
Notes from NSSLHA meeting, 10/6/08
Reconstructive surgery means to restore to the normal form or function (vs. cosmetic surgery). If the lip and/or palate doesn’t fuse, then form and function need to be restored.
Dr. Downey has been on 13 missions to different countries, but most recently she’s been focusing on Ecuador. Organizations she’s been with include Healing the Children, Interplast, and Operation Smile. The ultimate goal is to train people in other nations, and to go as teachers and educators. The type of palate repair surgery developed at CHLA is innovative and is not taught in other parts of the world. The advantage to this is that the muscles are repositioned and the palate is lengthened, which might result in little to no need for speech therapy following surgery.
Cleft lip/plate are among the most common birth defects worldwide, and are increased in areas with poor nutrition- especially folic acid. They affect an estimated 1 in 600 newborns. In some cases, there may be genetic components from smaller mating pools.
The goal is to operate on children or adults at any age. As long as children can eat appropriately, the need is not as urgent as with other surgeries. Palate repair in the US is ideally done at 1 year of age.
The team: nurses, anesthesia, plastic surgeons, medical records/coordinator, dentists, speech therapists, youth from a high school volunteer program, and med students.
Once in-country, Operation Smile does a screening of children. People find out about it through radios, churches, and non-profit organizations in the area. Because there is no back-up if things go wrong, they have to be careful not to operate on people with complicating medical conditions. Then they organize the charts to think about how they’re going to do the schedule of surgery. Because adults wake up slower from anesthesia, they have surgeries first in the day.
The airway is suddenly changed after surgery, so a “tongue stitch” can help bring the tongue forward and children are also placed on their side to help them breathe after surgery.
Operation on a cleft lip may take 45 minutes, whereas palate repair will take about 2 hours.
Some people walk for days and take the bus for hours afterward, in order to come for surgery. Often the father, then, is the one to accompany the child.
In surgery, they work closely with local doctors and anesthesiologists so that they can take over after the team leaves. Unfortunately, they don’t often get long-term follow-up, which is a problem for SLP’s—whose role is most effective when they do education with local professionals.
Operation Smile has training programs in the US also, to bring professionals for training. Occasionally children are also brought to the US for surgery. They often partner a lot with local organizations (e.g., Rotary Clubs, Mormon missionaries) overseas, and people in the community help with translation.
To find out about volunteer opportunities on these trips, consult the Operation Smile website or ask to accompany a speech therapist who has contacts in the community. The best way to get in is to be totally flexible in terms of time and say “call me if you have an opening”. If you speak another language, this increases the likelihood that they will need you. Some countries have stipulations on whether (or how) students can have a role on a team. Most trips last 1-2 weeks, with the first week for screening and the second week for operations.
Reconstructive surgery means to restore to the normal form or function (vs. cosmetic surgery). If the lip and/or palate doesn’t fuse, then form and function need to be restored.
Dr. Downey has been on 13 missions to different countries, but most recently she’s been focusing on Ecuador. Organizations she’s been with include Healing the Children, Interplast, and Operation Smile. The ultimate goal is to train people in other nations, and to go as teachers and educators. The type of palate repair surgery developed at CHLA is innovative and is not taught in other parts of the world. The advantage to this is that the muscles are repositioned and the palate is lengthened, which might result in little to no need for speech therapy following surgery.
Cleft lip/plate are among the most common birth defects worldwide, and are increased in areas with poor nutrition- especially folic acid. They affect an estimated 1 in 600 newborns. In some cases, there may be genetic components from smaller mating pools.
The goal is to operate on children or adults at any age. As long as children can eat appropriately, the need is not as urgent as with other surgeries. Palate repair in the US is ideally done at 1 year of age.
The team: nurses, anesthesia, plastic surgeons, medical records/coordinator, dentists, speech therapists, youth from a high school volunteer program, and med students.
Once in-country, Operation Smile does a screening of children. People find out about it through radios, churches, and non-profit organizations in the area. Because there is no back-up if things go wrong, they have to be careful not to operate on people with complicating medical conditions. Then they organize the charts to think about how they’re going to do the schedule of surgery. Because adults wake up slower from anesthesia, they have surgeries first in the day.
