Bailey Womack 0:03
All right, everyone. So welcome to the fifth episode of our Therapy Insights Resource Roadmap show, we’re going to talk about some ways to use all the different resources in our library today inside our Access Pass. And if you are subscribed to our Access Pass already, and you have the printabless feature included, you have instant access to everything that we’re talking about today. If you’re not and you’re interested in, go to our website at therapyinsights.com. And sign up today.
Bailey Womack 0:27
If you’re listening to this episode on a podcast or watching from YouTube, and you want credit for CEU today, go to our website therapyinsights.com. And find the form for the SLP or pediatric SLP resource roadmap show, episode number five, and you can get your certificate of completion today.
Bailey Womack 0:43
I’m your host Bailey. And we have our writers, Heidi and Tasanyia. Welcome. and Megan is in the background pulling up the resources to see on the screen. I need to verbalize our disclosures since we do offer CEU credit. So on the show, we are talking about Therapy Insights products, and we’re all being paid by Therapy Insights to run the show today. So we have another amazing collection of resources. I’m loving the topics this month, we have lots of variety, again, from articulation to executive functioning, we have information about pediatric medications and speaking valves. So let’s dive in.
Bailey Womack 1:18
First, we have- I think, Heidi, yours is first? Yes, so this one is called Pack My Backpack Executive Functioning Activity for Young Kids. This is a five page resource, and it has beautiful graphics on it. There’s a fun, visual schedule at the end. So Heidi, tell us more about what you were thinking with this piece?
Heidi Miller 1:44
Well, I think that my idea for it came, you know, we’ve been thinking about executive functioning a lot. And it seems like our subscribers really want more resources and information on it. And definitely for younger kids, it sometimes feels overwhelming, because maybe they’re not writing yet, like the planners too much like they’re not going to sit and write out a list of what they’re gonna do today.
Heidi Miller 3:03
So you make the list together and you try to then we have the graphics that have like the laptop, a coat gloves, boots, field trips, permission slip a bus ticket, binder, water bottle, lunchbox and homework. So you could obviously also make other ones they could draw some more if there’s other things that kind of fit where you know, maybe the region or country you’re living in. There’s other things kids take to school, we just wanted some broad, broad ones that may be applied to a lot of people. And then if you kind of want to level the activity up, there’s this picture of a house and it has it lists all of the items and then it it offers them a place where they can brainstorm like do you find this in the in your bedroom? Or in the bathroom? Or is it something that’s in the kitchen? So that they can sort of think because it’s it’s a multi level process? It’s not just the items and knowing what they are? It’s like, how do you get them yourself? And like, where would you go. And so really trying to think of this activity is like the first time, you’re probably going to have to do a lot of hand holding with them and really show them what you’re talking about and maybe even engage with their parents or caregivers to understand things they need to be taking. Maybe they have a medicine, you know, you could make a little medicine picture that they could also use for this activity.
Heidi Miller 4:22
And then as you go and do it each week or every couple of weeks with them, you should see them be able to do it quicker and faster and be more accurate. And then you’re also wanting to check in with the family like how’s this going at home? Like are they actually able to do this like should you time them? You can make things like that fun. You know, maybe one way to measure the success of this activity is like can they do it faster in the practice activity, but then also maybe at home. And then our designer put together a really nice like morning routine visual. It has like, what time? Do I wake up? When does school start? How do I get there? And what time do we need to leave, and then has a little checklist of like eating breakfast brush teeth, put on shoes, make my bed and then pack my backpack. So I think these are really great for our younger elementary school kids. And even younger kids that go to a daycare or to like a, you know, maybe they go to their aunt’s house for the day, but they still need to, like, take some items with them. And it’s really easy to understand it’s very visually appealing. And even if it doesn’t fit your exact, or the child’s exact plan, you see how you could build something comparable so that you could see what you wanted them to be practicing. So anyways, it’s a cute resource. It’s great for back to school or summer sessions, I was thinking some or therapy sessions to kind of get ready for that transition back to school in the phone. This is great.
Tasanyia Sebro-Calderon 6:02
Heidi, I was thinking just what you were wrapping up with, in the end, how this is a great resource for little ones who may have difficulty with like transitioning. And if it’s not exactly what’s in their day, is definitely a good sample of what caregivers could use to build something that’s more tailored tailored to their needs.
Heidi Miller 6:28
I think sometimes we assume if we just tell a parent, like make a visual schedule, or map out how you’d want them to do pack their backpack, it feels kind of overwhelming, or it’s hard to quantify. So this is, again, like this resource might work perfectly for somebody, like it will have all the activities and things that they need in their backpack. But if it didn’t, it’s not hard to add to it or just help families visualize what we’re kind of trying to talk about to get them to practice at home with their child. So
Bailey Womack 7:01
Love it. There’s so much you can do with this, like even you were saying like in the summertime using it, but really just throughout the school year, like coming back from a break. I know some schools around the country are like moving to more like year round, and they have longer breaks. So kind of helping them with that transition back to school.
Heidi Miller 7:16
Yeah, and again, it could be anything, you know, I do even as a parent now I when I was making this resource, I sent out word to the other writers and Bailey like, is there anything else you should put in your backpack? Like I don’t know what goes on in these days, because, you know, a laptop is not a thing or the iPad. So but yeah, hopefully, it’ll be a flexible starting point for activity for you for some of our subscribers.
