Monthly Archives: September 2013

9.26.13 — Talking about the value of coping strategies/emotional nourishment as an SLP

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One area that I’m not sure is talked about enough in classes or supervision (possibly in mentorship though), is what it feels like to be an SLP. There are conversations about stress and time management, about the various demands of high caseloads and low resources. But coming forward to engage with a person struggling with complex communication needs and their families often fundamentally features sadness. How a person internalizes that or processes that or copes with that is a very personalized experience. I am not a therapist or counselor, and I make that clear, but these are the thoughts I extend to students (typically by email), about my own values around self-awareness and being present for emotions as part of being healthy.

“On an airplane, in the event of an emergency, they always stress that anyone traveling with someone who may need assistance should take care of their own oxygen mask first. Because if a person was in the effort of putting someone else’s air mask passed out before they got the chance, there are now two (or more) people at risk. In short: you have to take care of yourself to be able to take care of others.

It has been a big, emotional, demanding week. There’s been a lot going on within PSU as the semester stampedes to a close, and there’s been a lot going on in the world. I encourage you to be mindful that these may have real impact on your energy, focus, patience, creativity, problem solving. Your well-being may be fatigued right now on more than one level. Please take care of yourselves.

There are lots of ways to do that and I certainly would never argue that there’s a best way. This is a link to giving yourself a moment: http://www.youtube.com/watch?v=F6eFFCi12v8. I have also recently read that even just taking a minute or two each day to look at a beautiful picture (of anything), helps.

Move, eat, sleep, breathe, talk, pray, dance, draw, be still: whatever. Invest in your well-being.

Airplane rules,
j.

The following is a set of readings about self-awareness that resonated for me; but, again, this is an entirely personal process.

Transformative Power of Crisis (Alter, Alter, & Hendrix, 2010), which I like very much. The chapters are short, which makes for easy reading. I don’t have a bookmark in it, I just open it and read wherever that is for as long as I like. I re-read a fair amount, but that’s okay. What I read tonight particularly resonated with me, and I wanted to share it with you:
>
> “At the end of our three-minute meditation at the beginning of the session, Dominic reported that he had so many ‘thoughts, feelings, and scenarios’ playing through his mind during it that he ‘couldn’t meditate at all.’
> ‘How do you *know* you had all those thoughts, feelings, and scenarios playing through your mind?’ I asked.
> ‘What do you mean?’
> ‘*Who* knows, and is able to report to me, that you had all those thoughts, feelings, and scenarios playing through your mind?’
> ‘I don’t know what you mean.’
> ‘Are you confused right now?’
> ‘Yes.’
> ‘How do you *know* you’re confused? *Who* knows that you’re confused?’
> ‘I do.’
> ‘You *know* that you’re confused?’
> ‘Yes.’
> ‘And who’s reporting it to me?’
> ‘I am.
> And what are you reporting that you know?’
> ‘That I’m confused.’
> ‘Who’s ‘I’?’
> “I am.”
> “And you’re confused?”
> “Yes.”
> “I thought you just said you’re the one who *knows* that you’re confused.”
> “I do.”
> “Well, which is it? Are you the one who’s confused or the one who knows he’s confused?”
> “I am confused, but I also know that I’m confused.”
> “Then you are two beings. You are what you are, which right now is confused, and you’re also something inside that seems to *know* what you are, and the *knower* is *not* confused.” (p. 55-56)

