An Open Letter: The Clinical Fellowship and Early Intervention

Even though I find myself irked on the regular, I continue to follow a few SLP boards on Facebook. Recently a graduate student (presumably) asked about doing her clinical fellowship in an early intervention setting. And I was really bothered by so many negative responses – most people seemed to feel that a CF would not get the support they needed in an EI position. So I wanted a chance to express my point of view as a fairly recent EI CF (without having to unsubscribe myself after posting on her question because notifications for days.)

tricks of the trade

I just had my 2 year workiversary! (At the end of July.) As such I thought I’d celebrate two months late by sharing some of my early intervention tips!

1. Put it on your head. I don’t know why, but kids think hats are hilarious. Whenever a kid is not looking at me, is about to cry, is crying, is about to bail on a toy, is distracted – whatever – I just put something on my head. 60% of the time this works every time.

2. Bubbles freeze in the winter and crayons melt in the summer. Plan accordingly.

3. Also on bubbles: blow UP not out. When you blow up, you have time to draw attention to the bubbles, talk about the bubbles, sing about the bubbles, and generally enjoy the bubbles. When you blow out they just fall down and suck.

4. Get yourself pants with a strong knee. I’ve gone through three pairs of pants in less than two years. Double duty knees. Support knees. Worker knees.  Utility knees. Or maybe buy one of those gardening squishy rectangles.

5. In addition, get yourself a poker face. You can’t buy this but I highly recommend obtaining one. Poker face has been something I’ve been working on for years, but now that I’ve sort of got my face under control I find my life is a lot easier. When a kid does something that grosses me out, annoys me, makes me mad, makes me laugh (when I shouldn’t), makes me sad, or shocks me – you would never know. I’m like Mona Lisa MS, CCC-SLP over here. You don’t want parents or children feeding into your emotions during therapy sessions so lock it up!

6. Patience is a virtue.  Learn to wait. I always tell the kids, “I know, waiting is so hard!” and I make them wait for everything…but it took me a long time to learn to wait for them. Waiting waiting waiting. I do it all day. Wait for them to reach, wait for them to vocalize, wait for them to calm down, wait for them to notice. Quit anticipating, quit assuming, quit rushing, quit pushing. COOL YOUR JETS.

7.  Embrace the germs. I mean, Clorox wipe everything and wear gloves when needed. Embrace that you are going to get sick a lot when you first start. Like, a LOT. Way more than you can possibly anticipate. Start stocking up now on all your favorite cold and cough meds, you’re gonna need them. I’m here to tell you that there is a light at the end of the tunnel…after two years I have the immune system of a feral mutt. I can withstand anything (A kid sneezed into my open mouth the other day and I lived to tell the tale.) And you will too. But you have to live through the first six months.

8. Get a mentor (or three). I have a lot of mentors. I have my mentor for picture exchange, I have my mentor for feeding, I have my mentor for behavior, I have my mentor for apraxia…the list goes on. I don’t harangue these people endlessly for lunch dates so we can discuss me and my progress in becoming a grown SLP like them. But I do say, “Hey can I pick your brain about this little guy?” when I need back up. Know when you need backup, and find strong resources. It’s okay to ask for help, and it’s okay to have lots of mentors. (I recommend reading Lean In’s chapter “Are You My Mentor?” if you’re looking to develop mentor-mentee relationships…it’s really very enlightening.)

9. Learn about the other disciplines as much as you can. In early intervention it is SO important to look at the whole child. And until you work with OT/PT/ECE regularly you’re going to have a harder time looking at the whole child (because what are you looking for!?) You’ll see so much improvement when you make adjustments based on those other disciplines. You’ll know when to make referrals, and when to just make a suggestion. It’s hard to help the whole child make major improvements when you’re just looking at his mouth. Cotreat. Observe. Ask. 

10. Be flexible. No two kids are alike. Seriously. None. What worked with one, will work again with none. It’s insane. You will see new things every single day. I always say, “Never a dull moment” with EI. It will keep you on your toes and keep you moving and thinking constantly.  As an early interventionist you’ve got to be open to new ideas – whatever you’ve got planned probably isn’t going to go as you imagined 🙂

 

If you’re just starting out in EI I hope some of these help you on your path. If you’re a seasoned EI Vet – share some of your tips and tricks, I’m always looking for new ideas!

