Teaching the persons that you serve in CSD programs - THAT would seem to be embarrassingly self-evident. Well, doesn't it?! Aren't you teaching these skills for communicating, thinking and swallowing to the people you serve? Don't you instruct their families, the caregivers, your colleagues, the referral sources and third party payers in the plan of care? When it becomes time for completion of the plan of care, doesn't the SLP lead the person served through the home exercise program? Well, yes, you might answer - but that is not all the teaching that might be done.
SLP's teach when they want the person served and her/his stakeholders, to understand what it all means. With the "Fantastic Four" movie coming later this summer, I think of Sue Storm Richards, alias Invisible Woman (what a commentary). Sue would often ask her husband during a mission: "Reed, what does it all mean?". My middle school peers and I (late 60's) would often make Sue jokes when reading the latest comic - but Sue was onto something.
That is why: you tell a mother of a child on the autistic spectrum, how communication may begin with the coding of behaviors that may occur regularly. For example, shaking both hands in the air may mean "I am afraid". If you are working with an intubated adult in the hospital's intensive care unit, that same gesture might mean "please come look at my bandage". A person with a severe stutter can show that same behavior, and it can be a learned behavior that at one time, helped extinguish the stuttering moment. For still another person, the evaluation findings of nonfluent aphasia may require you describe your decision making that came to the diagnosis. How does her performance on word repetition tasks, impact the impressions of her disability?
This is teaching's goal: to help the persons served use data obtained in the clinical setting. They then may feel full partners in the plan of care. When the person served has information that totally keeps them in the loop, she/he has greater focus upon treatment activities, and is possibly more efficient for completing the treatment program. What else can happen as a result of continual teaching?
Teaching the patient and stakeholders bolsters their skills for advocacy. Self-advocacy - "please approve my request for this speech generating device, Mr. Insurance Company"; stakeholder advocacy - " my husband can still do his job, after his brain injury, with the accommodation of wearing tinted glasses in the workplace"; system advocacy - "if cigarette taxes are kept high in states with the highest rates of head/neck cancer, rates of cancers which may lead to communication and swallowing impairments could come down".
Teaching is also essential to all aspects of preventing communication and swallowing problems. Treatment of these problems (tertiary prevention) is done to prevent permanent disability. Secondary prevention, or surveillance, includes teaching the person served and any stakeholder the implications os screening clinic data - or giving answers to questions after a community lecture. The quantum leap beyond teaching persons of their risk for communication and swallowing disorders, is to help people minimize their risk of impairment - or directly control factors that may bring on disease. Primary prevention activities remain undiscovered country to professionals in CSD. They may still hold the strongest hope for answering the question posed by our consumers: what does it all mean?
Monday, June 8, 2015
Sunday, May 31, 2015
On the trail of evil
Speech-language pathologists don't solve mysteries. They do not unearth lost treasures from obscure places around the world. When wrongs may be righted, there often is no great financial reward at the end of the quest. But we knew that, going into the professions. We knew that making a financial killing in CSD would require our working multiple jobs and sleeping seldom. And - we need our sleep! Instead of financial riches being our reward for a CSD career, many of us have seen the need to "fight evil".
Poor and ineffective communication* is often the source of poor and ineffective human relationships; by extension, the source of a deficit in the individuals' quality of life. I will often remind students who choose to train with me, at the beginning of each work day: "fight evil!". When our professions keep quality of life - and its implementation through improved function of communication processes -at the forefront, we fulfill our mission to the persons we serve.
May 2015, known as "Better Hearing and Speech Month", is now over. Each May, what have we and our peers done that will keep us remembered? Since 1927, professionals in communication sciences and disorders have used May to promote what they do, and why treating communication disorders by skilled professionals is important. Here is why.
People communicate everywhere. Most caring and observant persons are able to stimulate human communication in others. Speech-language pathologists know which stimulation methods are most effective. In a world that is more diverse and more dependent upon the sharing of information than ever, effective communication skills through the lifespan level the playing field for all persons. In making CSD an integral component of the human service system, society helps prevent human illness by sustaining communication wellness. I cannot say enough to support my colleagues in the professions, as well as those persons who have entrusted their care to me, for all the opportunities given us to fight evil.