> The Two-Step
> “Guide our feet into the way of peace…” Luke 1:79
> If meditation involves gaining access to the Inner Witness who observes all our feelings, but therapy involves getting in touch with our feelings, which is more important — to observe or to feel our emotions?
> Both.
> When we walk we step first with one foot and then with the other; alternating between the two feet, we go forward. In the same way, on this journey of self-transformation we must alternate between two feet. One foot is meditation. Through meditation and other techniques of self-awareness, we establish and keep strengthening our identification with the Inner Witness, the eye at the center of our storm of feelings, the one inside who’s watching our feelings in a state of perfect peace. The other foot is the feeling of those feelings. Because there is nothing hidden that shall not be revealed on this journey — and that includes all our emotions — we must sometimes go into that storm and be willing to feel the feelings that are whirling about in it. That’s a major step in overcoming them.
> It takes a brave person with a strong and steady consciousness to walk into that storm and face the swirling buffets and blasts of the primal energies that are our feelings. Stepping with one foot, we walk into the storm and feel the feelings in it. Stepping with the other foot, we walk out of the storm, into its center, and watch it peacefully from there. Like the systole and diastole of a heart, pumping in and out, or like the high and low tides of the ocean, we engage in a back-and-forth process. Stepping first with one foot and then with the other, feeling our feelings, watching our feelings, we go forth, we propel ourselves forward, to the Self. (p. 61).

End blip.

09.22.13 — Talking about cognitive rehabilitation with problem solving strategies

Notes on clinical supervision,

The following was my attempt to organize thoughts/strategies/approaches about cognitive rehabilitation strategies for working with an adolescent.
“Just in quick follow-up to our conversation earlier today, I wanted to send some examples of problem-solving strategies for your consideration. As we discussed, using a strategy-based approach has advantages for the learner, and can potentially support how we define the goals in structured/measurable ways.

I do place a high personal value on applying/modeling these kinds of strategies regardless of whether or not they are targeted/explicitly taught goals, particularly for any (a) young child, (b) individual with language difficulties, and (c) individual with social-pragmatic issues. To these groups, the problem-solving that the rest of do may well appear magical (or that we don’t have problems). Because often adults just manage difficulties discretely or out of sight, or because these populations already have difficulty interpreting language or social cues involved, the actual steps that are happening to cope with a problem are not identified and learned unless explicitly taught. So I did a lot of think-alouds for both actual and manufactured problems. Even for simple stuff — “Oh man! My pen ran out of ink. I wanted to use this pen. That’s frustrating. Okay, I’m flexible. What else do I have? I can use a pencil instead.”

Anyway, the following are some published ideas. I think you will notice similarities among different approaches overall, even with the different acronyms.

A problem-solving approach Dr. Janice Light and Dr. David McNaughton used with the AAC Mentor Project was summarized by the acronym, “Do It!”

Describe the specific problem or goal and explain why this is a problem or a goal
Outline lots of different ways to solve the problem or meet the goal
Identify the consequences of each plan and choose the best plan
Take action
! Celebrate success when the problem is solved or the goal achieved

Phelps-Teraski & Phelps-Gunn (2007) developed their FOCUS strategy based on Norris & Hoffman’s language model (situation-discourse-semantics, or SDS); this was primarily around helping individuals negotiate pragmatics (social dynamics), but certainly could be shaped more broadly around problem solving/emotional regulation:
F: Figure out what you want to say
O: Observe the partner and situation
C: Communicate message
U: Use your eyes, ears and brain to decide if message got expressed appropriately
S: Self-correct, if needed.

If you search using FOCUS under the Resources (password: “m4ter14ls”), the one with “Literacy Modifications” is based off of an actual activity I used years ago (which is why the icons are owls — that was the mascot of the school I worked at then), modified to sort of work as a shared reading piece: some decodable and sight words have been highlighted, although Client may be able to read substantially more than just those. I tried to use both sides of the conversation — one could be used as an example/model, the other for more of a guided practice.

The SPACE Storytelling Outline is from Social Problem Solving: Making Best Plans by K. Noel, 2013, The Chippewa Falls, WI: The Cognitive Press. (c) 2013. In this case, it is structured around story comprehension, but could also be used for problem solving/coping/communication in other ways.
S: Setting = Who is involved? When does it happen? Where does it happen? What’s going on?
P: Problem = What is the problem? How do the characters feel? What do the characters need or want?
A: Action = What did the character do?
C: Consequence = What was the result of the character’s action?
E: End / Evaluation = How did the story end? What was the lesson learned? How do you feel in response to the story?

Also under the Resources is a set of bookmarks (slightly blurry) using this acronymn — search under SPACE bookmark for comprehension.

