Wednesday, July 31, 2013

Speechie Freebies Post: How do you assess cognition when you are in acute care?

I have received this question a lot lately and so I decided I would share with you my version of what I do as a quick assessment of cognitive linguistic skills in the acute care setting. I hope you all find it useful =)

As I go through these questions (which I have pretty much memorized by now) I always look for eye gaze, attention, thought organization, informal memory and just general conversational skills. I try to keep track of how many cues they use. For example, if I ask "about what time of day is it right now?" I would mark whether the person just knew or whether the person had to look at a clock.

SO here is what I use- I made it simple and straight out of my mouth the questions I use in acute care. My speech supervisors used these same questions and I credit them with the vast amount of knowledge they gave me years ago that set me up to be the therapist I am today- Thanks Shannon and Christina!!!!!


Click the picture above to get the google docs to download the quick assessment! 




Thursday, July 11, 2013

Thank goodness for a comprehensive CFY Resource!

Hello my new SLP graduates and CF SLP's (hey maybe even a few of you SLP's that have been practicing a while!!)--I decided to write a blogpost because I am asked ALL the time. CONGRATS and WELCOME to your CFY! What do I need to know? Who do I ask? Where can I find some cheap resources? How in the world do I make a schedule? I don't know what I'm doing and I scared since I'm a new SLP!

Well here is a resource for you. It may not have all the resources out there in the world, but I am going to give you my best stab at giving you many places to reach out and learn! You MAY NOT copy this post in its entirety and repost under your blog. You may share and link to this blog post where you see fit or share on FB or pinterest. This blog is copyrighted and if I find out you stole my information- I will act upon it. Ok now that the stinky part is over.....here we go!

FIRST OF ALL--You WILL NOT know everything you need to know when you start a new job! It just isn't going to happen. I have been practicing for 4 years now and I STILL ask questions.


SECOND OF ALL--Try to enjoy the process and have fun. The more fun you look like your having, the more fun and energetic you will appear to your co-workers and the more they think you will care about the students that they take care of too. It can feel overwhelming, BUT there are people out there that will help you. If they are not willing, there are plenty of resources and people on FB. blogs and social media areas that WILL help you. I answer questions all the time on my blog/FB page and I know the other bloggers do too. We want our profession to grow and be successful- just ask us! I have many friends now that are online SLP bloggers that I haven't met before in my life. I actually consider them good friends now.


Inside school setting resources

1. Ask your CFY supervisor. 

You are operating under the license for a reason. They should be your go-to person when you have a question. However, some CFY supervisors are better than others, so if they don't have the answer. Keep asking other SLP's until you get the answer you desire. I am a question asker and I have never been afraid of looking dumb. In fact, I asked so many questions in my hospital setting that now physicians and nurses LOVE to teach me stuff. I get to see cool Xrays, MRI's, CT scans and other results. If I don't know I ask. My dad always said "The more you know, the more you find out that you don't know". That saying has proved true, so many times in my lifetime. (I have great parents).

2. Ask SLP's in your district or in your specific setting. 

SLP's are for the most part very nice people who want people to succeed. You will come across the occasional SLP who is not that way, but for the most part people in our profession are very giving and sweet. I know when I started at my school district the first year, I had no idea what was I supposed to be doing and when in terms of administrative stuff for caseload count, child find (Oklahoma's version of reaching out and finding at risk children in the community) etc. If it weren't for my friends/SLP's in the district I would have never made it. I wasn't even a CFY when I started in the schools. I was a CCC-SLP that just hadn't been in the schools since graduate school. So my point is its never too late to ask questions and learn a new setting. People will not think you are dumb and the district will be proud that you are trying to do your job correctly.

3. Ask a special education teacher or Occupational Therapist or Physical Therapist.

They know a lot about a lot of things. If you are new to your district and replaced a different SLP, they might be a wonderful resource. Many of special education teachers would respond to my questions like this "Well the previous SLP would do it this way....". There is a caviat here. Some of the special education teachers will judge you against a previous SLP. The previous SLP might have been the world's BEST SLP or the world's worst SLP. Be up front and stick up for yourself. Say 'I am new, I am willing to learn and I will never be that other SLP". Thats what I did and guess what they learned to love me and my learning style quickly because I told them up front I have no desire to be that other SLP- I am ME SLP!

