The CF

15 Oct

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

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Don’t be alarmed, we’re taking over the ship.

17 Sep

Whoa! Speechie off the port bow!

This post is in dedication to Talk like a Pirate Day (September 19th…of course.) The fine folks over at LessonPix asked the #slpeeps for some pirate-y themed therapy and we obliged (because we’re da bomb dot com.)

First let’s start by saying: LessonPix is AWESOME. I’m not just saying that because they asked me nicely to write this post and be part of their blogging hearties. I’m saying it because I DO WHAT I WANT, YO. What is LessonPix you ask, Dear Reader?

Well, “LessonPix is an easy-to-use online resource that allows users to create various customized learning materials.”

For serious – you can make SO MANY THINGS. It’s $36 a year, and in comparison to something similar (think in the ballpark of $400) I think it is WELL worth it. Especially since I can login on any computer – I don’t need a disk. For $36/yr I’m getting what – 11 years to the $400 one time price. (Obviously prices change and products change and therapy changes so don’t come crying to me in eleven years, that’s just a way to think of it if you’re having trouble with the cost in your brain.)

 What sorts of things can you make? I’ll tell you. Picture cards such as THESE:

Seriously. Do Not Copy. Or I will hunt you down.

Or you can create about a zillion other things. You pick the PIX you want, and the website creates PDFs with your material.

Materials Frankenstein

You can search what you need, upload personal images – it pretty much does all of the things. Which is awesome because I’ve got things to do, I can’t be hanging out in Paint all day trying to draw with my arrow mouse. I couldn’t do that in fourth grade and I can’t do it today.

Self Portrait

Anyway back to the pirates. I’m working for the MOST part as an Early Intervention Therapist. My caseload is composed primarily of two year olds (Yeah I didn’t know I had patience either, you aren’t the only one who is surprised.)

When LessonPix asked if I’d use their pirate materials to do therapy I was all about it. Here are some things I made:

Shapes treasure map

These are GREAT, because obviously I can put anything I need to in there. For a lot of my kiddos we’re working on receptive language – specifically identification of familiar objects/toys and following directions. So in the case of the treasure map up there, I put in images that correspond to a puzzle I was using in therapy. Then I can provide not only a verbal cue, but I can point to an image. Many of my clients require an extra prompt or two so adding a visual component is a great way to supplement cues I’m already providing. And since it’s on a treasure map, I can use these little guys to hop along to the next piece:

Me crew

If I wanted to do a themed therapy session with pirates, I could use the game board and a corresponding toy for a scavenger hunt type of activity. I found this in our therapy cabinet and it worked great for such a task:

Tis me ship

You can see that this toy has many components, such as cannon, helm, mast, spyglass, ladder, etc. While playing we could go over these vocabulary terms and then use the gameboard to prompt “giving” specific items or identifying by pointing. In early childhood therapy themes are often used so even if there was an ocean or beach unit, this type of toy could fit in nicely. And having engaging, novel materials to use with little ones is pretty much key to your survival so LessonPix really helps out with that!

I will absolutely be using LessonPix materials again, I think their product is amazing! My brain can’t even understand how the picture gets to the TV Screen so I have no idea how they’re making customizable materials out of thin air that make my life so easy.  Now all I need is a real pirate to help me cotreat…

NP: The Little Mermaid – Part of your World

please someone just shoot me

17 Jul

Good grief. This is a cautionary tale.

Okay so early in June I mailed my application to get my temporary license. I sent my Praxis scores, a letter from my graduate program, my transcripts, and my license application. I did, I really did.

When the state of DE receives a license application, they hold onto it for ten business days and then they process it. Why? I don’t know.

My CF supervisors signed my application and mailed it to the board on June 22nd.

Since then and now I’ve emailed, and called, and emailed, and called, one million times. Yes. One million. They never told me anything was wrong with it, but they also wouldn’t enter me into the system.

YESTERDAY, my mom got my application in the mail. They sent it back because I missed ONE YES/NO question. And guess what? TODAY is the day they give out licenses. So, long story short, I won’t be getting my license until the end of August.

What does this mean for me? Luckily, my company is willing to hire me on as an “aide” for the month and then let me start as an SLP at the end of August. Which is good, but I have to pay rent and bills. So I’m also trying to find a part time job.

Please shoot me. Why is nothing simple?

OH and best part – the question I missed asked if I excessively use drugs. OHMYGOD. NO! Jeeeeez.

questions to ask a grad program

5 Jun

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.

Aphasia therapy

26 May

APHASIA!

