Megan Berg 0:03
All right, welcome, everybody to the very first episode of the pediatric SLP edition of the resource roadmap show. This is something brand new, we’re doing here at therapy insights, I think we’re all feeling a little nervous and a little excited for it. Because it’s something brand new for us. It’s the result of years of feedback that we’ve gotten from members, requesting that we offer more resources and information on how to use our materials. And so that’s what this show is all about. So for most of you listening or watching, you know that we release new content into our library every month, and members vote on what we create next. And so on the first of every month, we’re going to drop a new episode into YouTube, or the a podcast on Apple podcasts, Google podcasts, and on Spotify. So you can catch it on any of those places. And we’re going to be talking about all of the new releases. And then we’ll also be talking about a case study. And that’ll give us a chance to talk about different clinical opinions, perspectives, ideas, and also pulling in resources from the library from the archives. So if you are subscribed to the access pass, and you have the printables feature included, you’ll have instant access to all of the resources that we’re talking about today, as well as hundreds more that are inside of the library. And if you’re not a member, you can sign up anytime at therapyinsights.com. We also offer Asha CEU credit for watching or listening to these shows. And so to get those credits, you just go to our website, you need to have the CEU feature included in your access pass membership. And then you find this episode, this is pediatric SLP edition episode number one, and you’ll just get a couple of questions. I can get your certificate. Um, so I’m your host for today and today only. My name is Megan Berg. I’m the founder of therapy insights. I’m a speech pathologist located in western Montana. I spend most of my time running therapy insights, but I also work appear in at a hospital a couple days a week right now. And I’m very excited to introduce you to the pediatric SLP team of therapy insights. These are the people in the trenches doing the work with all the experience with pediatric speech pathology, which I have very minimal experience. I survived one year as a school SLP outside of Fort Collins. So yeah, I’m excited for you guys to meet these three lovely women. And I’m going to start with Bailey Womack, who will be your host going forward. And Bailey is I think, located in her heart. She’s located in Nashville, but physically right now she’s located in Austin, and she has a new baby. So she’s navigating new motherhood. And I know she also has plans developing to start an outdoor preschool, which I think will be really cool. So Bailey, tell us a little bit more anything else you want us to know about your SLP life or otherwise?
Bailey Womack 3:06
Yes, thank you, Megan. Yeah, she said, My husband and I just had a baby last year. So that’s been awesome and cool being on the side of it kind of like as an SLP, but a parent. And yes, the algebra preschool, we are developing that and I’m trying to kind of tie in speech pathology with that, and make it all inclusive for anybody to come. And yeah, I’m just enjoying new motherhood and a new city. Austin is very similar to Nashville, which is great. But yeah, and then I also was in outpatient clinic doing feeding, mostly feeding therapy and speech language therapy. And I’m trying to kind of dive into private clients, hopefully soon. So that’s kind of where I am with my job. And all the work I do at therapy Insights is awesome. So thank you, Megan.
Megan Berg 3:55
Thank you. And then we have to Tasanyia Sebro-Calderon, and she is located in Brooklyn. And she is a mom. She is a foster mom. She is working on her PhD. You recently finished your clinical science degree, is that correct?
Tasanyia Sebro-Calderon 4:13
It’s a clinical science doctorate.
Megan Berg 4:16
Thank you. So every time I talk to you, I’m just like, in awe of everything you’re accomplishing. But yeah, tell us anything else you want everybody to know about you.
Tasanyia Sebro-Calderon 4:25
So I have I can’t believe I’m saying it. But over 15 years of experiences in life licensed SLP I can’t believe it’s 15 years already. And I am currently the director of pediatric rehab at a facility in New York. I enjoy international and domestic pro bono work. There’s a lot of children and adults locally, who don’t have access to services for various reasons. So it’s one of the highlights of what I do. And I have a private practice. I added service people across the lifespan.
Megan Berg 5:04
Great, thank you. And then we also have Heidi Miller, who is located in Virginia, she is a mom of a three year old and stays very, very busy. We were just talking about a full month of high acuity high volume patients at the facility where she works. So Heidi, tell us a little bit about yourself.
Heidi Miller 5:23
Um, well, I at a college, I actually was a special education teacher. So I sort of started there did a lot of work with on the autism population through schools. And then, you know, I’m always up for new challenges. So went back to school, after I was married, and everything and got my speech pathology degree. So I’ve been a speech therapist exclusively now for about five years, and I’ve kind of worked in a variety of settings from the schools to outpatient now, I’m inpatient, and all if pediatrics so I, yeah, that’s what I write. And I work in the NICU as well. So I’m doing a lot of babies here. So and then I got involved with therapy insights a few years ago, because I really, I think a lot of resources and education available in our field is not very responsive to the needs of clinicians, or to multiple, multiple types of people or practice areas. So I think this is a really exciting to kind of be able to talk through things. Because I also know some of the resources I work on don’t always in my brain are one way, but when you talk about it out loud, it makes more sense to me. So this will be awesome. But yeah, fantastic.
Megan Berg 6:39
Yeah, I’m excited to hear both of you just talk about how you would use the resources. And every time I hear any of the writers talk about that I’m always like, I never would have thought to use it that way, or that’s a different approach that just hadn’t come to mind. So we do want to verbalize our disclosure, since we are offering this for Ashesi use. So everybody here is being paid by therapy insights to present this show. And we are talking about therapy insights products. Um, and with that we’re going to dive in, we have a great lineup of resources from the cycles approach to social skills to disfluency strategies in the classroom. So what I’m gonna do is pull up the resources on the screen. I know if you’re listening on a podcast, you’re not going to be able to see this, but you can always go back and find it on YouTube or find it on our website. Each little video clip will also be on each resource page on our website. So you can find it that way. And we’ll do our best to describe what we’re seeing if needed. Okay, so the first resource we have up is WH question flashcards. And I will pass it off to to Tasanyia who wrote this resource.
