Teach the secrets

There is one function of the clinical life of SLP's; one component that is trained best, without a doubt, in the daily trenches where we find ourselves. It is a fundamental tenet that learning is most successful in the environment where the learning will be used. What we want to train in new and inexperienced SLP's, is their ability to teach the persons served, and their support systems, what is happening with the individual therapeutic encounter.

Teaching the person served, the skills that may help sustain the level of performance on skills you have seen in therapy. EXAMPLE: a schoolkid who has learned in the quiet room to use his "s's" clearly for reciting in therapy....gets to read to his family each weeknight the dinner menu, loaded with "s" sounds his mother has written out for him. "Tonight's meal: the spices include stevia, sarsparilla and sage..." Since the child gets to be the center of attention while practicing his speech skills back in real life, there is an increased chance for buy-in. The mindful SLP, one who realizes early in the clinical encounter that, - one day, sooner than later that this special relationship will have to end, begins to teach the persons and those around him some of the secrets of therapy.

After all, when the encounter is over and there is no longer means or rationale to continue treatment, someone else need be in control of using the skills treatment focused upon. In the majority of cases, the person becomes her/his own therapist. For those who benefit from continued guidance, the SLP brings in the circle of support.

Here's another example: when an adult with a swallowing disorder is progressing through her training, the earlier she or her surrogate can help perfect the skills that are desired through massed real life practice. Swallowing behavior having implications of high risk to health, the more frequently the training should occur. As the person served and his support gain confidence in generalizing a skill, from the clinic to everyday life, the final form of a long term skill use can be seen.

Some general tips for continuing a skill set introduced in SLP treatment, might include:
* Explain all procedures in simple terms. Instead of "paraphasia", say "word finding problems" or an equivalent; instead of "mand", say something like " "when you command someone to get a behavior you want". You are giving up management of this learning to others.
* Empower the persons who are assuming the management.  "When I am not here, I won't know what you do....but if you have liked what has occurred, try to do it this way. I hope it has made sense to you. You can DO this!"
*Establish the final form of the training material and carefully document the process and outcomes you get. There is a great satisfaction for the SLP who has seen a good outcome for the person served, equipped the person and the circle of supports, then communicated the program events clearly and efficiently.

Teaching the secrets of therapy to the person and the support circle? It increases buy in, improves the stature of the profession among its potential consumers; it brings closure to the therapeutic alliance for this specific instance, and expands the perspective of the person served for future encounters that could occur.
Comments, as always, are welcome!

Grab the Ledge

That's the feeling in a nutshell. Off a precipice, whatever. The moments in your work life when momentous change is possible and you feel it possibly happening. It may go positively or not, but you know you are at the cusp, on the edge, entering the wormhole and embarking on an adventure. This post will attempt to identify instances of when that may be so, and why it may be important to recognize the ledge-grabbing moment by being "in the moment".

Why anticipate those life changing moments in your SLP work? Can't you just deal with them as they come? Consider it a function of your growth as a professional, that you experience and grow your powers to predict these pivotal changes happening within yourself, for the people you are helping, or in the environments around you. Many change events are the cycles every person served may face, whether they are among your total caseload, or within a group of persons with a similar diagnosis. An example is called for:

Feeding someone who does not do it well for themselves - that's a good one. The person may only occasionally raise the spoon herself, so you scoop up the food, briefly hold the delivery system at eye level so she might open her mouth and accept the spoonful, then apply light pressure to the tongue - so she will EXTRACT the food from the spoon bowl, not just receive a DUMPING of the food at the front of her mouth; this action alone helps engage the oral preparation phase to swallow what she has taken - and so the spoon is withdrawn, she closes her lips in rhythm with the withdrawal; the cycle starts again. You are the change agent in this instance, at least the one more empowered to accelerate the change at a critical moment - to hurl yourself into the void. To be that adventuress/r, you should know -

Therbligs. Pronounce it just as it is spelled. When you were trained in behavior management, ABA or whatever it was called - you most likely did not learn this term. The therblig is a unit of activity, a component of any work being done. Though it was popularized for industry by F.B. Gilbreth of CHEAPER BY THE DOZEN fame, it is a fun analogy for the skill of analyzing a functional task, like feeding, into components that you may help manipulate and change. Which therbligs in the action of feeding this person might be altered? That is your leap.

The volume of material swallowed? The timing involved for opening the mouth? Placement and tactile feedback with the spoon? Extra feedback (tactile, visual, auditory) to encourage lip closure and continue the swallow? Changing the food qualities to encourage appetite? Any and all these variables can be and are easily manipulated by you, the skilled professional behavior changer, so that your person can be successful in real life. Just as the real Frank Gilbreth - and his movie double - demonstrated how his children learned to shower efficiently, for the school principal, you can take that leap to make the quality of life for your persons served, scrubbed and shiny. 