If you’re working with adults you’re PROBABLY working on aphasia. There are maaany types of aphasia. If you use the WAB, which there is a good case you will, then you will give your patients any one of eight aphasia diagnoses (Broca’s, Wernicke’s, Transcortical Motor, Transcortical Sensory, Global, Isolation, Conduction, Anomic). Most aphasias  be classified as fluent (receptive) or non-fluent (expressive). And there are other aphasias out there like primary progressive, alexia, agraphia etc. AND the way you classify aphasia will depend on your “theory” of aphasia.

I say all of this, but really you won’t see “pure” aphasias often – I would say many are mixed. You’ll see patients with a variety of difficulties that manifest themselves in all sorts of exciting ways.

AND QUITE FRANKLY – sometimes the diagnosis is SORTA irrelevant. To me – I’m not treating a diagnosis. I’m treating the issue. Just because someone has Broca’s aphasia doesn’t necessarily mean that the treatments typically used for Broca’s aphasia will work for this patient.

So what do you do with these patients – who may have difficulty speaking, understanding, reading, writing, spelling and a plethora of other troublesome word related tasks?

I’ll try to narrow it down a bit.

The patients I saw MOST OFTEN were having difficulty with word finding. I’ve had one patient with global aphasia and one patient with Wernicke’s. My externship had a very cool “Evidence Based Aphasia Clinic” which analyzed the aphasic characteristics of patients enrolled in the clinic, and then looked at EVIDENCE BASED protocols for treating aphasias. WHICH IS SO SMART. Everyone should do this. Not just with aphasia. With all things. One day I’d like to have at least one legit journal article printed off that explains why I do what I do with each kind of disorder that I focus on.

Back to what I was saying – What do we do with these patients? With a global aphasia you’ll likely be trying to find some kind of multi-modality communication system that will be consistently and appropriately utilized in the patient’s life. These are tough patients but you’ll find a way to communicate. One of my most favorite patients had global aphasia. She was the sassiest.

Wernicke’s? Wernicke’s aphasia is really cool. There is a Treatment for Wernicke’s Aphasia which works, but is extremely tedious and exhausting for EVERYBODY. Be sure to break up your sessions if you attempt it. The idea is you put out six photos (of 12 photos total) of everyday photos and first – hand the patient a card with a word on it. The patient matches the word to the picture. The patient then reads the word or verbally identifies the picture. The patient then repeats the word after you. Then you ask the patient to identify the picture with just a verbal cue. There is no scaffolding or cueing, but obviously for training purposes and for success purposes you’ll want to cue and prompt as necessary at the beginning. When I find the source for this I’ll share it – I’m not sure where I hid it. You can also do Response Elaboration Training, Cloze Procedures, Melodic Intonation Therapy, and I’m sure a number of other procedures.

And the biggie – word finding. This is going to change with each patient. I really enjoy category naming and teaching HOW to do this efficiently. I think often we say to a patient “Name all of the animals you can!” and then they have a hard time and we write down how many they got and then we tell them to name some other things. THIS IS NOT GOOD THERAPY.

Teach, don’t test, people.

So some ways we can deal with naming and word finding is to do semantic mapping tasks and semantic feature analysis. You can TEACH patients how to categorize by really thinking about how our brain works. How is our brain organized? Do we just have a jumble of animals in our brain all willy nilly? If someone asked YOU to name as many animals as you could what would you do? I often tell patients to subcategorize. Tell me animals, but first tell me farm animals, then zoo, pets, woodland, ocean, flying, etc. Tell me vegetables but envision yourself at the grocery store. And also consider – are you asking the patient to name CONCRETE items or ABSTRACT? Example time. Concrete: Animals. Abstract: Red things. Our brain is not organized by color.

Other tasks for word finding: synonym and antonym generation. And not just ONE word. Tell the patient to think of THREE antonyms. This gives you a good idea of where they are as far as what is difficult and what sorts of scaffolding is required. Can you give a patient a FIM score without really pushing them and figuring out what is hard? (No.)

Unscrambling tasks. Idiom defining.  Homonym explanation. Word defining. Seriously – ask a patient with a word finding disorder to define the word “tree”. Try that one. I really recommend the WALC books and Cognitive Reorganization if you work with aphasia often.

Now, I’m going to do the last edit of my thesis because I’ve been…not doing it.

NP: Anna Begins – Counting Crows

PS – if you Google just the word “WALC” you get this website. Lolz.

Memory Therapy

21 May

I don’t know about you guys, but I felt like in many of my SLP classes I learned a lot of “textbook knowledge.” Meaning it’s good info to know and it’ll help me pass the Praxis, but beyond that it’s sort of useless. For example, in aphasia we learned the symptoms of aphasia and the different classifications of aphasia and how to evaluate aphasia. But three months ago if I was presented with a person with aphasia and someone said “TREAT THEM!” I’d be all, “Oh Dear Mother of God.” The knowledge isn’t super practical sometimes.