Tasanyia Sebro-Calderon 7:55
Okay, so when writing resources, I try to create something that can be used to target multiple goals, if possible. And this is one of those resources that can be used for targeting both receptive and expressive language goal areas. So the way in which I would use this is, if I have, for example, a child who’s working on a receptive goals, I might have them work on pointing first, so I might present first of all, I cut this out, and I would fold it so that the pictures from the front and the wordings in the back, and then I would present the card and I’d ask the child to point to whatever I’m asking. So for the first one, for example, I’d say who is eating or who’s eating. And I’d, I look for a response where the child would point to the figure of the man in the image. And then sometimes you might have to give handled by hand assistance depending on the child’s functional level. So it might be way, you have to hold the child’s hand and have them point use your finger. If this is the case, to point to the data in the image. Same thing for something like who is sleeping, if you are working on an expressive, expressive goal, you could have your you can have the little one, voice this or verbally express this. They could say the man is eating they can say dad is eating. You could have them just say single word utterances, you could work on the length of utterance with this. So this is what I mean by using the resources for various various goal areas. If we turn can we turn to another one? Oh, this is the only one that we have. This is the only one okay, that’s fine. That’s fine. You can also address if you’re working on pronouns with this, you can have them work on he and she. But the point is that I would use it in that manner. So I would begin by having them use one word utterances if I was working on an expressive goal, and of course, you’re also working on them comprehending the major questions as well with this with this resource.
Bailey Womack 10:27
And just to chime in, if that’s okay, I don’t want to interrupt Tasanyia, I was kind of thinking we’re always like looking for ways to use the resources differently. So like, even like laminating them, and hiding them in like a sensory bin or putting them in eggs or something is like a scavenger hunt, I guess, to just kind of make it more engaging for them to if especially if it’s a younger child, just something to think about.
Tasanyia Sebro-Calderon 10:50
Yes, I’m glad you brought that up, because I love to laminate these, the resources. But you can also work on inference with this as well. So like, what the why question, if you’re asking, Why is he crying, of course, we can say because he fell down. But we also have we can work on, we can infer that he’s, he’s crying because it hurts. So we can also take these resources to that level and work on other areas as well.
Heidi Miller 11:18
I really like how our designer Megan, like how the pictures like that’s one of my biggest frustrations with a lot of materials for pediatrics is they’re not real picture. They’re cartoons, or they’re very, like flat, almost, there’s not a lot else. But you know, it’s a picture of a kid sitting at the beach. And it’s a cartoon stick figure. So I think that that’s something I really liked about how these cards turned out from the design end is that they’re more realistic. And there’s like you’re saying, there’s more you could talk about from each picture, it’s not just a closed set of one answer is correct, or there’s only one way to use them.
Tasanyia Sebro-Calderon 11:59
And the pictures can actually help you teach the concept of who, what, where, why. So like for the WHO picture who is reading, for example. So I would start as SLP, if the child I was working with didn’t understand what who meant, I may start by pointing out and teaching it first. So I might say this is a teacher, this is a student, these are the students, this boy, you know, there’s so much you can do with language, this boy, there’s a boy in a red shirt, there’s a girl and picture, there’s so much you can do. But the point is that I might say, this is the teacher, there are three girls, there are two boys who is reading, you know, I might start from there to build off of who, or I might just say right out, depending on the child’s functional level, I might say the teacher is reading to the students and I will say who is reading, you know, so it depends on the child’s needs and their functional level, you can you can actually teach the concept of it as well with these cards, rather than just practicing understanding and use of it.
Megan Berg 13:04
Great, thank you. Okay, let’s move on to the second new release for the month. And this is all about the cycles approach for speech, sound disorders. And Heidi wrote this piece.
Heidi Miller 13:19
Yeah, so um, I got this idea. I remember, like, in grad school, a few, you know, cycles approach was one of the more researched ones, it felt like it had a little bit more of a formula to it, versus some of the approaches are research based evidence based practice, it does still feel a little bit big. So I was trying to incorporate making this just an easy way, it would just be something you could just print out and fill out for any kid or, you know, you could start to get, you know, a file folder of like, what you would do if the kid had, you know, the G folder for the GUS sound or whatever. So you could really build this up or build it out. Or the other hope is that by using it frequently, you don’t actually have to sit down and maybe plan it out as much you kind of get to the point where you’re used to using this format. And so you can kind of operate more on on the fly with it. As well thinking I do work with a lot of graduate students that work with me. And so a lot of times you I tried to I really appreciate how the team came together because we were able to make it functional but easy to use, so that for those younger clinicians, you really can just kind of plug this in and go to work with it. Or you could use it as a teaching tool if you were working with a graduate student or in a graduate program, I guess as well. So it kind of outlines the dosage here because per research, this is kind of what they outlined. We want you to target one sound at a time. These are it gives you some ideas for like how long the cycle lasts or how long the sessions can last. I tried to touch on to like this one works in multiple settings? Or how could you modify it to work, you know, if you’re a school therapist, you don’t have a 45 to 60 minute session to sit down with somebody and do every part of this. But if you saw them every day, could you cycle through it that way. So that’s another way to think of it. It goes through kind of what kiddos on your caseload would be good fits for it, they have a lot of errors. And it’s not all just focused on one speech sound, it seems like there is the overlying font phonological issues as well not just maybe like a motor based issue. Some the data, it kind of helped me dive into the data, it doesn’t kind of have a mixed bag on whether apraxia works with this or not. But again, it doesn’t mean you can or shouldn’t use it, it’s just saying like trying to give you a place in this resource to see what the newest research is saying. And again, it points out not a good approach to be using if the child has like a cranial facial anomaly where you’re kind of asking them to do something they’re physically incapable of, so this wouldn’t maybe be a fit for that.
