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Getting Started: Non-English EI Referrals

12 Oct

Hey ya’ll.

If you were an early intervention speech therapist, and you got a referral for a child who does not speak a language that you speak – what would you do?

@liselschwartz and I discussed the other day and I wanted to share some of our ideas. I see a lot of Spanish-speaking children, but I don’t get too many referrals for other languages. Even though I speak some Spanish, my sessions can be a little disjointed. Early intervention is about coaching and guiding parents so they can provide therapy services all week long when you aren’t there. If you can’t talk to them during your sessions how can you make this happen? Here are some ideas!

Figure out how to get an interpreter in there. Our child-find program typically schedules an interpreter for at the least the first session, and then once a month following for non-English speaking families. If you don’t get an interpreter scheduled off the bat, ask your supervisor about what the protocol is for requesting one. When/if you get someone who can interpret for you, try to get some basic vocab words  in THEIR language written down for your knowledge and use. For early intervention my top ten in no particular order are usually:

1. More (some therapists aren’t into this being a first word but it’s quick and easy so I’m sticking with it)
2. Give me/my turn
3. All done
4. Open
5. Help
6. Eat
7. Drink
8. Cookie – or cracker, or apple, or whatever the child eats a lot of
9. Milk – or water, or juice, or whatever the child drinks a lot of
10. Play

– If you can’t get a list from someone who can interpret, trying Googling the words you want – if it’s the wrong word the family will likely know what you MEANT and will tell you the correct word (for example, I didn’t know the Spanish word for “marble” so I just called it “pelota” until a Mom told me “canica.”) If you put into Google “German for ball” it will give you several options, so I just pick the one that sounds closest and the families correct me if I picked the wrong concept. I also LOVE wordreference.com for colloquial definitions.

Put those words to signs for the family. In our center we even make a little sign language book with a picture of the sign and the word below. I know each language has its own corresponding sign language – but this is hard enough without adding extra sign languages to the picture so I just stick with ASL.

mas

de plusmehr

And so on and so forth.

– Do what you can to provide services in their native language. This can hard for a number of reasons (the main being that YOU do not speak Twi or Cantonese or Hmong or whatever). But also sometimes families know that the child is going to be exposed to English in the school system, and so they just want you to speak English to the child. But the two year old should really keep being exposed to their native language so they can communicate with their family members when you aren’t there. This is why it’s vital to get the family playing and doing the therapy, while you coach.

– If caregiver knows someone who can read English, who isn’t there at the time of your sessions, see if you can write down ideas to have translated later. Sometimes Dad or cousin or sister reads English, and so I’ll write down my “ideas” for the week, and then they’ll have that person read later. If you can find something like “Handy Handouts” from SuperDuper (which is in both English and Spanish) that’s ever better – you want to provide resources as much in the native language as you can. As the languages get more “obscure,” the harder this becomes.

– Sometimes families will have a little English in the home, or siblings will speak English, so families will ask, “If the English word is easier to say, can I just model the English word?” (think “ball” instead of “pelota” or “shoe” instead of “zapato.”) I usually try to steer clear of this unless that really is their preferred word that they’d typically use (I see a lot of Spanglish so some families really do just say “apple” instead of “manzana.”) I typically recommend in this circumstance to model approximations of the native language word, rather than modeling the English.

– If there are older siblings in the home who speak English try getting them involved, they can be a huge help for you, and they always love teaching the “teacher” their language and words. 🙂

 

Any other ideas out there? What do you do with kiddos and parents who don’t share your language? What if you can’t get an interpreter, or the family resists an interpreter? Please share!

NP: Florence + the Machine – Blinding

 

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Did you guys know that this is a thing?

28 Apr

I have not been doing the “AAC” thing long, and I don’t deal with tech-AAC frequently. I make a lot of communication books, gesture dictionaries, and just general working with families on implementing strategies to increase communicative attempts in the natural environment. I have recommended an actual communication device only 3 times so the funding piece of things tends to be a bit over my head. Most companies have someone that will work with you on getting devices to trial, completing the appropriate paperwork, and procuring the device and I worship the ground said person walks on.

I recently recommended a device for a client, contacted the company to find out about funding and was told that they don’t do it. AACK. WHAT? Mind blown. I just assumed that every speech generating device for every client would be funded in some capacity, one way or another (I also live in magical fairy AAC land, did I not mention that?)  But the device doesn’t qualify as “durable medical equipment” so the company doesn’t bill insurance.

So now what? The company told me to contact a durable medical equipment company in my area and have them “give them a call.” ABOUT WHAT? GIVE YOU A CALL? I swear some days I feel like I’m losing my mind with these hoops.