*please read: communication and swallowing
Poor and ineffective communication* is often the source of poor and ineffective human relationships; by extension, the source of a deficit in the individuals' quality of life. I will often remind students who choose to train with me, at the beginning of each work day: "fight evil!". When our professions keep quality of life - and its implementation through improved function of communication processes -at the forefront, we fulfill our mission to the persons we serve.
May 2015, known as "Better Hearing and Speech Month", is now over. Each May, what have we and our peers done that will keep us remembered? Since 1927, professionals in communication sciences and disorders have used May to promote what they do, and why treating communication disorders by skilled professionals is important. Here is why.
People communicate everywhere. Most caring and observant persons are able to stimulate human communication in others. Speech-language pathologists know which stimulation methods are most effective. In a world that is more diverse and more dependent upon the sharing of information than ever, effective communication skills through the lifespan level the playing field for all persons. In making CSD an integral component of the human service system, society helps prevent human illness by sustaining communication wellness. I cannot say enough to support my colleagues in the professions, as well as those persons who have entrusted their care to me, for all the opportunities given us to fight evil.
*please read: communication and swallowing
Sunday, May 24, 2015
Did you write it?
Documentation has often been the near death of my speech therapy career, more times than I can count. I write a blog now so - I must admire something about writing. But until recently, clinical writing threatened to become the black hole where most of my love for the field might be SUCKED! When I was in training, and even following graduate training - good writing was expected but not well taught. You were shown reports in the university clinic, and expected to emulate the style(s) shown in these reports. That's all!?! That's all good clinical writing is - ?!?!?!?!? Don't you believe it. But, until I had had enough experience in the trenches, writing many reports and notes - I rarely had more than other notes from which to learn good clinical writing principles.
Good clinical writing is, above all, a record of what you actually do with your patients. The SLP who writes well can tell the patient's story, in ways that not only satisfy the people who pay the bills. There is also a need to pass along the uniqueness of the person you serve. When you meet this benchmark of telling the person's story, you give your patient more effective treatment that fits these unique needs The effective clinical record also meets the standards for behavioral applied science, - namely, what you did and what the patient did in response. And, when the effective written record is completed, other professionals who may also serve your patient will give their best informed service.
There are day to day realities to face about good clinical documentation:
1. "If it wasn't documented, the encounter did not happen". The essence of the SLP ''s work then is - the production of the written record. With point of service documentation (performed at the time of the encounter) being the trend in clinical practice, the record is completed near the time of the encounter. The clinician who can meet these standards is more confident that the record accurately reflects the actions taken in the encounter.
2. "Data-driven" - your documentation provides value for your patient's care, when it contains the discrete measurements you specify to track changes in your patient's behavior. It could be number of correct initial "s" sounds from a word list, or the number of initiations of conversation, or the average duration of a swallow of ice cream. Your data trends drive your treatment. Let your documentation be easily read with data.
3. Writing clinical notes well tells your readers: you are a skilled observer, not only taking good data but telling a good story. It tells your reader how well behavior has been deconstructed to train the core skills, and anticipates how behavior will be reconstructed so your patient can reenter real life. It requires writing with economy to meet reporting pressures, and writing with clarity so that your patient receives appropriate care.
Good clinical writing is, above all, a record of what you actually do with your patients. The SLP who writes well can tell the patient's story, in ways that not only satisfy the people who pay the bills. There is also a need to pass along the uniqueness of the person you serve. When you meet this benchmark of telling the person's story, you give your patient more effective treatment that fits these unique needs The effective clinical record also meets the standards for behavioral applied science, - namely, what you did and what the patient did in response. And, when the effective written record is completed, other professionals who may also serve your patient will give their best informed service.
There are day to day realities to face about good clinical documentation:
1. "If it wasn't documented, the encounter did not happen". The essence of the SLP ''s work then is - the production of the written record. With point of service documentation (performed at the time of the encounter) being the trend in clinical practice, the record is completed near the time of the encounter. The clinician who can meet these standards is more confident that the record accurately reflects the actions taken in the encounter.
2. "Data-driven" - your documentation provides value for your patient's care, when it contains the discrete measurements you specify to track changes in your patient's behavior. It could be number of correct initial "s" sounds from a word list, or the number of initiations of conversation, or the average duration of a swallow of ice cream. Your data trends drive your treatment. Let your documentation be easily read with data.