Heidi Miller 16:08
And I think the first page here like that showing is it’s just kind of a catch all of all the things that I know, you should know off the top of your head, but we can I mean, we see so many kids and so many, such a diverse caseload, no matter your setting. So it kind of helps to have it all in one little place that you can just reference there on the first page with all the language and talks through what sounds to start with and what you should expect. And then, as you flip to the next pages you’re seeing like, you can fill in the words that you want to target in a given session, which you first start with reviewing the words you did the time before, if that’s applicable, if not, you would skip that part. Then you pick your phonological process for the week and kind of pick some words that way, this resource can kind of just be sitting on your clipboard beside you or wherever you are. Or, if you wanted to, you could plan this and then make appropriate flashcards or picture cards depending on if the child is literate or not, and can read it and again, it talks remind you during the next phase, and it gives you the time for five minutes, the child doesn’t have to be just staring at you saying these words, you’re kind of playing and doing something else and they’re just listening to you say them, then it goes into the 10 minutes of production via play. So then you’re helping the child actually practice five of the words that you’re working on. So we have another sheet that has the flashcards you can make for them. And again, be flexible, some kids, it’s not going to be helpful to have the word written as well. It’s just maybe a picture, they could make a picture, you know, you can make it pretty interactive. If you have a kid that needs something else to be doing. It’s like, hey, let’s make the flashcards together. And then there are words, and then you can take them home or do whatever. So that’s kind of another level they could add. And then kind of having that direct drill practice phase as part of this approach. So just saying that, the more attempts, the better and you try to slowly through more free for how through the higher frequency, you get closer and closer to the target sound, and then tells you part six, you go back up to part two and do that again, and then have kind of a walk away homework or home practice, which could be the flashcards that you made or if you had another list of words to give to parents. So yeah, I think I just this resource is meant to kind of make a vague, it’s not vague, but a big a big evidence based practice in articulation and phonology down to something you can just grab and go and use as you need and kind of keep in your library as a way to target these kids with multiple errors. So
Bailey Womack 18:57
Heidi, this is awesome. It’s sorry, Megan, I don’t mean to cut you off. I feel like there was a time recently when I was working in outpatient where I was getting this wave of kids with phonological or speech sound disorders. And the evaluating clinician would say, Oh, I think the cycles approach would be appropriate for this child. And I don’t know about you all, but I did not receive adequate training and cycles approach. I needed some guidance to know how to implement it. And I wish I had this at the time. And I always make binders for kids with the use the cycles approach. And just like having this in the front, like you said in a binder for me to kind of just like reference when we start the session because I would have the child bring the binder back and forth like from home to therapy. So I feel like this would have been super helpful. So I just think this is very well laid out. It’s very clear. So it’s great.
Megan Berg 19:51
Yeah, I love that. If you had never done the cycles approach, you can grab this resource and figure it out or if you’ve done a bunch of times and you feel comfortable with it. still a nice way to organize what you’re doing. All right, moving on to resource number three, this is all about SLP and OT feeding collaboration to Tasnyia tell us about this resource.
Tasanyia Sebro-Calderon 20:15
Um, so the reason why I thought about this one is because an aesthetic that I work in, when it comes to feeding therapy, it’s really helpful to have that collaborative approach between OT and SLP. Especially when you want to work from like a holistic standpoint, to try to help to try to help the patients make faster, or more or greater levels of progress. However, the thing is that a lot of pushes on know how to collaborate or where to start with collaborating. So it was just like, just a quick list of things that you can, you can do to collaborate. And it can be used by to your staff can be used by interns, or by just clinicians who don’t know where to start. And I also like that I like to have resources that families can use to advocate. So sometimes families want a guideline to know, how can what steps with the coalition’s do what should I look out for how can I help guide my child therapists to with interventions for them? So? Yeah, it’s just basically a checklist. And you can also use it. Maybe start with one and use it for goal building. So on the first few days of the session, you’ll work on doing the first three on the list. You know, it’s just there’s a lot of flexibility you can do you can use with this with this specific resource.
Megan Berg 21:48
Yeah. And I just thought of a question. Sorry, off the cuff question for you all. Because you mentioned this is a resource that could help parents, guide therapists, and I saw something the other day, that was basically posing the question of Do parents ever come to you with resources, or papers that they’ve read, like peer reviewed journal papers? or anything where they’re trying to give you feedback on the evidence base, or the approach that should be used? In how what do you deal with that? How do you handle it?