Bailey Womack 7:42
Yeah, I love it. I love the multi-use. Alright, let’s move on to our next resource.
Bailey Womack 7:50
Tasanyia, you wrote this piece, this looks like a four page resource. And it’s titled How Pediatric Medications Impact Speech and Swallow. I love this resource. I think this is kind of fresh to our library. We won’t have anything like this. But it’s just a massive chart filled with tons of information about different medications. So tell us more about your thoughts behind this piece.
Tasanyia Sebro-Calderon 8:11
So Megan, and I actually collaborated on perfecting this. So it created this, I wanted to have a resource that interns could use that junior clinicians can use. We have a lot of SLPs, who transition between environments, whether they’re under school, primarily that transitioning into nursing home acute care, and other settings. So I wanted to have something that could be used as like a pocket resource. So you clip it to your clipboard, you pin it up at the nurse’s station or wherever you document and it could be referred to. So as SLPs we do look at labs we don’t use it to necessarily assess or diagnose but we can use it to support our findings or recommendations or suggestions orrecommendations on like continuing or discontinuing oral feeding status, for example. So with this, what is listed are specific medications that can impact speech and language and then medications that can impact swallowing. So I find in working with junior clinicians or interns that schools are beginning to teach a little bit more about the use of labs, but many are coming in thinking that it’s just about feeding and swallowing, but it also there’s a lot of medications that can also impact speech and language production. So this resource has it all in there and it specifies medications or specifically- I’m sorry, I think I may have said labs earlier because the other resource that’s coming up first, but they go hand in hand.
Tasanyia Sebro-Calderon 10:00
But this, this resource I’m sorry, talks about medications, not labs that’s coming up. It talks about medications, and how they can impact feeding, speech and swallowing. And again, it list examples of those medications and what relevant side effects can be. So again, sorry about that, I totally had them both in mind, because medications and labs are both part of our assessment process. So I, I mixed it up. But this one specifically, for anyone who’s listening and not tuning in with a visual, this one is specifically about medications.
Heidi Miller 10:45
Bailey Womack 10:45
Oh – go ahead. Go ahead. Heidi, go ahead.
Heidi Miller 10:49
I was thinking just like you said, like for interns or new clinicians just having this in their, their binder, whatever it is, whether it’s online, just because you can’t list them all to them in one setting, and expect somebody to remember them. And I even think I would have some traction at work now using this with some of the doctors when you’re having trouble, like explaining to them why this might be related. Or maybe we should have orders on this child or this person would probably need some outpatient follow up, this would just give me a nice quick way again, so I don’t have to have a memorize. I mean, over time, I’ve learned a lot of these but not they’re not frequently used. So I think this is just like you’re saying like a pocket guide that sort of if you’re a beginning clinician in a medical setting. It would be super helpful, I assume. Do you know it? I mean, I assume these drugs are also adult you know, even though it says pediatric medications it could-
Tasanyia Sebro-Calderon 11:47
You see crossover.
Heidi Miller 11:49
Okay, there’s some some crossover.
Tasanyia Sebro-Calderon 11:51
Some crossover, but I wanted to make it specific to peds because there’s a lot of resources for those. These are specific to peds but they also crossover into adults as well. And another reason why I wanted to create this is because I’ve seen many times in reviewing documentation, clinicians will right see on the section for medication, they’ll say see nursing report or see doctor’s note see medical training. And it’s like how could you leave such a important component out from out of your assessment. And I think that a part of the reason why it’s often left out is because clinicians don’t always feel confident or competent, when it comes to medications and how it can impact speech and language and swallowing. So I think this is just a great resource for clinicians who feel like they experienced that, or for maybe school programs, who wants implemented into one of the courses that it’s pertains to, or again, in a clinical setting for not just for local fellows of interns, but for more junior staff or for staff who haven’t been working fully in settings where medication is really an important aspect to diagnosing, and treatment and what we might find a bedside.
Bailey Womack 13:12
Megan Berg 13:16
Sorry, I’m gonna interrupt. But one thing that was interesting putting this together and collaborating on this is, I learned that there are certain medications that are traditionally thought of being used for adults, like in particular Parkinson’s medication, and there are cases where they might a doctor might use it for a child over the age of three. And I think that’s what’s interesting about all medications is like, we have an idea of what they’re used for. But often doctors have to get creative and, and try different things. And maybe we might think that it’s for an adult, but it’s being used for a child. There’s also a lot of medications on here that are used during surgery. So that was really interesting to read the effect that they have. So again, those are drugs that are used for both children and adults. But yeah, pretty comprehensive list. Thanks for letting me interrupt.
Bailey Womack 14:11
I love that.
Heidi Miller 14:12
Yeah, I like how they’re, you say what they cause too, because that’s, you know, maybe you can remember the medicine you can’t remember it. It’s organized really nice, like each one pages for speech. And then the other three are more related to swallowing and it’s really obvious, which does watch and I was just thinking at work like this could be really useful in my acute phase part of my job to like, help. Think through like okay, if they’re on like Megan was saying they come out of surgery, like what drips are they on what things are they on when when can we agree that it’s appropriate for us to engage? I think we get in a lot of tense little discussion sometimes with attendings about that, like when is it appropriate to actually assess their swallowing or their speech because I can sit and say, well, they’re on this whole set of medicines like they’re, they’re impacted. This isn’t a good baseline, if that’s what you’re trying to get us to do. So I will definitely be printing this one and putting it to use soon.
