Strategies for EI – Says WHO?

8 Apr

Research Tuesday Numero Tres!

When “Simon Says” Doesn’t Work: Alternatives to Imitation for Facilitating Early Speech Development

Citation: Laura S. DeThorne, Cynthia J. Johnson, Louise Walder, Jamie Mahurin-Smith; When “Simon Says” Doesn’t Work: Alternatives to Imitation for Facilitating Early Speech Development. Am J Speech Lang Pathol 2009;18(2):133-145. doi: 10.1044/1058-0360(2008/07-0090).

 

As you know, I work with children 0-3 (I’d say the average age I get referrals is probably 26 months) in group center-based, individual center-based, and home-based therapy. I often make suggestions to parents on the very first day I see a child, maybe even in the evaluation – but I’ve often wondered …where do I get this stuff? Says who?

I saw this article while I was trying to find an article that supports the notion of putting an object near the face when you label it to gain attention and encourage imitation. I found a variety of sources that make the same suggestion but I have not seen any studies (if you know of one throw it my way). I seriously make this suggestion like three times a week but WHY? Who says it actually does anything? Somebody out there has to know.

ANYWAY, this literature review focused on six strategies that SLPs recommend and utilize for early speech imitation and language development. The review’s goal is to provide SLPs with evidence based strategies (rather than strategies that are anecdotal and maybe outdated and things that we just do because we see other therapists do it.) I have this dream that one day I’ll have a citation for every strategy I suggest to families. Which sounds alarming but really, I wouldn’t want a medication that hasn’t been proven to work.

What are these six strategies that SLPs frequently utilize to elicit speech imitation?

  1. Provide AAC access
  2. Minimize the pressure to speak
  3. Imitate the child
  4. Utilize exaggerated intonation and decrease rate
  5. Augment auditory, visual, tactile, and proprioceptive feedback
  6. Avoid emphasis on nonspeech-like articulator movements: focus on function

How did researchers pick these strategies?

First, they created a list of strategies that already had some theoretical framework which were supported by the big wigs of speech pathology. Then they used a variety of search methods to track down associated intervention studies. Then they narrowed down the list to these strategies with Level Two empirical evidence (supported by at least one experimental or quasi-experimental study on a relevant population).

You guys remember about empirical evidence right? Let’s review friends:

ebp

What is something cool that this literature review told me about each of these strategies?

  1. Provide AAC: The authors identified SIX studies which support providing AAC to children who do not easily imitate. Within those six studies, 89% of the children showed an increase in verbal output, and 11% showed no change. AAC had no detrimental impact on speech production in any of the children.
  2. Minimize pressure: In a study with 29 late-talking preschoolers, using mands and prompted imitation increased imitation within a speech session, however showed no carryover to the natural environment. The study indicated that directly prompting an imitation does not increase word-learning any more than low-pressure imitation.
  3. Imitate the child: Recent studies have shown that when you see someone perform a familiar action, neurons fire in YOUR brain too as though you’re doing the action. So when a child sees a clinician perform an action it may incite neurons in their brain which acts as an involuntary rehearsal. How neat is that? Super neat.
  4. Exaggerated intonation and slowed rate: This one is kind of weird because they call it exaggerated intonation and slow rate but they talk about singing – which I think are two separate things but nobody asked me. The research for singing and speech is extensive for adults. However, one study showed that melodic intonation therapy for children was more effective at increasing phoneme imitation versus oral motor therapy (which makes sense because we all know non-speech oral motor therapy does nothing for speech right? WE ALL KNOW THIS RIGHT?)
  5. Enhance sensory feedback: There’s a pretty small amount of literature on use of auditory and visual feedback for small children. However, tactile and proprioceptive information has shown promise for eliciting imitation in children via the PROMPT program. The idea of using enhanced sensory feedback is that we’re helping the child develop internal models for speech sound production (i.e. motor planning has a sensory result)
  6. Focus on function: Oral motor therapy is not effective based on a number of unpublished studies. If you feel the need to recommended non-speech oral motor exercises, do it only when a child is genuinely not imitating speech at all, and the activity should match as closely as possible in the areas of position, movement, and function of the target sounds.