Which is why externships and clinic are important.

Anyway, I thought I’d take some time to break down some of my favorite areas to work on in the adult realm. Today I thought I’d go over,

MEMORY

As SLPs we address cognition which is an umbrella term for: orientation, memory, attention, problem solving, reasoning, initiation etc. Executive functioning overall. You’ll find often that OTs work on this as well.

Memory is an umbrella as well, since there are so many types of memory. Short term, long term, delayed, procedural, working, autobiographical, muscle, semantic and so forth. And memory has many steps. Your brain has to absorb the info, it has to code it, store it, and make it available for retrieval.

Generally, what I worked on most often was working memory and training patients to compensate for short term memory loss. There are a few agreed upon tricks of the trade and I’ll share them with you now.

1. Teach your patients to associate. This is most often used in the case of remembering new names. I always give my patients the example, “My name is Sam. I am a Speech therapist. And I’m a Student.” Lots of /s/. You could also use physical traits or personality. Like “Democratic Diana” or “Tall Tina.” You can make an association between new information and something you already know like, “My niece’s name is Sam and your name is Sam so I’ll remember you” (I never get how this works but patients always do this as their example.)

2. Repeat repeat repeat. If you want to memorize a list, a phone number, a poem, song lyrics – whatever – what do you do? You say it or do it over and over until you can do it without prompts. If a patient can’t remember what month it is – tell them during your session. A lot. And write it down. Several places. Repetition and rehearsal are great tools for committing something to memory.

3. Visualize it. This is good for prospective memory because you imagine yourself calling the doctor at 3 PM, or you imagine yourself turning on the TV to watch your favorite show. It’s like a little movie in your mind. A way to train visualization is to give a patient a list of words and have them make a story out of the words. Sometimes patients don’t really get it and will just combine a bunch of unrelated sentences. You want to encourage the story to have flow and be related, though it can be really silly. So if the list of words is:

Sock. Keys. Pink. Word. Chair.

They might say something like, “I’m wearing socks. I have keys in my purse. My favorite color is pink. Chair is a word.”

This is beneficial to no one. You want a story like, “I put on my sock but couldn’t find the other. So I got my keys and unlocked my pink car, so I could go buy a new pair. When I got home, I said a curse word because my sock was under the chair.

They’ll say the story to themselves a few times and then you remove the list from their line of vision. Ask them to verbalize or write the list immediately. Then ask again 20 minutes later.

4. Grouping. Which is one we all do a lot anyway – putting like things together. So if you’re making a grocery list, put the meats, dairy, dessert, veggies on the list together so it makes sense. Also then if you forget the list at home you have a better chance of remembering if you had categories.

5. Writing things down. Putting new activities into a planner. Writing notes on your day. Keeping a pad of paper by the phone. Reviewing the day with someone. Writing on a calendar. However you want to do it. But you’re more likely to retain something if you’ve put it on paper. A lot of patients physically can’t do this, so encourage their families or caregivers to help them.

You’ll also want to encourage your patients to make changes in their home environment so it’s more conducive to memory. Like keeping everything in a specific place everyday. Labeling drawers. Using a pill organizer. Using external aids like alarms and calendars. Whatever is going to make their life a little easier.

Working memory is something I really enjoy therapizing and that is just the retention and manipulation of information. So doing things like numbers reversed, or unscrambling letters into words when provided verbally. If you have a patient who has visual impairment these are good tasks to get them settled into therapy and get that brain moving. It’s a challenge for me too!

NP: Memory

I need to…

8 Jan

…drive to Bolivar, Missouri today to finish gathering thesis data. But you know, I went to a wedding yesterday and drank my body weight in vodka. As such, I just want to snooze.

BUT THE VODKA WON’T WIN. I’M GETTING UP. I’M DOING IT. IT IS HAPPENING. MOTIVATION.

I CAN DO ANYTHING GOOD.

oh yeah

21 Nov

Here’s my second post on ASHAsphere: If you are younger than 80 this post is for you.

 

ASHAsphere Blog Post Numero Uno

1 Nov

Hey ya’ll,

If you’d like to read my blog on attending the ASHA Convention (Especially if you’re a first timer) it is posted on ASHAsphere!

Follow me (@slweathersby), @ASHAWeb, @SpeechDudes, @slotaag, or any other number of Tweeters and Bloggers to learn more about the ASHA Convention and Speech-Pathdom in general.