Bailey Womack 15:15
That’s what I was thinking, Heidi, like maybe print them out in like a smaller scale and have a laminated, almost like a pocket guide that you were talking about Tasanyia just to have a quick like, easy to reach, especially during like chart review, if you get a new patient coming in, and you want to know like, okay, what is that medication rather than googling it? It’s just, it’s right there, probably because like Megan said, this is pretty comprehensive. And then I also was thinking back to times in the clinic, like where I used to work and a child come in, and they just, they were kind of like acting differently, for lack of a better phrase there. And then I would find out their medication change. And then I would have to, like do some work on okay, what medication are they on? How’s it affecting, where they are their progress, like, I felt like there was some regression with some of the kids that would change medications, and just understanding how that might affect them and their progress and kind of giving them some grace there and understanding what’s going on. Yeah, this is a fantastic resource.
Bailey Womack 16:09
Awesome, let’s move on to the next one.
Bailey Womack 16:14
Heidi, you’re up. So this is a beautiful four page articulation resource. Really nice images looks like there are velars and affricates specifically. So there’s k, g, ch, and sh, four different pages with hidden picture activity. So tell us more about this, Heidi.
Heidi Miller 16:34
Um, so my daughter loves to do the this like kitten picture activity idea, like, oh, you’re just looking for things. And so I thought, Oh, let me transfer that to some target sounds and velars and affricates are ones I feel like an outpatient I’m targeting a lot. Along with that, you know, maybe we can build off the other ones too, at some point if these are popular, but basically, yeah, it’s, it’s an activity that’s easy to do together, like with the child, or if you’re in a group setting, it’s easy to stage the activity out and be like, Okay, I’m gonna give you this, you, you circle all this, all the animals that start with the sound. So it’s kind of an independent activity, or you could do it as a group together. So it’s a very versatile thing.
Heidi Miller 17:24
And the drawings are really cute, they’re really engaging, they’re not boring, it’s easy to see, I think. And then I was thinking, you know, there’s so much color that if you don’t get our print, if you’re printing it yourself print at once, this is definitely a laminate, laminate thing. Don’t print these every time a child wants to use them. But kind of like I use, all I still do. I don’t know why I said past tense, but I have a binder for each of my sounds. And so this is just a great activity, it doesn’t take any prep work for you, or the child really, it’s kind of it’s, it’s more straightforward than something. So I was thinking that, that was a lot of why I made it it is I was like, I think what I’m thinking about sitting in a therapy session, and I’m like, there’s just that down moment, or a kid comes in or something’s not working. And I need to shift gears, this type of activity is just really useful.
Heidi Miller 18:16
And you could even also use it to have conversations like, that’s silly, the goldfish looks like it’s drinking the coffee or you know, things like that you could have use it in a lot of ways. So this is, again, kind of a multi use resource. But again, it’s all the drawings currently are targeting affricates and velars and the sounds have them in initial and medial. And there’s pictures on each page with the sound and initial, medial and final positions. So then you could say, okay, now you’re trying to use it in a sentence or like, let’s write a story about this crazy picture where there’s burritos and caps and elephants and you know, a piñata. So things like that. I think that, yeah, sometimes you just need those easy to grab activities that just, you just handed out, like, okay, everyone, try this for a minute. And then we’ll come back together and figure out how to use it even more. So yeah, our designer did a really good job of making them interesting and cute. So
Tasanyia Sebro-Calderon 19:21
It’s really pretty, I like it. You know, with articulation, it can be so tedious sometimes, and it can be if you don’t stay on like your toes for being creative. It can be boring, sometimes permission say that. And this is a really fun activity. And I can see that you can definitely maintain a child’s interest in the task with something like this. And you can definitely work on like, how many of our little ones come in with articulation impairments in addition to receptive language or like attention, concentration, difficulties, so you can definitely work on something combining that with this, like, find the bear and find the whale. Now repeat after me, depending on what level they’re at, with the forming, but this is so this is really pretty and colorful and I could definitely see it being an activity that helps to maintain interest during the session.
Heidi Miller 20:17
Yeah, I agree articulation can get dry sometimes especially, I feel like kids working on these two sounds in particular, most likely, you know, they have sunlight, a lot of them have some these are difficult, more of the difficult sounds are later, sort of later developing sound. So it’s hard to keep those kids attention sometimes. And they’re, they’re smart enough and old enough to know, they’re not just gonna listen, if you’re just flashing cards at them, they’re gonna that’s gonna last about six minutes, maybe. So yeah, this is just something different. And yeah, if you’re a subscriber and you like them on the survey, we can make more for other sounds if you like them, but we’ll see how they go.
Bailey Womack 20:56
I was gonna say, yeah, we need like every sound with-
Heidi Miller 21:00
I didn’t want to overwhelm our designer. I mean, it was like, she did a lot of work to pull these and they’re beautiful. So I was like, I don’t want to say let’s do all the sounds in one resource. But if, if they’re popular, we could bring on bring some more.
