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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



30 Sep

My friend and fellow CF texted me earlier with this clinical dilemma and I bet it’s something a lot of us are dealing with. And it takes the heat off me and MY biggest struggle.

Place: School setting
Delivery: Autism group therapy
Grades: Anything K-8
# in Group: Three to Four
Severity: The whole spectrum. Nonverbal. Low cognition. High functioning. All over the place.
Goals: Expressive Language. Receptive Language. Pragmatic. The gamut.
Current status: Kids who are verbal are more focused on pragmatic USE of language. Kids who are non verbal have access to picture exchange or verbal output devices but have received no training.
Frequency: One hour a week

The breakdown:
UH what the heck do I do? Overwhelming much? None of these kids are on the same page. I have one hour with them. How do I maximize my time? How do I make sure they’re all benefiting? My caseload is nutty bananas – I can’t give them individual services even though some of these kids need them and that’s all I want to do.

Ok. So say two kids are verbal and their goals are more pragmatic. And two are nonverbal and their goals are more expressive. Here’s what you need: a craft. Or snack time/cooking. But more appropriately a craft. A craft that for all parties is going to require asking for school tools, commenting, rejecting, choice making, identifying, following directions, affirming etc – critical communication skills (per the Pyramid people). So you could do a letter home maybe once a month. Letter home might be a good thing to try. And you could do holiday themed crafts. You’ll have to make sure the kids with AAC have the appropriate access to vocabulary for the tasks (paper, scissors, glue, colors, more, paint, markers, stickers – anything they’d need to complete the task). You’ll be doing a LOT of hand over hand.

You might try work contracts for kids with completion difficulties or behaviors. Work contracts are AWESOME – find out what motivates a kid – they get a sticker every time they do something compliant and when they get five they get their thing – sensory break, their fav toy, their stimmy behavior.

I would get all my tools for the task and I’d put them in a clear container. I’d pull out the ones they’d need step by step, but also pull out the wrong things too. If they need to glue, pull out glue and scissors. That way they have to identify and make a choice. Hold things up near your face to encourage eye contact. Or hold two of the same thing – like a blue marker and a red marker. Or keep things in the box so they have to ask you to open, or ask for more. When they’re done ask for specific things back so they have to follow simple directions. And just follow their lead, if they need a break or something let them have it and then bring them back to the task. Make sure the kids with AAC have a way to ask for a break.

I’m always thinking in terms of critical communication skills. What do these kids need to express? How can I manipulate the situation to reach that goal? Just like in early intervention, I find it easier to squash goals into an activity rather than planning an activity around goals.

If your seventh grader, high functioning students are going to hate this, make theirs more complicated. Change the task so it suits their goals, but so that they’re still participating in the “same” task. Because while its important that they don’t think its dumb you can’t spend your whole life trying to think of “cool” things for them to do – you’ve got an hour to address their goals. Maybe they can paint rather than glue or color. Or they can write a haiku about the day’s theme. Or talk about what they like about your unit theme, they could categorize and list, compare/contrast, make a language web. Maybe there is an app or a website about your theme. Talk to the science teacher or the language arts teacher and find out the units in the classroom.

Anyway boys and girls. This is just one idea, if you have more ideas for what to do with a REALLY varied group therapy session please share! We all know that this setup is not ideal, but it IS real life.

NP: The Weepies – Twilight


3 Jun

(I got a job offer 🙂 )


Interviewing like it’s my job

15 May

As many of you know, I flew out to Delaware on Sunday for an interview with a company that I’m very excited about. I’ll tell you more about the results of said interview at a later date but I did want to share a little about the experience as I know everyone is kind of going through the same thing right now.

SO, Sunday I arrived at the Philadelphia airport and the company’s recruiter who has been in contact with myself and PediaStaff picked me up. I completely love this woman, she made me feel totally comfortable and so going to dinner and clinical/employment talk wasn’t scary at all.

Monday between the hours of 8:30-3:00, I did the following: met with the director of therapy services and toured the facility. Observed a children’s therapy group. Observed a home health visit. Talked with their most recent CF (she graduated in 2007) about ‘the process.’ Talked with an OT. Interviewed with the director (several times) who was also an SLP. Talked more with the recruiter.