Tasanyia Sebro-Calderon 22:28
Well, yeah, that does happen. Sometimes they’ll come either from someone else’s experience, they’ll say, Well, my, my friend’s son’s therapist tried this with them. Or, you know, I saw this on social media. And depending on what it is, I will, I will be open to incorporating it if it’s if it’s functionally appropriate, if it’s safe. If it’s something that’s not really evidence based, I might explain that. Or if it’s something that I think would compromise their progress, I would I pretty open with the patients in the family I work with i i Just tell them that, you know, it’s not something that I think would be feasible at the time, and I explained why, but it does happen sometimes. And I think it’s always coming from a good place, at least in the experience I’ve had, it’s never been like, you know, with Mal intent. Unlike some of the nurses, I think some of the nurses get, you know, I was a nurse before and this is how it’s a little bit it comes off differently. I think when they approached us with it, it’s just like, you know, just trying to get those, those goals achieved faster and better.
Heidi Miller 23:37
I think feeding therapy, in particular in the pediatric world is ripe for social media, like exploitation of like parent fear and parent stress. And I would say it’s that kind of, like you said to Sandy, I like it’s one of my least favorite, you know, it’s that area and our field I feel like are really, it’s easy to get off track as a new clinician, or as a parent Googling, like, my kids disorder or syndrome, and you kind of get into these really niche things. And then at the end of the day, the evidence based practice is just whoever has the best website, or you get a certification that you paid, however much for so I think that resources like this that we create, are helpful to say like, this isn’t accessible to anybody and like you’re saying we’re responding to the child as well. But I feel like what your question again, it’s kind of fun. Yes, I would say mostly I’m getting stuff parents are saying, well, I read on social media, or this mommy blogger or this mommy Instagram account told me I needed to be on organic formula. What do you think about that? And I’m like, That is way outside of my realm. But you know, let’s try to come And teach them as well like how to critically analyze maybe all the input they’re getting about pediatric feeding when they open up Pandora’s box of social media.
Tasanyia Sebro-Calderon 25:10
Yeah. And it happens a lot with feeding, like you said, feeding swallowing. And with anything that pertains to children who are diagnosed with ASD, we get a lot with those, those areas. But you know what the thing is, the reason why I don’t try to the reason why I try to be cautious in the way that I approach it with the families, is because, like you mentioned, Heidi, like, when it comes to determining what’s evidence based out there, it’s a little biased sometimes. And I think, within our field, it’s a relatively new field. Still, as far as like how long it’s been in existence. And we just don’t have that much research, we don’t have a lot of researchers. And we tend to dismiss a lot of things because we say it’s not evidence based. So I just try to be cautious in the way I approach it. But I do agree with you, that it helps a lot to help them with like problem solving. And like, you know, just being more critical of it and helping them to understand how it could potentially negatively have negative impacts on your children’s versus the positive impacts that they’re actually seeking.
Megan Berg 26:24
Yeah, I think you’re right that, especially with Feeding and Swallowing, and autism, those are areas where families are very vulnerable. And SLPs are very vulnerable right now. You can pay 1000s of dollars for certifications, and there’s a lot of silver bullet solutions being offered. And I think like what Dasani is saying that field is very young, the evidence base is very young, like we’re just babies as far as the profession goes. And so the field is ripe with a lot of for profit companies or individuals trying to take advantage of that situation. So I think it’s important to think critically, as an SLP. And then like, you guys are saying help families do that as well.
Bailey Womack 27:12
Maybe Tasanyia, just to add quickly, do you find that when when parents do come to you like, Oh, I saw this on social media? Like, is it more argumentative? Or are they like, like receptive to what you’re saying, I love it, they bring it to you all, and ask those questions rather than just like, kind of blindly believing whatever they see on social media. So do you find that they listen to you, and they’re receptive for the most part?
Tasanyia Sebro-Calderon 27:37
I feel like they’re receptive to it, I feel like when they’re coming, they’re just really eager to get something that quote unquote, works, you know, they’re trying to, you know, they try to have their child many times fit into a bracket of what society calls normal. So they’re just trying to seek something that that society has told them will help their child to reach these levels that, that they want, many times for them to fit into. And oftentimes, when they do approach me, it’s, it’s from a good, it’s from a good place. And they’re, they’re very receptive to the feedback.
Heidi Miller 28:14
Yeah, I think most of the time, it’s, it’s, it’s asked us a question, have you ever heard of this? Or could we try it? And so you can sort of answer that and say, Sure, I mean, unless it’s dangerous, obviously, you know, let’s try it or let’s, again, teaching those skills to say like, Hey, you might read something different next week, or hear something different from another source. But here’s how you could think through does this work? Kind of going back to the strategies we know, especially with feeding like, is it improving their tolerance? Or is it improving their safety with it, you know, so kind of me using it to empower the parents and caregivers and say, I appreciate your initiative to like, go out and find this, like, I had never seen that. And then kind of working backwards that way. But yeah, it’s never really argued everyone, I don’t want to say it’s never been argumentative. But that’s not generally how it’s feel.
Tasanyia Sebro-Calderon 29:09
Yeah, I’ll tell you, when it becomes a little bit more difficult for me is like if I do if I’m doing like an international event, and there’s just really limited resources. And, you know, in those situations, sometimes, you know, it becomes a little bit more difficult because you kind of, I don’t know, I kind of have to work with what they have to adapt it to what you know, as evidence. I don’t know how to explain it. But those are the only situations where I can think about where, you know, there might be the response might not be as kind from the families and it’s really because the resources are just got bigger, and what you’re bringing is not something that they’re always going to have available.
Megan Berg 29:59
Thanks for taking my off the cuff question, we’ll move on to the fourth resources that we have released into the library this month in this is written by Heidi. And it’s called self advocacy statements, social skills worksheet for neurodiverse teens.