Bailey Womack 21:13
Yeah, test the waters. I also like this kind of it’s one page, which makes it easy for everybody. And like maybe another quick ideas like getting little this little, you know, colorful magnets with the magnet wand. And you know, placing them on the images. And however you want to do that, you know, uncover this one. And let’s see what what picture it is and then pick it pick all of them up and just, you know, a way to possibly keep it engaging. Like you said Tasanyia, you have to keep it really interesting for these kiddos for sure.
Bailey Womack 21:42
Awesome. Let’s move on to our next resource today.
Bailey Womack 21:50
Okay, so Tasanyia, you wrote this one, the Importance of Lab Values for Clinical Swallow Assessments. This is another four page resource just packed with lots of awesome information. I learned a lot myself when you created this. Such a great reference. So tell us more about this.
Tasanyia Sebro-Calderon 22:09
So this is what I initially started talking about. But I think that these lab values can go hand in hand with the medications as well when you’re doing your clinical swallow assessments, and even for instrumentation. So if you’re doing your modified, or your face, you can also use this as well. And as I started saying earlier, you’re not using it to diagnose but more so to support your findings to support your recommendations to support any, anything that you are suggesting as far as maintaining or discontinuing non oral feeding status. And all that might vary as far as like what your role will be, depending on state to state but as an SLP. This is something that’s very important when we’re trying to decide the safety of ongoing feeding, for example, we’re looking at if there are any clinical indications of dehydration, any clinical indications of malnourishment.
Tasanyia Sebro-Calderon 23:16
And if you look for indications of lung infections, such as aspiration, such as pneumonia, and when we’re trying to help to make the most ethical decision for our patients, when it comes to diet consistency, texture that we recommending. So this specifically list the lab values that we would look at as SLPs, there’s a number of labs that will come up when you’re looking at labs for children. The labs won’t be as frequent as we see with adults. But these specifically list the lab values that are important to us such as albumin, potassium, and more, you’ll see if you get the resource. And again, we just use it to support what our recommendations might be. So for example, if you have a little one that you’re working with, and let’s say you want to support your suggestion for a modified barium swallow study that you want to support why you want to perform a modified barium swallow study or a flexible endoscopic evaluation of swallowing. And you’re saying that at bedside there’s no overt signs of espacially penetration, so there’s no coughing, there’s no throat clearing.
Tasanyia Sebro-Calderon 24:39
However, the lab values say such as such as such, indicating that there potentially might be let’s say that the white blood cell count is showing a certain number, you’re looking at your albumin and you’re creating, and there’s indicating that there might be something else going on. It’s of course, your justification for suggesting that the physician gives you a script for instrumentation, instrumental swallow assessment. So this is just a good resource for any clinician at any level. In their practice, I always say it’s good to load up our interns that political fellows or junior staff with things that can help them to become more proficient, and more confident as clinicians.
Tasanyia Sebro-Calderon 25:24
And this is definitely something that I would place in. If you have like a speech office, if you, you can put it up at the nurse’s station as well, you can put it where multiple discipline disciplines are able to access it and see it. Or again, you can make it a pocket reference and laminate it and use it. However it works best for you keeping your clipboard, or however, is most convenient for you and your practice.
Bailey Womack 25:58
I wonder too, this is really helpful information especially like if you’re in, you know, a hospital setting, really any setting. I wonder if this could help like support, like insurance coverage? I don’t know if that would play into it. Like if maybe a family seeking reimbursement for clinical swallow study. If this is just more, you know, this is just additional information that supports the need for that. Does that make sense? I don’t really know, I was kind of what I was thinking,,,
Tasanyia Sebro-Calderon 26:26
I understand – maybe from like the case manager, maybe they can use that. From their perspective, I can tell you, maybe from the SLP’s perspective, in my experience, I didn’t use it like that. I use it, for example like there was a patient from a group home once that needed to have alternative means of nutrition because oral feeding just was not safe anymore. If there were, it was like a severe aspiration case, and a group home just would not agree to signing off on it. But it was just because they did not accept residents who have feeding tubes, so it wasn’t patient centered or resident centered at all. So it became a legal situation. And I had to justify why this was ethically or medically the best suggestion from the team on why we’re saying that the person should have had an alternative diet considered, and even continuing with recreational feed, recreational feeding for quality of life, but things of that nature. But that’s a good question. I’m not sure about the reimbursement stuff, but I can definitely see maybe like case management because those are usually RNs. Like they might use that information. Maybe other SLPs have used it before, I’m not sure. But I’ve never used that, for billing reason. I can’t think of it at this moment.
Heidi Miller 27:59
I think like in my acute experience, I would use this sort of as my own knowledge to kind of feel like at rounds, or when I’m reading the chart that I understand, like if they’re just like, oh, the hemoglobin is low, or their sodium is high. That is a difficult, you know, this is just an easy way to be oh, yeah, that reminds me that they’re going to look like this. So then even thinking to not always just for swallowing but you know, if there was cognitive issues or concerns, it’s like, oh, well, surprise, they’relike they’re restless, they’ll count down their sodium is this this way or that way. And you can just kind of have a good understanding kind of like you were saying, if you’re thinking about doing an instrumental assessment, something, especially with the modifieds, where I am, we really try not to do those unless it’s a severe risk, or we’re trying to see what their new baseline is.
