Marble Runs and blog recognition

I want to do a quick cheat and show you two blog posts that really impressed me this week:

First: Playing with words 365's post (or posts) regarding Phonological delay.
I really really wish that I had this knowledge when I first started working with children 12 years ago.  Actually this knowledge would have been good even 5 years ago. I highly recommend that everyone working with the birth to 3, preschool, or elementary age students read her four posts regarding phonological delays. 

Second: Tatyana Elleseff MA CCC-SLP does an excellent job as the a guest blogger for ASHAsphere.  While I never wrote a goal about emotional vocabulary, I couldn't help but work on it with every single one of my language delayed kids.  Most of the kids I have worked with could identify 3 feelings: sad, mad, and happy.  Their limited language truly impacted how they experienced the world.  And in general they responded to stimuli with the limited emotions that their language allowed.  Is it any wonder, that language delayed kids have such high incidence of behavior problems? 

Now that I have cheated, I thought I'd share with one of my favorite therapy activities.  I won't lie, I am a drill and kill kind of girl when it comes to speech sound disorders.  Part of it is my general belief that I have a limited time with these students and I want to get everything I can out that time.  I struggle with coming up with highly motivating activities that still allow me to get up to 100 correct productions of my target.  But a marble run has never failed me.  My marble run is made up of multiple partial Discovery Toys Marble works:

I went through two separate phases of selling Discovery Toys and combined both sets from my demo products. I also have found partial kits on ebay and garage sales.    Of course, Discovery Toys is not the only place that sells marble runs. So while that's my preference, I don't think it's your only option.

So how do I use the marble run:

First is the building. I have learned through trial and error that I should be the one to do the building. I usually eliminate the difficult pieces, for my own sanity.  Then I let the child pick one at a time.  Depending on the child I can have the child practice their target sounds/words/ or phrases as they pick pieces.  I try to limit the building to about 5 minutes.

The next step is control the marbles. I've learned to make sure that the marbles come towards me and away from the child.  Occasionally, they will try to get a hold of the marbles, but I make it clear that after the marble has run down, I get the marble. If they want the marble back, they have to say words.

I usually have the general rule that for every 5 or 10 words they get 1 marble.  This will depend on their attention and maturity.  But I can often tempt them to attempt even more trials with the promise of more marbles.  20 words at time could give them 4 marbles to send down the marble run.  The final motivation is that if everyone has given 100 correct productions then I quite drilling them and they get to just play.  I find I do need to use a timer for this, or I have a hard time convincing them to clean up.

I have used a marble run successfully from ages 2 years to 12.  And I suspect that I could get kids 12 and up to work for the marble run, but I've never tried.  

Grief

I have a few posts in the works, and I was going to post one today, but instead I just want to say that my thoughts and prayers are with the community Newtown Conn.  The idea of this kind of violence happening in an Elementary School hits closer to home than I would like. 

Stories

It was a good week.  With the break in my caseload, I was actually able to catch up completely in all my documentation and send off my medicaid billing.  I wasn't comfortable with  how far behind I had gotten, but it's nice to feel like things a bit under control.

I have now gotten some time to get to know Sandy.  Supervising an apprentice Speech Therapist is very different from supervising someone who doing their clinicals for coursework.  Supervising someone  to meet course work implies a certain level of experience.  For instance all the students I have supervised up until now have already had some experience with clients.  This is not the case for Sandy.  She has just started Grad school and outside of doing her 25 hours of observation. she  has had no experience doing therapy.

Fortunately, she has that something that just can't be taught, and I think she's going to make a great clinician.  But I am having to make sure she has solid plans for each student.

 I am a big fan of the Story Grammer Marker.

I like it because if I had to pick one single thing to teach my language delayed students to do, it would be to tell their own story.  It is one of the most important communication skills we can have.  Our stories are who we are, and not being able to share our stories, means not sharing ourselves.
Of course, I manage to work in vocabulary, grammar, inferencing, direction following, and figurative language into my lesson.  But the core is telling a story. 

I used it a great deal with my language students last year, when my caseload primarily consisted of elementary school age children.  And, because that is the majority of Sandy's caseload, I thought it might be smart to give her my lessons from last year and let her use them for her groups.

 But then Karol showed me something that was even better for a novice clinician:  The Webber Story Builder.  It has the exact same elements of the SGM, although it has different symbols.  It's more scripted and comes with worksheets that Sandy can do with her students.  It even comes with some starter stories that she can do.  I can still give her my lessons, but now she access to a more scripted program that will make sure, that even though she is new, she can still provide intensive and systematic intervention that will have a great impact on our students. 