Heidi Miller 30:16
Um, so we’ve been getting a lot of feedback, it seemed like for like more stuff for older kids and teens. And, you know, at that point, you’re assuming they’re verbal, on some level based on the feedback we’ve gotten for the, the, you know, what do we do with these kids? How do we get to a point where we’re doing something super functional, but also, that’s responsive to this new, I don’t want to call it a new neurodiversity movement. But I think you all know it, you know, that’s kind of a trending theme in our field as like, we shouldn’t be teaching kids social skills that meet the criteria for one culture, or one idea of what is the right way to communicate. So that’s kind of where the seeds of this activity activity yeah came from. So I like things to be organized. So I kind of sort of like the WH questions I just started there, like, what are questions we could have? How would you know, this is a good resource to use for someone on your caseload. So definitely more of one for our verbal friends, people that are, you know, kids that are chatting and talking. And then, you know, it’s important in I think, in our field, to teach the reasoning behind what we’re doing, we’re not asking them to say, Okay, now we need to master self advocate advocacy statements, it’s like, let’s teach them what that is. And what that means, because maybe they’ll intuitively or independently generalize that to some other part of their life or interaction that were not part of. So kind of thinking it the what is teaching them what it is, when to use it, I think that’s a big piece kind of moving away from like, you’re either interacting correctly or incorrectly with a typical neurotypical person, it’s saying, this is fine. I mean, I could use these as well.
Heidi Miller 32:07
And I’m not a neurodiverse team, you know, like, I feel misunderstood, or I’m having trouble communicating my point, these would be a good strategy to use to maybe get through to my communication partner, where anytime, any, anywhere, anytime, like I said, I could use more of them probably in my work life, even interacting with coworkers stuff, too. So it’s not just for teens, but um, why? Why are we focusing on this, I think nothing makes my skin kind of crawl a little bit when I was in the school world, when I would get kids or in outpatient as well, from a former therapist, that they came to me and I was like, we’ll make eye contact for five minutes. And it’s like, I don’t want to do that either. Or, they will engage in back and forth conversation, like trying to get, you know, for three interactions, it’s like, let’s find goals or activities that are more vibrant and functional and meaningful for this type of kiddo, because if you’re in a school setting, and you’re working in the older grades, I mean, this is something a lot of the kids I think on your caseload would have definitely in the autism population, this is helpful. And then kind of built out this worksheet again, it’s just have as a resource to kind of make it more salient way to go through this like, okay, the child, you know, you could work on me, it’s all just talking, you don’t have to write anything if you didn’t want to, but kind of talking about what’s an I need statement? And those are, you know, okay, that’s a self advocacy statement, because there are needs that people don’t all you know, kind of work on perspective taking, they may not know what you need, everyone doesn’t know what someone else needs in a situation. So just saying that can be really empowering for both the person you’re working with, but also for them, and the people they’re trying to interact with. So how many communication barriers and missteps? Could we avoid it for just a little more straightforward thing I need to stand up when I’m taking so I give some examples, you know, I need to stand up when I’m taking a test. That’s not something, someone who doesn’t do that would know about you. So here’s a way you can communicate that it’s not rude. It’s not mean, it’s advocating for yourself. The ICANN statements really came from the and how you would work with your client on them is like, what are things people might think it’s crazy that you can do but instead of seeing them as something weird or strange or not normal. It’s pretty cool. If you say I can do this and you’re taking you’re kind of teaching your client or patient to say like, that’s really cool that I can do that. I can do it because a lot of people cannot do these things. And again, the whole thread of this is really through that autism.
Heidi Miller 34:59
You know my work in the autism community, I worked with older kids. And so, you know, I had kids that could do these crazy. They felt so random, but then it’s like, take back the power away from somebody saying that that’s a weird or negative thing by saying, Well, I can do that, you know. So the I wish statements, I think that’s those were ones I was thinking of like, again, reframing how someone may perceive their, their missteps and communication and making them taking back the control as the, the, the teenager to say, I wish people just knew I don’t make eye contact, because it makes me uncomfortable. But hey, I’m still listening. And, you know, I wish people knew I wanted to be their friends, I just don’t always know how to follow the exact way that everyone else around me makes friends. Or it’s just a good avenue to talk about other things they might struggle with, with like executive functioning skills, like, hey, I can rearrange my library at home to be all color and alphabetize. But then I can’t get my homework done, because I can’t go to my planner and put it in the right place. And remember, so sort of those I wish statements of things they hope they could do in the future with the skills that they have. And really, the whole idea of the resources to be strength, strength based, not deficit based. And I think unfortunately, that’s a lot of the gold targeting activities in certain populations. For neuro diverse individuals, especially teenagers, we know they’re struggling, you know, with COVID. And all the things being a teen is rough. So just using these, this worksheet as a way to start those conversations, but also kind of make it measurable, kind of make it a way that you feel like okay, I can write about this, in my treatment note, I could say, worked on self advocacy statements and was able, you know, the patient was able to generate three, three out of five with minimal prompting, you know, it’s easy to toggle into that language, because that can feel really overwhelming when you have these more abstract goals that aren’t like, okay, they said a sound 10 times check, you know, this is kind of gives you a way to think through that. And then the other two are just, it’s hard for me and definitely, I hope like what it does anyone, I feel like a lot of times when a child struggles in school or struggles in a setting or struggles with social communication, we don’t we forget to ask them like, what do you hope? What do you want to do in the future, instead of assuming that we’re kind of just trying to get them from point A to point B? It’s like, what is their big picture goal? And how can we work back to help them through our work with them? So anyways? Yeah, easy resource.