Heidi Miller 28:58
And so like, to me, I think I would use this like, well, they’re not really at a baseline, you’re not going to send them home when their sodium is all out of whack. So like having those conversations to maybe, at least on an inpatient model kind of advocate for or against like an instrumental, especially with timing, I have a hard time getting that through to doctor sometimes, like this isn’t the best time to do this. Like they’re not actually doing well. So you don’t give somebody a test when you know, they’re gonna kind of fail it what’s wait until these things come up. So maybe that would be a way I could see using this for my own understanding and then to have those thoughtful, really specific conversations with doctors about things.
Bailey Womack 29:42
Yeah. This is such a unique resource. I don’t we don’t have anything like this. I love this addition to our library. Awesome. Alright, let’s move on to the next one.
Bailey Womack 29:54
So this one is called Closed Position Speaking Valves in Pediatric Speech Therapy. Tasanyia, you wrote this one, it’s a one page resource, really cute graphics on the border there. But yeah, this is talking about what it is benefits, how to use it, etc. So tell us more about this.
Tasanyia Sebro-Calderon 30:13
So, there are so many types of speaking about that we may encounter in various settings and with various patient populations. And I know sometimes, clinicians are not always versed on how to use it based on their experience, and more importantly, patients and families and aren’t really too sure and how to use it. So in making this resource, I was thinking about patients and their families, and how they could help to carry over goals that we are doing with increase in tolerance for speaking about placement outside of the therapy setting. So many times when we’re working on speaking about in acute care, we have any setting, there’s a point depending on your practice, where the valve is only put on put on by the SLP, or by respiratory therapists or nurse or whoever is trained to do so. And when the family comes to visit, the patient even has no voice.
Tasanyia Sebro-Calderon 31:14
Because their valve is not there to occlude the trach from waiting to occur, because the leak speech. And research has shown that speaking about placement helps to increase taste and overall swell function and safety. And why would we want to take away from a patient when just because we’re not there, you know, it’s like their glasses, for lack of a better description. So this resource could be provided to families who were trained, who have gone through training, under your guidance, under the guidance of anyone who has been involved in their training based on your setting. And flow, you want to leave with not not just visual, and verbal instruction, demonstration, and real demonstration, but also something that they can have in hand because people aren’t human. And it’s not necessarily their skill, and they forget. So this is something that we had in mind for this is what I had in mind for this resource. And it just discusses what it is, the benefits of using it and how to use it. And I gave a few tips and strategies that I like to use with this population to help with tolerance of our place placement, placing the valve on the trach can be can cause a lot of anxiety for children who have had the trade in place from whether it’s a day or whether it’s months or years. It can be it can be it was a lot of anxiety, and fear. So it’s just a few tips and strategies on how to initiate that Valve placement and some voicing with it. And swallowing.
Bailey Womack 33:09
This is great Tasanyia. Again, I could see myself like having this ready to go in a folder. And then you know the setting that I’m in I don’t I don’t come across a lot of patients with speaking valve. So I would pull this out every single time. Yeah, and I love the tips and strategies, those are just extremely helpful.
Heidi Miller 33:31
Yeah, yeah, I agree. Like, it’s one of the areas of our field that it’s hard to practice because if you’re if you don’t see it often, I feel like even though I see it sort of regularly, I’m a little bit rusty every time it comes up again, because it’s just not like my whole case was not doing this. And so this is a nice, like, starter resource. And it also kind of jogs my memory about things. And I like actually really your number one tip there. Just reminding everyone, this feels extremely strange. It’s not just like, oh, all of a sudden they’re going to talk and love it, you know, just that setting the appropriate expectation that a lot of times it’s anxiety provoking and weird the first couple of times till they get comfortable. So I really like this and agree, I think I would use this a lot. And we’ll use it actually because they it’s just not something that’s always frequent, but it is very exciting. And everyone gets their hopes up. And all of a sudden somebody can talk that hasn’t really been able to talk before or there’s been some period where they weren’t able to. And I think we have a couple other resources about them as well. So you should feel you know, really good if you’re in our library that you can get enough to kind of get yourself started if you don’t have a lot of experience. So, but also yet good for the parents too. And caregivers.
Bailey Womack 34:56
Definitely, that’s a good point, Heidi- it’s nice when it’s like a one page resource you can hand out.
Bailey Womack 35:01
Alright, let’s move on to the article snapshot of the month, I believe.
Bailey Womack 35:06
Oh, hey, Megan.
Bailey Womack 35:07
Yeah, I’m back. I just wanted to put a plug in for Passy-Muir- they put a lot of resources into creating free content for therapists. So if you are providing a passage in your valve for your patients and families, definitely seek out their resources. The configure a really nice job.
Heidi Miller 35:26
They have a lot of peds specific stuff too, which is helpful sometimes. I’m in there a lot actually
Bailey Womack 35:33
Good to know. All right, so one of our writers, Kate Hawkins, she writes an article snapshot every month on a topic related to the content that was written by writers. So this one is titled Speech and Phonological Characteristics of Individual Children with a History of Tracheostomy and I thought this was fascinating because it’s from 1999. And I think, you know, it’s important to look at research done a while ago and see how it compares to what’s been done recently.