4. Ask the support staff and counselors.

 Boy I am SOOOOOO glad I know the support staff at my schools. Now I am talking about secretaries, counselors and janitorial staff. They hear all the gossip and know a TON about what goes on behind the scenes. Keep them on your good side. I got extra supplies, many morning hello's and a good pat on the back when your day isn't going the best.

5. Listen

You can find out a lot and learn a lot just by listening to people. Go to the lunch room and sit with the teachers. Go to the break room and listen to what people have to say. The more you are around, the more people will get used to you, your personality, your teaching style etc.


Outside of school setting resources

1. Follow Bloggers! 

I follow many blogs and I LEARN SO MUCH from them. There are many SLP's that have been doing this for a long time or are very creative or have already done the research behind questions you might have. So my suggestion is follow Katie's SLP Facebook List from "Playing with Words 365 blog".  Katie also has some must have resources on her blog: materials she loves, reference books she loves and her top SLP resources.



Jenna from Speech Room News has a discussion section for questions on her blog as well as a TPT Resource List and a Blogger Resource List.

Nicole from Allison's Speech Peeps has a great reference list on Evidence Based Practices.



2. Teachers Pay Teachers.


I am always surprised about how many people do not know about this site. http://www.teacherspayteachers.com/  Step 1: Go here and make an account. If you don't have funds to buy, go grab ALL the freebies. You better bet your britches thats what i did when I first started out. Eventually, I started making my own and began a successful side income =) Don't make them right away though....give yourself time to settle in to your job and caseload. THEN start to think about making your own stuff if you just can't find what you are looking for and hey you might make some extra cash. BUT DO YOUR RESEARCH!!!!! There are MANY copyright laws and regulations and you can get in a LOT of trouble if you break them. There is a section of this site that is dedicated to discussions as well so before starting out-read read read read read. On another note, if you purchase items from TPT-leave feedback on your purchases. Here is a blog post I wrote on how to leave effective feedback and how it effects a sellers reputation. When you leave feedback you get credit that you can put towards future purchases- another way to save some major casheesh!
I started a regular thing on my blog called Tangled Tuesday's--I review items from other TPT material creators for others to see prior to purchasing. Check all the items out here that I have reviewed to date.


3. Buy materials- but in a cost effective way!

Super Duper has a 40% off list that changes every week. I buy things regularly on this list. I just made a big wish list one day and check my wish list each week to see if any of those items are on sale =) Super Duper Publications also has a overstock section that changes weekly. These items are 50% off! There is nothing wrong with any of these items, but I highly encourage you to check them regularly.  Super Duper also has a list of free items and CEU's available to you. The free worksheets are a great way to sample pages in a book prior to purchasing too. Materials are expensive (believe me I know), so research before you buy to make sure you are getting the most bang for your buck.


Here is a list of companies who have generously donated to an amazing cause and have really awesome therapy materials to purchase from-check out all the links and go visit their websites and start creating a wish list.

Here is a list of items that I love and have blogged about. Read through and you might see something that you like too.

Linguisystems has a sale each year on their items. They only go on sale once or twice a year, so have your wish list ready! Linguisystems has free CEU's and a whole menu of free stuff!! Once you become a certified SLP, Linguisystems also has a opportunity to administer tests to various populations of students to help them standardize the tests. I took advantage of this last year and earned about 1000 dollars in therapy material credit.

Sometimes you need to pay full price for stuff. Thats what happens when you just can't wait!

4. Take advantage of things you already have.


For example: If you are working in a secondary setting with students that require functional skills. Look around your house. You are functional at home right? So that means you have everything you need to teach too! One of the lessons I did my first year was laundry. So I took clothes, detergent, dryer cloths, towels, sheets, and a laundry basket to school. I did a 60 minute language lesson using those items (sorting, compare-contrast, labeling, function labeling, sequencing using a worksheet I had on laundry completion tasks and overall describing). They had SO much fun and so did I. Another thing I did my first year was start saving boxes and food containers that were easily washed or could be re-used. I was careful when I opened them the first time, then I would re-fasten them together with scotch tape and hey it looked like it belonged on a shelf again. I again did compare-contrast, describing, what aisle would I find it in, associations, categories, the list goes on and on and on!