So now when you recommend a speech imitation strategy to a family or caregiver you can at least rest easy knowing these six strategies do have an evidence base. There are numerous other suggestions we make as clinicians that don’t have a Level 2 evidence rating – we should strive to increase our EBP for early language imitation and development. Don’t you think?

Classification Accuracy of Brief Parent Report Measures of Language Development in Spanish-Speaking Toddlers

11 Mar

Mark Guiberson, Barbara L. Rodríguez, Philip S. Dale; Classification Accuracy of Brief Parent Report Measures of Language Development in Spanish-Speaking Toddlers. Lang Speech Hear Serv Sch 2011;42(4):536-549. doi: 10.1044/0161-1461(2011/10-0076).

RT image

As a follow up to last month’s Research Tuesday article, I chose this research article as my second topic. Also in my workplace, we use the SPLS as our qualifying assessment for Spanish-speaking children, so I was curious to see what these researchers had to say.

The goal in this project was to evaluate the classification accuracy of three different parent report measures as they assess they language development of Spanish-speaking toddlers. The three parent report measures chosen were the Ages and Stages Questionnaire (Spanish ASQ; Squires, Potter, & Bricker, 1999), he short-form of the Inventarios del Desarrollo de Habilidades Comunicativas Palabras y Enunciados (INV–II; Jackson-Maldonado, Bates, & Thal, 1992; Jackson-Maldonado et al., 2003), and reported children’s 3 longest utterances (M3L–W). The children were also administered the Spanish Preschool Language Scale-4 (SPLS–4; Zimmerman, Steiner, & Pond, 2002) to assess concurrent validity of the parent report measures in comparison to the Expressive Language Subtest.

Who took part in this study? 45 Spanish-speaking families and their 2 year olds. 22 of the children had expressive language delays (ELD), and 23 of the children were typically developing in their language development (TD.)

What’s going on with these parent measures? Well, the Communication Subscale of the ASQ is six questions long. The short-form INV-II is a 100 word checklist with a question regarding combining words. The M3L-W is assessed by asking parents to write down the three longest utterances their child has produced (To calculate a score you add the number of words and then divide by three.)

And what did we learn? Tell me about the results!

  • All three parent measures were significantly correlated with the SPLS-4. They showed concurrent validity (a type of evidence that is demonstrated when a test elicits similar results to a test which has already been validated).
  • When researchers compared the test scores of the children with expressive language delays and those test scores of the children considered typically developing, children with ELD received significantly lower scores than the children considered TD. (…which makes perfect sense? I guess that’s good to know – probably wouldn’t be great if both groups scored similarly.) The biggest difference was noted on the M3L-W measure.
  •  The classification accuracy aspect of the project looked at sensitivity, specificity, negative predictive value, and positive predictive value. Sensitivity of the measures reveals how many of the children who had a dx of ELD, also tested as ELD. Specificity of the measures reveals the portion of children considered TD, who tested as TD. Negative predictive value (NPV) is the percentage of children with negative screening results who were accurately classified, and the positive predictive value (PPV) with positive screening results that were accurately classified. (This is all very confusing for me, I’m hoping as I read it becomes clearer.)
    • The ASQ showed low sensitivity and NPV, but strong specificity and PPV – the ASQ was determined to be inadequate at detecting children with ELD (Possibly due to the fact that the questions are direct translations from English, and the ASQ was developed specifically for parental styles typical for Europe and America.)
    • The INV-II had high sensitivity, specificity, NPV, and PPV – it “shows promise” for use as an expressive language screener
    • The M3L-W had high sensitivity, specificity, NPV, and PPV – promising in terms of “pass/fail” screenings to determine need for in-depth assessment
    • Since the INV-II and the M3L-W had similar results, the researchers performed another test called a “receiver operating characteristics” which revealed the M3L-W was “non-significantly” better and demonstrated stronger classification accuracy.

To sum it up, when screening toddler-age, Spanish-speaking children it is appropriate to use a vocabulary checklist as well as a parent report on MLU to gain clinical information prior to an in-depth evaluation. But don’t bother with the translated ASQ. 

Stay tuned kids, for Research Tuesday in April!

