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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

Planning early intervention sessions: should you even try?!

29 Sep

I got an email from Emily, a new CF and an EI therapist asking how I plan my sessions. It seems like good info to share. If you guys have ideas or things you do please share! I always love hearing new ideas:

“I’ll tell ya, I have NOT been doing lesson plans like I did in grad school. How can I? Right now I’ve got, 6 kids I see in the center and 7 that I see in their homes – plus adult and child evals. There’s not a chance to do lesson plans unless I want to work a zillion hours of overtime!

Here’s what I do: before a session I make sure I have a data sheet with my client’s goals written on them. I bring a bag of items into the home. One bag, for the whole day. Every kid gets the same bag (except sometimes I take out the doll or the barbie coloring books for the boys – more for the parents than for the kid.) (Also I wash the toys between sessions!) I alternate the items every week or two so I’m not using the same toys every week. Then I offer choices, “Hey Timmy, I brought a puzzle and a car” and then follow their lead. That way I know whatever we’re using – they’re motivated by it.

With 0-3 you really CAN’T plan – you have no idea what this kid is going to want or how long they’ll be interested. My supervisor says make yourself the toy, you are the spectacle, you need to be in the spotlight. I’m not so great at that yet – but I’m working on it!

I take what interests the kids and I fit their speech-lang goals into their interests. If I don’t have a toy that I can see an obvious way to slip in /m/ words I make that toy make robot /m/ sounds or car /m/. It is way easier to squash goals into an activity rather than hoping that a kid will want to play with the MMMMMonkey or the M-soup you brought. In grad school I would try to plan a WHOLE 50 minute session around the sound /p/ but I had the time and energy to do that. Now it just isn’t realistic. And how badly does a two year old need to say “peach” or some other crazy initial p-word?

And you’re right: targeting functional language is a great thing to do! More, give me, mine, all done, go, up, down, in, out, wow, hi, help, no, etc. I do it in every session and there is a lot of functional language that targets those early sounds (p, b, m, n, w, h) and then (t, d, g, k) (at least according to the GFTA).”

NP: KT Tunstall – The Other Side of the World


Breakin’ the Law

4 Sep

Something that has been on my mind lately is following the rules.

As an undergrad when I was first introduced to testing protocol it was hammered into our heads, “DO WHAT THE MANUAL SAYS.” No extra prompting, no coloring outside the lines, just do what you are supposed to do or the test is invalidated and you suck.

And I’m okay with this, but only in the case of eligibility. You give a test to determine eligibility for services, then you want the results to be reliable and valid. So follow the rules.

However, tests have a lot of purposes. You can use a test to probe a specific area of concern, to screen, to compare to previous results. As an SLP I am certainly curious about my clients’ problem areas and I want them to qualify for skilled services. But I also want to know how they perform with prompts and cues. I want to alter protocols to explore my clients’ strengths and weaknesses. I want to make goals that truly suit their needs. And in these cases I say, go ahead and break the rules! (Do it, I dare you.)

The same goes for specific therapy techniques. There are a lot of programs out there that you must attend the workshop, obtain a certification, and follow the rules! This program won’t work unless you follow those rules! And you know what – some of these programs genuinely work, have excellent evidence backing them up, and are truly wonderful for our clients.

But by suggesting that “the rules” work for every single client is unrealistic. Our clients are individuals and between them, their needs are so different. I say take those rules and stick with the main basis and the main theory, but alter them as needed! I want my clients to experience success and I’ll change up things if I determine that it is appropriate to do so.

You’ll often hear “You aren’t doing X-program if you aren’t following the rules outlined by said program.” And to that I say, “So be it.” I don’t particularly care if I’m following the rules so long as I’m making therapy beneficial to my client. Obviously you should NOT run around saying you’re a provider of a specific kind of therapy or program if you haven’t actually been certified (that’s a quick way to get yourself sued), but if you have and you want to make some changes I think you should be able to. I understand and respect companies’ desire to charge money to certify and educate SLPs in their specific program, but I also think it is a little backwards that companies have resources and ideas that WORK that aren’t open sourced to all clinicians. We should all have equal access to important research and programs.