Interview questions really focused on my experiences and skills (course work, externships, AAC, dysphagia).

They did ask the questions we all think of with an interview like “Where do you see yourself in ten years?” (A: working and pursuing a Ph.D.), “How might someone describe you?” (A: I can’t remember but I didn’t use all C words this time.) “What are some areas you could improve in?” (A: I always think I can improve my clinical writing. I’d like to improve in my ability to counsel.)

They also wanted to know about my professional skills – how do I stayed organized? How do I document? Time management and paperwork opinions. Working on a team, collaborating, working with parents.

After that, I got dinner with the recruiter and we talked more about professional business and what the next steps were. Then I went back to my room and got in my jammies and watched cable all night.

THIS MORNING my shuttle picked me up from the hotel to take me to the airport and wouldn’t ya know it – the shuttle driver drove right into a bus at the airport. I don’t know what the deal is with me and the buses but I’m starting to develop a pretty severe bus-phobia.

NP: Stuck in the Moment – Justin Bieber


Sucking at blogging

21 Apr

You guys, it’s been almost a month. I suck. But seriously, a lot has been going on and I’ll tell you all about it!

1) The Job Front – things are looking up! I’ve had a lot of phone interviews and I’m working with the WONDERFUL staff at PediaStaff. They are rocking my world. I totally recommend contacting them if you’re on the job hunt! I would tell you more about which position I’m most excited about but I’m scared to jinx it – feel free to email me if you want to know more about PediaStaff or the positions they’re helping me with 🙂 I want to tell you guys more about phone interviews and I plan to do so in a blog post or so.

2) The Thesis Front – I should totally be doing edits right now but it’s fiiiine. Ha. I defended and got my thesis passed on Monday! Woo-Woo! I have to have the completed draft in to the Graduate College by Monday the 23rd (which is why I should be working on it…) If you’re working on preparing for a Master’s defense I recommend a powerpoint – it’s the easiest and clearest way to review your whole project and you can make sure you’ve got all your bases covered.

What's that? Oh just my signed thesis.

3) The Externship Front – it has been A WEEK at my externship site. I DO NOT LIKE INPATIENT THERAPY. Don’t. Like. It. Don’t make me do it. Please. Outpatient – I wanna do it all day long. LOVES the outpatient. But my supervisor just started floating between inpatient and outpatient and frankly, I am not comfortable in inpatient and I keep messing crap up. I know I’ll get better because I hate being bad at anything speech-related, but I don’t know that I’ll enjoy it more. My supervisor and I went over my midterm yesterday and she started that most of my skills are “emerging” – which makes perfect sense. It’s halfway through my time there, I’ve never worked in a medical, adult setting before – why would I be perfect at it? I wouldn’t. But it’s still hard to hear. As a group SLPs are kind of perfectionists and any kind of criticism tends to make us run and hide. So if you’re in your first medical setting and you’re not so comfortable my advice to you is, “Take a deep breath and remember – you are still a student. You are green. This is NEW. It is OKAY to not be perfect.”

If your supervisor has told you ten times to stop or start doing something differently and you still haven’t figured it out – that’s a problem. But try to keep in mind that you are there to LEARN.

4) The Life Front – got my car back! Boys suck! I really want to adopt this dog from the APA of Missouri. I don’t think I should get a dog because my life is a disaster but like…she’s so precious.  Her name is Peanut. I’ve seen her twice in person and I just want to put her in my pocket. I loves her. If you want to adopt her please do – and then let me come play with her. I contacted the APA about her so we’ll see, maybe I’ll be making an insane decision here in the near future.

Do you love this puppy or what?

My apartment is a friggin’ disaster. Did you see the picture on the Twitter? I’ll put it here. It’s nutso. And my friend Ellie is coming to crash with me today so I hope she doesn’t mind staying in a pig sty.

This is your brain on grad school

5) The Blogging Front – I just sent in my first blog post for the Hearing Journal so look for that soon! Also I’m working on a post for PediaStaff so look for that too :). And I promise to get back in the swing of things here too.

6) The Professional Front – recently attended Missouri’s Speech-Language-Hearing Association annual convention. We won Quest for the Cup! We are here and rocking your world with our brain power.