Works Cited

Jackson-Maldonado, D., Bates, E., Thal, D. (1992). Fundación MacArthur: Inventario del desarrollo de habilidades comunicativas. San Diego, CA San Diego State University

Jackson-Maldonado, D., Thal, D. J., Fenson, L., Marchman, V. A., Newton, T., Conboy, B. (2003). MacArthur Inventarios del Desarrollo de Habilidades Comunicativas user’s guide and technical manual. Baltimore, MD Brooke

Squires, J., Potter, L., Bricker, D. (1999). Ages and Stages Questionnaire user’s guide. Baltimore, MD Brookes

Zimmerman, I. L., Steiner, V. G., Pond, R. E. (2002). Preschool Language Scale, Fourth Edition, Spanish Edition. San Antonio, TX Harcourt Assessment

Disconnect de comunicacion

3 Mar

Currently in my caseload, I am working with approximately 13 Spanish-speaking families. Communication at times can be very tricky – not between the child and I, but rather between parents and me! I have enough Spanish to interact with a toddler, and I can generally express myself to parents, but when they ask me a question or tell me a story – not a chance. My receptive Spanish skills are pretty limited (in classes when a Spanish professor asked me a question I was always a deer in the headlights.) Oftentimes I’m working with a child in a daycare, so I’ve never even met the parents, or spoken to them on the phone. In this case I leave a carryover note in Spanish, but I’m constantly using wordrerefence.com (they need an app) to look up phrases and words.

I don’t love the disconnect, and I never know what the parents have questions about or concerns until their service coordinator comes to me after months of therapy and says, “Oh Mom thinks they aren’t making progress” or “Dad is worried about XYZ” and then I have to do this crazy tango between the coordinator and the parents. Plus I have no idea about what suggestions or techniques are being carried over.

I do get an interpreter once a month, when I specifically request one, but that’s pretty useless when I’m in a daycare since I don’t need an interpreter to play. We have a receptionist at work who speaks Spanish, so I can potentially use her to call families though scheduling this with the receptionist and the working parents and my schedule isn’t necessarily going smoothly.  For one child I’m developing a communication notebook to stay in the daycare cubby so Mom can ask questions and let me know her concerns, or tell me what is working at home and what isn’t. But I have no idea if Mom will actually use it or if I’m just going to be writing note after note with no sign of life on the other side.

I’m wondering what other strategies clinicians are using for parents interaction. I’m sure this happens in the schools frequently. How do you find out what is going on at home? Have you learned any tricks for communicating when the parents aren’t sitting inches away from you every week?

Ayudeme!

OH and does anyone happen to know student-friendly Spanish musical artists? I have a client who is highly motivated by Latino tunes but I don’t wanna download the Latino equivalent of Lil Wayne by accident.

Okay now this is too funny

1 Mar

I had NO idea that this blog was being pinned on Pinterest (it’s all good, I’m glad not mad…I just didn’t think about it.)

So I was looking at the site stats and referral sites etc and I click on Pinterest. And this is what I see:

 

AHHHH oh my God. I cannot stop laughing. It's just too funny.

AHHHH oh my God. I cannot stop laughing. It’s just too funny.

 

Thank you all for reading and making me laugh. This is way awesome.

The Special Mother and Ginny

1 Mar

Erma Bombeck is absolutely one of my most favorite authors. I’m not a mom so it doesn’t make a whole ton of sense that I’m obsessed with her. But her writing is funny and honest, and one day I’ll probably reproduce so she’ll come in handy.

I was reading her book Motherhood: The Second Oldest Profession and she touched on the subject of mothers of children with special needs. I’ve read a lot of her books and I haven’t seen this topic before so I was surprised. The first of these stories was: The Special Mother.

The Special Mother

I think this was beautifully written and touching. But when put in the perspective of the second story, I came to love Erma even more. It’s a little darker, but also just as beautifully written and touching as the first. The chapter is entitled, Ginny. You’re able to read it here as a GoogleBook (if you can’t find it, it is Chapter 17 – you should be able to just search it.)

