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Managing Behavior in Speech Therapy

If you work in the world of special education, I’m sure you’ve heard of the ABC’s of behavior.
The ABC’s are important to remember when you are evaluating the behavior of your students. I don’t know about you, but I didn’t take a single behavior course in grad school. Not one. That is why I heavily rely on the BCBAs available to me. I also don’t know about you, but not every BCBA and SLP agree 100% of the time. With that said, I hope to bridge the gap a tiny bit and use evidence based practices from both fields!
First, we must remember that there are typically three functions of behavior…
1) Escape/Avoidance
2) Attention Seeking/Seeking access to tangibles
3) Sensory Stimulation
And when establishing the ABCs isn’t obvious, a BCBA can be a huge help when completing a functional behaviors analysis. Our main role as the speech expert of the team is to create a means of functional communication for our students. We can do this by going through a simple step-by-step process.
-Find out what their present level of communication is.
-Reflect on what the best functional and meaningful form of communication would be for that student.
-Build rapport.
-Errorless learning techniques (For Example: Discrete Trial Training)
With our more complex learners, a tool called the VB-MAPP (Verbal Behavior Milestones Assessment and Program Placement) can give us great information on where to begin therapy. Are they requesting? Are they labeling? It can tell you their functional level of communication, provides a scoring guide so you can give multiple times to see the progression of treatment, and provides a developmental sequence of what to work on next in the therapy room.

Functional Communication Training (FCT) can help reduce behaviors by providing an alternative response form that results in the desired behavior. It basically helps them communicate in a more appropriate way. For example, when I have a student that swipes at me when we’ve been working for 30 minutes straight I can implement a visual break card and prompt him/her with, “It seems like you want a break. You can say, “Break, please.” Or touch the break card that is on the table. The steps to establishing a positive behavior support system include…
1) ID the function of the behavior
2) Match the function of behavior to the message of alternative communication that will be taught.
3) Prompt the use of the communication and reinforce the desired behavior with the desired outcome.
4) Ignore the problem behavior and prompt the appropriate communication.

Easier said than done, am I right? I’ve found that if I always have a way for the student to use their response form (PECS, choice board, AAC device, verbal, etc) and I give them some power, my sessions go over much smoothly compared to when I don’t give them some “out” if you will.

Some quick tips about behavior management in the speech room.
1) Errorless learning increases confidence and decreases frustration
2) Reinforcement should be immediate and consistent
3) Use the prompt hierarchy when teaching a skill

I hope these tips help you out with those kiddos with tricky behavior! What are some things you do in your therapy room??
Speech Me Maybe
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Facilitating AAC Interactions

Sometimes we get to do really cool things with our jobs. At the time, I thought it was pretty neat that the governor was coming to our little school but I didn't realize HOW neat. This little guy was able to show the governor how he communicates. Sometimes we forget how important the work is that we do...and I definitely forget how lucky I am to do it every day. Just remember, you ARE making a difference!

-Stay Amazing!!

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Lesson Planning in Speech Therapy

I know a lot of SLPs. Most are Type-A, “plan all the things” type people. I am not. I pride myself on being flexible and flying by the seat of my pants when it comes to therapy. I think it is important to be present and look at a session by what the student brings in that very moment in time. However, with that said, there are some very good reasons why lesson plans are beneficial in therapy and sometimes even necessary. When I think of typical lesson plans, I think of 4 page documents that illustrate EXACTLY how things are going to go and what I am going to say. That does not have to be the case. When I say lesson plans, I’m even talking about a mental map of how you plan for things to go down.

Why Lesson Plans?