5. Donor Choose Projects.

Another awesome way to get OTHER people to purchase items for you is a website called DonorsChoose.org  It's easy! Go on there, make a username and follow the instructions on how to create a project. How this works is you place a request for materials (create a project) and it posts it on the website for all possible donors to see. The lower the socioeconomic status of your area, the more likely you will get funded. I to date have been able to have 3/3 projects funded without paying a penny. The catch here is the materials need to stay at your school- they belong to the school and not you. BUT HEY- who cares when you get to use them all year. I have found that the materials available on here are better for elementary kids than secondary kids, but that is just my opinion. 

6. Borrow from other SLP's

I was not above this. I borrowed materials from other SLP's in my district to use before I bought to see if I liked it or not or if it would fit my caseload or not. This was so the way to go. I was surprised how many things I actually didn't like when I actually used it that I thought for sure I would like after reading the description on the selling site. PLEASE use their items as if they were brand spanking new and return them quickly after you have made a decision. I aways told the SLP/friend I will bring this back to you by the end of the week if that is ok and then I was very prompt on my return date. 

7. Garage Sales and Goodwill Stores

Go garage sale hopping. Surprisingly I found many speech items in a garage sale. I once even bumped into a retired speech path that was selling all her stuff in that garage sale for CHEAP and I bought it all haha. You can find gently used games and other things. BE CREATIVE. 

8. Make your own

I have made myself many materials for use in my own classroom.  Eventually after a lot of research and thought I started selling my creations on teachers pay teachers, but that is not something I suggest jumping into blindly like I said above.


9. Ask for speech stuff for your birthday-the holidays!

I totally did this and my family thought I was crazy. I felt like I was getting to the age where it was hard for others to buy things for me. I have always been hard to buy for though. So what I did was ask for gift certificates to various companies and I purchased many of my items that way as well.


10. Go complete Continuing Education Units. 

Continuing education can be expensive, but it can not be too. Speechpathology.com has unlimited CEU's for 99 dollars a year. There is a course out there for everything now. Do your research and determine which courses would be most helpful to you in the beginning. Although you are not required to get them right away by ASHA, get them anyways. Knowledge is NEVER a bad call.  In fact, if you do enough CEUs you can get recognized by ASHA by being an ACE. ASHA is a great resource for CEU's and information required to keep your license. LEARN it, you don't want to try to get your license reinstated because of a dumb mistake of just not knowing. 

11. Pinterest

There are so many neat social media pages now to follow. Pinterest is a wonderful way to learn new craft's, therapy ideas and get access to resources. There are many pages like mine that have collaborative boards where people can post blog posts to it. You can follow specific boards or you can follow the person. 

12. Speechie Freebies Blog and FB Page

There is a neat website that has been up for a while now called Speechie Freebies by Jessica. I happen to be one of the collaborators, but there are many others who are collaborators as well. This page blog and FB page is dedicated to ONLY freebies! Yup EVERYTHING is free. Who doesn't like free???

13. Speaking of Speech 

www.speakingofspeech.com is a very cool resource. It even has a help line to ask questions! There is an awesome goal bank and an awesome materials sharing area. There is even a section called "what works for me".


14. Facebook Groups

There are more and more everyday!
Here are just a few: 

** some of these groups might be closed groups. All that means is that you have to request to join. Someone will let you in. We close groups so the general public cannot see what we discuss. Always consider HIPPA when discussing things in these groups.


How to make a schedule: 



This is a question I get a lot and it's one of the hardest to answer. Making a schedule depends on a number of things. 
1. The number of students on your caseload.
2. The various goals that need to be targeted.
3. Students schedules.
4. Teacher requests.
5. Administrative guidelines.
6. Many many more things

I will be at two junior high's next year, so here is how I do it with my schools. I go through all my IEP's and write down service times from the service page of the IEP and record how long each student requires speech services. This helps me start to get organized. I don't look at goals just yet. Luckily For me, one of my schools has 6 periods and one has 7 periods. One of my junior high's has a built in study period and my other does not. That makes it difficult for me because my time allotments aren't the same. You might not have this issue, but there will be SOMETHING that creates a challenge. I guarantee it! My district has the students scheduled under the same teacher for reading and english so technically they have that student for like 90-100 minutes a day. I spoke with the english and reading departments and we came to an agreement that I would get kids out of one of these classes since they would be able to catch up in a later period when the teacher is done teaching. This worked out for me. As a rule, I try NOT to take kids out of their core classes--reading, english, science and math. However, it sometimes is just not possible. I try to take them out of electives first, then non-core classes then core classes. I then have a these lists of students under different class periods throughout the day. THEN I go through their IEP goals and separate them by articulation and language goals. If someone is social goals only, then I just put them in one of the groups to work on social skills while doing whichever activity I have planned for the day. Social skills are in everything we do all day long in my speech room. Once I have them separated by goals, then I separate even more by grade level (if possible). Surprisingly there is a large maturity gap between 7th and 8th grades (and 1st and 3rd, and 4th and 6th). I try to make my sessions 20-30 minutes long but that is not always possible. Usually I hold a language group for 60 minutes weekly for my students with intellectual disabilities and my students with autism for a more comprehensive session. 