Sometimes at work we have to have the conversation – while we think that as therapists we’re fun, and we play, and the children are happy (sometimes) -  it isn’t necessarily “fun” for families to come to us. If a family is coming to us, there may be something “wrong.” The story of Ginny reminded me that our families love their children and want the best, but also life (and therapy) can be hard. A reminder that those of us who work predominantly with families need sometimes.

I think Ginny also serves as a nice reminder (copywrite 1983) that because of Early Intervention, families don’t necessarily have to feel as though their children will never accomplish things. We’ve come a long way, and we’ve still got a long way to go.

NP: Santigold – Riots gone

Measuring vocabulary development in bilingual children

10 Feb

The topic of my first Research Tuesday Blog is (drumroll please): “Total and Conceptual Vocabulary in Spanish–English Bilinguals From 22 to 30 Months: Implications for Assessment.”

This is all there is to see folks

This is all there is to see, folks

To understand the purpose and findings of this article it is beneficial to know the difference between total and conceptual vocabulary.

Total vocabulary is the sum of the words a child knows across two languages.

Conceptual vocabulary gives the child credit for knowing concepts rather than words, and concepts that are represented in both languages are counted only once.

So basically, when looking at a bilingual child’s total vocabulary you would count both the word perro and the word dog. If you were looking at conceptual vocabulary you would only give the child credit for knowing one concept: the furry, four-legged creature in my house which barks and eats kibble is a dog/perro.

The bottom line about this article? The researchers found that when assessing bilingual children, it is most appropriate and beneficial to look at total vocabulary (total vocab FTW!) A clinician is able to look at total vocabulary in a bilingual child by providing the MacArthur Bates Communicative Development Inventory (CDI; Fenson et al.,1993) in English as well as in the family’s home language.

What happened in this research project? Cynthia Core, Erika Hoff, Rosario Rumiche, and Melissa Señor provided families of 47 bilingual families with the CDI and the Inventario del Desarrollo de Habilidades Comunicativas (IDHC; Jackson-Maldonado et al., 2003.) This was a longitudinal study; the children were assessed at 22, 25, and 30 months-of-age.  The children were age and socioeconomically matched with 56 monolingual (English-speaking) children who were assessed with only the CDI.

At the initial 22 month trial, all parents completed the Ages and Stages Questionaire (Squires et al., 1999). The parents of monolingual children completed the CDI, and the parents of bilingual children completed both the CDI and IDHC, at the 22, 25, and 30 month session. The CDI and IDHC provide parents with a checklist of words they have heard their child produce and yields raw vocabulary scores based on this checklist. Both tests provide a percentile based on monolingual norms.

Then the researchers ran all sorts of crazy ANOVAs and t-tests and z-ratios which were totally over my head so I skipped ahead to the conclusion.

Researchers found:

The Spanish-English bilingual children showed a mean conceptual vocabulary which was significantly lower than their total vocabulary.

Total vocabulary in the bilingual children was not different from the monolingual children at any of the three sessions.

Conceptual vocabulary in the bilingWual children was considerably lower than the monolingual children at the 30 month visit.

Total vocabulary assessment did not identify any more/less at-risk bilingual children than bilingual children. Conceptual vocabulary assessment identified a higher number of bilingual children who appeared to have vocab development in the low-average range.

When one compares a bilingual child’s vocabulary to monolingual norms it underestimates the child’s expressive language and over-identifies at-risk children.

Using the CDI (and the home-language counterpart) clinicians can get a clear picture of a bilingual child’s total vocabulary without being responsible for considering the child’s language experiences, and language dominance, and language overlap, and the “balance” in their bilingualism. Clinicians are able to see clear change using these protocols (which we all love).

The authors caution us to remember to take socioeconomic status and receptive language into account. They also suggest that monolingual testing may be appropriate in the event that a clinician wants to know about English proficiency (or the proficiency of the home language.) They also pointed out that similar studies have been done previously with mixed results. ALSO the researchers did a really nice literature review to give you more background on bilingualism, total and conceptual vocab etc., so please read that if you desire.

