Bible Reflections 

So as mentioned in an earlier post this month, one of the habits I am trying to get into this year is reading scripture daily. For those of you who may be interested, I will most likely be trying to post at least once a week regarding what I’m reading and my reflections on  it.

This month specifically I am trying to read the book of Proverbs although I skip around quite a bit when inspiration strikes. Here’s a few verses I’ve highlighted:

  • Proverbs 11:14 With a great deal of change and reflection in the United States right now, I really took this verse to heart. Who does not benefit from sound advisement? Even as I age I realize how little of the world I know and I appreciate those who grant me counsel. It is wise to gather opinions before making decisions, as others may consider perspectives you have not. I also continue to seek God’s counsel. I hope and pray that the leaders in our country do the same.
  • Proverbs 12:25 “Anxiety weighs down the heart, but a kind word cheers it up” Have you ever had one of those days where you seen my to be struggling to get through and you keep worrying about every move you make and things already past and the future and…. you get my drift. Have you had one of these days and then someone gives you a compliment or maybe even a stranger just smiles at you and for one moment the worry stops and you realize that it’s going to work out? This is what came to my mind as I read this verse. It also goes the other way – have you ever noticed someone, maybe even and coworker who just seemed to be having a very hard day? Did you do anything to help them or make their day a little brighter? “…let your light shine before others, that they may see your good deeds and glorify your Father in heaven” (Matthew5:16). No matter how small the deed (again think of that smile), you may make someone’s day that much brighter.
  • Exodus 20 Because I can recall the commandments but not the order or exact wording, I reread this chapter…which tied me into…
  • Matthew 5:21

Feel free to let me know your thoughts on these verses. As always, thanks for reading.

What I’m buying from January’s TPT must have sale…

I very much appreciate teacherspayteachers.com and all of the wonderful sellers who put so much time and energy into creating amazing resources for other professionals to use. I have often thought about blogging about all of the super helpful products I find and use, so here it goes.

For those of you SLPs who have not heard the news, some Teachers Pay Teachers sellers put at least one product on sale (usually 50% off) on the 7th of every month [#slpmonthlymusthave sale]. I usually try to limit myself to 1-2 purchases a month for awesome new materials (or else I would have no extra spending money left ever), but this month I have committed to these items which were too good to pass up:

  1. Cycles for Phonology Toolkit: Assessment, Progress Monitoring, & Intervention by Speechy Musings  –> I’ve learned about using cycles for highly unintelligible students in graduate school; however, implementing this is a completely different story. This document is a steal right now at $8, with assessment protocols and materials.
  2. Articulation Comics by Speech Time Fun –> These appear to be a great purchase for my mixed groups, with engaging comic strip/story as well as comprehension questions, vocabulary, incorporated social skills, etc.
  3. Social Language and Behavior – Coloring Book Lessons by Super Power Speech –> Who doesn’t have students on their caseloads that can benefit from these great reminders like keeping hands and feet to self and following directions? Super cute way to introduce expectations at the beginning of the year as well as review throughout the year.
  4. Winter Speech & Language MEGA BUNDLE by Fun in Speech –> This amazing packet includes articulation worksheets, an interactive describing book, vocabulary activities, and grammar activities. There will be something in this bundle for every student on your caseload!

Items that look/sound amazing that I would buy if I was richer (and they have been added to my Wish List for possible future purchase):

  1. Articulation Playing Cards BUNDLE for Speech Therapy by Speechy Musings –> so many possibilities for these. So many games you can play with a regular card deck, and now the card deck has targeted sounds!
  2. Articulation Game Boards Bundle by Speech is Sweet –> Because what students don’t love gameboards? I have used the sample gameboards from this seller in the past for engaging homework to send home with my students to complete with their parents.
  3. Match It Quick Bundle – Later Developing Sounds by Speech Therapy with Courtney Gragg –> Looks like so much fun.

Check out all these materials and more by using #Jan17SLPMustHave on teacherspayteachers.com before it’s too late! And make sure to visit the website on February 7 for more great deals!