Luckily I have my very own AT guru (you may all express your jealousy) who explained that the client’s primary insurance company likely has a DME company they work with for AAC. So the trick is to contact that specific DME company, and work with THEM on funding the device. It’s just more red tape than usual but seriously who knew? In case you didn’t know – now you do!

Learn something new every day I suppose.

(On the AAC-upside, I’m working with a client right now who is actually having success and demonstrating progress with the Tobii I-15 eye-gaze system and I couldn’t be more thrilled. I’ve only ever seen typical adults use eye-gaze systems so it’s a beautiful thing to watch it happen before your very eyes with someone who has disabilities.)

NP: Dime Porque (One of my client’s parents was listening to this during a home visit today and I was like, “This is quite catchy even though I do not understand.)

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.

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

What’s in my bag?

28 May

I’m sorry but I just have to say that writing about “my bag” makes me think of Austin Powers. (Warning: that link is NSFW).

Now that we’ve got that out of the way: my therapy bag. What is in it? How do I decide? As many of you know, I’m doing some home health for kids 0-3 (mostly in the two-three range). My car and home are filled with toys, but I abhor taking the same toys into homes every week – I get bored, the kids are bored, the parents are bored. It’s like “Yeah, we know, you knock the blocks down and say, ‘UH OH’ – message and vocabulary received.” I like to keep things fresh and exciting. However, I also have to be realistic regarding my time and energy, and the children’s…everything.

When I’m considering what toys are going into my bag, I have to think about my kids. Some kids are age-level in terms of play. They have strong fine motor skills, strong attention, strong cognition: everything is age appropriate with the exception of their language. The toys I take into these houses are a little more complex and require more imagination: baby dolls with food and cups and plates, Little People paraphernalia, high-level puzzles, high level books.

On the other hand, I have some kiddos who do not yet shake musical toys or bang two objects together. Some of my kids have rather limited attention. Some need a lot of sensory breaks. The toys I take into these houses are more cause-and-effect, texture-based,  noisy, etc.

As a result of all of these factors, I keep some good ol’ stand-bys in the trunk of my car. My employer has a few cabinets of “Community Materials” so those, combined with my own toys, give me enough material to change it up once a week. That doesn’t mean that kids don’t frequently play with the same toys, it just means that something new or something they haven’t seen in awhile gets thrown in the mix pretty regularly.

When I pack my bag to go into a house I try to ensure I have: one book, one fine motor oriented toy, one sensory-something, something with pieces for receptive language,   something for turn-taking and social games, and my phone so I have some language-apps as back up.  Some therapists may think this is a lot but frankly, my sessions are one hour long with two year olds. Five or six toys doesn’t seem like that much to me.

Toys from my personal collection that I have a lot of success with? I share them with you now:

BOOKS!

I like books that have manipulative features for the EI population.

I like books that have manipulative features for the EI population.

 

Puzzles!

Think of the different skill sets required to complete each of these puzzles. Something as simple as taking a puzzle to a kid's house takes a lot more thought than you would ever think.

Think of the different skill sets required to complete each of these puzzles. Something as simple as taking a puzzle to a kid’s house takes a lot more thought than you would ever think.

Sensory!

Bean Box! I like these but holy smokes get ready for a mess.

Bean Box! I like these but holy smokes get ready for a mess.

 

This stuff is called "Gazz it" - it's 99 cents at Walgreens and it's a weird alternative if you're sick of play-doh

This stuff is called “Gazz it” – it’s 99 cents at Walgreens and it’s a weird alternative if you’re sick of play-doh

 

Fine motor!

Kids love to bang on things.

Kids love to bang on things.

Shape sorter ball is always a hit. Wooden stacker is a personal fave. And that ball thing is just something different.

Shape sorter ball is always a hit. Wooden stacker is a personal fave. And that other ball thing is just something different.

Social fun times

I just want to bang on my drum all day. And shake shake shake. And pat. And tap. And clap. And imitate motor movement. And sing songs using baby signs. Yay!

I just want to bang on my drum all day.
And shake shake shake. And pat. And tap. And clap. And imitate motor movement. And sing songs using baby signs. Yay!

Cause-and-effect

These poppers are always fun. For early players you can do a simple "POP" and for more advanced kids you can do some receptive "Who is in the trash can? Push the boat. Where'd he go?" games

These poppers are always fun. For early players you can do a simple “POP” and for more advanced kids you can do some receptive “Who is in the trash can? Push the boat. Where’d he go?” prompts.