We plan, God Laughs.

So last weekend I started working on a post about my current lesson for my pre-school classes, but this week happened instead.

• Monday was just one of those days that I could not get anything done.  
• I thought I would do some progress notes during my half hour lunch break.  Not even 5 minutes into my break a parent shows up with their child.  The child is normally brought by her grandmother, but today her father brought her.  A half hour early.  So I put down my lunch and work with the child.   
• It's just as well I worked with the child when I did, because as soon as the parents leave and I get situated with my now cold lunch someone else knocked on my door.  Turns out it was a diagnostician trying to find who was serving the students she was testing.  A little research, and I manage to figure that out.  
• While the diagnostician was there another parent showed up.  The parent was confused by my very bad Spanish, and thought I had wanted her to bring her son back this afternoon.  
• After the parent left, with the Diag still in my room, our new speech therapist showed up. This was exciting and wonderful, but there went my lunch and my time working on daily notes.  Such is the life of the SLP. 
• I am a member of our district's SLP instructional council and Monday evening was the meeting for November.  With all the chaos in my room, is it any surprise I showed up almost 1/2 hour late. Fortunately it's a good group, and I wasn't the only one late.  We discussed the following topics:
• What is an appropriate service time on IEP's.  Typically SLP's in our district put one hour a week on the service schedule.  Less if the child has less need, and more if he needs more.  Some SLP's will put 4 hours a month with the idea that somehow they are giving themselves more flexibility.  My personal stance is that service should be offered per semester and we should be leaving room for activities such as assemblies, field trips, and special events by the school.  I believe this for three reasons: 1) By putting 1 hour a week we are legally obligating ourselves to provide 1 hour of service for every single week that school is in session. This includes the first week of school when we might not (and probably don't) know where the child is, and the last week of school where we are often in the process of closing up shop.  This means that any cancellations not done by a student being absent is a cancellation that has to be made up. 2) By writing 1 hour a week on an IEP we are saying that the child will not be able to access their special education or regular education program without our support every single week.  And this isn't true for most students.  Most students function just fine missing one or two weeks of service.  There are students who do not succeed without weekly intervention, and we need to plan accordingly, but most students don't need 18 hours of service a semester (i.e. 1 hour a week.)  3) Putting hours on a weekly basis reduces our flexibility in meeting a students needs.  One SLP in my district tends to work heavily with her high functioning autism students at the beginning of the year, where they need help designing schedules to help them stay organized, but once that is done they need less support.  A middle school fluency student might need heavy support in October as he prepares for a big presentation in his class, but might not need the support in September and November. My suggestion is 12 hours a semester for my typical student,  less if they need less more if they need more. 
• Too much paperwork.  This is a long standing problem in the schools.  The level of paperwork far exceeds the amount of time we spend working with a child.  
• Too high of a caseload.  Most of our SLP's have high caseloads.  As  a preschool therapist, mine was particularly high, and I made a comment about it in the meeting.  However, I was optimistic because we did finally have a replacement for an SLP that had left at the end of October.
• Tuesday- Actually nothing extreme happened on Tuesday.  It might have been the only normal day of the whole entire week.  The new SLP was there and while she was waiting for her caseload list she cleared off a chunk of screenings. That was quite nice. (I had to come back and edit Tuesday, something exciting did happen.  I got an email from the district administration, asking me if I would like to supervise an Apprentice.  She's in grad school and  wants to work.  I know this is a lot of work, but I love supervision. After all, it's like having a captive audience.  She has to listen to all my crazy ideas and act like they are brilliant.  Kidding, I'm kidding. Of course she won't have to act.) 
• Wednesday- Wednesday is a half day at our school. I do see some students, but typically I have the afternoon off for meetings and/or paperwork.  On this day we are doing an addendum for a student who had been evaluated over the summer and given an IEP.  For reasons unknown to us, they (the mysterious "they" who wrote this IEP)  gave this child 1.5 hours of SL service a week.  (She's in my highest group.) In addition "they" gave her special education services with no goal.  So we were cleaning that up.  Our district employs "IEP Specialists"  Some are good and some are okay.  The one running this IEP is amazing, but we start off on the wrong foot.  She is extremely reluctant to put 12 hours a semester, because someone in their infinite wisdom had told her that SLP's couldn't do that.  If you have actually made it this far in reading this post, you know full well that I completely disagree with her.   A phone call to the district is made and we have an uneasy truce.  This has apparently started a dialogue with the district so that's good. We shall see what happens. That said, this woman is brilliant.  It was one of the best IEP's I've ever seen. She earned her paycheck.  And in random gossip news it turns out that she's friends with our new SLP, Karol (that's not her real name, but just in case I want to talk about her later, I thought I'd give her a name so you guys could follow along.) 
• Thursday- Well that is a tough day.  I wake up sick.  Feverish, achy, congested and with a sore throat.  But I can't miss today. 1) Because there is so much to do, and 2) today is the day I get to give up some of my caseload.  Yay!!!!  I actually spend most of the day trying to figure out what students were actually on the SL caseload. We get stuck by a couple of roadblocks.  Karol took the place of Jennifer.  When Jennifer left she hadn't quite finished everything she needed to. I am fully confident that she would have finished on her own time, but that weekend she was involved in a major car accident, and while it wasn't life threatening, she did spend the night in the hospital and is in major pain. She left our wonderful group to start another job, but hasn't been able to start the job yet, and it's been a month.  So there have been a few things that weren't big deals when she left but eventually turned into a crisis.  (Let this be a lesson to you: Don't procrastinate.) So after putting out a few fires, the four SLP's sit down and sort out caseloads.  I pick students for Sandy, my new apprentice.  (I am so going to have write a cheat sheet for what I've named everybody.) And we manage to balance caseloads.  In addition we also manage to create a master list which actually identifies who is responsible for what.  We send it to head special ed teacher and she is overjoyed. 
• Friday- Still sick.  But again, I can't call in because today is the day Sandy (the apprentice) shows up.  She is right on time, and followed me as I served kids.   I do make it through most of the day, but I leave early and pass out in bed.  
• Saturday-Still sick, but at least I can spend my day in my jammies.  I review ASHA's, my States, and my districts guidelines on having an apprentice.   I'm excited, but I'm nervous as well. This is a big responsibility.  I've done supervision before of graduate students who are doing their clinicals.  This is different because they usually take over my caseload, and so I can just follow them around and observe.  But she is going to be running her own caseload, and ironically she hasn't done her clinicals yet, so she has less experience than anyone else I have supervised.    Still she is smart, has that natural talent that you can't teach and appears to have a good work ethic. I can work with that.

