Carryover Activities for Speech Therapy

5 Nov

No matter what goals you are working on with a student, there comes a time to move those newly developed skills outside your therapy setting. This is referred to as carry over.  For some students we know it can be a real struggle.  We all have experience with the student who does a perfect /s/ during therapy and then you see them  in the hallway and they turn to you to ask “Is it my peech day?”  All of  that work does little good if it does not  transfer to the real world.  Therefore carryover skills are important to address. It is important to have this in mind from the very beginning.   

There are things to keep in mind when planning tasks for carry over.  It is important that the student is able to do the required task correctly in a controlled setting and hear the difference between his correct and incorrect productions before doing homework assignments on his own.  If he doesn’t self correct errors he is likely to practice homework wrong which only reinforces errors.  Homework  should be given at the level where student is successful.

It is important to reinforce the correct behavior to get it established but after that don’t give immediate feedback every time.  Instead, teach self monitoring by asking the student what they think about their production and then give feedback.  This makes them responsible for their behavior and not as dependent on your approval.  Children often work for approval and do not see the big picture.  We want them to be self-disciplined and responsible for their actions.  I often tell them they need to become their own therapist because they certainly don’t want me following them around all day correcting them.

As soon as students are at a spontaneous sentence level I encourage them to self monitor by using  a  hand counter  or tally counter. They self monitor by  making a click each time they observe themselves doing an assigned task correctly during therapy.  This could be monitoring a correct speech sound, using correct grammatical structures, or using fluency techniques. All those things we tend to work on. 

Hand counter

It is easiest to do this in an hierarchy.  Train the student how to use the clicker when reading a word list or reading sentences that have the words they are working on. Then bring it up to the next level by working on  more spontaneous productions.   The Silly Sentences in the  “Expressive”  section are great for a reading task.  It goes to the next level of spontaneous speech when student explain what is wrong with the sentence that was read.  The Association cards in the “Vocabulary” section are also a way of getting more spontaneous output as the student explains how words are similar  in meaning. I often have students working on vocabulary skills as well as sound production in the same group.  With the clicker almost any task that requires a spontaneous response can work and meet a variety of needs. 

There are a few bonuses for having the student use the tally counters.   You can keep track with a second counter or paper and pencil, and compare accuracy of the self monitoring as well number of attempts with the student’s tally.  The students finds it motivating to hit a target number of correct productions and you have data for your records.

The clicker can add natural controls at the  level of conversational speech.
 Often students get carried away with a conversation, and forget to monitor or allow others to talk.  The flow is stopped if you need to remind them.  The tally counter in their hand is a good reminder there is a goal in mind. When working with multiple students you can give an assigned number to tally before passing it to another student.   The group can earn a chosen activity when they reach a certain number.  For some reason the clicker by itself can be motivating to some students.

The “Social”  section at the top has quite a few activities to encourage spontaneous speech in social situations.  There are ideas for role playing in this section.  Role playing is a good activity for practicing   real life situations.  Ideally you will be providing tasks that reflect real life speaking  situations so students practice what they will actually be saying and then carry it over.

The Forms and Letters section has a “Home Work Rating Scale” I have used to get feedback from parents, teachers, and caregivers. The student becomes aware he is being listened to by others and parents know what can be expected from the student.  I often use this sheet as an exit requirement.   When parents have been part of the process, they are more likely to know and agree when it is time for the student to discontinue speech services.

I hope you find something you can use in this blog post.  I enjoy hearing what works for you or any other feedback.  You are always welcome to leave comments.   In addition, let me know if you run into links that do not work.  I found some recently and deleted or fixed them.  It is a hard thing to keep track of some of these things.  








 

 

The Virtues of a Grab Bag and Grab Bag Hack

1 Nov

Have you ever wished for extra arms while conducting speech therapy?  Who can forget those early days of  SLP training and starting of clinical hours.   At the time, it seemed impossible to manage everything. I wished for more hands to manage materials, data taking tools, and especially the young clients.   If you turned  your back, your clients had control of the materials and you became an octopus trying to get them back.  This was not a good start to the session.