As CSD professionals we are lucky enough to have an incredible amount of resources at hand. Tests and tools and strategies that are becoming more and more evidence based. With the #slpeeps on Twitter we can discuss what we like and don’t like, and explore what really works. It is really wonderful. I think we should use each other’s skills, expertise, and ideas for adapting protocols even more than we do now, and really encourage the concept of open-source therapy. Share the adaptations that work, so we can all help our clients benefit!

NP: The Cure – Pictures of You


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


bored in grad school

17 Feb

Oh readers. It’s like we share a brain sometimes. Probably because all SLP programs are made of the same DNA.

SOMEBODY out there in cyberspace is “bored in grad school” and I will tell you what – so was I.

One might say to themself, “Self, how does someone possibly get BORED in GRAD SCHOOL?”

It is actually rather easy. I went to a highly selective, public university – the best in the state. I got my butt handed to me every. single. day. It sucked. I worked hard. And what was expected out of students at my undergrad isn’t really the norm at many other schools. It was no surprise to anyone at my undergrad to hear of someone going above and beyond, getting incredibly involved, and working themselves to exhaustion. It was standard issue behavior. I went to nerd camp for four years basically.

Then, I needed a change.

And I became the kid in your third grade class who is gifted and going nutty bananas because they’re tired of reading Accelerated Reader Level 3.

I picked my graduate school not by reputation or rankings, but by what they could offer me – the opportunity to do my thesis, public school in-state tuition, a large faculty with a lot of PhDs, a nice clinic, and a new adventure. And I got all of that and more. I loved my grad school experience. I would recommend my program to anyone who wants a thorough, comprehensive education in SLP.

But it is a state school with a bajillion students and I was bored. The status quo was NOT what it was at my undergrad – a lot was expected of the students but the teaching style was different and what was expected is exactly what was done by the students. Anything out of the ordinary appeared to be brown nosing.

My advice to you, “Bored In Grad School,” is to make the most of your experience. Sign up for some volunteering, get a job, offer to take on extra responsibilities, go to conferences, say yes when someone asks for your help – I promise, with a full schedule, you will not be bored. The boredom you may feel in class might be soon appreciated because your time and energy will be elsewhere and you’ll find yourself just as stressed as you like!

And if anyone calls you a brown noser – just smile and tell them that’s why you’ll be their boss one day. Because people who say yes today, will have others saying yes to them tomorrow.

If you do all that and you’re still bored…maybe there is something wrong with you. Or maybe you aren’t enjoying your program and you need to pursue a new field.

NP: Jason Mraz – I Won’t Give Up


first week of new site

3 Feb

I’m all moved into my new apt in St. Louis and it was my first week at my new externship site. I don’t have internet and I don’t have computer access at school, so expect to hear from me on weekends!

I’ve been deliberating on what to say in this post. I had a really great week at Special School District, it is an interesting facility and a very different experience than what I imagine many of my classmates are doing. Some background:

Special School District STL is rather unique. There are five schools that are solely dedicated to the education of students with special needs. They aren’t state schools, they are a part of St. Louis County Public Schools. SSD-STL also serves 22 other “partner” school districts (265 schools total). They do everything from EC to tech schools.

I say it is unique because I think it is unusual to find exclusive schools, where there are zero regular education classrooms. Every student in the five special education schools has an IEP. Most of my classmates are in a regular education school and are providing services to students with IEPs, RTIs, 504s – what have you. But those students are involved in the reg ed process.