3. Writing clinical notes well tells your readers: you are a skilled observer, not only taking good data but telling a good story. It tells your reader how well behavior has been deconstructed to train the core skills, and anticipates how behavior will be reconstructed so your patient can reenter real life. It requires writing with economy to meet reporting pressures, and writing with clarity so that your patient receives appropriate care.
Sunday, April 19, 2015
Negotiate the plan
"Hi! It's good to see you again. Is everyone well at your house? Thanks for coming today to speech therapy. Is there anything you want to talk about - about our last time together? Do you have any questions about what we have been doing in your program? If not, do you feel you are getting better? *DISCUSSION*"
"I'm glad to hear what you think. I want to talk with you about the next step in what we do together...."
Here begins a tale about negotiating with your speech therapy patient. No matter the age, gender, the presenting conditions, the locale of your CSD services, your clinical model or even your business model - you will have the need to make deals and set commitments with your patient through your encounters. If establishing a context with the patient allows you to say "This is what I want to do", then - negotiating a plan for treatment allows you to say "Let's do this". In an ideal world, your patient does all you ask in a reasonable time period. This is not an ideal world.
The question is: Why do you negotiate? To set the path for the clinical program, and to adjust to any unexpected changes in the same program. Another question worth asking is - why make such a big deal out of negotiating? If you have determined your patient needs "A", "B" and "D", that should be enough. "It's time to work" may be the message you want to get done, but your patient may have other needs and agenda that emerge as replies to your message: "Can't we do this some other time?"; "It is too hard!"; "I'd much rather play a game"; "I need the bathroom!", or "Are you sure this will work?"
Your negotiating with the patient keeps the message of your evaluation visit fresh; namely, that a change in function that the evaluation had found, can be remedied through special strategies and techniques. Therefore: "If you can't do this for more than five minutes, then - let's work for five minutes and take a break". Or: "Remember that the speech test said, you can make this sound in everyday conversation when you _____". Or maybe: "Your voice won't improve solely with the passage of time; you need practice on deep breathing to sustain a louder voice!".
It sounds as if negotiation in the CSD clinical encounter is service after the sale. After the evaluation is done and after the course of treatment is charted; - there are continual opportunities to refine and reinforce the message: first, "I care about you. We have formed a relationship. Part of what I see as my role in the relationship is to help you grow and change. Let's keep on track, by working on the things we found will help you." And, second - "I have plenty of time to hear what you need to say. Healthcare (or education) may seem rush, rush, rush - but communication is what I do. It is the essence of my work. Tell me what you need".
"I'm glad to hear what you think. I want to talk with you about the next step in what we do together...."
Here begins a tale about negotiating with your speech therapy patient. No matter the age, gender, the presenting conditions, the locale of your CSD services, your clinical model or even your business model - you will have the need to make deals and set commitments with your patient through your encounters. If establishing a context with the patient allows you to say "This is what I want to do", then - negotiating a plan for treatment allows you to say "Let's do this". In an ideal world, your patient does all you ask in a reasonable time period. This is not an ideal world.
The question is: Why do you negotiate? To set the path for the clinical program, and to adjust to any unexpected changes in the same program. Another question worth asking is - why make such a big deal out of negotiating? If you have determined your patient needs "A", "B" and "D", that should be enough. "It's time to work" may be the message you want to get done, but your patient may have other needs and agenda that emerge as replies to your message: "Can't we do this some other time?"; "It is too hard!"; "I'd much rather play a game"; "I need the bathroom!", or "Are you sure this will work?"
Your negotiating with the patient keeps the message of your evaluation visit fresh; namely, that a change in function that the evaluation had found, can be remedied through special strategies and techniques. Therefore: "If you can't do this for more than five minutes, then - let's work for five minutes and take a break". Or: "Remember that the speech test said, you can make this sound in everyday conversation when you _____". Or maybe: "Your voice won't improve solely with the passage of time; you need practice on deep breathing to sustain a louder voice!".