I got  to thinking about the hacks I discovered along the way that made a difference.  A grab bag was one of my real life savers. If you haven’t discovered the virtues of a grab bag  you have really missed out.

There are lots of advantages to using a grab bag.  A bag allows for control of the materials and prevents students from helping themselves to  items before you are ready to use them.  It allows for controlled  turn taking.  Only the person with the bag has access to the items. They  take items one by one before handing it on to the next person.

It creates  intrigue for some  students who would not otherwise be interested. Who doesn’t like discovering what is hidden in the mystery bag?   And finally, when you find yourself switching locations and working from room to room, you can keep better tabs of those small pieces if they are contained in a  bag that is portable.

I used grab bags frequently with my  early language learners, especially in small groups.  It creates a natural context for communication boards when training core vocabulary such as “I have, I see, I want,” and that mportant question for vocabulary development,  “What is it?”.   I have used grab bags with a activities such as potato head, the car races, and windup toys.  You can use a clear freezer for students who need  to see the parts and request them.

Here is an example of a communication board I used with  mechanical toys and a grab bag. The board is made from Picto-Selector graph which is a free download.  It can be found at https://www.pictoselector.eu/  

A bag can also be used with older students seated around a large table.  The bag can be passed so items can always be reached.  You have one less thing in your hands which really helps when taking data.  You can even have different  bags and different cards in each so students can work on different objectives by pulling from their bag. I have a lot less trouble with a stack of cards being scattered across the table and floor.

I imagine you are saying, “I want one of those. Give me the directions for that grab bag already.”   Well here they are:

Find an old sweater or sweatshirt that has long sleeves and cuffs.  Simply cut the sleeve off, turn it inside out and sew across the flat bottom.  You can glue the bottom opening closed with a glue gun if you can’t sew or don’t have a sewing machine.  Turn it back to the right side and you should have a bag with a cuff opening for the top. Now tell me that isn’t simple.

 

 

Using stories to teach social concepts

21 Jun

If you have worked with students with autism or other disabilities,  it doesn’t take long before you find out the value of a good story to teach social situations.  “Social Stories” is actually a trademark of  Carol Gray who first developed the idea and gives conferences and trainings on how to write and use  them.  In her words,  “The goal of a Social Story™ is to share accurate social information in a patient and reassuring manner that is easily understood by its audience.”     She has developed a site that has more information then what I can possibly put here and I wouldn’t want to violate her trademark.   So go to Carol’s site to find out more information  on how to actually write one.

I have used stories  to help students correct challenging behaviors or deal with  new situations.  They can be written for all levels of development.  They can be made as a picture book or in just written form.  You can even use technology with program like ‘Power Point”.  If you  add a switch  a child with physical limitations can turn pages independently. Sometimes real pictures are helpful.  We’ve taken pictures of staff and the building to prepare a student for transition to a new school.  They’ve been useful for getting children to line up and return from the playground,  and wait their turn.  An important thing to remember is to focus on the positive.   Let the child know what  behavior you want them to do  and what to expect.  Don’t emphasize the bad behavior.  A child that is hitting for attention may actually need a story on how to ask someone for a turn or to play with them rather than “We don’t hit”.

There are many sites with already made stories.  They can be a resource for downloading or writing your own stories.  I have found stories on “Speaking of Speech“,”Boardmaker share“,and One Place for Special Needs. I’ve added a comic strip maker to the tool section.  This would be a great tool for  older elementary or middle school students who might like writing their own stories.

Bilingual Speech Assessments

18 Oct

My elementary school population has been going through a transition and is becoming  more of a melting pot.  I’ve been completing more bilingual assessments lately.  There is always a risk of over identifying children that come from different cultural backgrounds.  Most of our speech and language tests are normed for the average English speaking American child.   In order to determine if the child has a language disability we need to determine it is not  a language difference and the disability is apparent in both languages.  This can be even more difficult if the child is caught between the use of two languages.  The primary care giver may not have a good handle on English, but this is the primary language used at home.  The child’s English model may not be standard English and they are not exposed to it until they reach school age.  As a result their vocabulary and syntax  skills may also be lower than expected.