Singer (2013) summarized a problem-solving approach with EMPOWER:
Evaluate
make a
Plan
Organize
Work
Evaluate
Re-work

This one feels the most contrived to me since the “M” is “Make a” and does not stand on its own.

Finally, Larson (2013) recommends the following for adolescents who may respond to problems/frustration with an emotional reaction (such as anger or abandonment/giving up), or be impulsive and guess; summarized by Stop-Plot-Go-So:

Stop: I can stay calm by [insert personal strategy].

Plot: My problem is: [identify and label], My options are: [identify and list], Consequences of each are: [identify and evaluate], My choice is: [select one]; social-emotional skills I need are: [identify and label; e.g., to be calm and think things through, to find help, to draw, etc.]

Go: What can I say or do so I actually use my plan?

So: How did my plan work?

Certainly there are others and these all take a broad view of problem solving; that is, the idea that knowing a generic strategy can support/structure across a wide range of concerns. There may be reasonable arguments in favor of a more narrow view: spending time assessing with observations, interview, review of work portfolios, etc. for trends which identify specific concerns. These might include (but are not limited to): (1) paying attention, (2) remembering what he is supposed to do specifically, (3) applying what he is supposed to do with purpose (e.g., not guessing), (4) comprehending the sequence of a situation (social or academic), (5) making plans to set goals or solve problems, (6) making appropriate choices, & (7) self-monitoring/awareness.  There may be much more effective interventions directed towards the unique demands of these needs/concerns.”

End blip.

09.21.13 — Talking about positive reinforcement, instructive feedback, and creative ways to praise

Notes on clinical supervision, , ,

I think most of the students I have worked with for clinical practicum are on board with the value of positive reinforcement (and appreciate receiving it themselves), but I have some particular opinions on what I consider to be truly helpful in promoting skill learning and productive behavior. For one, I’m not a huge fan of generic and/or constant praise — to me, it seems insincere and weird to say things like, “Nice looking” or “Good talking.” There are certainly situations where a clinician needs to focus on whatever positives are available to help promote a better rapport/atmosphere at that time, but I start to get worried if I hear a regular stream of this kind of praise without actually examining if it is in fact (a) true, (b) actually a distraction from learning or adjusting the teaching/situation to get more authentic intervention, or even (c) helpful. Sometimes it feels a lot to me like chatter…just more noise the learner has to navigate through to figure out why they are there. If this is really the best/only praise a clinician can offer, it is time to seriously look at whether or not the goals are appropriate, the teaching has been presented to be well matched to the student need, and the environment has been structured to promote focus and success, etc.

The following is a set of information I organized to emphasize my own belief in the value of instructive feedback — anchoring the praise with the skill and/or why the skill is relevant. With instructive feedback, positive reinforcement can include re-stating the rationale (“You are working hard to learn to read!”), and/or the strategy (“Wow! You looked at each letter and thought of the sound it makes.”). That’s not to say these features would need to be present every trial, but they do keep the presence of why they are working with you, and what they do which promotes their success. This distinguishes what we as SLPs do as unique from praise they may receive elsewhere (it orients the individual to his/her communication or literacy), raises metacognitive awareness to promote self-monitoring, and provides the structure for corrective feedback in a non-threatening way. That is, if the client gets something wrong, the feedback is provided in the same way: “Remember, look at each letter and think about the sound it makes.” is, in my opinion, infinitely more helpful and less threatening than, “No. Try again.”

I would also say that it’s helpful, whenever possible, to keep it sincere and fun.

This is an example of a simple way to have a small gesture of phonological awareness is to match a praise comment with the initial phoneme associated in the task. For example, if a student found the letter /i/ in a letter-sound-correspondence (LSC) activity on the keyboard, to say, “Incredible!” The following try to keep with that principle, but I wouldn’t consider it exhaustive or perfect. In any case, strategies like these should be what you are personally comfortable with.

Absolutely, Amazing,
Beautiful
Cool
Dynamite
Excellent
Fantastic
Great, good (for you), gorgeous
Hooray, holy cow
Incredible!
Joy! Jinkies! just like that,

Kiss your brain!, keep it up!