It sounds as if negotiation in the CSD clinical encounter is service after the sale. After the evaluation is done and after the course of treatment is charted; - there are continual opportunities to refine and reinforce the message: first, "I care about you. We have formed a relationship. Part of what I see as my role in the relationship is to help you grow and change. Let's keep on track, by working on the things we found will help you." And, second - "I have plenty of time to hear what you need to say. Healthcare (or education) may seem rush, rush, rush - but communication is what I do. It is the essence of my work. Tell me what you need".
Sunday, March 29, 2015
Establish a context
Blogger ' s note : this post is the 5th in a series that follow the outline of "Closing the Sale", originally posted to this blog on 1/24/15.
Context. Milieu. Mutually Supportive Environment. "A Clean, Well-Lighted Place". "What I Want to Do", one of my first submissions to this platform, made my eureka moment at conducting the therapy session, front and center. There is not just the treasure collected by a session that has proper context and focus; that has resonant and reverberant boundaries, working to distill actions and thoughts of the person served.
The desire for context and perspective, on the needs of persons who receive our communication sciences and disorders (CSD) services, is crucial for intervention reaching its maximum effectiveness. Is there any there, there? Does this work actually impact real life? Does it impact THIS PERSON's real life??
Why would you need to establish a clear context in therapy sessions? It is part and parcel with the need to teach others about the profession. There is also a need to establish and maintain an environment conducive for learning. With the unrelenting pressure for cost containment in SLP services, the clinician has an obligation to stay organized and on track to get the work done for persons served.
Teaching others about, and promoting the profession: through improved clinical outcomes we create our best ad campaign. Our customers are not only the person served, the family, the referring professionals or the professional community, -they are also the general community who may never consume your services. The clinician who helps her/his client stay focused, and working toward goals, makes the Sale of SLP as a community service that much easier.
"This is what I want". No matter what the client's age or needs, our training and experience allow CSD clinicians to move from this initial proposal; to "What I Want to Do"; - then finally, "Please do this". At its core, our profession is one involved in helping transforming people's lives. The ease of our completing our work with each person served, assures that the personal transformations actually take place. They are the reasons many of us entered the profession. We want to serve others.
The persons in charge of CSD programs may be CSD professionals, yet many times they are not. You as a CSD professional, and your managers, want to know that you manage every clinical case efficiently. If you work for yourself, or if you are part of an interdisciplinary team, controlling your expenses of materials and time helps keep the lights on. Keeping the lights on, in turn, let's your market area know you are open to serve them. When you can serve more of the community - then you have the opportunity say once more, as the authority: now, today....
Context. Milieu. Mutually Supportive Environment. "A Clean, Well-Lighted Place". "What I Want to Do", one of my first submissions to this platform, made my eureka moment at conducting the therapy session, front and center. There is not just the treasure collected by a session that has proper context and focus; that has resonant and reverberant boundaries, working to distill actions and thoughts of the person served.
The desire for context and perspective, on the needs of persons who receive our communication sciences and disorders (CSD) services, is crucial for intervention reaching its maximum effectiveness. Is there any there, there? Does this work actually impact real life? Does it impact THIS PERSON's real life??
Why would you need to establish a clear context in therapy sessions? It is part and parcel with the need to teach others about the profession. There is also a need to establish and maintain an environment conducive for learning. With the unrelenting pressure for cost containment in SLP services, the clinician has an obligation to stay organized and on track to get the work done for persons served.
Teaching others about, and promoting the profession: through improved clinical outcomes we create our best ad campaign. Our customers are not only the person served, the family, the referring professionals or the professional community, -they are also the general community who may never consume your services. The clinician who helps her/his client stay focused, and working toward goals, makes the Sale of SLP as a community service that much easier.
"This is what I want". No matter what the client's age or needs, our training and experience allow CSD clinicians to move from this initial proposal; to "What I Want to Do"; - then finally, "Please do this". At its core, our profession is one involved in helping transforming people's lives. The ease of our completing our work with each person served, assures that the personal transformations actually take place. They are the reasons many of us entered the profession. We want to serve others.
The persons in charge of CSD programs may be CSD professionals, yet many times they are not. You as a CSD professional, and your managers, want to know that you manage every clinical case efficiently. If you work for yourself, or if you are part of an interdisciplinary team, controlling your expenses of materials and time helps keep the lights on. Keeping the lights on, in turn, let's your market area know you are open to serve them. When you can serve more of the community - then you have the opportunity say once more, as the authority: now, today....