When starting an assessment for special education, it is important to determine which language is  dominant for the child.  An interview with the caregiver will tell you how much the child has been exposed to English and what the predominant  language is used in the household.   The caregiver can also give developmental information.  If the child made developmental milestones, there is less chance he/she has a  language disability.  Our English Learning program conducts regular testing to show progress.  This information can be used to address the child’s functioning in English and if progress is steady.  I am fortunate that my district employs interpreters that can help complete speech assessments.  Sometimes it’s possible to get a speech assessment in both languages such as using the Spanish CELF and English CELF.  The scores can be compared to reveal discrepancies and if the child has a delay in both languages.

I found a  web sites that I find useful when completing bilingual assessments.   It gives resources and considerations for doing bilingual assessments.   Its called Multicultural Topics in Communication Sciences and Disorders .   I also  put it  on the blog roll  for easy reference.  There is also a handy site that provides text to speech and translation for multiple languages. It is Text to Speech Translator.

When the spoken word is not enough

16 Sep

Often parents will be concerned about their child’s development when he /she is not speaking  or is not understandable at age 3 yrs.  They want the child to be able to say words.  They are surprised to find out that saying words verbally can be only part of the problem.

A Child with autism often needs to develop intent or a purpose for communication.  Without purpose there isn’t a  reason to talk.   Caregivers believe they can help by talking for the child or telling them what to say.   Communication is reduced to  repeating back what is said to them. Caregivers with the best intentions respond to wants and needs without requiring the child to communicate to them.  The child’s development becomes stagnant  because it can’t go beyond this hurdle.

Children with speech that is not understandable also run into difficulties.  They become frustrated because they can’t get their needs met and are asked to say words over and over again.  By first grade their peers begin to notice and they may be teased.  It’s not unusual for children to exhibit behavior problems along with a speech and language delay.

When children are slow to develop understandable speech at a reasonable rate, communication boards or pictures can make a difference.  They can bridge the gap between the speaker and the listener and reduce the frustration associated with speaking.  They allow for communication which is really the main goal.  It encourages the child to continue to speak because he is understood.  Parents often think that the use of communication boards will inhibit the development of speech, but actually the opposite is true.  The pictured words are often the words the child learns to say first.  If you are lucky you may have a program named Boardmaker which allows you to design your own communication boards or books.  There are also a lot of sites that have downloads available.   It is possible to access a communication book on this site, Boardmaker templatesBoardmakershare.com is a site that allows you to download already made boards that people have shared.  If you have Boardmaker,  you can edit the boards after you download them.  Otherwise you can download them and use them as they were shared.  It is free and well worth the registration.

If a child doesn’t have intent to speak, pictures may be linked with a consequence so that the child has a purpose to communicate.  For instance they may exchange a picture of a snack in order to get that item.  This can be built upon until the child is actually forming sentences.  This promotes the development of meaningful language rather than imitative speech or reciting of nonsense phrases.  The Picture Exchange Communication System is an example of  using an exchange method.  It has the advantage of being low tech and not expensive.

Often pictures are used to make schedules and help with transitions for children with autism.   However, do not confuse their use with communication.   Schedules are helpful for letting a child know what to expect with their day and reduce stress.  They can also be used as a bargaining tool.  The child can select a preferred activity after completing a number of tasks.  They tell the child what is happening but do not allow the child to express himself.   A schedule is not meant for multiple communication exchanges. A child benefits from both a picture schedule and a communication method.

Are you a new SLP in a new school?

3 Sep

I believe most people have started back to work in the schools by now.  The west coast always seems to be last and next week is our first week with children.  When I  started this blog, I reflected on when I first started working in the schools.   I was uncertain on how to start a year because I did my internship in the Spring.   At that point everything was scheduled and running so I had no idea what I should expect.   Since that first fateful day, I’ve started school years  in about 20 different buildings in 10 different districts with every kind of mix of caseload you can imagine.   Some things have changed over those 20+ years, but much remains the same.  This post is written for those people starting their first school year experience as a speech pathologist.  I thought I would give some words of encouragement because after those first few days of meetings your head is probably swimming.