Lovely, Lookin’ good!

Magnificent, Marvelous
Neat, Nice one/job
Outstanding, Oh my gosh
Perfect, pat yourself on the back, powerful
Quite right
Right on!, Rockin’
Super, sweet, *
Terrific
Up, up and away — you are taking off!
Very nice, va-va-voom!
Wow, woah!, woo-hoo!, Working hard!
X-ray your brain: I need to look at all that learning!
Yahoo!, yipee, yay!, yes!, you got it!
Zoom! Zowie!

You can find more (with accompanying ‘cheers’ at http://www.drjean.org/html/monthly_act/act_2004/06_june/06_2004a.html — click on the links at the top or bottom of the page that say “Cards 4-6” etc.

*One cautionary note: Please avoid using the word “smart” with kids and parents. This word is remarkably entangled with emotions – not unlike “stupid” or “dumb.” Research has shown that kids who are praised for being smart are less likely to take learning risks than kids who are praised for their effort (Dweck, 2007). So if a situation is presented where they are not confident they can keep the “smart” label, they will withdraw and not try at all because they do not want to appear “not-smart.” Kids who were praised for perseverance and effort (regardless of accuracy), were more willing to try and/or ask questions even when they weren’t sure they knew the answer.

09.21.13 — Talking about interviews

Notes on clinical supervision, ,

During the assessment process for individuals with complex communication needs, I try to provide some coaching to the students around developing interview questions.  Tools like Social Networks Inventory are specific to this effort, and I also encourage the students to keep in mind what information they need for other such published tools like the Functional Communication Profile-Revised or TECEL.  I do not work for the companies and have no interest in whether or not they are used, I present them to students as examples of systematic means to structure their efforts.  Gathering information related to multimodal communication/AAC is a HUGE process, and it’s been my experience that students feel completely at odds with ~how~ to approach it.  So I share these kinds of tools as resources for their consideration to guide their efforts strategically.

After we talk in person, I send a follow-up email to review the key points in written form (in this instance, the client is a “she/her”):

“Thank you for meeting today — we were able to talk about a lot, and it is clear that you have been reflecting on our fundamental questions of “what do we know?” and “what do we need to know?”

Even just in our discussions, I might broadly characterize these questions to be dispersed around three main threads:

– learning more about the client overall (e.g., elements of a typical day, interests, sensory needs, etc.),
– specifics related to her communication (e.g., what she may understand, what she may signal/express with her behavior), and
– partner interaction patterns (e.g., how information is presented, how she is watched for meaningful responses, how responses are confirmed, etc.)

We talked about how the next step will be to carefully consider what the best means of getting this information may be — email, requests for reports, talking on the phone or in person and, if through talking, how to structure and unfold that interaction to “maintain a comfortable and productive relationship” using the information from Westby, Burda & Mehta (2003) as a guide.

(1).  Do you already have a sense of what may be reasonably developed by email or requests for reports?  I think we used as a loose guide that any question where we may want to have an example would be good to have on the phone or wait for them to actually be here because it may be best handled in such a way that you can attend to subtleties of tone of voice, pausing, and more detail.

(2).  If you have not done so already, I strongly encourage you to review the protocols for the published tools we have discussed to begin filling in what has been observed, what areas you would want to ask about (by email or interview) for this part of the process, and what areas you feel you would definitely need to observe (either by video or directly).  Please consider your questions as a means to the end goal of being able to use these published tools to structure information gathering, and informing the process’ next steps.

(3).  In terms of interview etiquette, I would always strongly encourage starting off with introductions and giving a general overview of the goals.  This is an opportunity to establish that the intention is learning/sharing (information discovery) and planning (preparing for next steps), not to judge or criticize (which is often how any questioning format may feel).

As an example, I put this as if Student 1 was the first speaker and covering a general sense of the client — there’s no particular reasoning for that in my thinking, and we could structure this in whatever way you guys felt appropriate; however, it needs to be outlined more specifically for who is asking what so that there is a coordinated plan.