Still in graduate school or don’t have the extra $$$ right now? Here are some of my favorite freebies on TPT right now:

  • Roll & Describe/Roll & Respond by The TLC Shop –> I recently have been very much obsessed with dice games in therapy, so this freebie is great.
  • Snowbuddies Pronoun Smashmats by Beautiful Speech Life –> Love, love, love anything with Play-Doh that keeps my students engaged. Plus these just look super cute. Amazing to model and practice subject-verb agreement and pronouns.
  • Snow Globe Categories by The Speech Attic –> great for any of your kiddos who are working on categorization/association.

As always, thanks for reading.

 

Starting 2017

It has been almost 5 months since I have written a post on this blog. To my followers, I apologize. A lot has happened since then, including me finding an amazing SLP job with pediatrics and moving.

As the new year has already begun, I have been very focused on habits. What do I mean by this? Well, you have all heard people make resolutions over the years; often these do not last. Why? I feel it has a lot to do with trying to make unrealistic changes all at once. To address this, I have instead decided to focus on habits. Supposedly, it takes at least 30 days of doing something for it to become a habit. I am not sure of how long it takes to undo a bad habit, but anyway…

Habits I have been focusing on adding so far these year:

  • Eat at least one fruit a day (I started this before the new year, got a little off track during the holidays, but have been back on track) – I love Cuties clementines and bananas as they are relatively easy to peel and eat on the go
  • Read scripture daily (whether it is one verse, a chapter, or multiple chapters/books – I typically have been trying to read at least a chapter). Recent focus on Proverbs and Genesis for me.
  • Exercise daily (even if it is very minimal). Lately I have been making sure I do a combo of squats and crunches or a mix of lunges and timed planks. These are quick exercises to do at the very beginning or end of the day.

Habits I have not yet focused on but wish to add in as the year continues:

  • Addressing my nail biting habit. No it has not gone away as I have aged, and anxiety often increases this for me. I know it is gross and unhealthy.
  • Drinking more water. I had been doing good for a while, then after switching jobs, I have fallen off the track. My soda and coffee consumption has increased whereas my water consumption has decreased.
  • Decreasing my independence on sugar. I know that I crave it. Especially in the late afternoon and by the end of my day. Peanut butter M & Ms are one of my worst culprits. I can mindlessly eat them and feel like I have no self-control once that bag is cracked open.
  • Eating more earlier in the day rather than binging after work at night. I love food. All the time. At work it is not always easy to eat/have snacks/etc., and I often feel that I eat the majority of my calories later than 4 p.m. Typically the less healthy calories as well.

In other news, I have set a date for my wedding, but a lot of planning has not been done. The past few days I have been at least setting aside a minimum of a few minutes to work on something wedding related. The date is later this year, so I need to get a move on with this.

I also need to find a good ENT before the end of the year. I have had sinus problems from an early age and have had a sinus infection every 3 months or less probably since 7th grade. I am tired of going on antibiotics and feeling drained all the time, even after taking multivitamins and practicing good hand-washing protocols. I need to eventually find out if this is happening because of my structures or if I should investigate the idea of allergies further (I already take an allergy pill on a daily basis and use a nasal spray at times during the year).

As always, thanks for reading. I hope that you are off to an amazing start to 2017. Take care.

Trying to Stay Optimistic

Losing a job is hard, especially when it was out of your control. Especially when it was your “first full-time SLP job.” For those of you who do not know me personally, let me catch you up here… For those of you who already know my situation, skip down 3 paragraphs.

I have lived in Pennsylvania my whole life and never planned on leaving this state. I recently graduated this May with a Master of Science in Speech Language Pathology. This is a field where individuals address a multitude of things, including cognitive/communication/swallowing disorders for all ages. I was so happy to graduate after 6 years of school and get started in a field that I love.

In my field, we are required to complete a 9 month clinical fellowship (CF) after graduating before we can obtain our credentials – Certificate of Clinical Competence (CCCs). In Pennsylvania, we are required to hold our CCCs before we can apply for a license whereas most other states offer a provisional or temporary license for CFs. I accepted a position at a skilled nursing facility and was employed by them for the last 9 weeks as a Speech Language Pathologist Clinical Fellow. Last Friday, my company “realized” that they could not meet the necessary supervision requirements in PA for Medicare B patients as PA STILL doesn’t have a temporary or provisional licenses in place for new CFs like myself. Myself and a colleague completing her CF were “laid off” permanently. The company had given us no prior warning/indication that we would soon be unemployed.