The airway is suddenly changed after surgery, so a “tongue stitch” can help bring the tongue forward and children are also placed on their side to help them breathe after surgery.
Operation on a cleft lip may take 45 minutes, whereas palate repair will take about 2 hours.
Some people walk for days and take the bus for hours afterward, in order to come for surgery. Often the father, then, is the one to accompany the child.
In surgery, they work closely with local doctors and anesthesiologists so that they can take over after the team leaves. Unfortunately, they don’t often get long-term follow-up, which is a problem for SLP’s—whose role is most effective when they do education with local professionals.
Operation Smile has training programs in the US also, to bring professionals for training. Occasionally children are also brought to the US for surgery. They often partner a lot with local organizations (e.g., Rotary Clubs, Mormon missionaries) overseas, and people in the community help with translation.
To find out about volunteer opportunities on these trips, consult the Operation Smile website or ask to accompany a speech therapist who has contacts in the community. The best way to get in is to be totally flexible in terms of time and say “call me if you have an opening”. If you speak another language, this increases the likelihood that they will need you. Some countries have stipulations on whether (or how) students can have a role on a team. Most trips last 1-2 weeks, with the first week for screening and the second week for operations.
Thursday, October 09, 2008
FREE Offers from ASHA!
1. Free 1 Month Trial of NSSLHA/ASHA Website
NSSLHA and ASHA are pleased to announce the launch of a NSSLHA national membership recruitment project on approximately 20 campuses early next month. Both associations, in partnership, will offer CSD students who are not currently national NSSLHA members on YOUR campus, a free, one-month trial subscription to ASHA's web site, www.asha.org .
www.nsslha.org/trial
Please note that national membership is different from a local chapter membership. Please note that access to the site will be available from October 1 – 31, 2008, regardless of the date students register for it, so the sooner they sign up (beginning on October 1), the longer their access will be.
2. Free Mentor Service from ASHA's STEP mentor Program
The Student to Empowered Professional (S.T.E.P.) program offers one-to-one mentoring for students enrolled in undergraduate, graduate and doctoral communication sciences and disorders programs. All students are eligible to apply, however, preference for program placement and matching with mentors will be given to those students from racial/ethnic backgrounds that have been historically underrepresented in the communication sciences and disorders professions. Students are strongly encouraged to
be national NSSLHA members in order to reap the full benefits of the S.T.E.P. mentoring program.
http://www.nsslha.org/students/gatheringplace/
http://www.asha.org/students/gatheringplace/step/menteeform
NSSLHA and ASHA are pleased to announce the launch of a NSSLHA national membership recruitment project on approximately 20 campuses early next month. Both associations, in partnership, will offer CSD students who are not currently national NSSLHA members on YOUR campus, a free, one-month trial subscription to ASHA's web site, www.asha.org .
www.nsslha.org/trial
Please note that national membership is different from a local chapter membership. Please note that access to the site will be available from October 1 – 31, 2008, regardless of the date students register for it, so the sooner they sign up (beginning on October 1), the longer their access will be.
2. Free Mentor Service from ASHA's STEP mentor Program
The Student to Empowered Professional (S.T.E.P.) program offers one-to-one mentoring for students enrolled in undergraduate, graduate and doctoral communication sciences and disorders programs. All students are eligible to apply, however, preference for program placement and matching with mentors will be given to those students from racial/ethnic backgrounds that have been historically underrepresented in the communication sciences and disorders professions. Students are strongly encouraged to
be national NSSLHA members in order to reap the full benefits of the S.T.E.P. mentoring program.
http://www.nsslha.org/
http://www.asha.org/students/
Tuesday, September 30, 2008
Who is "Abby?"
Our "Abby" for the September newsletter was ......(drumroll please)........
Dr. Cari Flint!
Dr. Cari Flint!
Thursday, September 25, 2008
Alumni Spotlight - Cindy Siu, MA, CCC-SLP, Class of 2002
(full article)
Where did you work during your CFY? i worked at Little Company of Mary in San Pedro.