Bailey Womack 36:00
So I’ll talk about just the takeaways from the article. Children who have undergone long term tracheostomy are at risk for developmental delays including speech delay, prevalent phonological processes for this population include stridency, deletion liquid deviation, cluster reduction, postvcalic, obstruent omission and velar deviation. Voicing errors and vowel distortions were also common errors noted clinician should complete a thorough evaluation of phonological processes for all children who have undergone tracheostomy. Close attention should also be spent on voicing differences and valid production problems.
Bailey Womack 36:33
Clinicians must also consider the other factors impacting the child’s development, including possible neurological factors, such as premature birth need for ventilation, causing possible oxygen deprivation and or recurrent hospitalizations, in parentheses impacting socio emotional supports. So I love how they just they dived into, or they dove into just the specific characteristics and patterns of speech for this population. And I think it’s important to note that this study was only done on six, the sample size was six, so it’s small, but still, you know, worth something. And I just thought it was interesting, just the specific processes that they found. And they also mentioned that the speech characteristics were slow but not unusual. And then they really emphasize in the article to just do a thorough articulation assessment and really look at voicing and valid production. And I don’t know about you too, but I think a lot of times with articulation assessment in general vowels get overlooked or they’re not really assessed. That level isn’t assessed. And I, I think it’s really important to look at vowel distortions. So I thought this is really interesting article, I would love to do more searching for like, maybe newer articles with this population and diagnoses and see how like, how it compares if there have been any other articles with larger sample sizes. I don’t know what you all have read. But it was really helpful to like have like a list of like specific processes that you can see with this population and how it relates to some of the other stuff that we talked about. So yeah, I thought that was super interesting.
Bailey Womack 38:16
Alright, let’s move on to our case study. So we always do a case study every month, it helps us tell you about some of the other resources in our library that relates to the case study and just talking about potential situations we might see in the clinic or hospital, etc. and different ways to approach or just different angles to approach those cases.
Bailey Womack 38:38
So this is a two year old female who has a diagnosis of expressive language delay. She has just been evaluated and is recommended to receive speech language therapy twice a week for 30 minutes sessions. Her receptive language skills and play skills are age appropriate within the average range. Her parents are both involved in want to attend all sessions and have requested strategies and ideas for home carryover, they’re concerned that 30 minute sessions are not long enough. And we’d like to understand why sessions aren’t 45 minutes or an hour. And then we all pick some resources from our library that might relate to this.
Bailey Womack 39:10
So this was the one that I chose. It’s a one page resource. It’s called Promoting Early Language Through Songs and Nursery Rhymes and we all know, music and singing are it’s a great way to support language development. And I the reason I like this resource is it’s not just you’re not just telling the parent Oh, just sing songs with them like okay, so how, how can I do it in different ways? Can I use props? How can I keep it engaging? Do I do the same song over and over again? So this resource list, just some bullets of like strategies and ways to engage your child with songs and nursery rhymes in different ways to support language development. So that’s why I love this one. And then it gives some examples of songs and rhymes, which I sometimes meet. I’m like, Okay, what’s another nursery rhyme I can sing with this child. So I like that one a lot.
Bailey Womack 39:57
Let’s move on, I think Tasanyia You had a few of our resources related to this case study. So tell us about this one.
Tasanyia Sebro-Calderon 40:07
So I chose this one, the author that created this one, I think it was really cool because it lays out what’s expected within each developmental stage. And it has five stages that is on the page. And I think it’s good for parents who have the kinds of questions that these parents presented in this, in this case study. And it also speaks to even questions about their concerns as to why it’s actually a certain length or not. And I think whichever finishing working with them, can you use this to explain, perhaps maybe the reason why it’s, it’s short, it’s because of their tolerance, their attention. There’s their ability to attend for shorter periods of time, what’s been more successful, shorter periods of time. But overall, I like this because it lays out what’s expected per stage. And the parents can use this to decide what activities they want to carry over at home, since they’re interested in knowing what they can do at home. So they can use it to create their own family centered home centered goals for the loved one. The next one. So this is something I have created for children who were ASL communicators. But the reason why I put it in this case is because I always think it’s good to equip children with multiple means of communication. Many families think if you do sign or if you do AAC device, alternative augmentative communication device that it’s going to limit a child’s verbal expression or ability to use their voice for communication, when we especially show that it really helps to boost their ability to use multiple modes of communication. So I will give this to the family to give them some ideas on how they can use signing and how they could use some, if they may have a pet in the home. Or maybe they might want to get something as simple as a goldfish, which might not be so simple for some families, but just different different examples of how they can help your child to develop their expressive language skills without just focusing on verbalization. And I think there’s one more…
Tasanyia Sebro-Calderon 42:23
Heidi, did you do this one? So this one, this so many children are so interested in screen time right now like, whether it’s their parents phones, whether it’s a television, whether it’s an iPad, or a tablet that they’re walking around with, they’re so interested in it, they’re so skilled with using it compared to how we were when we were their age. So and also parents are so focused on pulling it away, when we could find different ways to use it, if it’s a strength for them. So we can use some Can we have some devices that they have already in your home as a method of communication, and as a way to help boost deliver their, their expression. So that’s why I picked this one because the author listed some ideas on how you could help with beginning language learners, developing language learners and established language learners with their addressing their special language skills. For a family who’s so interested in helping to carry over goals into the home, I think this is a good one.
Bailey Womack 43:34
All right, Heidi, you chose two resources. Tell us about this one page resource.