Sunday, March 8, 2015
Watch your time!
So many reality television shows now - and reality shows now inhabit a huge percentage of our TV time - engage us in competition. Build this! Cook that! Find this faster than the other contestants! And RUN, RUN, RUN while you do it. Slog through the mud! Outlast, outwit, outlandish! But working with speed is a hallmark not only of the world of television, but also the workaday world of you and me.
Professionals in speech-language pathology now find themselves in work environments where, at the interview for a new position, they are told uniformly that the work day is "fast paced", - demanding a lot of focus by the applicant. Where do the fast pace and high productivity demands allow for an additional emphasis on service quality, during the clinical day?
Powerful real-time time management is an indispensable tool for today's clinical professional. The pressures for maximizing reimbursement and minimizing costs are equally seen across the spectrum of modern healthcare. Yet, quality doesn't have to be sacrificed to meet today's standards for productivity.How can this work?
The people you are entrusted to serve; they still deserve high quality healthcare. To meet the productivity targets and likewise give persons served the best possible outcomes, keep a few principles in mind:
* Become confident in your clinical skills - no matter where you are in your career, prepare your case work to the best of your ability. If you are a new clinician and continue to receive mentoring : depend on it and use it, without fail. See many, many cases having similar presentations. When you have your own script for the clinical presentations you may see most often in your practice, you will most easily detect clinical cases that are atypical 'outliers' from your script, requiring their special attention.
* Get your work done - when the visit starts, some minutes rightly get used for checking in with the person served. Have communication skills ready, to signal a transition to the activity you have planned : "what I want to do today...". Remember to keep your client's spirits high with the proper reinforcement schedule. Periodically check in to ask: is this making sense, what we're doing? Do you think you are getting better? Can you practice what we are doing between times we meet? Give the client when attention starts to drift, the best preparatory set. When time approaches to end the session, help the client focus on what has happened and what should come next.
* Manage your non productive time smartly: when you are confident in your clinical skills, and when your visits allow you to get your work done, then you are able to use the remaining time in your workday well. Be on time. Prepare for your day. Communicate with everyone who will impact your clinical work. Between shifts, take good care of yourself physically and mentally. We work hard , and helping others in need to better communicate and swallow - it takes good care, to take good care of the persons served.
In the final analysis, time is a human Invention. When your client has a need you can serve, you give them every minute they deserve. Manage this human invention using wisdom, focus and joy for what we are allowed to do.
Professionals in speech-language pathology now find themselves in work environments where, at the interview for a new position, they are told uniformly that the work day is "fast paced", - demanding a lot of focus by the applicant. Where do the fast pace and high productivity demands allow for an additional emphasis on service quality, during the clinical day?
Powerful real-time time management is an indispensable tool for today's clinical professional. The pressures for maximizing reimbursement and minimizing costs are equally seen across the spectrum of modern healthcare. Yet, quality doesn't have to be sacrificed to meet today's standards for productivity.How can this work?
The people you are entrusted to serve; they still deserve high quality healthcare. To meet the productivity targets and likewise give persons served the best possible outcomes, keep a few principles in mind:
* Become confident in your clinical skills - no matter where you are in your career, prepare your case work to the best of your ability. If you are a new clinician and continue to receive mentoring : depend on it and use it, without fail. See many, many cases having similar presentations. When you have your own script for the clinical presentations you may see most often in your practice, you will most easily detect clinical cases that are atypical 'outliers' from your script, requiring their special attention.
* Get your work done - when the visit starts, some minutes rightly get used for checking in with the person served. Have communication skills ready, to signal a transition to the activity you have planned : "what I want to do today...". Remember to keep your client's spirits high with the proper reinforcement schedule. Periodically check in to ask: is this making sense, what we're doing? Do you think you are getting better? Can you practice what we are doing between times we meet? Give the client when attention starts to drift, the best preparatory set. When time approaches to end the session, help the client focus on what has happened and what should come next.
* Manage your non productive time smartly: when you are confident in your clinical skills, and when your visits allow you to get your work done, then you are able to use the remaining time in your workday well. Be on time. Prepare for your day. Communicate with everyone who will impact your clinical work. Between shifts, take good care of yourself physically and mentally. We work hard , and helping others in need to better communicate and swallow - it takes good care, to take good care of the persons served.