As always, I have a lot of thoughts after attending a convention and I’ll get into that later. But please please please please JOIN YOUR STATE ASSOCIATION. I cannot say this enough. DO IT. RIGHT NOW.

Alright I’m outta here. I need to brush my teeth and I’m going to see the Lucky One. It’s going to be terrible.

NP: Matchbox 20 – Push


ranting. raving. want a job.

16 Mar

Listen ya’ll. Finding a job is hard.

Don’t get me wrong – there’s a lot of them. When people say that SLP is a field that needs people, they aren’t lying. But nobody wants CFs! I’ve lost count of the number of jobs I’ve applied to and I’ve had three interviews. I’ve applied to schools, early childhood centers, contract companies, hopsitals, nursing homes. I’ve applied to full-time, part-time, PRN. I’ve applied all over the state of Missouri but I may need to start branching out. I told the contract company I’ve done a phone interview with that I will go anywhere within a 300 mile radius of St. Louis. WANT JOB.

Even finding the open positions is hard. You have to

(1) think up the names of schools and hospitals or do a ton of research finding places in the city you want,

(2) navigate their website,

(3) find out if there are any SLP positions available,  and

(4) fill out each individual application which takes one thousand billion years.

Contract companies often just have you fill out their inquiry form and then they call you so that isn’t too bad. If you’re looking for something specific – good luck. Trying to find early childhood centers that hire SLPs is quite the undertaking.

Then you have the nasty little problem of not being certified. In Missouri I can pretty much count on one month post-graduation before I can get a provisional license. Today I had an interview and it felt good but then it came down to, “Give me a call when you have your license.” Which is completely understandable – but it still sucks. I want to know at graduation I have a job.

The whole process of getting licensed and certified is also really convoluted. Here’s a little checklist of things you have to do if you want to work in the schools in Missouri:

– 6 years of school! NBD

– Pass the Praxis II – SLP

– Get a provisional license (and then a full license) from the Board of Healing Arts

– Get a Temporary Authorization Certificate from the Dept of Elementary and Secondary Education (DESE) – you have to get the go ahead from the Board of Healing Arts before you can do anything through DESE.

– Get a school certificate through DESE after you complete your CF (don’t forget – schools treat us like teachers!) called the Student Services Certificate.

– Complete your CF (36 weeks, supervised)

– Get your CCCs

– If you’re contracted in the schools you’ll need to get a Medicaid number. You cannot get a Medicaid number as a CF. So you cannot bill Medicaid.


– Maintain your certification with CEUs (30 hours of continuing education per biennium) through ASHA, Board of Healing Arts, and DESE

– PS. If you get your CCCs and THEN decide to work in the schools you’ll apply for an Initial Student Services certificate which expires in four years and THEN you get the Career Student Services certificate.

– PSS. You may also wish to be a part of your state association – so remember to pay for that as well!

Completely. Friggin. Insane.

Oh oh oh – and here’s something that is just AWESOME. In order to get a MO Provisional License – you must have a job, supervisor name, and employer name, before you can apply. Yeah. Don’t bother applying for a license unless you have a job already – but you may NOT see clients/patients until receive your license number. WHAT? So basically when you go into an interview you’re saying “Hire me now, but I can’t work for you until the end of June.”

Which is why it’s so hard to find medical placements – they’re hiring for NOW not four months from now.

If you want to find out about your state’s redonkulusness – you may do so on ASHA’s State-by-State website.

NP: Eric Church – Springsteen


trying to stay in a happy place

5 Mar

Today my research mentor approved my thesis to move onto my thesis committee to be edited.

Which doesn’t sound so great but it is! It is great! I’m down to 44 pages so thank goodness. 115 pages was really out of control.

The downside of my life, is the Praxis is Saturday and I am just not prepared even a smidgen. BLECH. I need to mainly focus on reviewing Speech and Hearing Science, Audiology, and Motor Speech. Everything else I feel pretty confident about.

I wasn’t offered the job I interviewed for, but I have a phone interview with LinguaHealth tomorrow so yippee! I’m not too bummed, as it was my first interview and also I used all C words to describe myself like some freak.