Heidi Miller 43:40
Um, so this resource is called Strategies to Encourage Speech and Language Skills and Toddlers. And then it says remember your your child’s model for speech and language. So it gives just basic kind of environmental setting, like how to set the stage for some success here. So getting on your child’s level, repeat and recast, asked questions and it emphasizes reading this particular case study felt like at least 30% of my early intervention casteless because you just have these parents that are like, really anxious, really concerned. And you’re kind of looking at the statistics here, you know, or the breakdown here, like it’s just expressive language, other things are going well. Parents are extremely involved, which is a good thing, but I think they need the teaching as much as the child needs the teaching to sort of say, are you actually like sitting down on the farm playing with your child? Are you giving them a chance to speak or I’ve had so many parents, I used to have a cool phrase for like a funny phrase, but I can’t remember it off the top of my head where I’d be like, you know, they really don’t have a chance to respond or, or have stress because you have provided every option in a visual manner.
Heidi Miller 44:57
And so why would they speak you know, I think I would say like, they’re smart, they know they don’t actually have to talk to get things that they want. And you’re providing, you know, so this resource is a good starting point for parents like, Okay, let’s start with the basics here. Are you on their level? If they say something, are you responding back to what they’re saying? Are you wanting them to say something different? Sometimes we ran run into that a lot where the response the child is giving us not what the parent thinks the answer should be. And so this repeat and recast and then asking them questions, is just a good one. And then anytime, reading is always a, making sure they know that that is the best one of the best and easiest ways to kind of incite some more expressive language. So yeah, that’s the one and I picked one other one. So this is similar to the other ones we’re talking about. It’s called Encourage Language While Playing with Simple Toys. And it just lists things that most houses have or would have access to, at some point, a ball like how could you? What words could you practice with? A ball because I think sometimes parents too, when they’re so worried that there’s some delay going on, they forget. Well, all you’re ever asking them to do is say the word ball, you could ask them what color it was, or like this one says making sounds about like the ball goes whoosh, showy or those stop, throw catch, like, trying to teach parents there’s a lot of levels to any toy, you don’t just label because we don’t walk around as adults labeling everything.
Heidi Miller 46:34
But it’s funny because when you ask an adult to teach a child how to talk, they do that they say like, what is this? What is that it’s kind of this resource I found particularly helpful to maybe combat against that bubbles i I’ve never not had bubbles be successful to get some sort of language, whether it’s pop or ah, or mine or more. So those are good ones, blokes, always good. windup toys are also I’m thinking I’m 100, you know, 10 for 10, on those getting some sort of reaction from a child, and then like a stalking ring type of choice. So I think when I read this case study, it reminded me of all the resources I wish I had, at that time in my career to just print and like handout in math, like, okay, here we go, we’re gonna go through all these things, to make sure the caregivers are doing what they can do to promote language, but also reminding them that play is play. I mean, that’s how you’re going to get most language, it’s not going to be a scholarly paper that the two year old, all of a sudden starts talking. I, when I was, it’s making me laugh, because I’m just having all these flashbacks, I worked in a small town. And the town was a lot. There’s a big university there. So a lot of the parents were professors and like, they were up here trying to teach their kids like academic language. And I was like, No, or hear those stuff. No. And also just thinking of, I know, we have other resources on this, too, we have quite a bit. So I tried to narrow it down.
Heidi Miller 48:07
But one other plug about a case study like this is if you find a resource we have, I can’t remember the name. But talking about how, like refusing and protesting is also language, not just willingly accepting every toy and activity that the parents provide them. So I have lots of thoughts on this particular case study, as well as the 30 minute session thing, that’s always I’ve frequently or I’m having that conversation about that. So I don’t know what you guys run into. I know, sometimes it’s insurance, to try to get multiple sessions in a week, because you can make more more cash that way as a practice, but also for attention span, you know, the, the PC thing to say is like, oh, it’s their attention span and frequency, but I know the reality is sometimes different for families. So
Tasanyia Sebro-Calderon 49:02
I don’t know what it’s like outside of New York right now. But in New York, there’s such a shortage of SLPs, OTs and PTs as well, but there’s such a shortage of SLPs. So a lot of children are not receiving services. So for me, even though I have a lot of parents who have who said like why are you 30 minutes like, you know, like we get that question a lot. I always love when a parent would ask or inquire about it because I find that they’re advocating and so many children in early intervention at the EI or CPSC stage don’t have that advocate because their parents don’t know how to do it. Or they don’t know that they can. So I always love I prefer that they ask and have to explain the reason why it is what it is then they don’t ask it all because there’s some times when I’m like you know I have to like love some of it like you can ask you know your child is not verbal. and has no right now they’re, they’re severely impaired and they’re punching you. They’re punching themselves, they’re hitting themselves, their head against the wall, because right now they don’t have any method of communication, your child is due to more than one time per week, more than two days per week. So I love when they do try to advocate and I prefer having to explain why their mandate is lower frequency and duration than what they would love to have. You know, but it is a question that we do get a lot. But I know in New York right now, post COVID, there’s so many children who needs services and so little SLPs. Like, it’s it’s really like, it really amazes me that there was a point when we had so many SOPs providing treatment, I can’t tell you why. I know a lot of people just don’t want to go back to work in person post COVID. But there’s so many little ones who need it. And the parents just, you know, they just, they’re just okay, they’re just because they don’t know what to say they don’t know that they can ask, and they just like, This is what they gave me. That’s why.