NP: The Weepies – Nobody Knows Me At All

this is a long one. sorry boutcha.

21 Oct

I’ve had a request to post a lil’ about getting into graduate school. I’m giving a presentation next week to NSSLHA about this topic so I’m all ready to go! (ADDENDUM: I don’t know anything about using CSDCAS so don’t ask me!)

I’ll try to do this in steps so you can check things off as you go.

1. Make a list of schools you’re interested in and a pros and cons list if you have more than…six. I went to a presentation by Donald Asher my senior year and he said six was a good number. 2 reach, 2 safe, 2 middle of the road.

2. Once you have that list, make a check list for each school‘s requirements. Schools are weird, they can’t all just have a uniform manner in which they accept applications. Different deadlines, different costs, different expectations, different requirements. BE VERY CAREFUL HERE. If you eff it up, you’re OUT.

3. Compile. Get it together. Make a resume/Curriculum Vitae. Write a personal statement (I’ll blog a different time about writing a personal statement). Get your references in line. Start requesting transcripts yesterday.

4. Send in your actual application and fee as soon as possible. That way you’ll be on file and they’ll have a safe place to keep your stuff. The actual application shouldn’t be hard to do – it’s just the general things they need to know about you.

5. Ask people for recommendations as early as humanly possible. Schools vary on how many recommendations you need, but expect about three. I’d try to get them from people in your major who can write you STRONG letters of recommendation. Ask in person – “Would you be willing to write me a strong letter of recommendation for graduate school?”

6. Make the life of your recommender EASY. Give them a folder with everything they need in it. Supply your CV, your transcripts, your personal statement. Some schools may have a specific form they want your recommender to fill out, some may have an online survey, some just want a letter. Provide an addressed and stamped envelope and tell them the specifics about that letter. Some schools want YOU to mail it with all of your other stuff, but many want your recommender to seal it and sign it on the seal and mail it themselves. Once again, be very careful here, get it right the first time.

7. Also on that note, your school may require that you fill out a “waiver of rights” so recommenders may talk freely about your grades. Provide each person with a waiver about each school.

8. Transcripts suck. They take forever, they cost money, they never go to the right place. It’s a disaster so get started early. And remember to get transcripts from every school you attended – even if you did dual credit your junior year of high school through the community college.

9. Get your resume/CV together and edited by EVERYONE. You don’t want to look like a dummy with typos. And if your GPA isn’t AWESOME feel free to just mention the last 60 hours. (I mean, if they specifically ask your GPA, tell them, but on your resume you can put “3.45/4.00 last 60 hours”).

10. FOLLOW UP ON YOUR LETTERS OF REC. Ugh. Okay. This is the worst but it has to happen. Sometimes it is Christmas break, you gave all of your stuff to your recommender in October, and you get an email from your schools saying “We have two of three letters of recommendation” – sometimes they tell you who they’ve gotten them from. So it’s easy to narrow it down. You must hunt that person down and kindly, gently, nudge them to write that letter. They’ve likely just forgotten because they’re crazy busy just like you – they appreciate the reminder even if you feel awkward doing it. ON THAT NOTE – when you hand them the folders with all of the stuff they need – label that folder “YOUR NAME, The date you provided them with the folder, and the school it is for” – some people just do one folder for all their schools but I made an individual folder for each school and each professor.

11. Oh, and you can ask the same professor to write you multiple letters. And tell them which school you REALLY want. Professors want to help you, I promise.

12. Right, right, right before the deadline CALL the school and MAKE SURE they have received EVERYTHING. You might feel like you’re bugging them, but you’ll feel better once you do it. Especially if you applied to several schools. I’ve seen it happen where it is two days before the deadline and someone finds out a school never got their transcript. (Usually a school will accept an unofficial transcript until a real one gets to them – just FYI)

13. Once it is all said and done, you’ll start receiving notice in the mail (may go to your parents’ home) after spring break. And rejections come first. So if you haven’t heard from your number one school and it is early April don’t stress yet.

14. After that, write your thanks-you’s to the people who wrote your recommendations. Literally write them. On thank you cards. In pen. I waited until I got my decisions from schools because I didn’t want them to think I was sucking up to them (even though I sucked up to them all of the time any way because I am a suck up.)

15. If you get into multiple schools you’ll need to pick a school and write an acceptance letter by the date they give you. You’ll also have to write refusal letters. You can Google how to do that.

The end. If you want to know more about the types of graduate schools to apply to I wrote this last spring: for the chitlins

NP: Conor Maynard – Marvin’s Room (gorgeous. gorgeous. gorgeous cover.)