Example:  “Hi, Client Mom, this is Student 1.  It is so great to have this chance to talk.  We have reviewed the information that you sent ahead, and watched the videos.  I just have a few questions for you so that we can get to know Client better.  Then Student 2 is going to ask a little more about Client’s communication.  All of this will help us plan for your visit here.  To start though, do you have any questions or concerns?”

If she is feeling okay about things, my all-time favorite “Descriptive” or “Grand Tour” question for parents or teachers to start is simply:  “Tell me about Client.”  In this case, I might add a clause like, “You have provided us with so much wonderful information with the reports you sent, but it would be great to hear from you:  Tell me about Client.”  A remarkable amount of information can unfold in such a simple question:  the parent or teacher’s frame of reference for that child, his/her conceptualization of the specific concern and/or of disability in general; the most important goal or most critical need; a sense of the child’s personality/interests/activities/family life; parent/teacher anxieties/concerns/fatigue, etc.  Follow-up or “Mini Tour” questions would include asking for use rather than meaning (e.g., “Give me an example of….”), restating (repeating in exact words, do not paraphrase or interpret), and summarizing with the intent of allowing for clarification.   “Tell me about a typical day” is another great descriptive/grand tour question and presents lots of opportunities to follow up with likes/dislikes (what does he do to convey preferences/rejection), sense of mood or energy across the day, motor skills, sensory demands, etc.

Listening to her responses to these kinds of questions may well resolve many of the questions you guys identified on its own, or lead into unexpected directions as well.  A key piece though is anchoring her as the expert of her child; therefore, letting her lead the revelations about her within a gentle structure of getting information we need to get a profile of her skills/needs and plan appropriately.

Student 1 would then ‘wrap-up’ and transition to Student 2:  “Client Mom, I feel like we are learning so much about Client.  Student 2 has a few questions for you which are more specific to her communication but I wanted to confirm if there is anything else you would like us to know about her generally?”

With this piece, there would be a brief overview again and to try and start with a Descriptive/Grand Tour question related to communication; as in, Student 2:  “Good afternoon, Client Mom.  I just have a few questions to clarify our sense of what Client understands and expresses from what you have shared with us so far with the videos and today.  Please share with us your thoughts on Client’s communication.”    More detailed questions about her hearing, vocabulary she may know, functions of communicating (requests, protest/reject, get attention, etc.), behaviors or signals observed, etc., may naturally unfold or can be asked as follow-ups in the same way as described above (use rather than meaning, restating, summarizing).

I would encourage again an opportunity for her to convey questions/concerns, and “Is there anything else that you feel is important for us to know about Client.”

I then close with an Action Plan for what I need from them next; primarily, dates/times that we can share with the parent to schedule the interview, an outline of who is asking what.  I also indicate that they need to be actively thinking about the next step as well:  what information they will need to observe directly, and how they will go about establishing situations and gathering that data.

09.21.13 Supervisory Notes re: iPad and apps

Notes on clinical supervision

Frequently I am asked by students or others about resources related to the iPad and apps.  It’s increasingly becoming a bigger and bigger question.  This is a series of information that I commonly extend:

>> Relative to the iPad as a platform (the hardware), I recently learned of a video that may support efforts when working with the iPad (or other iOS technologies).  It’s just under a half-hour long, and reviews the settings and features of the system, not any particular app.  For example, they review how to use Guided Access and other Accessibility settings (such as “Zoom”).  It is more specifically directed for parents and teachers working with individuals who have autism spectrum disorders, but certainly the features may be appropriate for any variety of learners/communicators: http://www.youtube.com/watch?v=_qQkyrdBcSc&feature=share.

>> The QIAT listserv community compiled a reference for the iPad which reviews its features — it considers demands ranging from required motor skills, implications for individuals with vision impairment, and cost.  This can be found by searching the archives, and their website (http://indicators.knowbility.org/) generally has tons of useful information.