I’d have to say that because of this, I would strongly recommend all SLP students to take advantage of every experience they can get. My experience now is SO COMPLETELY different than my Early Childhood setting. And those two settings are going to be COMPLETELY different than the experiences of my classmates. Here are some ways JUST my two sites have been different:

Service Delivery Pull Out except for once a week lang group Almost solely push in, with some pull out
Supervisor Female Male
Case Load Verbal, core vocab, literacy, increasing MLU, intelligibility Non-verbal, picture exchange, AAC
Resources Supervisor had personal supply of materials All SLPs have a community materials closet
Experiences w paraprofessionals Mostly positive Mixed interactions
Collaboration Strong collab w teachers, paras, behavior tech, OT Strong collab with teachers, paras, OT, ABA
Hours of TX a day Saw approx 4-6 hours 2 hours/day
Interaction Lunch everyday with teachers, paras Lunch in office
Set Up Supervisor had her own room w table and materials Supervisor shares large office space w other SLPs, OTs, PTs, ABA, guidance
Outside duties Bus duty on Weds, collaboration, some IEP write ups, meetings Assist w buses, collab, IEP write ups, data team, meetings, AAC consult/planning

Right now, I don’t have a strong opinion of one being better than the other. Each has pros and cons and I’ve learned a TON at both sites. WHICH IS WHHHHHY it is SO important that you get as much hands on experience as possible. I’ll keep you updated on my SSD adventures and insights!




23 Jan

I’ve been getting all sorts of questions lately so I thought I’d knock it out in one post!

Here is how my resume has ended up (without my personal info so don’t stalk me k thanks)

do do do doooo

When writing my cover letters I try to stick to a sort of general shape because otherwise I’ll get crazy. This is how I go:

1. I address it to HR because…that’s generally who I’m applying to.

2. I make it clear what I’m applying for.

3. I tell them how I learned of the position.

4. I tell them I’m a CF and I explain the CF.

5. NEW PARAGRAPH! I tell them why I want to work for them! I do my homework, don’t just be all, “Uh hey I want to work for you because you have an SLP position and I’m an SLP!” You should explore their websites, know about them! You should have a legit reason to apply.

6. NEW PARAGRAPH. I thank them for the opportunity to apply and that I hope to hear from them. I’d like an interview.

7. Love, Sam

Also a blog reader asked me to write about personal statements but I suck and keep forgetting. So I emailed her and this is what I said!

Okay. So, start with an attention grabber. Something special about
yourself or something sassy or just SOMETHING that sets you apart. I
started mine by saying something along the lines of “hey guess what –
everyone I know has wanted to be an SLP since they were babies. I just
found out a few years ago. But I’m still passionate and this is WHY:”

Focus the majority of your essay on (a) why you want to go to THAT
school and (b) your plans and why they’re important. You need to sell
yourself. You need to appear confident. But also make sure you don’t
come off as overly cocky, or overly set in your ways. A LOT is going
to happen to you in grad school, you’re going to learn and grow and
what you think your interests are NOW might not be in 2 years – you
should be flexible but have a general plan. Make sure you show that
you would be FORTUNATE to go to their school. If there is someone you
foresee as a research mentor – say so! Be complimentary. Tell them
what you’re expecting to learn, what you want to get out of your
education, and what you plan to do with it (not just as far as
academics – how are you going to put your education to use? Are you
going to advocate? Are you going to support your colleagues and
clients? Are you going to do research? Do you want to supervise? What
else are you going to do outside of straight up speech therapy?) They
want to know that you’ll add to their reputation.

Try to stay moderate in your expression. I tell people to leave out
religion, leave out politics, leave out your sob stories. IF you have
some grade discrepancies or GRE discrepancies feel free to qualify
them, but focus on the positives – what are you getting from them,
what are they getting from you?

I try to end personal statements with a thank you for their time and
their consideration.

I really hope this helps! I know how hard it is to write a personal
statement. Be honest and be yourself! You’ll do great.

 This is what I think for all of you! If anyone ever wants to see one of my personal statements I’ll dig one up.

Also I just got an email about this website: We Connect Now. It is a web resource for college students who have disabilities.

Also, @azspeechguy just sent me this link about interviewing for your first speechpath job: if you’re applying and interviewing – you should read it!