      1)   Lesson plans can be an outlet of how we communicate our services to others. By others I mean, the special education director, paraprofessionals, teachers, or parents. This is important for not only our jobs, but helps us stay on the same page as the rest of the team.
      2)   It keeps us organized and on track as we set goals for services. We can set what our objective will be for each session. I love doing this because it makes each session meaningful.
      3)   It validates that we are providing quality services with our treatment delivery model that matches our style as a clinician. Yes, we each have our own style!
      4)   They promote problem solving when dealing with a challenging case. By simply writing it out, it can allow you to really look at what is working or not working and reevaluate.
      5)   Creates a ‘road map’ so to speak of ‘if this à then this’. When creating a visual ‘road map’ it allows us to follow a system that is consistent with the rest of the team. For example, IF a student avoids a task, THEN prompt for one successful trial and take a break.
      6)   It allows us to take a PROACTIVE approach rather than REACTIVE approach. Obviously, we want to be as proactive as possible but we will inevitably have to react in some situations. Lesson maps can actually allow for more flexibility in this case.
      7)   Allows us to be more intentional. This can be a struggle when we’re seeing kids back to back for 5 hours a day. If you’ve taken the time to think through a session, you will automatically become more intentional.
      8)   Lastly, if you ever supervise a CF, grad student, or SLPA, it allows them to see how you structure your sessions. It creates teachable moments of how and why you do certain techniques in your therapy room.
      There are so many different lesson plan templates and research that backs their efficacy. However, I believe a good general plan of your sessions can be sufficient for the majority of your caseload. When I take the time to plan my sessions at the beginning of the week I included a few basic ideas…

     1)   Intro – This includes what activity we’ll be doing and the goals that each student is working on specifically. 
     2)   Instruction – This is when I TEACH the skill we will be learning or probing for.
     3)   Production/Practice – This is when I take data on how the student does on their objective.
     4)   Closure – Provide the students feedback and ideas on how they can work on this goal in class or at home. Sometimes I give them a “challenge activity” depending on the students level.
   A few tips to keep in mind…
*Too detailed of a lesson plan runs the risk of making therapy too rigid.
*Make sure you hold the goals, skills, and needs of the student in higher regard than the materials. 

*Lesson plans drive documentation.

Marisha from SLP Now Membership has some great tips and tricks as well!

When I started planning for therapy, my sessions were more productive. But I know what you're thinking!
• "I don't have time for that!" There are ways to do this without having to invest hours and hours of your time every week.
• "Won't planning make me less flexible in therapy?" I don't stick to my plans 100%. But--by having a plan--I'm better able to problem solve in the moment. Having a plan allows me to be more flexible and to better adapt to students' needs.
Lacee shared some great planning ideas in this blog post! Even if we have a great system, we might still struggle to come up with fun, engaging activity ideas week after week. We also need time to find and prep those activities. That's why I created the SLP Now Membership. It includes a database of therapy activities for easy planning. From the themed activities (e.g., book guides, crafts, and open-ended activities) to the skill packs (to help you teach and scaffold new skills), the majority of planning is taken care of. You just have to pick which resources you want to use on any given week. Better yet, the membership includes an awesome community of SLPs who are there to offer encouragement and help you problem solve on "those days." I also share tutorials on how to work smarter (not harder!) and make the most of the membership resources.

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It Takes A Team!

Have you ever heard the saying, “It takes a village” when speaking about raising kids? Well, the same goes for working with students on the autism spectrum and students with language disorders. It takes a team. That team can included anyone from the parents to the habilitation workers that see the student on a day-to-day basis. (Which really makes for a stuffy conference room when you pile 15 people around a small table come IEP time) I wanted to share with you how important it is to create a systematic and collaborative approach when we provide services to our students.

Step 1) Provide Effective Interventions.
In order to do this, we need to make sure we are current in our research about evidence based practices and keep in mind what we are capable of doing on our own and knowing when to reach out for help. When a new student comes to me, I work through a “system “and it looks something like this…
Assessment/Evaluation – Goal Planning/IEP – Material Prep – Treatment – Reflect
Once I’ve established a good baseline of where the student is at, I try to figure out what we can do to increase this students’ independence. I try to make goals obtainable, reasonable, and relevant. Working with lower functioning students on the autism spectrum, I try to keep in mind a couple of key things…
1)   Provide some form of communication (whether it be PECS, sign language, or total communication) so that they can effectively communicate their basic wants and needs. 
2)   Decrease behaviors (hopefully, by establishing #1 this will happen naturally)
3)   Increase their quality of life (#1 and #2 are preceding factors to this)