Direct Link (you will need your ASHA login): http://jslhr.pubs.asha.org/article.aspx?articleid=1797298&resultClick=1

Citations:

Cynthia Core, Erika Hoff, Rosario Rumiche, Melissa Señor; Total and Conceptual Vocabulary in Spanish–English Bilinguals From 22 to 30 Months: Implications for Assessment. J Speech Lang Hear Res 2013;56(5):1637-1649. doi: 10.1044/1092-4388(2013/11-0044).

Fenson, L., Dale, P. S., Reznick, J. S., Thal, D., Bates, E., Hartung, J. P., … Reilly, J. S. (1993). The MacArthur Communicative Development Inventories: User’s guide and technical manual. San Diego, CA: Singular.

Jackson-Maldonado, D., Thal, D. J., Fenson, L., Marchman, V., Newton, T., Conboy, B. (2003). El Inventario del Desarrollo de Habilidades Comunicativas: User’s guide and technical manual. Baltimore, MD: Brookes.

Squires, J., Potter, L., Bricker, D. (1999). Ages and Stages Questionnaire: Parent-Completed Child Monitoring System (2nd ed.). Baltimore, MD: Brookes.

Coming Soon: Research Tuesday!

3 Feb

As some of you may know, many of the SLP Bloggers of the World (official title) have been participating in an undertaking known as Research Tuesday.

The purpose of Research Tuesday is to encourage awareness of current professional research! I know that for me since graduating, I haven’t put much oomph into reading research articles. Which is silly because access to ASHA Journals is part of what I pay ASHA for every year. But there you have it. Unless someone forces me to read an article I am probably not going to. If say, research articles weren’t a thousand years long and full of jargon-y jargon, maybe it wouldn’t be so painful!

SO, as a result of this being the case for everybody in the club, Research Tuesday was founded. “The goal is to increase accountability for reading the research, advocate for reading the research, and improving exposure to research.”

Since my blog is in a current state of transition and lackluster blandness, I decided I would participate. I’m hoping that (a) I’ll learn (and you! You’ll learn!) more about professional topics that I like and (b) I’ll be encouraged to blog more because I’m slacking.

Keep your eyes peeled boys and girls!

Clinical self-discovery. It’s okay!

21 Jan

Hey 2014, great to see ya!

It’s been two (TWO!) years since I started my internships and I’ve been thinking quite a bit on the narrowing of my clinical interests.

When I started my internships, I had no idea what I liked and didn’t like. I mean, I THOUGHT I knew (but we all know that’s silly…you have no clue until you get experience under that very cute belt you’re wearing.) I THOUGHT I wanted adult and hospitals. I THOUGHT I hated AAC (now we have a love-hate relationship.) I THOUGHT I wanted middle school students with diagnoses of ED/BD.

Hahaha. Thoughts.

I knew after my first internship that I loved working with the little children – you know, the weensy ones with the munchkin voices. I knew after my second internship that I did not want to focus on ED/BD. I knew after my third internship that hospitals are not my scene. Even after that, we still have quite an elaborate scope of practice to choose from.

So I got my first job and started my CF with a great, big, wide open caseload. Early intervention, bilingual early intervention, adult dysphagia, adult AAC and cognitive communicative therapy, peds feeding. Behavior, family coaching, communication strategies, group homes, ASL. Lions, tigers, and bears, OH MY!

When I started I was all, “Ohmygod I loooove it allllllll.” Now, a year and a half in, I’m seeing that I have clientele that I get excited about and things I look forward to and enjoy learning about. In turn, there are clinical things I don’t get super thrilled to death about. (Don’t get me wrong. I love all of my patients, but as far as clinical interests go there are things that I just professionally am more intrigued by.) (Was that a fragmented sentence?)(Sorry.) Since I would like to pursue the Ph.D. at some point, figuring out those clinical interests is a really important thing! I can’t stroll into a Ph.D. program and say, “Hey ya’ll – I like everything!” I need to find out what I love so that I won’t mind studying it for the rest of the foreseeable future.

So what do I enjoy? I love working with my Latino babies and families for language therapy. I love working with adults with developmental disabilities. I love adult dysphagia. I just wanna do those things all day.  Is there some communicative disorder where all three happen at once? Oh and I weirdly enjoy evaluations. Can’t really explain that one.