For your sanity, it’s important to tell yourself  you will be overwhelmed for the next few weeks, and that is OK.  I’ve been overwhelmed the first couple of weeks  no matter where I started.  The first thing you will use is your skills of discrimination.  You will find  much of the information you are given doesn’t pertain to you directly.   Try to stay tuned long enough not to miss the information you need and don’t get overwhelmed by the stuff you can ignore. A lot of it is meant for general education teachers only.

As a new person, you need directions on how to get places, such as from the district office to your school/s and the floor plans of your buildings.  I am directionally  challenged so maps are very important to me. One year I worked in a district that had flipped the High School floor plan of one school to make a 2nd school across town.  I worked in both buildings.  I spent my year heading out in the opposite direction every time I stepped out of a room.  You would think I would have a 50% chance of being right but it didn’t work that way.  Other things we take for granted are phone numbers (district and within the building), voice mail, email (you probably have messages and you don’t know it).   Some districts are better at setting some of these things up than others.   If I travel between buildings,  I place all of this information in a folder for easy access.  Now, since I’m in one location,  I tack all of it to a bulletin board next to my desk.

One of the most important things to do is to get to know your teachers.  We may be tempted to do the more tangible thing such as paperwork and bury ourselves in our office. Getting to know the people will  be the most beneficial in the long-term.   The teachers you work with are your best resource and it’s good to have them working with you.   It’s important to introduce yourself so you are on speaking terms and they can recognize you.  In my district we are required to make copies of IEPs for  teachers, so they are aware of any special needs of students in their classroom.  I make copies and hand carry them to the teachers because it gives me a chance to talk to them.  I also ask them for their class schedules with circled times of when they would like me to see children from their rooms.  This comes in handy when I start scheduling.  Don’t forget to introduce yourself to the janitor and office secretary as well.

Many places now use computer programs for electronic IEPs and Medicaid Billing.  This may require some training, but it doesn’t take long once you start using a program. I recommend finding a mentor if at all possible to answer questions.   Computers have helped with keeping paperwork organized, but I’m not sure it has decreased any paperwork.  The paperwork load continues to increase as the powers above keep adding one more form to fill out.  The rules can be quite different on how IEPs and  CUM files are stored and who has access to them.  You will be lucky if there is actually a written form of the rules.

Then it’s time to dig into those files.  I usually have files from new kids that have moved in.  These need to be looked at and updated fairly quickly.  Hopefully someone knows where the caseload files are and can direct you to them.    The first year is the roughest because you do not know kids from last year and the file represents all that you will know about a child.  I try not to get too hung up on what it says in the files.  Most of the time the worse cases in print are not really as complicated as they may seem at first reading.  Usually until you put a face to the file you will not remember much of it.  I usually read it over and put the goals and objectives on to my data sheets I use for recording information from therapy sessions.  This goal sheet is what I use when I do scheduling for therapy sessions because it is easier to manage a one page synopsis when scheduling and making groups.  I use a simple excel template for each child.   I update the sheet as new IEP goals are written annually.  The 1st year involved a lot of time to put them together.  After that I’ve saved them from year to year and it has saved me a lot of time and effort as I only need to do the new students.

I do not start seeing children for the  first week of school.  The scheduling often changes after that first week and I found myself making too many changes.  A lot of kids need to become comfortable with their classmates and schedules anyway.  I spend the first day in the kindergarten room.  They always benefit from a few extra hands to get kids settled and parents assured that Johnny can do without them. The rest of the week is spent organizing the schedule, getting meetings set for new move ins, and checking on kids I haven’t seen since last spring that may be ready to test out.  I try to have everyone scheduled for services by the second week.

If anyone wants to chime in and give words of advice that would be helpful.  You can use the comment button.  I need to approve comments to prevent spamming, so you may not see it immediately, but  no worries as long as you aren’t spam.