Tasanyia Sebro-Calderon 37:52
I really like this resource. Heidi, I can think of some little ones I’ve used this with already. And in TBI cute we have. And I can think of one of someone from my practice, I would use this with, he kind of got lost a little bit. I wouldn’t say lost, but that’s the way his his mom describes it. It’s post COVID. So you know what the hybrid remote in the classroom hybrid remote. He’s more of the shy kid. And then on top of it with like, you know, some ADHD involvement. And I can totally see him using this to help him become more verbal, in the classroom. And with heightening his social skills, I really like this, I’m gonna use it.
Bailey Womack 38:41
This is awesome. It’s really versatile. I love that you can just kind of go in different directions with it. And it also might be an opportunity to like tie in emotional vocabulary, which I think is an important part of our job. I feel like even neurotypical adults have a hard time identifying what they’re feeling and labeling emotions and just verbalizing that. So I feel like tying that into like kind of the feelings category, I guess with some of these statements, I think would be a great way to use it too.
Megan Berg 39:09
Absolutely. Thanks, Heidi. We will move on to our final new resource for the month. This is written by to Sonya and it is called disfluency strategies for the classroom.
Tasanyia Sebro-Calderon 39:22
So bullying is a big thing about a lot of children experience and children who have very learning styles or who come with their beautiful valuations. Excuse me, they experienced this a lot. So this is one of those resources that I I did thinking of that population as well. And thinking about some of the students have worked with or patients who were this fluid and and how they kind of became isolated because they wouldn’t speak up in the classroom and didn’t have anyone to provide them the support in the classroom, not necessarily because there wasn’t anyone to but because it didn’t know how to do it. So this resource would be for like, it can be for educators, it could be for therapists, it could be for parents, and even for older, some of our older children who are able to understand how they use this. And I’ve used it, too, as a guideline, just as a guideline. And, and if I knew, let’s say I was the treating physician for a child who I knew was disfluent. And I wanted to help to create a environment, a classroom environment that would support the language and support the academic world, I would use this as, like a goal, a bank of ideas for making that happen. I also think about the parents a lot, because sometimes in the classroom setting, the parents have the teachers, excuse me, have to think about 20 somethings students.
Tasanyia Sebro-Calderon 41:03
So as a parent, you want to be your child’s advocate. So this is a way that you can use it as well. And simply by printing it and providing it to your child’s educator, whether it be the therapist in the school, or it might be the gym teacher, because we’d be surprised, sometimes the the classroom or the school based environments that children really feel isolated from, because they just don’t know how to communicate, or because they’re anticipate they anticipate their disfluencies. So instead of being communicative with their fellow students, they just shut down and say nothing. So in short, I would, I would use this, I if I was a SLP, in the classroom setting, in a school setting, excuse me, I would provide it to the principal or the theme. And I would have them dispersed to various teachers, just something like they could either sent home to the parents, or as something that the teachers can use as a resource for knowing how to provide that support in the classroom. Because I I can, I’m assuming I can guarantee that most schools have children who aren’t as fluent in some form of the other. And I’d also just use it as a guideline as a teacher, for, you know, many of you just want to know what they can do, and they just don’t know what to do. So I use it as an idea to get some ideas, excuse me, of how I could use it to help my student to make the best of the academic day. Thanks.
Megan Berg 42:48
Yeah, those of you who are listening via podcast, this has, like basically a bullet point list or very straightforward and concrete strategies from, you know, give your students full of your full attention when they are speaking, Do not deprive them of your eye contact or give them awkward body language, if disfluent speech occurs, do not finish your set students sentences for them. So a whole page of those types of strategies.
Tasanyia Sebro-Calderon 43:18
Oh, okay, one last thing, excuse me. So as SLPs, we, we tend to know, or we most of us know that we want to tell the child to slow down or stop and start again. But it’s a common thing that families do, when they’re trying to help their child. Teachers do it, I’ve seen it, where they will say, okay, you know, slow down or start again, and it’s meant, it’s with good intention, but it’s, it’s not beneficial to the students at all. So it’s just like Megan mentioned, it’s just a list of, of ideas of, of what strategies that you could use to implement. And it doesn’t have to be in a school setting, it could just be in general.
Heidi Miller 44:01
I think I was thinking of a cool way to use it too. And be like, I remember when I worked in the schools like you don’t you have like seconds with teachers, you know, everyone, it’s a tight turnaround. And so this is a nice thing. Like you’re saying to just leave somewhere be like, Hey, look at this, you know, when you have a second I’m here to answer questions, or also like finding really good ways to compliment you know, kind of say to the teacher, like I really liked how you didn’t interrupt that student when they were, I noticed that you did that to try to make it you know, show them you’re already doing some of these things. And then maybe that’s an avenue to have the harder conversation about, like, hey, let’s try the like, I really liked the one in the first column there where it’s like, Give Kids a second to write their answers out before you just start calling everybody’s name out. So you know, little things like that. Maybe the harder ones to implement. You can start start by Hey, you did a really good job this other thing like thanks for using that resource I left you or something like that,
Tasanyia Sebro-Calderon 45:04
you know, it’s hard I like I said, I know teachers have to manage a classroom full of students with varied needs. So one of the strategies was to have like a general approach with Glass classroom activity. So for example, rather than only applying that to one student, you know, you just make it something that you do a general principle for the classroom.