In the final analysis, time is a human Invention. When your client has a need you can serve, you give them every minute they deserve. Manage this human invention using wisdom, focus and joy for what we are allowed to do.
Sunday, March 1, 2015
The relationship you forge must be primary
You go into work one morning in the speech therapy department. Others may call it the therapy department, or the speech-language pathology or rehab department - irregardless, that morning the secretary hands you a case file and says "We need an evaluation done and written by noon". There are thirteen other persons on your caseload already, each with their own paperwork and logistical needs. But, hey, let's get this evaluation done in the morning, when the patient is relatively fresh. What could go wrong, and how to prepare for the contingencies?
It starts with our stock in trade: Communication. Though we feel the pressure of time and someone watching us during the daily caseload grind, at the moment we meet that new customer - she or he is the center of our attention. The relationship we develop and maintain with the person largely determines what the outcomes may include. If you as an SLP have a good working relationship with the person, then what you might ask of that person, she/he may more likely follow whatever lead you provide. Some specifics on relationship-building, that begins with the first encounter at the evaluation:
BE HONEST. Tell the person referred you are sent (using the authority of the referring physician's order if necessary) to describe the person's skills for communicating, or thinking or swallowing. Explain in a manner the person can understand, the processes and mechanics of the evaluation and treatment planning process. Describe each step you are taking concisely, with its rationale. When you are done, explain the data analysis as possible while you are still online (in the evaluation setting). If data requires further offline analysis, offer to supply the interpretation as soon as possible.
BE EFFICIENT. Collect as much of the history information prior to entering the assessment setting. Have your interview questions polished and in a framework; insert additional questions to flesh out impressions as necessary. Practice your formal testing before the first visit, so that you have a routine that allows you to get the data and process it with the person present - when it is possible. Have your report writing procedure ready to start as soon as possible after the visit is over.
BE REASSURING. Given your data analysis and interpretation, your job is then to supply the recommendations and "close the sale". When you follow the guidelines of our Code of Ethics, by not guaranteeting results of treatment - but instead, by painting the picture of how treatment is systematic and designed to help the person function better - you have the best opportunity to show that therapy matters. If therapy is not an option, and you may see the person again, reassure them that you are available again if needed. If you are to treat the person, let them know that the standards for communication you set at the first visit, will continue throughout her/his association with you.
As the relationship continues and grows: Stay honest. Work efficiently. Always reassure your patient that she/he can count on YOU.
It starts with our stock in trade: Communication. Though we feel the pressure of time and someone watching us during the daily caseload grind, at the moment we meet that new customer - she or he is the center of our attention. The relationship we develop and maintain with the person largely determines what the outcomes may include. If you as an SLP have a good working relationship with the person, then what you might ask of that person, she/he may more likely follow whatever lead you provide. Some specifics on relationship-building, that begins with the first encounter at the evaluation:
BE HONEST. Tell the person referred you are sent (using the authority of the referring physician's order if necessary) to describe the person's skills for communicating, or thinking or swallowing. Explain in a manner the person can understand, the processes and mechanics of the evaluation and treatment planning process. Describe each step you are taking concisely, with its rationale. When you are done, explain the data analysis as possible while you are still online (in the evaluation setting). If data requires further offline analysis, offer to supply the interpretation as soon as possible.
BE EFFICIENT. Collect as much of the history information prior to entering the assessment setting. Have your interview questions polished and in a framework; insert additional questions to flesh out impressions as necessary. Practice your formal testing before the first visit, so that you have a routine that allows you to get the data and process it with the person present - when it is possible. Have your report writing procedure ready to start as soon as possible after the visit is over.
BE REASSURING. Given your data analysis and interpretation, your job is then to supply the recommendations and "close the sale". When you follow the guidelines of our Code of Ethics, by not guaranteeting results of treatment - but instead, by painting the picture of how treatment is systematic and designed to help the person function better - you have the best opportunity to show that therapy matters. If therapy is not an option, and you may see the person again, reassure them that you are available again if needed. If you are to treat the person, let them know that the standards for communication you set at the first visit, will continue throughout her/his association with you.
As the relationship continues and grows: Stay honest. Work efficiently. Always reassure your patient that she/he can count on YOU.
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