 

These are just some of my favorites right now, DEFINITELY not a be-all-end-all list. And as an FYI – I get nearly all of my toys at Goodwill. Don’t feel like you have to spend a fortune to get some nice materials. And if you don’t have a lot that is okay, my supervisor always says you should be more interesting than the toy. If you can get a kid engaged and playing with YOU then you are all good in the hood.

NP: Love Somebody – Maroon 5

The NSSLHA discount brain explosion!

21 May

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

Learning about Deaf culture

10 Mar

I owe Liza a post!

To start at the beginning, I took “sign language” as an undergrad. It was pretty much a VERY BASIC sign course where we talked a little about grammar and Deaf culture and learned a lot of nouns. I never used it functionally and lost most of it pretty quickly. As of July I had retained toddler signs, and that was about it.  I’m currently enrolled in a legit ASL course taught by a Deaf woman and it’s bad ass. But still, I’m learning a lot and by no means think that I can “sign.”

Anyway, things got interesting as my caseload expanded and I started seeing adults for AAC. A majority of my adults have developmental disabilities and three of them are Deaf. They had sign language interpreters attend evaluations as well as therapy
Continue reading

Undergrad – What to look for!

3 Mar

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

Receptive Language….huh?

25 Feb

Once again I have to point out that during my time in the higher education system, I learned the definitions and the textbook information and other sorts of useless stuff, BUT I didn’t really learn quite how to specifically address disorders. When I got out in the world for internships and you know, MY JOB, that proved to be a problem since I do speech THERAPY.

What disorder do I speak of today? Receptive language delays and disorder.

As I had been taught, receptive language abilities and skills enable a child to understand the meaning of sound and spoken language.

Yeaaaah….so…..about that?

After a few weeks at my CF I finally asked my supervisor, “Um, so, this is really embarrassing but…if a kid has receptive language delay…what do you DO for that?”

She, luckily, is a kind and non-judgmental human and gave me some tips. Which I now pass onto you!

Make a word sandwich: Say it, Show it, SAY IT

Use a slow speech rate

Exaggerate key words and speech sounds

Support comprehension with signs, touch, vision, music and any other modalities/senses

Use simple language, give plenty of repetition and experience with new words

Model response expected then repeat the direction

Give visual cues when giving directions

And the part that I’m bad at: reduce cues to assess comprehension

How can someone be bad at that? It’s my natural inclination to point, or repeat myself WAY too many times. My supervisor and I were watching a video of me doing therapy last week and Lord Almighty if I told that kid to “Get the cup”  one more time he probably would have punched me.

I need to improve my scaffolding. To say the least. My supervisor gave me a way to kind of…think about what I’m doing.

Step One: Give child direction “Get the cup!”

If child does not respond, Step Two: Repeat yourself and give them an extended period of time to respond.

If child does not respond, Step Three: Point to the cup and say “Get the cup!”

If child does not respond, Step Four: Hand over hand, help the child get the cup, and say “You got the cup!”

Also consider things like, is the child doing something else when you prompt him? We noticed that I was telling my kiddo to get the cup while he was pretty focused on cleaning up. It would have been more beneficial for me to wait for him to finish what he was doing, then prompt him.

And don’t prompt the child to do something that hasn’t been the focus of play or isn’t in his line of vision (unless you’re testing object permanence which why would you be doing that? Get back in your scope!) I’ve been known to do this when trying to do the PLS (it’s all, “Get the child to identify a duck” and I’m like “Crap where is the duck? ‘Find the duck!‘” and the duck is over on the table behind a book and the kid is doing a puzzle or blowing bubbles.)

Also be thinking, is the child not responding to me because of a processing issue or because he doesn’t understand the language?

Hopefully since I just shared this with you, it will stick in my brain a little better. And Liza – I’ll write about Deaf culture after my ASL course on Thursday because that’s our last day talking about culture specifically!

NP: The Lumineers – Stubborn Love

 

I don’t even know where to start.

20 Feb

It has been a really, really long time. SO LONG. MONTHS. I wish I had a valid excuse but basically it is cold and I’m sleepy and I’m busy and I don’t wanna go to the library to blog. I’ve had so many things to share, and I can’t even begin to pick a topic. I think the last thing I blogged about was CFs and swallowing therapy and how I suck at dealing with behaviors. I still suck at dealing with behaviors. I’m working on it OKAY?!

But I’ve been doing so many new things and meeting so many people and I learn something new every day. I think my most challenging area since my last blog has been AAC! Oh yeah my friends. Can I just tell you – in grad school and undergrad I was all, “UGGGGH AAC.” Now I eat-sleep-breathe AAC. And I enjoy it! It still scares me and confuses me and and overwhelms me and I’m still learning an INCREDIBLE amount. It seems so daunting! AAC is changing every day and that stresses me out – how am I supposed to stay on top of it? How can I make sure my clients have the best system for them when I might discharge them and find out about a new system the next day? I DON’T LIKE THAT.