Look in Deeply

Sally is distracted for awhile. I think she is yelling something like "There's no tomorrow!" to the news broadcast on TV....so I can share a topic with you that is crucial for the long-term health and vitality of YOU in the field. Stay healthy, my friends - the "most interesting man in the world", if he were a poster boy for SLP's; that would be his tag line. Stay healthy, look inside yourself deeply and let the bad stuff out.

Don't forget you have a life
When there is so much workplace strife
Paper deadlines
Children sneezing
In your face
And then, you're sneezing

Have a happy place to go
When you're commuting through the snow;
When someone used the last test form
And didn't order more - the WORM!

"Now what, doctor?"
Only say that in your head
"She's sick again; OH NO!"
Don't get blue and don't see red!

Say 3 dozen PA - TA - KA's
And a score of spondee words
Swallow your saliva
Let go of stress - it's for the birds!

There are so many ways to stay sane in your work!
So you don't go home, feeling like a stone cold jerk!
(Massive orchestral finish...with full credit given to Maestro Offenbach!!)
 

Good grief - the news conference is over. Here she comes!

Live Your Passion

Welcome back. Sally is not the only one who is passionate about her philosophy! But, why equate passion with success in your SLP job at all? If you have been doing this kind of work for more than ten years, does passion still correlate with success in serving persons who come to you?

To ground you, blog reader, in what we're talking about, - passion can be described by paraphrasing  the President: without passion you have no energy; without energy you have nothing. Whatever your opinion of the current President, you may find it hard to dispute his perception that passion exists in us below a level of cognition; that even though the discipline of a skilled professional career puts passion to work, the fuel of desire and idealism helps the engine of professionalism run smoothly.

My peers and colleagues in many adult service settings have spoken about their work days as resembling an assembly line: "how many do you have left? Did you get your hours?". That is a business model and we can get pumped up about getting the check, but that is not the genuine passionate life as an SLP. We can make good money in this work, but we could do as well and better financially in many other work lives. The bread and butter of our work as SLP's is helping persons served find the skills they want and need. It is service. It is a duty and an honor to serve persons who may benefit from our professional skills. It is a joy, a thrill and a burning need to write this blog, for anyone who will read and consider my perspectives on the field of speech-language pathology, and how we do and can impact still the greater societies in which we live.

Passion is a force. Passion is a nagging tune in your head that gets your muscles moving, and your brain firing. Passion helps you get results during the workday, - be they at the therapy table or in a table you are formatting for a report....because you believe in their worth.  One constant challenge as you grow and change in your work days is to sustain the passion - the flame that brought you to this career choice and sustained you through preparation and formative years of a career. The extinguisher of passion is the poison to a successful long career as an SLP. It can not be said any more plainly: if you lose your passion for people, you had better find work outside the community of SLP.

What might spur on your life-long vitality as a passionate professional in SLP? Your ability to -

* Educate - for yourself, your stakeholders, your circles of support, and your society

* Advocate - for your practice, your profession, your persons served and their support circles

* Demonstrate - for the fair and equitable support of all affected by your passionate professional life.

The Handoff

The whistle is being blown today on the series of posts about being a better SLP. Time out while we explore something happening on the football field, which also happens in every SLP practice when a staff member has a day off.

It's the "handoff"! When another staff is covering the caseload which is usually assigned to you, there is an acute need to communicate clearly to that covering clinician what you think is necessary for a successful treatment session. Of course, there already is the treatment plan or plan of care. This document outlines the short term and long term objectives of your encounter with the person served, and guides you to develop activities that helps the person work on the goals. If you are the SLP who regularly sees this person, you may have collected a basket of activities. If you are the clinician who is at work to cover the caseload, you should not be expected to generate all the activities yourself. Why?

The covering clinician does not have the relationship formed that you, the SLP of record, had formed. The therapeutic alliance with the covering clinician might consist of a cursory review: "Are you pleased with what you've accomplished in speech therapy? What exercises have helped you the most?" If the person served does not give you clear direction about the activities that have been used, and the handoff instructions are not sufficiently clear - you can resort to a packaged approach to meeting the goals assigned by the plan of care:

Even though the covering SLP may have used this packaged material scores of times, there is little predictive power in your guessing that an activity you have used with THIS DIAGNOSIS, will work with THIS PERSON. Your handoff report to the covering clinician should include some description of what works; for example:

"Reminisce with her about the family days. Use the photo album kept near her bed to point out the family members, and describe activities in the photos. When she is talking about her family, she is very fluent".

As much as sixty seconds might be required to give this extra bit of data to the covering clinician; the result may be as glorious as points on the board.