Don't be afraid to change your schedule. I make MANY drafts of my schedule throughout the year. It never stops evolving. As I dismiss kids, I try to make the groups smaller in size so students get more 1 on 1 attention. I also add groups and move students around as I see fit. 

Talk to your teachers before setting up a schedule as well. They WILL have preferences based on when they teach, days they teach certain important info and just preferences in general. Some teachers will not be happy with you. When it comes down to it, you hold an IEP in front of them and say this is a LEGAL document stating I need to take this student for therapy sometime during this day. 


What to do if your CF Supervisor isn't really around much......

This happens unfortunately. Companies MAKE a person be a CF supervisor and they don't want to be and it shows. There are other people out there that are willing to help. You just have to find them. 

Discussion topics to have with your CFY Supervisor prior to school starting:
1. When will you be available to ask questions?
2. What is your contact information and what is the most convenient way to contact you (email, phone, text)
3. What are your pet peeves?
4. If you are not available, who else do you suggest I ask if I need a question answered ASAP?
5. Find out information about them. What are their best therapy tactics? What do they specialize in? ASK!
6. What are your favorite materials? testing information? 

If he/she still isn't around- here are some things to consider: 

1. Join SLP FB groups
2. ask bloggers questions
3. Become friends with other SLP's in your district
4. Look up stuff in your textbooks
5. Ask previous professors and clinical supervisors--OMG I would not be clinician today without each and every one of them during my clinicals and after!
6. ASHA.org- just look around.
7.  Join Special Interest Groups on ASHA and read the forums. I dished out the extra cash and joined an SIG for each setting I wanted to get involved with during m CFY and settings I wanted to work in the future. It was well worth it. I learned a lot from what other people asked and what other's responses were.
8. Make sure your CF supervisor completes the requirements of supervision. It's your license they are messing and possibly delaying..not theirs. Your future is in your own hands. 
9. Reach out to your state speech organization. There are plenty of people that want to help- just ask questions and they will direct you or answer them themselves. 
10. Ask your graduate school friends or ask for their CFY supervisors phone number (with their permission of course). If you need information, you need information- FIND IT. 
11. Research on your own. There are many research articles and many good sources of information in the ASHA Leader-read it, you might learn something. 


Continuing Education Opportunities and Certifications that you might consider in the future:

As a CFY you don't need CEU's for ASHA, but you made need them for your state. I did. Ask people in your SLP community what CEU's they liked and what certifications they benefitted from. Research ones now that you would like to do in the future and plan for them- financially, schedule wise and consider everything else that is needed for travel.


Advice from ME and other SLP's that I know:

1. Schedule a lunch break. 
Even if you don't actually eat during your lunch break or you do admin stuff while you eat lunch. Always include that into your daily schedule. 

2. You might have an outrageous caseload starting out--like 80 to 100 students for 1 week. Guess what! It's impossible to get good therapy done with that amount of students on your caseload. You are just going to have to swallow the fact that it is what it is and do the best you can. Now I am not saying you can't stay after school and that you can't try to make it as successful as possible. KNOW that that is a hard task for any SLP no matter how long they have been practicing. Go HOME after school when you need to do. Work will always be there tomorrow (unless you have an IEP due the next day- stay and do it, don't wait til the day of). 

3. An IEP can be held at any time. You can have 10 IEP's for 1 student in a year if someone from the IEP requests it. I don't suggest this practice, but if its needed that what needs to be done. I have held an IEP max of 3 times during a year in my short experience of school speech path life. You don't HAVE to wait until the IEP anniversary date to hold the IEP. If it is easier for you to hold the meeting early and it works out for the team- go for it!  I always write my monthly IEP dates on the first day of the month. I send an email out to my teachers reminding them to include me on the notification of meeting and to remind them that I am part of the IEP team. For some teachers, they need multiple reminders so give it to them. I have found in my experience that SLP's are very organized people and use that to your advantage. 