Also I need to start thinking about my first blog post for the Hearing Journal‘s new student website. If anyone has any ideas please share.

NP: Right Above It – Lil Wayne


NP During the Day: Waka Waka (my kids are OBSESSED with this song)


C Words

27 Feb

Today I had my second interview with a school district in Kansas City. My interviewer asked me to tell him five words that describe myself. (There is apparently a point. I probably smiled a little. Mostly because it was really hard to think of on the spot.)

And do you know, 4/5 words I used started with “C.”


I said, “Responsible. Committed. Creative. Compassionate. Competent.”

I couldn’t even throw the “R” word in the middle.

Good grief Charlie Brown.

NP: Edward Sharpe and The Magnetic Zeros – Home




this is about to be a cluster

21 Feb

Oh hey there. I’m just hanging at my mom’s. I need to go home and work on my thesis. But for now I’m blogging.

I have many a comment. Where to start. I don’t know.

Someone got to my site asking if there is a grad school that is so desperate they’ll accept anybody. Uh. Well don’t have TOO much confidence in yourself there buddy? I have no idea. I’m sure there are schools with lower standards, I don’t know which ones they are. Ask your professors where they think you can get in.

Someone else wanted to know how big guinea pigs get. WELL, Monty is a fatty but he isn’t as fat as some get. Some get GIGANTOROUS. I think it depends. Apparently you’re supposed to weigh them once a week which seems really silly. Also there is a breed of “guinea pig” known as a Capybara and they are Rodents Of Unusual Size.


OMG I want one. Imagine the snuggling!

Today I went to Missouri’s Speech-Language-Hearing Association Legislative Day. It was interesting. I was the only person there from my University so like, that was cool.

Or horribly awkward. Whatever.

I buddied up with some #slpeeps from other schools and we sat in on some House and Senate hearings which was cool. I didn’t really talk to any legislators because…I didn’t know what to talk to them about. I feel that as a student, I wasn’t particularly well prepared for such an event, and as a MSHA member I wasn’t well prepared either. I’m on the MSHA Legislative Committee and I hope next year I can help them get this thing a little more…comprehensive. I didn’t even know how to get to the Capitol, where to park, how to navigate the building. Those are things that the Association could ensure that attendees know. Once I was there I didn’t know what the current issues are, beside encouraging legislators to maintain funding for the professions and their clients.

I think it was a good learning experience and next year I’ll be able to attend the event with a little more info under my belt. And I’ll have been working for a year so I might know more about legitimate issues. It really bothers me that my program isn’t more involved in state events, it can actually be a little embarrassing.

Side note: my dog thinks my brother’s name means “toy” and it’s hilarious.

More news: I have my second interview in KC on Monday. I’m trying to decide what to do. It is the first job I’ve interviewed with, and I haven’t finished my third internship yet – so if I’m offered the job do I want to take it? It’s a great school district, and I think I’d feel a little ridiculous turning down A JOB. Like really? Who turns down a job? The unemployment rate it 8.3%. I should take the job if it’s offered to me. TIME FOR A PROS AND CONS CHART.

IT IS A JOB It is the first interview and offer I will have
They have a mentor for me It is three hours from home
New city = new adventure New city = I don’t know anyone
Good school district, decent paycheck, solid benefits It isn’t a medical setting
IT IS A JOB Haven’t finished my experiences yet
It’s only a year so I can do medical after that year I have to move again

You may be wondering why I’m NOT focusing on working on a medical setting. I’ve been pretty medically inclined all along. If you’re in the process of applying to jobs or looking forward to the job process you will find – Medical rarely takes CFs.

It happens, they’re out there. But they are certainly not easy positions to find. My plan is to do schools for a year and PRN nursing homes to maintain my medical skills. I really love working with kids so schools aren’t a punishment by any means. I just know it is harder to break back into medical positions after years of being in the schools. I’d rather get my start in medical, but I don’t mind starting a CF as a school SLP. For all I know, I’ll love it and stay there forever.

MORE NEWS: My first draft of my thesis has been turned in. I’m still editing and such but I’d like to be majorly done with the writing by the end of February. Thesis deadline is April 23rd! I’M SO READY.

NP: Over You – Miranda Lambert