What do I sorta enjoy-ish? AAC. But not high-tech. I enjoy helping families use no-tech, low-tech strategies for targeting critical communication acts. (High-tech AAC makes me want to crawl in a hole. My brain rejects it. And the process for obtaining any device is the worst thing that ever happened. And it is just getting harder. And it is terrible. Run away!)

What am I unsure about? Peds feeding. It makes me so nervous. I don’t have a lot of practical experience and my book-knowledge is useless because it’s book-knowledge. Observation is an option, but frankly every child is so different there isn’t a ton I can take away from watching someone else do it. I’m learning as I go. Progress is slow (for me, not the kids.)

What am I pretty certain I don’t find particularly intriguing? High tech AAC! Adult acquired communicative-cognitive deficits pooooooooost-onset. School aged ANYTHING.

Part of me feels bad, about not loving it all. I have to remember that we ALL have clinical interests. That’s how we grow and develop specified skill sets. I can’t, mentally, love it all and I can’t know it all. I do truly enjoy interacting with and getting to know all of my clients. However, when faced with a puzzle, some situations get me all excited and riled up and I want to learn more. And I’m finding out what those exciting things are! Woo woo! Self-discovery!

And for your viewing pleasure, here is a picture of Simon snuggling with his own tail:

He is sooooo cute

He is sooooo cute

to eat or not to eat,

6 Dec

(that is the question.) (duh.)

I don’t know about you guys, but I grew up in a society that says, “Unless it’s your grandma, don’t take food that is offered to you.” I don’t really know why other than it isn’t polite. I go to parties and just nibble when I’d love to shove my face full of delicious dips and home made snackies. I’m at a friends house and they ask if I’m hungry and I say no EVEN IF I’M SO HUNGRY I MAY DIE. If it is someone I don’t really know then all bets are off – I am absolutely turning down what is being offered. Thanks but no thanks!

And when I was in college taking ethics classes and professional classes we all learned – you don’t take from clients. You don’t take food. You don’t accept gifts. When you get a job your employer will tell you that you cannot accept things your clients give you. YOU JUST DON’T. You don’t. So there. It’s that easy. If a client says, “Here I made you this.” You say, “Nope” and you just walk away.  I get it – professionally you can’t be accepting things from clients and you can’t be giving things to clients. I’m on board. Message received. Thanks but no thanks!

Right? Right.

I’ve talked with some clinicians about this before and one flat out said, “I do not take food from clients. I have never taken food from clients.”

“NEVER?” I said.

“NEVER.” she replied.

At the time this seemed reasonable. We go to homes to do therapy and people want you to feel comfortable so they say, “Can I get you a coffee? Can I bring you a muffin? It’s hot out today would you like a bottle of water?” You respond accordingly, “Oh you’re so sweet but I’m okay. Thanks for offering!” Generally, then the mom says, “okay” and we move on. No one is stressed by the situation. No harm. No foul.

HOWEVER. I was chatting with an admin assistant today about how frequently families try to feed me. I don’t know if I just look malnourished (I believe the bathroom scale would report otherwise) or if I have the look of a mangy raccoon. But moms really love to offer me food.

Now, I use the word offer. If someone OFFERS me food I graciously decline.

What I told the the admin asst and what I tell you now is… I encounter people who just push food upon me. There isn’t an offer. They just give it to me. And it very rarely is something like a granola bar that is pre-packaged. No. I’m talking people handing me a plate of hot rice and a fork.

What in the HELL am I supposed to do about that?

I asked the aforementioned clinician what she does when someone gives her food and she said, “I just leave it there.”

How? How do I just “leave it?” I can’t just leave a plate of hot food, untouched, sitting on the floor next to me. How insulting and rude is THAT?

The other day one of my moms literally handed me a banana and I was already out the front door leaving for my next appointment. She actually handed me TWO bananas and I was like, “No no no I don’t need a banana” and she was like, “TAKE THE BANANAS” and I was like “I DEFINITELY AM NOT TAKING TWO BANANAS.”

What do you do? Do you drop it and run? I wasn’t standing by a table where I could casually set it down and “forget” it! I WAS OUTSIDE IN THE RAIN.