My kit

A few years ago, My school district sponsored Dr. Judy Montgomery to come and talk to all the SLP's that worked in our district.  One of the things that she really stressed was that we needed to follow a program in our therapy.  It didn't have to be one that you bought, but it needed to be something that was consistent and systematic.  She suggested that if you put all your items for your therapy sessions in a box or kit and you used the items every time, you had created your own program.

I have taken her advice to heart.  I don't use a box.  Instead I use a 3 ring binder with plastic bags, so that I can easily carry my materials from class to class.

It's blurry on purpose.  On the outside of the notebook, I keep my schedule.  It helps me both keep track of where I'm supposed to be when, but I can't tell you how many times people ask me about my schedule, and I honestly can't remember when I see who when.

I also keep my schedule on Microsoft outlook, which is nice for scheduling re occurring  appointments like therapy sessions. But that's also where  I  schedule things like IEP's, SAT meeting, and Parent teacher conferences.  I print out my weekly schedule to give me more detail on my availability at any given time.  In the pockets I keep my data sheets.

I got this idea from Pinterest.  I use ziploc type plastic bags.  I used duct tape at the bottom and punched holes so I could put the bag in the notebook.  They've held up pretty well.

In my notebook, I carry everything I need for my lesson:  A book, sentence strips, paper puppets, pictures for my song.  My lesson follows the same routine routine every single session:
1) book
2)Review of vocabulary /Direction following (using the paper puppets)
3) Song
4) Reread the book
5) practice sentences with targeted vocabulary using  a sentence strip

I adjust in complexity and requirements for each students based on each level.

Raindrops...

Two more work days until Thanksgiving break, and I'm looking forward to the time off.  The last two days mark the end of my unit on the book Raindrops by Sandy Gay. I bought the book at a library book sale, but you can find the book on Amazon as well.

My typical preschool language lesson runs a little like this:
1. Read a book.
2. Review  vocabulary/practice direction following.
3. Read the book again, but talk about events in the book/expand vocabulary concepts.
4. Sing  a song
5. Sentence strips.

The vocabulary I addressed was: house, window, hat,  flowers, dog, dad, umbrella and rain, as well as prepositions on top and under. To address the vocabulary I used puppets made from lessonpix.com. 