Megan Berg 45:30
Right. And Kate Hawkins, another writer who’s not on the show, wrote an article snapshot, about non traditional fluency program developed for the public school setting. And this was published by working with at all it was published in 1994. So it’s an older article. But I think it’s one of those sort of landmark articles where it’s withstands the tests of time. And basically, the study was set up where they brought, they have an after school program for students to to address fluency disorders. And then they also brought the parents in for group therapy, or within a group setting after school. And sometimes that would happen in tandem with individual therapy. And the focus of what they were talking about in these group settings was really unearthing negative feelings and misperceptions about stuttering, before addressing any kind of behavioral modifications. And then they just noted that effective behavioral modification options supported by the research include rate modification, volume modification, ease of vocal onset and intonation patterns. And some of that might have changed through the research research since 1994. But the key takeaway from this paper is really, if you if you are in a school setting, and you have the capacity to consider bringing the parents in for a group setting, you can really target key messaging to relate to students and their parents, including the concept that children are still hold people, even though they stutter at times.
Megan Berg 47:15
And it’s important that students and their parents do not you view them as faulty or less than the one who is fluent. And I think this is important because I was Googling last night. Like if I was a parent, where would I be going for resources and I found like one website that was like, written by this woman who who started off introducing herself, she’s like, I am not a speech therapist, but I spend a lot of time with kids who have speech sound disorders. And one of the recommendations that she had was using marbles in the mouth, like that’s still a thing that is out there on the internet, and parents are reading this and you have the option, opportunity or resources to get parents into therapy in a group setting after school, you could use this article as a way kind of a jumping off point to get that started. All right. So those are all of our new resources. And we’re gonna wrap up this episode with our case study. So again, this is a chance for us to just talk about different clinical ideas and perspectives, as well as talk about resources from the therapy and science library that we would apply for this case study. So this month, we’re talking about a 13 year old male with one illogical disorder specific to errors with postnatal colic are errors that occur at the word phrase, sentence and conversation level, but he is stimulable for post Vocalic are in isolation. He has been in therapy, both in the clinic and in school for almost eight years. But he has had many different therapists, he and his parents demonstrate good home carryover and he is motivated. It was recently discovered that he appears to have a restricted posterior lingual frenulum. But it is uncertain if this is affecting speech errors. So we will start with Bailey. Bailey, if you want to just tell us about the resource that you chose and any clinical thoughts or perspectives you have about this case?
Bailey Womack 49:14
Yes. So this resource I love. Really, it’s it’s a warm up and I I’ve used this with children of all different age groups who are…
Megan Berg 49:25
For those who are listening on the podcast. It’s called speech activity. Vocalic are warm up. Can you just describe it really quick?
Bailey Womack 49:33
Yes, I’m sorry. So as you said, it’s a warmup. And basically, it’s a visual and it has post Vocalic R, so or, or our IR air and IR and they’re in different colors. And so they’re the sound is in a box and then there’s an arrow going to the other side of the page. And the reason or the way I use it is I will kind of use this for elongation practice. So once we get a nice production of Have the are in isolation with the vowel, then I’ll have them usually run their finger across the arrow and sustain that our sound, making sure it’s it’s accurate, but kind of just practicing in an isolation before moving to words or phrases or sentences. And I feel like it helps them build more awareness of what their articulators are doing and kind of like holding it for a while, I know a lot of SLPs do that elongation practice. So I like to use this at the beginning of sessions for a quick warmup to make sure we do have that sound accurately. And like I said, with young clients or older clients, so that’s how I would use this resource.
Unknown Speaker 50:41
Thank you. And Tanya, you selected techniques for achieving the R sound, can you tell us about this resource?
Tasanyia Sebro-Calderon 50:50
Yeah, so um, so this resource has activity attached to it with a puppet. And it’s an oral component to it. And there are four steps and some tips as well on the resource. And the reason why I selected this and why I think that this is a good resource is because sometimes children who have difficulty with producing Dr sounds, it’s because of the lingual placement. And with the puppet, sometimes just having a visual, as a method of feedback has been helpful. In my practice, I’ve seen that. So that’s why I like this one. And in the resource, there are some ideas on how to keep it fun, and to keep the child motivated. Because we know that ours are difficult. It’s one of those difficult sounds in therapy. And I know, no matter what the age is, sometimes it can be a little discouraging for the child when they’re working on this particular sound. So it talks about ways to make it fun. Also on how you work on building awareness first, sometimes it’s a matter of just awareness of placement awareness of what the sound should sound like, awareness of when they’re pronounced when it’s being pronounced correctly or incorrectly. So that’s what this resource is about. And that’s why I picked this one. And did you as far as the situation you want me to wait until after?
Megan Berg 52:27
Yeah, let’s kind of have a conversation after about this resource, or she has got a couple of resources. So the first one is how we produce R in English.
Heidi Miller 52:40
So this resource Yeah, how we produce are in English, it has been really nice. I don’t want to say a skull, but like a facial dress, like I cut out a lateral. Yeah, lateral view. No, yeah, lateral view of someone and kind of shows you the two tongue positions for retroflex are in bunched are. And kind of like, we were just saying, I think a lot of times, people just, you know, we want them to understand where their tongue is, or isn’t or should or shouldn’t be to make this sound. So it’s just a really nice drawing, it could definitely be something you even just had up in your you know, if you had your own outpatient space, I’m sure tons of people could just look at it and get something from it. So it’s a super visual, not a lot of instructions are on it. But kind of says when you’re using the bunch, or the tongue tip is down and retroflex, the tongue tip is up and kind of gives you a little picture. So I just think that’s a nice resource to have pretty handy no matter what those are situation. And then the other one I picked, it’s called tongue tie. And this resource is a little bit more geared towards the babies it’s talking about, some babies are born with, but it would still apply. I mean, there’s kids we’ve all met that have made it quite far in life with maybe a it has the four classes of tongue tie 1, 2, 3, and 4 and kind of shows you where they are. Again, I think just the pictures are valuable enough because you’re kind of talking about the posterior tongue tie in the case study. So that’s not one that’s really pictured here. But again, having an idea of what that is to have an educated discussion with the child or the family and you know, any other relevant provider. So again, just some more things to look at that might help you process what’s going on for this kiddo.