NP: Ingrid Michaelson – Home

forgot to tell anyone about this post

I wrote a blog post for PrAACtical AAC on motivating adult clients to utilize AAC systems. You may read it here if you so desire:

AACtual Therapy: On Motivation and AAC

 

Enjoy! Let me know if you have questions or comments or ideas or suggestions or if you just want to see more pictures of Simon (he is ultra-cute.)

Strategies for EI – Says WHO?

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:

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

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).

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

Measuring vocabulary development in bilingual children

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

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.

The NSSLHA discount brain explosion!

I’m writing this because I was misinformed and I want to make sure new SLP students get the correct info!

When I was in undergrad, my CMDS program encouraged us to join NSSLHA – for the support, for the resources, and because of this great program: 2 years in NSSLHA and you get a discount for your first ASHA membership. It’s that simple! Join NSSLHA – it’s $60 a year and it is TOTALLY worth it. I joined (I think) my junior year and continued to renew my membership through my first year of grad school. By my second year of grad school I thought, “I got no money and I’ve met my ‘Two Years’ so it will be okay for my membership to lapse.”

Fast forward to my application for my CCCs: I call ASHA’s Action Center to get my NSSLHA number and was told to not expect my discount because too much time had elapsed between my last year in NSSLHA and my ASHA membership.

And I was like, “UHHH HUH? WHAT?”

As far as I knew – there was no expiration date on my two+ years in NSSLHA. No one ever mentioned that I basically had to be in NSSLHA at the time I graduated from grad school in order to get my discount. When I was in grad school no one ever even talked about NSSLHA – it was what the undergrads did. Right? Right.

HOWEVER, I was wrong! (As were a majority of my peers it turns out.) Everyone I’ve talked to thought you just had to be in NSSLHA for two years…at SOME point. After talking to an Exec NSSLHA member I was told that INDEED: you are SUPPOSED to be a NSSLHA member for the two years directly prior to applying for your CCCs!

Who knew?! Not me. I mean it says it directly on the website but I never even looked because why would I? Professors are never wrong! (Right? Hahaha.) (Also I’m not the brightest crayon in the box.)

So grad students – JOIN UP (like, yesterday). And grad schools – TELL YOUR STUDENTS. Encourage your students! Don’t just make NSSLHA about undergrads! This is important, yo.

And don’t forget about Gift to the Grad!

NP: Lisa Loeb – Stay

Undergrad – What to look for!

Howdy. It’s four AM and I’m wiiiiiide awake. I went to bed weirdly early because I felt crappy and now here I am, blogging and answering emails because…what else is there to do? (Eat.)

I got an email from a high school junior (Melissa) this week, asking me what to look for in an undergraduate speech therapy program. (Which may be known as any number of things: communication disorders, communication sciences and disorders…who knows?)

GOOD QUESTION! Never really thought about it since I sort of…fell into my program. But if I was specifically looking for a program, I came up with some things that I really liked about my program (Or didn’t like…though there wasn’t much to dislike.)

1) Class size! My undergrad was teensy. We had about 30-40 girls in my program. And consider, that’s 30-40 girls that I saw every day. For four years. So depending on your personality a small class size or a big one might make more sense. To me, small was better than other state schools that had 60-100+ students in the comm dis program. I got to know the girls in my class, some of them are my best friends. But also, small means cliquey. Small means getting to know EVERYONE (even the people that make you INSANE. You may sit by your best friend for four years, but you may also sit by someone you want to judo chop for four years.) In a bigger program there’s more of a buffer.

Another benefit to a small class size is getting to know the professors more personally. These are people you’re going to be asking for references and recommendation letters in three years. If they don’t know you, your letters may be rather impersonal and vague. I got to know my professors, I’m friends with them on Facebook, I give them big hugs at state conferences. If your class size is humungous you’re going to have to work very hard to stand out.

2) Do they have a NSSLHA chapter? We had one at my undergrad but it was sort of…disorganized. It was affiliated, but involvement was rather willy nilly and professors didn’t really push you to be in it. If you were in it, it was likely just because you wanted it to be on your resume. We did community projects and that kind of thing intermittently. But some programs have really cool NSSLHA programs! They have a lot to offer students, they support students, and they push students to get involved early. NSSLHA is awesome too, because if you’re in it for …two consecutive years (?) you get a discount when you become a grown up ASHA member. Which is sweet. So yeah, ask about NSSLHA. If they don’t have one or it isn’t well-organized, and you really like the program, get in there quick and help organize it yourself! I’m pretty sure National NSSLHA has resources to help students put together their local chapter.