4. Know your administration and what they require of you. This is important. My district has a high population of special education students so our special education director is strict on paperwork and what it contains, wording etc. Know what your administration expects of you and EXCEED it. Its a good practice and if for some reason you get called into court, you have your hiney covered. It's a good feeling to have. I have not been called to court to date, but I always cover my bases as if I will get called to court on every student I have on my caseload. It keeps me organized, honest and following proper procedures.

5. You will make mistakes! You WILL. Own up to them, don't lie and know its part of being a CFY. 

6. Have confidence in yourself. NOT arrogance, confidence and if you have to fake it to make it. Teachers, parents, administrators might try to take advantage of your lack of knowledge, confidence or lack of experience. Don't let them belittle you. The only one who can make you feel insufficient is yourself so if you have confidence in yourself, you can go home knowing you did your best.

7. When an SLP gives you advice or asks you to change something in the ways that you do. Listen, don't take offense. If you decide that their advice is a good idea-go for it and do it. If you really think your way is better I would have a reason why you think that your way is better. Many districts require evidence based practices to be used in your therapy rooms. Luckily some of the bigger companies have EBP and common core objectives listed on their products information which makes it easier to justify your use of certain materials.

8. Stay up to date on all of your paperwork. I had binders and binders of charts, schedules and dates that helped me stay current. I even wrote down the information in multiple places so there was no excuse like "I lost my binder".

9. Back up your information and keep records of information in multiple places (if possible) with still abiding by your district regulations re: storage of information.

10.  Go with your gut. There are things you can't explain. There was some research study done a while ago that I recall learning about in graduate school that stated that your gut feeling is 90% correct. Don't quote me on this, but it has never lead me astray.

11. There are certain parents that give you that heeby geeby feeling and threaten you with lawsuits ALL the time. Just know that they are out there and that you have a district that more than likely will back you. In these cases, document EVERYTHING-emails, phone calls, face to face meetings etc. I had a parent once that I required another staff member to be present before I participated in any communication with them. Now thats been 1 of 300 students, but they ARE out there. Pick your battles and if in doubt, document it. CC administration on emails (I've done it), I CC my principal on stuff all the time for my "difficult parents". She appreciates it because it keeps her in the know as well. I have never been in trouble for keeping too many people informed. HOWEVER, make sure that the people that you are keeping "in the loop" requires to be in the loop. Don't go chit chatting with friends in the lunchroom about a horrible parent because you never know who is listening, recording or quoting you. It's never happened to me, but I have heard of it happening.

12. Parents are sometimes crazy. Parents will go to extreme measures to pressure you, try to change your mind and try to get information that they want. Stick to your guns unless they bring up a good point. See below.

13. On the flip side, parents have good points and they definitely deserve to be listened to. They have been with their child MUCH longer that you have. Consider that.

14. Sometimes you are going to fail. YUP it SUCKS, but you will FEEL like you failed a child. I am here to tell you, you did not fail that child. Some children have just such small levels of progress over the course of their lifetime and time in school that you might not be the therapist that brings out one of those gains. If you did everything you possibly could to help that child, you did not fail that child. If nothing else, you showed a child that there is another person in this world that cares for them and THAT is a big deal.

15. Some of your sessions will feel like counseling sessions. Some therapy sessions need to be cancelled. Its ok. Kids have bad days. Be aware of how your students enter the room. How they interact with others. How they communicate and interact in the hallways. Listen to how they do in other classess. You will pick up on patterns. Sometimes kids just need to talk. Let them let it out. I've had students cry and be mad. I even let them let anger out by throwing those "sticky hands" against a wall for 10 minutes  then start speech. Speech Pathology is not only about their goals-remember we are making PEOPLE just as much as we are helping them academically or IEP goal wise.

16. This is a petty one, but I seriously didn't know/understand when I first started
--0.1 ASHA CEU's is 1 hour.
--3.0 ASHA CEU's is 30 hours.
--1.5 ASHA CEU's is 15 hours
--etc

Other Blog Posts/Articles on Advice for your first year out

Pathologically Speaking
Speech Room News
The Speech Bubble 
Advance 
ASHA
Speech Language Play 

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