>> Penn State’s technology department has also pulled together a variety of resources at:  http://www.hhd.psu.edu/iss/training/training.html#ipad

>>  Two:  using the iPad should have careful consideration about the implications for the interaction; and, specific to intervention, the teaching piece.  Positioning the iPad (or other technology, such as a laptop running Powerpoint or Keynote), changes the dynamic between client(s) and clinician:  there is now a third thing to direct and share attention between.  Are the two persons now looking down at it instead of at each other, and how does this change the priorities of the SLP re: communication as an act inherently intended to connect between people?   One strategy to preserve more natural face-to-face interaction may be to position the technology held by the clinician at about heart level facing the client; which requires some manual dexterity and stamina on the part of the clinician, likely occupies both hands (pointing?  sign?  data collection?),  and means she/he will probably have to look at the materials upside down.   Who controls the buttons?  Are clients allowed to touch the screen, and what are the boundaries established regarding how hard buttons/screens may be touched?  In terms of teaching, how does the SLP apply visual or gesture references, such as pointing with the iPad or other touch screen technologies without incidentally activating the screen.  I had put forward one idea relative to Instructional Materials related to this challenge in the Resources (password, “m4ter14ls”), search under “iPad.”  My primary point with all of these questions is I feel strongly that there are implications with using the iPad that need to be considered carefully.

>> “There’s no question that Apps have taken the field of Speech-Language Pathology by storm, but I have huge concerns about *how* they are being found/used.  Two, the most important thing in my mind is that the app remains a *tool* not the whole point.  For assessment/intervention, using an app should be a component of an interaction.  It should matter whether or not another person is in the room (it’s not just an idle activity which has no social component); and if we’re using it, it should matter that that person is an SLP.  It is *not* enough that apps are fun or convenient.

>> Apps for SLPs can be categorized in 4 groups:  (1) specific to SLP use, targeting a communication skill; (2) re-purposed from some other area (e.g., literacy), and used in intervention for targeting a communication skill; (3) motivational only, having no particular relationship to communication; (4) for collecting and interpreting data.

>> Why an app is selected for an intervention should be based on Evidence Based Practice, or EBP.  This is the intersection of available evidence/research/theory, the clinician’s personal expertise/experience, and the particulars of the client’s skills and needs.  If there is an imbalance from these components, it will impact the effectiveness of the intervention.  For example, if an app is being used because it’s the one the clinician is most familiar with and there is no research base which connects to the design/approach of the app, and it isn’t fit to the unique individual profile of the client, it *may* be something that client will learn from; HOWEVER, it will take much longer, and demonstrate less functional generalization.  That is, it will not be as effective as it could be if there was better balance among the components of EBP.

>> Clinical instructors for practical experiences (aka, supervisors and mentors), may also find value in a great article about a protocol for clinical supervision which includes app decision-making that was published in the April Perspectives for Administration and Supervision –Technology: Project Using iPads for Clinical Supervision by Karen Brown, Akilah Heggs, and Katie Milican.  Their tool for structuring and documenting the process of why an app is selected and how it will be used strikes me as hitting the key points without being overwhelming.

>> ASHA has a ton of information on their website, but I specifically want to call attention to an ASHA Leader article which talks about EBP for selecting apps is:  http://www.asha.org/Publications/leader/2012/120731/APP-titude–Use-the-Evidence-to-Choose-a-Treatment-App.htm  Unfortunately, this is just a bare-bones article, but it does give the basic structure of the author’s recommendation.  The authors have also put together a two-part series of information on EBP app selection through www.speechpathology.com, both of which I found to be very helpful.

>> Specific to AAC issues, Dr. Light and Dr. McNaughton very recently published “The iPad and Mobile Technology Revolution: Benefits and Challenges for Individuals who require Augmentative and Alternative Communication  Read More: http://informahealthcare.com/doi/abs/10.3109/07434618.2013.784930.  The http://aac-rerc.psu.edu website also has the White Paper on these issues, and is worth knowing about.