What is was like, and how much support (from supervisors, fellow alumni, former professors, etc.) did you receive throughout that time?
it was very informative and eye opening to get a taste of what responsibilities and duties are required of you in future professional arena. it was a good safe prep ground before entering into a hospital setting on my own. i was allowed to work with variety of outpts and inpts with many neurological, voice, speech, communication problems. the hospital also had a few outpatients who were children so that was fun to also have a diverse variety of ages as well.
Where do you work now? i currently work at little company of mary in torrance.
How long have you been working there? for 5 years, gosh time flies by!
What is a typical day for you at work? this is kind of a general question... but... i'll try to answer as best as i can. i get into work around 7:30/8:00 am, collect my referrals from the printer for the day, then prioritize my evals and treatments. the referrals can encompass anything from dysphagia evaluations, OPMS (a swallowing test), to speech/language/cognitive linguistic evaluations. after i finish with evaluations i proceed onto to priority patient treatments.
What are the pros and cons about your job?
PROS:
1. interdisciplinary team approach with all physicians and therapists working towards benefitting pts' physical and mental health as well as accomplishing their goals.
2. working with great coworkers who are very informative and listen to you.
3. very mentally stimulating and challenging at the same time- learning something new everyday on the job, medically, clinically, etc.
4. it's fun for me deal with different types of personalities on the job... from dealing with aggitated pts, to grateful family members, to educating uninformed nurses, to discussing and working on pt goals with other occupational and physical therapists.
CONS:
1. Nursing is not always compliant and sometimes do not follow through with our recommendations. this happens at all hospitals.
2. Hospital administration is often difficult to deal with for all therapists.
3. sometimes pts stay in 2 patient rooms and that gets a little distracting for my patient to focus on my therapy, especially if her/his roommate has visitors.
How long did it take you to feel comfortable/confident with your work? immediately! j/k i was pretty confident and prepared in regards to my clinical skills on site, i think it took a little bit more time to get used to the procedural aspects and computer system at the hospital. with hospital and paperwork procedures it took me probably 3 months before i was fully comfortable where i was working at.
What is the most memorable moment of your career? probably when i received the "employee of the month" award from among the entire hospital staff/facility. it just validates that i'm in the right profession and that my patients and coworkers appreciate all the hard i do.
What do you wish you learned in grad school before hitting the real world? there are many skills you learn on-site rather than in grad school. i think majority of skills you acquire is based on hands on experience as with most professions. .....mmmmhhh.....i think my graduate program really prepped me for the real world setting.
Do you have any advice for the graduate students of CSULA?
Yes, it's not all about the money as long as you have the passion!!!
Where did you work during your CFY? i worked at Little Company of Mary in San Pedro. What is was like, and how much support (from supervisors, fellow alumni, former professors, etc.) did you receive throughout that time?
it was very informative and eye opening to get a taste of what responsibilities and duties are required of you in future professional arena. it was a good safe prep ground before entering into a hospital setting on my own. i was allowed to work with variety of outpts and inpts with many neurological, voice, speech, communication problems. the hospital also had a few outpatients who were children so that was fun to also have a diverse variety of ages as well.
Where do you work now? i currently work at little company of mary in torrance.
How long have you been working there? for 5 years, gosh time flies by!
What is a typical day for you at work? this is kind of a general question... but... i'll try to answer as best as i can. i get into work around 7:30/8:00 am, collect my referrals from the printer for the day, then prioritize my evals and treatments. the referrals can encompass anything from dysphagia evaluations, OPMS (a swallowing test), to speech/language/cognitive linguistic evaluations. after i finish with evaluations i proceed onto to priority patient treatments.
What are the pros and cons about your job?
PROS:
1. interdisciplinary team approach with all physicians and therapists working towards benefitting pts' physical and mental health as well as accomplishing their goals.
2. working with great coworkers who are very informative and listen to you.
3. very mentally stimulating and challenging at the same time- learning something new everyday on the job, medically, clinically, etc.
4. it's fun for me deal with different types of personalities on the job... from dealing with aggitated pts, to grateful family members, to educating uninformed nurses, to discussing and working on pt goals with other occupational and physical therapists.