Heidi Miller 51:05
Yeah, I think early intervention is maybe one of the most impacted of the pediatric spectrum because like, I have a lot, I had a lot of parents like, because I was in there at the beginning of COVID, I was doing EI and then as it was sort of entering the like normal phase where you could start going back to the houses and things. And there were a lot of therapists that didn’t want to go back into the homes, they kind of saw that this was because it is it saves money and time, because you’re not driving all over some place or, you know, Metro-ing around to different houses. And the burnout is so real for EI that it’s it’s hard I left it, I mean, it was burning me out, I was driving all the time, and always on the phone trying to schedule things and had the productivity demands. And you’re just talking about I mean, I know our research across not just for speech, but supports that the age from zero to three, I mean, that’s when you can make a lot of gains if you’re given support. So I we see it to where we are, we get so many kids coming into the hospital. And then they’re like, well, yeah, I was supposed to start, but then they didn’t have anybody that could come to my area. So it just never happened. And you’re like, Oh, no that like, that shouldn’t be okay, but like, what are we supposed to do? I mean, you know, it feels sometimes really helpless to try and help to find a solution.
Tasanyia Sebro-Calderon 52:31
It’s true, I really hope that there’s something that happens, because I just think about the level of delays that children will have as they get older, like this group of children, I hate to refer to them as the COVID generation. But that’s what people are saying. But I hate to think of the level of delays and what we’re going to see with them. By the time they get to like fifth grade, because of the lack of access that they’re having right now. Even school aged children here. It’s called related service providers. And there’s such a lack of it right now. Or they’re recommending that everyone gets virtual therapy, and it’s probably a whole different topic. But we know that not every child is a candidate for virtual therapy, especially when they’re a certain age and when there’s certain cognitive, when they are, cognitively a certain developmental level. So I hope that there’s a some kind of like, answer for it eventually. But it just all ties back down to just me being so happy with your parents do ask. And even if it if it like I have to answer a million times or like try to find a way to calm them down. And rather than do ask because these children need advocates, they need people to advocate for them, especially now in post COVID. America.
Bailey Womack 53:52
And to add to that, like I found like in you know, in Tennessee, there’s a lot of rural parts, like there are everywhere, I guess in the country, but we would have families who would like you know, have their evaluation, and they’ll say, okay, we recommend, you know, 30 minute sessions twice a week or once a week, and then they say, so I’m supposed to drive an hour to your clinic for a 30 minute session. Like that doesn’t really seem like we’re, you know, maximizing our time or is that you know, enough. And so that’s another thing to think about is just like accessibility for families and feasibility and logistics and is it worth you know, for a 30 minute session, and like you were saying Tasanyia with with teletherapy like, of course it has its limitations. It’s not appropriate for every family. But that did open a lot of opportunity, I think for therapists and to reach families who maybe couldn’t make it into the clinic, or maybe do like one session a week in person and like another session teletherapy and a lot of times, like at all the clinics where I’ve worked, you know, you have several of the kids that we see have OT and PT depending on their case. So they could maybe as far as scheduling, they could do like, you know, back to back sessions. I don’t know how it is where you all work, but we do that often in Tennessee, at least we have like, they have speech OT and NPT or whatever order it’s in and then co treat sometimes I don’t know if you guys do a lot of CO treats, insurances, like, at least where I am, they usually don’t allow that. Or I don’t know, but about the reimbursement, but just a lot of factors for sure. And I agree, I like when parents ask about why is it 30 minutes like, and even like the research, I see a lot of the research articles I read like it, they’ll say, you know, more research is needed on duration and frequency of sessions for this particular disorder that you’re treating. So yeah, that’s a good good convo there.
Tasanyia Sebro-Calderon 55:39
About insurance quickly, something that I’m seeing now is that the insurance companies will refer their will refer patients to you, right, so you’ll be in their network, and then they won’t reimburse, and the reason why they won’t, versus we don’t reimburse for anything within 15 minutes, which is mind blowing, because it’s like, how much therapy how rehabilitative can 15 minutes before a child that has a severe apraxia? Or, you know, what are severe feeding aversion? How much can you do with 15 minutes? So what I end up doing with cases like that is I ended up just, you know, just keeping them on the duration that I recommend and just don’t get paid for the amount of they’re not paying for it. But this is what it’s coming to nowadays with insurance. And I don’t know if it’s, I don’t know if it’s because I always go back to Asha. I don’t know if it’s because it’s not really pushed from our governing board. The importance of what, I don’t know what that missing piece is. But I know that there are physicians and nurses who make decisions within these insurance companies. And many times they just say like, no, it’s over 15 minutes, or no, there’s no medical diagnosis to support why they have expressive language disorder. So we’re not going to be immersed, we can improve therapy of this child. It’s just beyond- beyond understanding.
Bailey Womack 57:10
Yeah, man, we need to have a whole episode of Just ethics and insurance and ASHA. And yeah, To be continued.
Bailey Womack 57:16
Alright, so we’re at the hour mark, y’all. Let’s wrap it up. So thank you, everyone, for listening in. We really appreciate you we can’t wait together next month for another great therapy insights resource roadmap show. We want to thank everyone all of our therapists for making therapy informative, empowering and person centered. So until next time!