So currently, my caseload is right around 30 plus evals. Which feels kinda crazy-pants some weeks, so I feel really bad for people in schools and hospitals who have more than that. Don’t forget, my friends: ASHA says no more than 40 but I know you all are doing way more than 40. Average is 50ish. Max is 110ish. SCARY.

Anyway, so about half my caseload is adults. I see two adults with acquired disabilities, and the rest have developmental disabilities. I’m not seeing anyone for swallowing currently, and I see one adult for cognitive-communicative tx, and the REST are AAC. So I’m seeing like 12 adults for AAC. It is a LOT of work. My adult clients require way more planning than my kiddos. The kids are challenging, but in a very different way. I’m doing some AAC with a couple of my kiddos but it isn’t the ONLY thing we’re working on. Basically my desk looks like the birthplace of AAC on most days:

DESK EXPLOSION

DESK EXPLOSION

So what am I doing with these clients? Some I’m working on developing low-tech communication books and wallets. So far I’ve successfully created two functional and effective communication books for clients who use ASL, but have difficulty communicating with hearing individuals (specifically group home staff and workshop employees.) I’m learning a lot about interacting with the Deaf community, and I’m taking a sign language course right now. It’s…interesting. We’ll get there one day once I catch up on this blogging business.

A couple of clients I’m helping to obtain high-tech speech generating devices for. One client my goal is a Dynavox Maestro, the other a NovaChat7. I’m also trialing a Springboard Lite with a client.

Some clients I’m going more mid-tech with – Go Talk 20, 7 Level Communicator, Three Message Platform Communicator etc.

Some devices I’ve trialed include: Dynavox Xpress, Dynavox V+, Dynavox DV4, NovaChat7, Springboard Lite, Alt Chat, Tobii C12, ProxTalker, Go Talk 4, Go Talk 20, 7 Level Communicator, One Message Communicator, Three Message Platform, Four Message Communicator. The DV4 isn’t made anymore, but we have one in a cabinet and I like using it during evaluations because it has a large screen and “exploratory” pages that assist in evaluating category skills, access skills, identification skills etc. Someone today referred to it as a dinosaur, but I think this ol’ dinosaur still has a place.

Also of course, I’ve been working with the iPad and apps. I don’t LOVE the iPad the way everyone else does. Don’t get me wrong: it is awesome and there’s so many things that can be done with it in therapy and in terms of using it for a communication device. My main beef with it is that damn 60 minutes piece that focused on its use with people with autism. I think just about every person I see for AAC has asked if they can get an iPad. I’m like:

WELL, you certainly CAN but I can’t promise that insurance will pay for it or any apps on it (probably not). And I also can’t promise that using it will be successful or that it will be appropriate for the person using it. The iPad IS NOT a be all end all.

I’ve also been downloading free AAC apps for my Android phone and there are SO MANY. I think I want to start reviewing them and sharing what I think here on my blog. So get excited for that. I think it is a great idea especially for home-health therapists to be able to just pull out their phone and try an AAC app with a client.

You may be wondering how I get my hands on all this good stuff.  First of all, my workplace has an AWESOME Resource Center that has SO MANY AAC and AT products. It’s great. I just be-bop down there about a million times a week and borrow devices. Also, I utilize DATI a LOT.  In fact I’m on their wait list right now to borrow a Dynavox Maestro. DATI is a life-saver! They’re so incredibly knowledgeable and helpful. LOVE. And of course, if I need to I can always contact companies directly and ask them if they know of a device I can borrow in the area (I tweeted at Saltillo and they were so helpful in my hunt for a NovaChat. Thanks Cara at Saltillo!) I think I’m pretty in what is available to me.

I think one of the more frustrating things about AAC is actually GETTING a device. The process is so long. I wrote up an explanation for families for the steps it will take to get a device. I found that families were coming to the evaluation and expecting that their loved one would have a device by the next time I saw them. And while I don’t want to discourage anyone from coming to therapy to get a device, I also don’t want them to be surprised if it takes a long long lonnnnng time.

My letter to families and caregivers

My letter to families and caregivers

I think overall, the learning curve for AAC is a little intense, but I’m getting there. I tell people that I’m learning just like they are and that it is definitely a trial-and-error process. If you have any questions, ideas, suggestions, stories – WHATEVER – about AAC, please share!

PS – I’m obsessed with the NovaChat7. OBSESSED.