CONS:
1. Nursing is not always compliant and sometimes do not follow through with our recommendations. this happens at all hospitals.
2. Hospital administration is often difficult to deal with for all therapists.
3. sometimes pts stay in 2 patient rooms and that gets a little distracting for my patient to focus on my therapy, especially if her/his roommate has visitors.
How long did it take you to feel comfortable/confident with your work? immediately! j/k i was pretty confident and prepared in regards to my clinical skills on site, i think it took a little bit more time to get used to the procedural aspects and computer system at the hospital. with hospital and paperwork procedures it took me probably 3 months before i was fully comfortable where i was working at.
What is the most memorable moment of your career? probably when i received the "employee of the month" award from among the entire hospital staff/facility. it just validates that i'm in the right profession and that my patients and coworkers appreciate all the hard i do.
What do you wish you learned in grad school before hitting the real world? there are many skills you learn on-site rather than in grad school. i think majority of skills you acquire is based on hands on experience as with most professions. .....mmmmhhh.....i think my graduate program really prepped me for the real world setting.
Do you have any advice for the graduate students of CSULA?
Yes, it's not all about the money as long as you have the passion!!!
Saturday, August 16, 2008
The Many Faces of ADHD: Michael Phelps, Olympic Gold Medalist
by Eileen BaileySource: http://www.healthcentral.com
Michael Phelps was born June 30, 1985 in Baltimore MD. He enjoys football, music and video games. He became a professional swimmer at the age of 16. Michael was also the younger male world record holder in modern history. In he 2007 FINA World Championships he won seven gold medals and shattered five world records. At the Olympics in Beijing, he is hoping to break Mark Spitz's record and win eight gold medals. (In the 2004 Olympics, he won eight medals: 6 Gold and 2 Bronze).
Michael Phelps has ADHD. He was diagnosed at the age of 9 years old. Michael's mother, in an interview for WJZ in Baltimore MD., discussed his diagnosis and some of the difficulties he has overcome in his life. Michael was hyperactive as a child, according to his mother he "never sat still, never closed his mouth, was always asking questions, always jumping from one thing to another."
Although he started medication and behavior modification, he stopped medication by age 11 and instead ADHD symptoms were managed through tightly managing his time and swimming. According to his mother, swimming helped because, "it's very regimented. There's time management build into that component, there's set things you do sequentially."
A blog on ADDerWorld.com pinpoints one of the reasons Michael Phelps is a winner is because of his ability to hyperfocus. He is often described as having a laser-like focus when swimming and has a level of concentration not often seen. Michael has the physical characteristics to make swimming the perfect sport, he has the training and the family support. He also has the mental focus that allows him to rise levels above other swimmers and break world records.
As of the writing of this Share Post, Michael Phelps has won two gold medals in the Beijing Olympics, one for the Men's 400m Individual Medley and one for the 4 x 100 Freestyle Relay.
Wednesday, July 23, 2008
CFY and Contract Negotiation
(Notes from July's meeting with Maria Rubalcaba and Carl Borders)
How to manage a big caseload
Organization is the key, because caseloads are always large. Do it in stages, working slowly to see what children need speech and how much. Not every child needs the same amount of therapy each week, whereas others will need more intense intervention. Later in the year, you can begin to thin out your caseload. Observation and assessment will go a long way to keep the caseload a reasonable size. Best practice requires some standard assessment and informal observation to warrant dismissal, although you can also point to their meeting of goals and objectives, or a plateau in performance. Talk to parents about changing service delivery models, which requires an addendum IEP. Help parents know that you are approachable, knowledgeable, and want their child to do the best.
You may not be able to do the paperwork of dismissal until you have completed your CFY and are well-established. Do what is appropriate for the child, and use good clinical decision-making. These might be difficult conversations to have with parents, especially if children have been in speech therapy for a long time. The average special education student costs the district $70,000/year.
As a new SLP, you’ll probably be given a large caseload. Some districts have caps, although the average caseload is 55.