>> I also strongly encourage folks to watch this free webcast on Mobile Devices and Communication Apps:  Current Trends and Future Directions (http://aac.psu.edu/?p=841).  There is also a link to Boston Children’s Hospital which has good information about this process, and a feature matching toolhttp://www.childrenshospital.org/clinicalservices/Site2016/mainpageS2016P19.html

>> Blog/article regarding communication and language apps: http://speechdudes.wordpress.com/2012/05/03/stop-with-the-little-words-grab-bag-in-aac/  It’s very much in keeping with what has been talked about at PSU & Colloquium for some time now relative to how *language* is represented and organized (although with a spunky hipster tone) and he makes a well-reasoned, succinct, and impassioned point.

>> http://www.speechtechie.com/ is one example of site that has considerable information about using mobile technologies.  It is written by an SLP who works in the schools and his “FIVES” criteria may give some structure to deciding what apps may be worth an SLPs time.  He also oversees a Google.docs collection of apps relevant to SLPs.  Since the “F” in his acroynym refers to Free (or nearly free), these tend to be very cost effective.  Of course, none of these apps replace effective, thoughtful, data-based intervention.  Recently he had a thorough discussion on how to manage the iPad’s digital space.

>> As “review” lists go, I think this one has some positive aspects and is better than many I’ve seen http://www.spectronicsinoz.com/article/iphoneipad-apps-for-aac)

>> This is a slightly different perspective on Apps (originally developed for Elementary education):  But I do find Harry Walker’s work in the Baltimore schools interesting and I think his rubric does a tremendous job for educational Apps (article at http://embedit.in/Wp28yIHnc2.swf, rubric itself at:  http://iteachthererforeipod.blogspot.com/2011/11/evaluation-rubric-for-ipodipad-apps.html)

>> Finally, relative to out-standing or underdiscussed issues for me:  I feel somewhat nervous about the notion of people using their personal technologies for assessment and intervention.  I don’t know what the legal responsibilities are; for example, if an SLPs personal iPad gets damaged by a client/student, who pays for that?  If an SLP in a school uses an iPad with a student, could the parents therefore have reasonable grounds to petition the school to buy the student one (clearly the SLP already places a value on it…); or, alternatively, if a client/student brings in a Mobile Technology of their own (which is increasingly common), whose responsiblity is it to program/maintain it?  I have not found what I consider to be sufficient discussion on these kinds of issues to help guide SLPs to know how best to respond.

>> Hopefully that will give you a place to start!  I know that this is a lot to take in, but be patient and strategic with yourself and your time.

>>Thanks,
j.

>> p.s. At less than a minute long, it’s definitely worthwhile to check out Sesame Street’s, “There’s an App for that”:  http://www.youtube.com/watch?v=EhkxDIr0y2U

End blip.

01.17.15 UPDATE Supervisory Notes — Talking about beginning vocabularies (originally posted 9/20/13)

Notes on clinical supervision

I regularly have conversations with students about the challenges around figuring out appropriate vocabulary to feature in assessment or use as target focuses in intervention which features multimodal communication/AAC for beginning communicators (either within Early Intervention and a true “first lexicon,” or when serving individuals with complex profiles and may be chronologically older but communicating at earlier levels), and the following is a summary of my thoughts evolving from those discussions and subsequent reading I have done.

As per the research by Light & Drager (http://aackids.psu.edu/index.php/page/show/id/6), appropriate vocabulary should reflect the interests/needs of the communicator (determined with interviews, observations, survey tools, Communication Signal Inventory); and developmentally appropriate vocabulary based on the individual’s age/life experiences.

In terms of Resources relative to the first piece — individualized vocabulary of high personal relevance as per the recommendations of Drs. Light & Drager — the Vocabulary Selection Questionnaire for Preschoolers Who Use AAC from Fallon et al (2001) is an excellent resource available for free download at the http://aackids.psu.edu website. This can also be adapted for older communicators or used as an example for how we need to consider various contexts/environments.