3) Can you be a clinician as an undergrad? This was one my most favorite things about my undergrad program and such a bragging point for me in grad school! I was a clinician as a senior. And as a junior I was an “assistant” clinician. It was awesome! I had clients! Three to be exact. It was so nice to go into grad school with clinical hours already and clinical experience under my belt. I felt so much more confident and secure than many of my peers. And God knows, I love feeling confident and secure.

4) How else can you get involved in your department? I knew as an undergrad that I needed to get in there, get to know the professors, get to know our department administrators. I wanted them to know my face, know my name, and to like me. So I worked for the department – I started working for our admin assistant shredding confidential papers 2 hours a morning, 3 days a week, for a whole summer. Then I moved up in the world and started working for our professor who was in charge of the alumni files, so I spent a lot of time filing, inputting data, sending out surveys, etc. Then I started working for another professor just doing her general bidding (seriously, one time I vacuumed bugs from under her desk. I also opened her mail for her. WHATEVER. I’LL DO IT.) I spent so much time in our department it was ridiculous. But guess what — they knew my name, they knew my face, they knew I was a hard worker. And I made some excellent friends/colleagues/mentors.

5) WHAT ELSE CAN YOU DO FOR THEM? My undergrad program had a lot of opportunities for research. Which is rare for an undergrad program so ask about it. As a junior I did research in a group setting – there was five or six of us. We picked a research project, put it all together with the guidance of a professor, and presented it at our university’s undergrad research conference. Then senior year my best friend and I did an independent research study, so the two of us picked a topic, did the project, and presented it at a local and state wide conference. It was awesome. And it gave me great experience for when I went to do my thesis in my Master’s program.

6) MELISSA! – I forgot something important: do they have an onsite clinic? Some schools don’t! And that means you have to go out in the world to do your 25 observation hours. Which might be good because it is more realistic. But it might also be super inconvenient. I honestly had ENOUGH going on as an undergrad without worrying about driving all over creation trying to do my observation hours.

7) @goldstein25 pointed out that undergrad programs don’t have to be accredited so I deleted this. But in its place I’m replacing it with this tid bit: if the school you’re looking at doesn’t have an undergrad SLP program, but you want to go to SLP grad school – you’ll have to “level“. Which means that you’ll have to take both the undergrad SLP courses as well as the grad courses. So you DEFINITELY want to find a university with a CMDS major for undergrads. Otherwise you might as well slap at least another year onto the 2 years for your Masters.

If anyone can think of anything else, please comment and share your ideas. This is just what my brain produced with minimal sleep.

NP: Brandi Carlile – Heart’s Content

The CF

Okay I was GOING to blog about AAC assessment and device trialing but I am doing my first days of device trialing this week and I figure I should wait until that actually happens to have an opinion on it. (Don’t worry though – I already have opinions.)

The Clinical Fellowship. The ol’ CF. Ye olde CFY. (It isn’t a year anymore I HATE when people call it the CFY now. IT ISN’T A CFY STOP THAT STOP IT RIGHT NOW.) (STOP IT.)

What’s the deal with the CF? According to ASHA:

The Clinical Fellowship (CF) is a transition between being a student and being an independent provider of clinical services that involves a mentored professional experience after the completion of academic course work and clinical practicum.

Purpose of the Clinical Fellowship

• Integration and application of the theoretical knowledge from academic training
• Evaluation of strengths and identification of limitations
• Development and refinement of clinical skills consistent with the Scope of Practice
• Advancement from constant supervision to independent practitioner

It is 36 weeks of full-time clinical practice. You get paid don’t panic. It isn’t a continuation of an internship. You’re expected to do real work and you’re the SLP. You just don’t have your CCCs yet because probably you’re a screw up. Don’t worry – we all are. As my mom says, “YOUR PROFESSION HAS A CF FOR A REASON.” (And I’m all, “Yeaaah Mom but like, I like being perfect at everythiiiiiing.”)

What do you have to DO for a CF? Here, read this:

Clinical Fellowship Requirements

• 36 weeks of full-time (35 hours per week) experience (or the equivalent part-time experience), totaling a minimum of 1260 hours. Part-time work can be completed, as long as the CF works more than 5 hours per week. Working more than 35 hours per week will not shorten the minimum requirement of 36 weeks.
• Mentoring by an individual holding ASHA certification in speech-language pathology. It is the responsibility of the Clinical Fellow to verify certification of the mentoring SLP, and can do so by contacting the ASHA Action Center to verify at 1-800-498-2071.
• A score of “3” or better on the core skills in the final segment of the experience, as rated by SLPCF Mentor using the SLP Clinical Fellowship Skills Inventory form.
• 80% of time must be spent in direct clinical contact (assessment/diagnosis/evaluation, screening, treatment, report writing, family/client consultation, and/or counseling) related to the management of disordered that fit within the ASHA Speech and Language Pathology Scope of Practice.
• Submission of an approvable CF Report and Rating Form.