ASHA introduced the 3:1 model, which is three weeks of therapy and one week of assessment (some districts use this). IEP-writing has been changed, in some districts, to required therapy hours per month or year versus per week. This allows you to draw therapy time back for children that are moving toward dismissal or need less time. A lot of this depends on the philosophy of the school district or SELPA that you belong to. Discuss these things with your superiors. Consider the intensity and severity of the disorders of children on your caseload, because this affects your workload level. Diagnosis, level of services, level of impairment are involved. Also monthly meetings, high-profile parents, IEP’s, etc, will take your time.
Having communication with the administration, teachers, and parents will help you on your caseload. A certain tone was set by your predecessor, who may or may not have developed a good reputation for the speech therapist. Be willing to explain your approach and how it may differ from the SLP who came before. These things will take time, and it will be a process.
Look at therapy with a triage approach. Kids with cerebral palsy, autism or unknown disorders have a higher priority than children with mild articulation problems. If you don’t know how to work with a particular student or situation, ask for advice from your colleagues. Move students to a consult model, vs. direct therapy, when possible.
If parents and children are happy, then the administration will be happy with you.
How to negotiate your contract
Negotiating your contract is hard as a first-year SLP. You need to be competent, confident and willing to work hard. Some SLP’s in the schools are on an itinerant contract basis, whereas others are hired by the school district. If you’re not sure where you want to settle permanently, working for an agency gives you a little more flexibility, and may cut through some of the red tape for working out of the state where you got your credential. Working for school districts requires you to honor your contract for the year. If you work directly for the district, collective bargaining units usually include SLP’s. Some districts have SLP’s on a separate salary schedule than teachers, because of the high need. Look at the benefit package (including health insurance) for the various districts in the area, especially if you have a family. If you want to negotiate through an agency such as Progressus Therapy, call to talk about salary, benefits, weekly hours, and vacation time (because you will get sick your first year!). If you are confident and know what you want and what you are willing to give, you will be able to advocate for yourself. Look at the school contracts and ask for something comparable. They will give you whatever they think they will be able to get out of the school district.
Pros and Cons
The school caseload Is variable, which keeps work interesting. Every day is completely different. There is a lot of energy in each day, and you and your kids will become attached. There is constant flexibility and change. You will see children on your caseload with medical problems, such as myasthenia gravis or TBI, and you might be the only one on campus with clinical training in these areas. You make good money for 181-192 days per year, and you don’t need to work weekends and holidays. This makes it a good job for parents. You’ll probably be done at 3:30 or 4:00 each day, depending on your contract, although your first year you will work much more. In the hospitals, you will rarely see things to completion due to death or transition to other settings for further services, and you will work long hours and often weekends.
In either hospitals or schools, you will see a lot of joys and pains of people you’re working with. Find out what your strengths and leanings are as an SLP, and you will find an environment that fits you well. Give yourself the opportunity to explore. You can even work in multiple settings part-time, or work per diem. When you work per diem, you’ll see patients on a one-time basis, or do intake assessments that other therapists will follow up with.
Common mistakes made by first clinicians
- Doing a full assessment for every single child that is referred to you; trying to please everybody by doing more than is reasonable or needed
- Lacking organizational skills; not planning ahead
- Being afraid to ask for help when needed (CFY supervisor, other SLP’s, other specialists in the district, online discussion boards)
More resources
ASHA
See www.asha.org for more information on the CFY. You will get a packet once you graduate.
Speech-Language Pathology and Audiology Board (the board that gives your state license)
916-263-2666
Saturday, May 03, 2008
Gwendolyn Meier on autism
(Notes from April NSSLHA meeting)
Gwendolyn Meier works at Villa Esperanza, which mostly serves children with severe communication disorders (often autism), aged 2-22. Many children come to them because they can’t be managed in their own school district. They have a Speech-Language center adjacent to the school. It’s a very specialized place, because they see very few stuttering or voice disorders, or even articulation unless it is a verbal apraxia in conjunction with autism.
Autism is a behaviorally-defined disorder. There is no medical battery given to confirm it; it is characterized by behavioral symptoms. It was first talked about in 1943. The incidence estimates have significantly increased from 1 in 10,000 in 1980 to 1 in 100 today.