Step 2) Collaborate.
In my whopping 4 years of experience I’ve worked for two different school districts and two private practices. So needless to say, I’ve been the new person a couple of times. I cannot tell you how many times I have been asked, “What’s your name?” mid school year by staff members. In those moments, I realize that I haven’t been doing my job.
1)   Introduce yourself.
Build rapport with ALL the staff members at your building, as they will likely be a part of “the team.”
2)   Touch base oftenYou will need their buy-in when implementing new systems with your students. Give them a voice in how/where they feel they would do their best.
3)   Discuss IEP goals with teachers, para-professionals, secretaries, etc. Don’t keep to yourself about a student having a goal for ‘asking for help’ because it won’t generalize into other settings if they can only do it when they come to speech.
4)   Reinforcement.
And I don’t mean to your students; of course you reinforce them. I mean reinforce the adults working with your students. Tell them how great of a job they’re doing, how much you appreciate it, and how thankful you are for them. Adults that don’t get reinforced are less likely to want to do better. I’m sure we’ve all been there!
5)   Train.
Train your staff by holding in-services, modeling, and reviewing techniques you use in therapy. Don’t just tell them to read a packet on how to provide Aided Language Stimulation and expect them to be doing it when you walk in the classroom. Let me tell you from experience…it won’t happen. Teach them the “why” behind the madness. Explain the methodology, model it with the student, let them practice, and give them feedback. 

Step 3) Communicate.
It’s kind of silly to talk to SLPs about communication because…well…we’re experts in it, right? But, sometimes we can get caught up in the hustle and bustle of the everyday routine that we don’t talk with the teacher or the para-professional and that can be devastating to our clients. There are many different modes of communication we can use to keep in touch. If I don’t have time for a 5 minute face to face chat with the students one-on-one or teacher, I sometimes create a daily data sheet. This can be as simple as a checklist or a simple +/- data sheet. This is especially helpful for me since I travel in between placements and can’t be at the school everyday. It helps everyone stay on the same page and can also aid in generalizing goals across all settings.

I know that we do not live in a perfect world, but I do know that most people mean well and want to do a good job. It takes a team. It won’t happen over night. It can be complicated. But, you can do it!

Speech Me Maybe
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New Year, New SLP

As SLPs we are naturally trying to better ourselves on a daily basis. However, the new year allows us time to reflect on our accomplishments and challenges of the past year. 2016 was a great year for me yet, I still have some areas that I would like to improve or change in my life.

Some new years resolutions I've made for 2017 are...

1) Save more...or as my husband says, "2017 will be the year of savings." I hope he is right...

1) Be more present. I wish I could say (and believe) I will only have 1 hour or less a day of screen time, but I know that it isn't realistic to set a timer every time I pick up my phone. However, I think a good goal is to be more consious and to leave my phone in my purse or in the car when I go to dinner with a friend, for example. Less screen time. More face time.
2) Travel. We have some big plans for travel this year. We are going to Europe in June and going on a cruise in November. Yay!!

1) Specialize and learn as much as I can about Autism. As some of you know, I switched jobs this year and work for an amazing non-profit where I get to be in the clinic setting, home health, and school. My caseload is 99% individuals with ASD. I also get to supervise some amazing SLPAs and I want to grow in that area as well!
2) Blog and connect more with you!! I really want to focus on Speech Me Maybe and connecting with the SLP world! I have some excited things coming starting in January and I think it's going to be a GREAT year. Stay tuned ;)

1) Sweat every day. I don't really have an excuse not to when I live in Arizona and the sun is shining just about every day. I have two very active pups that wouldn't mind to go for a run either before or after the work day.
2) Eat more whole foods. A few of us SLPs are doing a Whole30 challenge for the month of January. I think it's time to really focus on treating my body better.

I hope you have an AMAZING start to the year. I love sharing and connecting with you and want to know what your goals are for 2017!! Comment below on some things you plan on being more mindful about!
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