Bailey Womack 54:29
And maybe I know we’re trying to wrap up the resource that Heidi was just talking about. I like that the visuals are a little more realistic. They’re not just like a cartoon tongue. So I like that.
Megan Berg 54:43
Great, okay, well, what thoughts do you have above a case study?
Bailey Womack 54:48
Is this open for anybody, any of us? Oh, yeah. So the restricted lingual frenulum, I don’t know. It’s hard, hard to say if that would be affecting his speech. Um, I don’t know what what do you guys think, Heidi and Tasanyia?
Tasanyia Sebro-Calderon 55:04
Well, okay, well, there’s a few things. He’s 13. He had therapy for eight years, there’s carryover in the home setting. Of course, it could just be that he hasn’t acquired it yet. But there is that potential for it to be impacting his ability to grasp it. So I don’t see why. I would say that I would have, I would if it was me working with this child, I would recommend that the family saw a specialist to rule that out as a component. Because I’m eight years is a long time. Good carryover Charles motivated. I went oh, no, I would I would recommend you pull it out.
Heidi Miller 55:47
I agree. I think the time that you’re talking about in the reported carryover means that people have made a good faith effort. I mean, a lot of different therapists. So who knows? What you’d want to do? I mean, I think when I get situations like this, yeah, I normally would also refer output, say, like, let’s work for like three or four weeks, kind of see if we get somewhere. If not, you know, these are the other options. I think, also to kind of, I think only because it’s fresh in my mind from just having done it. I mean, if it’s at a point where there’s not something else that they can do about it, sort of helping the 13 year old get to a point of accepting that, like, maybe this is just how it’s gonna be and like, How can I, you know, who’s driving the, the need or urge to correct it for lack of a better word? I mean, are you able Are you intelligible? Okay, cool. You know, could you just, how could you use your own self advocacy to kind of talk through it in scenarios in the time between now and maybe when we solve it or now, and when we realize there’s not really something to be to be solved, that’s kind of just how it’s going to be.
Tasanyia Sebro-Calderon 56:57
I like that point, Heidi. Especially because it’s kind of like voice to me, voices, voters, I like that, too, if it’s not an issue. And residents, if it’s not an issue to you, if it’s an issue culturally, then why treat it. However, I always think about bullying and like, let’s be real kids, for me, that impacts many times quality of life, and impacts like well being and functioning. So all of that comes to the table. And it’s so funny, because last week, I had, I worked with a child justice case, I did an evaluation. And the first question that parents ask is, what do you think? Should I have it clipped? And I’m like, well, it’s not up to me. You know, and I’ll explain, you know, just like we just did today, you know, we’d have that kind of discussion. And one of the things that many families don’t realize is, I’ll tell them many times, it’s hereditary. So do you notice anyone on either side, if they do know, depending on the birth on the child’s family situation, do you know if anyone has any time, so one of the parents or may have had it. And that helps because they realize they can look at how that parent dealt with it. And if that parent is able to communicate, and were able to communicate effectively or or sufficiently was able to manage eating fine without clipping it, and that helps a lot of families with deciding what they want to do.
Heidi Miller 58:27
I think that’s a really good point. I think the only other thing I would add to this whole thing is also having that discussion beforehand, or like during before you refer out or they do get potentially their tongue clipped is saying like, this may not like solve it, just so you know, setting expectations appropriately because it’s easy. I think I’ve met a couple of families that are popping in my head that thought this wasn’t a like solve this and like some other problem, and it’s like, good, but we it’s not maybe a Silverback, you know maybe have that expectation that this could help some but there may be other like you’re saying hereditary or just it you cannot get to the point where you’re our sounds like everyone else’s, you know, kind of managing expectations around tongue ties, especially in the older kids.
Bailey Womack 59:17
Yeah, families appreciate the transparency and just like laying it all out right there, especially when they’ve been in therapy for so long and who who knows what they’ve been told over the years by different people so
Tasanyia Sebro-Calderon 59:27
and and problems that come after, like you said, with that can come after? Because they’ve been compensating all these years. So now you clip it, and then sometimes it turns into a whole nother disaster. So that’s a good point.
Megan Berg 59:42
Yeah. Interesting. Sounds. Great.
Megan Berg 59:48
Thank you guys. And that, I believe wraps up our first show. So thank you. Like I said, if you want instant access to all the resources that we talked To vote today and hundreds more, you can go to therapyinsights.com. If you’re already subscribed to the access path you already have instant access. We’re going to put all links in the show notes on YouTube and on the podcast platform so you can easily find links to all of the resources that we talked about today. If you have any questions for the team, that could be a question related to what resource would you use for this particular case? Or do you have any clinical thoughts or perspectives on this other type of case study, we will happily take those questions you can context contact us at support at therapyinsights.com. And if you are a member, be sure to vote on what we create next. And we will be back on April 1 with a whole new episode. So we will see you then. And in the meantime, thanks to all the therapists out there for making therapy functional person centered, empowering, informed. Thanks, everyone!