Key aspects of an autism diagnosis:
1) Limited social interaction—including eye contact, response to communication, initiation of interaction (e.g. peek-a-boo)
2) Communication—verbal communication may be disordered, with words used unusually and, the developmental progression won’t be ordered typically. For example, the first words might be requests instead of comments (unlike typically-developing children).
3) Restrictive, repetitive, stereotyped behavior—including self-stimulation. We think this might be due to sensory stimulation, although it may serve some sort of purpose (we don’t know much about this).
Symptoms may appear to different degrees and affect different areas of functioning. There is reduced connectivity shown between brain regions (association tracts); these are underdeveloped and don’t work as a whole system.
The core deficits of ASD affect many areas of function. For example, an inability to shift attention easy can result in stereotyped behaviors. Impaired use of symbols (shared meanings) especially affects abstract concepts.
There are very few standardized measures that look at the core deficits of autism. We know that standardized measures usually look at form and content, which are often disordered. However, this might not be their biggest area of need, e.g. Can they use. back-and-forth interaction with another child?
Language functions, initiation and rate of communication are very different from a typically-developing child. Requests are the easiest to teach, while commenting is much more difficult. Few resources aid us in evaluating pre-intentional, preverbal and non-verbal communication. PECS (Picture Exchange Communication System) is one example of an AAC strategy, but there is little guidance on selecting and implementing such intervention.
Other important factors:
1) Communication mode—e.g. using eyes or sounds to communicate, even if these don’t seem intentional to a casual observer
2) Rate—we need to look at rate of initiation vs. response. Do we need to ask questions differently in order to get a response?
3) Communicative functions—do they comment/show/share at all? These may be absent, especially for younger children
a. Request
i. Object/activity
ii. Information
b. Response
c. Comment
d. Express feelings
e. Prosocial statement
f. Conversational skill
4) Non-verbal communication—eye gaze and facial expression for social regulation, regulating interaction, gaining info—e.g. looking at someone for a request to spin around
5) Social communication—the most basic is back-and-forth between mom and baby’s smiles, up to more abstract, such as appropriate ways to interrupt mom when she’s on the phone. A high-functioning intervention are “social inferencing” questions. Register-switching is also under this category.
6) Language content and form—although the more foundational skills are basic turn-taking and conversational abilities that enable them to make friends and have interaction!
Aided language stimulation/visually cued instruction—gives visual cues along with oral language input, building off their visual sense and using an intransient form of communication.
Assessment:
- Context- have natural communication exchanges (Wetherby et al. 1997)
- Who the individual is interacting with
- What cueing is helpful; including what parents are doing
- Motivation to communicate
- Hidden abilities or inroads—where can these kids function? Some grow up and write that actually, they understood much more than we realized. Non-verbal children may learn how to type or use visual forms of communication.
- Multiple sources of information, such as interviews with parents or teachers, observations of everyday situations.
Treatment
1. Functional communication (basic wants and needs)—including understanding of cause and effect, reducing learned helplessness by reinforcing any type of communication. For the adult, these skills might include toileting skills, identification of feelings, school readliness, yes/no responses, labeling. However for the child, these are most likely to be foods, toys and activities at the very beginning.
2. Initiation and Motivation
Motivation drives communication—first teach cause and effect, then expand communicative functions. Increasing functional equivalents to challenging behavior have been shown to reduce such problems. Find out what is reinforcing and personally meaningful to the child.
3. Language development
Language is learned in interaction with others. Competence is much more than vocabulary and sentence structure; we want to teach warm communicative interactions. Pragmatic functions make children stand out vs. blending in- much more dramatically than proper grammar or complete sentences. Interaction skills may be more important to real-world functioning than other language skills.
4. Plan for and practice generalization from the very start.
Online resources:
Indiana Resource Center for Autism
http://www.iidc.indiana.edu/irca/IRCAarticles/fcommunicationarticles.html
Susan Stokes Autism Articles and IEP goals
http://www.specialed.us/autism/index2.htm
Autism Inspiration Sensory Ideas
http://www.autisminspiration.com/public/department44.cfm
WIRED magazine article
http://www.wired.com/medtech/health/magazine/16-03/ff_autism
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