I have also tried to pull together a couple of options under the Resource link above (password: “m4ter14ls”), including:  (1) a “Kid Culture” Alphabet of a range of characters, movies, places, toys, etc. that may be of appeal to younger audiences, and (2) an adaptation on the work of Laura Molleur/M.Ed — she had put together a really solid Interests and Preferences summary through Victoriesnautism.com.  I added a little detail related to teasing out what observable signals, behaviors, or expressions lent to impressions of likes or dislikes.  That’s titled “Review of Interests and Preferences.”

With the second piece (developmentally appropriate vocabulary based on the individual’s age/life experiences), there are a couple of resources that may be helpful.

>>With Early Intervention with young children, the MacArthur-Bates Communicative Developmental Inventories are now available online through the CLEX website and even includes gestures:  http://www.cdi-clex.org/  This can give insight into terms by age and gender that may be relevant for review and consideration.

>>In 2009, Susan Lederer presented “First Words, First Books and Focused Language Stimulation” for www.speechpathology.com.  She discussed a review she had completed of a number of resources to develop a list of 30 possible targets that met the following criteria:  mastered by 50% of children by 20 months (Fenson et al., 1994), mastered by 80% of children developing typically by 24 months, and mastered by 80% of late talkers by 36 months (Rescorla, Christine, & Alley, 2001).

She also stipulated that “these 30 words could be demonstrated easily by gesture, picture, or sign; are meaningful and pragmatically useful; include substantive and relational words from all of Bloom & Lahey’s (1978) early content categories; and are phonemically simple.”

In subsequent research (2007), Lederer added words that 50% of children with developmental delays acquired by age three (bring her total under review to 42).

Substantive
Existence/People: mommy, daddy, baby, me
Existence/Animals: bird, cat, cow, dog, duck
Existence/Foods: apple, banana, cookie
Existence/Toys: book, bubbles, bus, car, ball

Relational
Action: eat, go, hug, kiss, open, wash, drink
Greetings: bye, goodnight, hi
Attribution: big, dirty, hot
Locatives: down, in, off, on, out, up
Recurrence: more
Rejection: no
Non-existence: go away
Possession: (none)

I very much appreciate that the above list is specific and covers a range of semantic categories/communicative functions — it’s not just all nouns to be used in “I want…” sequences.  I also find her Focused Language Stimulation and premise through shared storybook reading activities to be very compelling — consistent with the research here at PSU as well.

Then she has another presentation on www.speechpathology.com on the first lexicon and there she adds that as of 2010 she has revised her position on “more”:  specifically, delaying using it until a child is at a point to combine words/concepts — that “more” is not a stand-alone concept, it’s really “more toys” or “more milk” or whatever.  That blew my mind.  For many years, I have always felt comfortable using and teaching it, but I have also seen the patterns Lederer identified as problematic — that kids may not get the concept as “more+,” they learn and use it as a complete request on it’s own, like “[I want] more.” or “more [partner fills in based on situation or guesses],” and as a result it may actually limit vocabulary growth.  Two, that many kids may know that it is a communicative act along the lines of “I do this thing and stuff happens for me” but not associate it with a specific message — so beginning communicators start to use it indiscriminately in a variety of situations (such as to start interactions or convey protest), not just express a request to continue.

Anyway, as a starting point:  I like her list, and LOVE her book list.

>> The University of Nebraska-Lincoln has done considerable research around vocabularies (as well as other AAC-related work) for a wide variety of age groups and population profiles.

>> In September of 2014, the SIG 12 Perspectives article, “Promoting Academic Achievement for Early Communicators of All Ages” by Lois Geist, Penny Hatch, and Karen Erickson argued strongly in favor of strongly considering the DLM Core:   “The DLM Core is intended to be flexible enough for repeated and frequent use across a variety of contexts. Words were prioritized based on their frequency of use in oral and written language and necessity for academic engagement, learning, and demonstration of knowledge.”  There is substantial information available about this at Department of Allied Health Sciences Center for Literacy and Disabilities website, but I find the DLM Core first 40 vocabulary the easiest to read as a basic start.  As an aside, I found the Geist, Hatch, Erickson article to be compelling on a number of levels — lots of solid information relevant to school-based SLPs.

End blip.