What I left out, because I want to know if this impacts anyone’s opinion on how to deal with the situation, is that the moms who most frequently GIVE me food (not offer. they just hand it to me.) are my foreign moms. I work with a lot of families from India and from Mexico, as well as a variety of other South American countries. I’ve researched this (I really am trying to be ethical about accepting/declining food) and it appears that often culturally these moms may expect that you’ll say no initially…but then they expect you to take it and eat it.

I’ve even tried to outsmart Moms. Once I had a mom give me a smoothie because she was worried that I was thirsty and it was hot outside. So the next time I went, I brought in my own water bottle.  She said to me, “Would you like a smoothie or a yogurt bar?” I said, “Oh thank you but I brought a water I’m okay.” She said,

“You’re getting one so pick one.”

OHMYGOD OKAY YOGURT BAR DEAR GOD.

In some cases I’m there during a “mid morning snack” so the whole family is eating together and clearly, it would be a little strange if I’m just sitting there staring at them.

One of the clinicians I spoke to about this was horrified that I actually eat food given to me. “But you don’t know where it came from! What if it was dirty? What if they didn’t wash their hands? What if it is expired? What if you get raging diarrhea because you are not from Mexico and your gentle tummy is not accustomed to the intense flavors?”

All valid questions. But I am not trying to insult my families. If my kiddos can eat it, then so can I. I cannot look at a woman who cooks and provides and cares for her family every day and turn down the hot food she just cooked for her children and herself and ME. What is so special about me? I feel like in this situation I would look a little high-and-mighty rejecting the food they eat every day. They’re inviting me into their homes, into their lives, into their mid-morning snacks, and they feel comfortable enough with me to allow me to be a part of their routine and their culture. I think that’s a pretty special compliment and I feel honored when it happens.

I feel like I could attempt to explain that most clinicians have work related policies that we don’t accept things from clients. But I still can’t get over that culturally they are doing what is polite to them, and I’m being a total asshole by shooting them down. And it really doesn’t make a ton of sense. I get that gifts and food and THINGS in general = money. And we can’t take people’s money. And I don’t WANT to take people’s money. But I also don’t want to take their way of welcoming me into their home and their lives and throw it in their faces.

So I want to know…do other clinicians have this happen to them? And if so, how do you address it? One of the other therapists at work also works with one of these families and she also accepts the food (except in the case where she is allergic to whatever they give her.) Do you think we’re doing the right thing? And if not, do you have ideas about how to graciously decline without being sneaky or lying or looking like a jerk?

NP: It’s Gonna Snow

further details regarding my BAG

11 Nov

I was having mall and lunch time with MsSohanSLP on Sunday and she asked when the last time I blogged was.

Shame. I AM ASHAMED. It’s been a stupid long time. I have a wide variety of things I could blog about, and I choose not to because I’m a lazy, lazy SLP.

I thought the easiest way to return to the blogging was to segue from the previous post!

(lazy. i’m so lazy.)

As we know, I do home health with 0-3 about half my work week. As we also know, I have raging ADHD and can’t play with the same toys week after week after week like some kind of therapy zombie. So I *try* to change what I bring to homes each week. It can be a challenge and it requires some creativity, but it can be done, and if you’re a home therapist I encourage you to change it up when you can!

Anyway, since this “school” year started in September, I have been attempting to do THEMES! Yes, my bag is now themed! We do group therapy in my center and we do monthly themes so I thought, why not translate themes to home therapy as well?

So far I’ve done: farm animals, zoo animals, transportation, body parts, food, shapes/colors, letters/numbers, actions, and this week is SENSORY.

Since it’s sensory week I’ve got playdough, paint, shaving cream, crazy textured balls, a small bean box, touch and feel books, and so on and so forth. Also I have wipes and a table cloth because…I’m not dumb.

I’m kind of running out of ideas. I’ll probably do “home” as a theme, and “school” as a theme. Any suggestions are welcome! What are some concepts that you think 0-3 year olds should have under their belt by preschool?

Okay, that’s all for now. I’m going to be better, I swear! Well, I don’t swear but I’m making a sort of promise to be a better blogger. And give me theme ideas please and thank you!

 

NP: Lady Antebellum – Get to Me (this song gets me right in the feels).

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