I actually filled out my own rating scale the other day of how I think I’m doing. I mostly gave myself 3s and 4s. November 15th is the last day of Segment 1 for me and then my supervisor and I will compare and discuss.

Something you’ll also note on the CF Rating Form is:

A full-time SLPCF consists of a minimum of 35 hours worked per week and equals 1,260 hours throughout the 36-week SLPCF. The SLPCF must consist of at least 36 mentoring activities, including 18 hours of on-site direct client contact observations and 18 other monitoring activities.

Ew.

That equals 6 hours of direct supervision and 6 hours of “mentoring” per segment. THAT’S A LOT OF BONDING TIME. Sheesh ASHA, you’re killin’ me.

Overall I think the CF is going pretty well – I love my supervisors and I have wonderful support at my facility. I think for a CF it is SO important to have support – you NEED other SLPs, you SHOULD HAVE an onsite supervisor who you see regularly. A few jobs I interviewed for would have supervisors for me in other buildings, or I’d be doing only home health and wouldn’t really have a home base. It would have been a mistake for me to take one of those positions. I have a sounding board, I have people to observe, people to bounce ideas off, people to share/commiserate with.  I do group therapy twice a week where I get to see PTs, OTs, and Early Childhood Educators in action. My supervisor and I meet every Friday. There are SIX other SLPs for me to talk to and they’re such amazing resources. If you’re considering somewhere for your CF – please consider the support system your facility will have in place for you, it’s incredibly important.

Shoot me questions! I’m happy to help.

NP: Lee Brice – Hard to Love

questions to ask a grad program

If you visit a graduate program I think it’s incredibly important to arrive with questions. It shows that you’re actively involved in the process and interested. Should you visit a graduate program? YES. It gives your name a face, it gives you contacts within a program, it gives you a chance to find out if you actually like the program as much as you think you do!

Do it.

So yes please bring questions. I think some of the most important questions you can ask are going to relate to clinical practicum. How long is practicum? How is it done? My program, for example, we had a year of on campus clinicals and one semester of externships. We have a longer medical externship than school based. Some schools however, you’re doing externships the whole time. You may have a semester or two of on campus placements and the rest of the time you’re off campus and taking night classes. I liked my program because I wasn’t taking courses while I did my externship. Also, I had the opportunity to go away. We had girls doing their clinicals all over the country. Other programs – if you’re taking classes you’ll have to do your externships in the same city. But with the extended off campus clinical time you really get the opportunity to try out many different settings and see a really wide variety of populations.

As I’ve said previously, ASHA mandates what sort of information you MUST be exposed to in a graduate program so that’s kind of predictable. Some programs offer EDHH focus or other extra classes for specific interests like AAC or craniofacial disorders. If you have a special interest ask if you’ll have an opportunity to take courses in that area. In my program we had no choice, we took all of the exact same classes. There were no electives.

It’s also important to know the set up of the program. How many people are in the program? My program was huge and I gotta say – I didn’t love it. I came from a small undergrad program and I just didn’t like so many people in my classes. Also if the program is large and you have a lot of on campus clinic you may see some panic for hours and available clients. It’s also good to know how many Ph.D.s will be teaching your courses and how available they are. Are they willing to supervise theses? Will they be gone for sabbatical? What are their research interests? These are the people who are guiding your education for the next two years so it’s good to know that they’ll be around.

I also like to just know little things about programs. Is their clinic set up on a sliding scale? How do patients get access to services in monetary terms? Do you spend time in the community doing screenings or volunteer work? Is the thesis required or an option? If it’s an option – how many students do it and is it supported/encouraged? Are students involved in NSSLHA nationally? Locally? State? Do students regularly attend conferences and is there funding for attendance? What sorts of clinic materials are available to clinicians? Is the clinic up to date in terms of technology support? Can you use iPad, Boardmaker, and AAC devices? Are there GAs and if so, how do you apply and get one? If you don’t get a GA, can you get a job? Where do students live most often?

This is a lot of information but you want to know the answers to these questions so you can make the best decision for yourself.