 Using these pictures, I can work on naming and identifying.  But, I also use them for following two-step directions: "Put the dog under the chair.  I use one of the cube chairs already in the classroom and my students get to practice listening for objects and prepositions.

I used the following song: (To the tune of "I'm a little teacup)

Pitter Patter Raindrops falling from the sky. (Wiggling fingers in a downward motion to make rain.)
Here is my umbrella to keep me safe and dry. (Hold the umbrella.)
When the rain is over, the sun begins to glow (Raise arms in a circle above your head to make the sun.)
Little flowers start to bud and grow grow grow.  (Bring hand down making bud raise them up for each grow.)

(Original author unknown)

I like this song because it talks about the function of an umbrella.  Many of our language delayed students may know  a vocabulary word when looking at the picture but lack the skills to describe the object or explain it's use. 


The last thing I do in this lesson is sentence strips.  Again, I used lessonpix.com  to create the pictures for our sentences.

 On one side I have the target sentence. For this book, the target sentence is "Raining on my _________."

On the back side I keep the extra vocabulary so that my students can quickly change out the word.
I find that students who struggle to formulate 3 to 5 word phrases are more successful with the visual and tactile cues of a sentence strip. Since I repeat the lesson over several week, my students have lots of opportunities to practice using longer sentences.  For some of my students, I've made it more challenging by adding a "It is..." to the beginning of the sentence. 
For my non-verbal students, I have them point to the picture as I say the word. Initially, I need to do hand over hand pointing, eventually I find they can point with out needing my help, and one of my "non-verbal students" is now attempting word approximations while pointing. 

In the desert, we don't get much rain, but we've had two rainy days since I started this lesson.  This makes me happy. 

#slpeeps flashmob

Welcome back to all our speechie friends who attended ASHA in Atlanta.  Have you seen the #slpeeps flashmob video?

Great fun!  I wish I had been there!

But I had a busy week anyway.  I saw students on Monday and Tuesday. Wednesday all day and Thursday Morning, I attended a non violent crisis intervention workshop. Thursday and Friday were parent teacher conferences which kept me hopping.

Data Keeping

I have worked in variety settings as an SLP: Skilled Nursing, Long Term Care, Early Intervention, HomeHealth, and Schools.  I can safely say that no other setting has even close to the same amount of paperwork as the schools.  Medicaid, IEPs, SATs, Progress towards goals, Early Childhood Outcomes Data, Reports, REED's, etc.  And school SLP's have larger caseloads than  SLP's in other settings, so all of that paperwork is multiplied exponentially.  I am not complaining. The truth is I understand the need for most of it and do believe the bulk of it is for the benefit of the student.  A well written IEP protects my student and that makes it worth it for me.

But sometimes the paperwork can be a bit overwhelming, and it's easy to get behind.  I run at max efficiency, and still don't get everything done that I need to in my "duty day."  The hardest thing to keep up with is my daily logs.  As the name suggests, the best practice is to document daily.  But throw in three IEP's in a week (That never ever get started on time) and somehow my daily documentation time is out the window.    That might mean that I am documenting Tuesday kids on Friday.  Unfortunately, age has taken it's toll, and I have learned the hard way that I can't rely on memory. So I need clear ways of taking and keeping data.

This isn't as hard for my students that I see in the speech room.  It's usually a very small group and I can take data as I go.  The real challenge are our Developmental Preschool classrooms.  My school has 3 DD pre-schools classrooms, each with an AM and a PM class. The classes are typically 8 students  and I see them all at once.  So taking data as I go is a little difficult. 

That's why this weekend, I spent time working on this data sheet:

I haven't put it into use yet, but I'm hoping that with a few check marks, I will have a good picture of what each student did each day.  I haven't put it to use yet, but I think this will work better than using a notebook or sticky notes.  And if I get behind on notes, I won't have to rely on my memory to create documentation.

You can download this file for free at my Teacherspayteachers store.  If you do use it, be sure to let me know what you think. 

Why I am blogging...

Do you watch Parks and Recreation?  I am a late convert to the show, but after watching the last two seasons, I realized I am a Leslie Knope.  I am a little bit obsessive about being a speech therapist the way she is about politics and the parks and recreation department.  But the reality is, I love my job.  I love what I do and I feel like I make a difference in peoples lives.  I get a charge out of seeing my kids succeed.  And after 15 years, my head is exploding with ideas that I want to share.  I drive my poor office mates crazy with my ideas and thoughts, but thankfully they are patient with me.  So that is why I am blogging.  I want to share my thoughts and ideas about being an SLP in the school settings.