NP: The Band Perry – All Your Life


I don’t know if I can help you!

10 Jan

As you know, I can see what people type into search engines to turn up my blog. Lately, it’s been a little blue.

1. I feel like I don’t know what I’m doing speech pathology

2. Don’t think I’m a good speech path

3. One day I’ll drive away (I feel you, yo.)

4. Quit SLP grad school

5. Drop out SLP grad school

(Also one time someone got me from this: אוריגמי צפרדע  UH WHAT DOES THAT SAY?)

Anyway. So I don’t know about you guys, but if it turned out I had seasonal affective disorder I wouldn’t be surprised. Between Thanksgiving and April 1st – I get way down into the depths of my despair. And maybe that’s the case with you search engine-ers too! Maybe you’re being a little too hard on yourself.

If that’s not the case and you’re feeling pretty serious, then LET’S TALK ABOUT IT!

Okay. So. When I feel like I don’t know what I’m doing or that I’m doing poorly, I tend to spend awhile in denial. Because I like to be right and good at everything. Because I’m an SLP and I don’t handle failure well.

Once I climb down from my high horse my first tactic is to call my mom and whine.

After that, assuming it is school or profession related, I would reach out to a superior or mentor who I am comfortable with.

If they don’t have a suggestion or their suggestions don’t work – I would try to do my own homework. When I feel like I’m lacking in an area I try to pursue new avenues for learning. There are SO MANY sources for learning – contact local universities with speech path programs and see if they’re offering any courses you could jump in on, look for local conferences and presentations, check out online CEU events, contact your state association’s website to see if they are hosting any short courses, get on Twitter and use the hashtag #slpeeps to ask questions. I truly think there are a lot of ways to learn as a speech path – we have a STRONG support system in “real life” and online.

As someone who has a Master’s degree and certification in speech path you know HOW to learn. Don’t be afraid to ask questions. And honestly, you aren’t alone. I’ve heard a lot of SLPs say they feel a little lost sometimes, or that they weren’t so sure of themselves right out of the shoot. Plus there’s many skills that have to be honed. If you get a sudden caseload of students who struggle with language – you might not actually know anything about using PECS or AAC or WHATEVER.

We aren’t done learning as soon as we graduate. SLP is a field that is consistently evolving and growing – you gotta grow with it!

And seriously – if you want to quit SLP grad school that’s fine and all. But make sure you’re doing it for the right reasons. There isn’t a whole ton you can do with a bachelor in communication disorders and SLP is a field that has promising job opportunities. We’d love to have you among our ranks – but only if it’s something you enjoy. Our clients need you to be motivated, engaging, honest, competant, and compassionate.

If you can’t be those things, this might not be your place in the world. If you’re unsure – TALK TO SOMEONE. I always think it’s a good idea to get second, third, fourth opinions. And if there’s something you need help with – feel free to email me!


I just don’t know

4 Jan

I don’t have a right or wrong answer here – just some thoughts. I’ve noticed that when doing therapy with students in a group there are two options. You can (a) match the students based on need, or (b) do the complete opposite and pair up students who are advanced in therapy (a “role model” if you will) with students who are still beginning.

Now, there is a side and benefit to each. There are also draw backs. If you choose to match students based on similar supports needed you can get a lot of work done. You can tackle the same skills and still reap the benefits of peer interaction. Both students win. But there is no peer leader, there isn’t anyone saying “Look at me do it – now it’s your turn” and a lot of kids need that. Kind of the “cool kid” effect.

If you match up an advanced student with a student who needs more support you get to work with that cool kid effect. However, do you feel like you’re jipping the advanced student? Perhaps that student, with a little extra time and focus on their exact deficits could be dismissed from therapy. By pairing them with a student who has quite different skilled services, are you retracting from their time?

I’ve seen both of these options used in my externship setting, and I think it is also something we need to consider for push in therapy. Any ideas or opinions?