Many SNFs cannot offer 100% supervision to CFs for treatment of B (long term care) patients and those patients are the majority of the caseload. There is just not enough staffing most places to allow this to happen. Even if a supervisor knows that my treatment is exceptional with a B patient she still would have to provide 100% supervision to me, even though I hold a Master of Science in Speech Pathology, because I do not hold a state license that allows me to bill for those services directly. In states with provisional or temporary licenses for CFs this is not an issue as Medicare does not view someone with a license as a student who requires 100% supervision for Medicare B patients and that CF can bill for the services rendered under his or her name. The laws that would establish a provisional license in PA for CFs are written, regulations for the laws have been written by the Board of Examiners; however, the regulations sit somewhere “in legal.” I have contacted multiple legislators regarding this issue.

In the mean time, it’s hard not to feel discouraged. It took me a while to find this medical placement that I thought I would be able to complete my clinical fellowship position at, and I am not enjoying the job application process. There are a lot of jobs offered right now – out of state. There are jobs in PA advertised that require CCCs and a license (I have neither right now – Yay!) such as home health and SNFs with no other SLPs.

A lot of people (especially recruiters) keep telling me “You’re just starting out – you shouldn’t be picky til you get your CCCs. Once you have them, so many more doors will be open.” It’s not that I don’t understand their point. But I also am a human being who has lived in PA my whole life, who has a great supportive network in my current area, who has a fiance with a steady job, who loves this area and the people in it. It’s not that I don’t enjoy traveling and exploring – it’s that this is always home for me at the end of the day.

So I will continue to attempt to find a placement in PA and hope something good turns up. I will trust that the LORD will help me end up where I am supposed to be.

If you wish to address/voice your opinion of the lack of provisional license for SLP-CFs, here is a link to Find Your Legislator. Myself and other new SLP graduates in PA appreciate it.

The Pains of Job Searching

“I will apply for jobs tomorrow…” I keep telling myself this daily. But then, after scrolling through pages of possible job openings, I become disgusted. “Must have CCC’s.” “Must have state licensure.” “Must have 3 years experience.” “Must promise to let us name your firstborn.” Ok, so I made that last one up. But you’re getting the gist. There’s not a lot of job postings that say they will accept a student who’s working for their CCC’s in the speech path world. Plus you throw PA state regulations into the mix that don’t allow for a provisional license for students. I’ve been told by many people to apply for jobs even if I don’t necessarily “meet the requirements” because who knows, they might call me, they may take a well-rounded student. It’s just disheartening to be applying for a job when you’re scared that they might throw out your application once they see you’re graduating this May and will need some supervision in order to get your CCC’s (whether or not you may be a good candidate). End of rant/rambling. Thanks for reading.

Working on memory

One of my favorite things to address with my patients is memory. It may partially be because I feel like I am exercising my own brain, since I try to remember what I want them to without looking it up as well. At times I also feel like my memory lapses from day to day about little things (like most people’s most likely) and I’m hoping to have effects from my own therapy haha.

I usually begin activities by introducing different strategies to the patient, such as visualization/imagery, rehearsal/rote memorization, chunking, associations with existing memories, making lists, etc. For example, if I’m targeting memory through immediate recall then delayed recall of facts from short stories, I may say, “I’m going to read you a story and I want you to try to picture what I’m describing in you mind. If you have existing knowledge about the topic, you can try to link the new information I’m telling you to that as well.”

Some other activities I use to target memory include:

  • Immediately recalling predetermined auditory targets from sentences (example: “I want you to listen for a sport. The class played kickball at recess. What was the sport?” – you can then do it without a predetermined target depending on patient’s level – “The gray clouds covered the sky. What was the color?” –> also good for auditory attention
  • Recall of recent daily events for the patient (example: therapy tasks from earlier in the day from ST or other therapies, if they had an important medical/other appointment I know about, etc.) –> good for orientation/memory of personal situations/events
  • Delayed recall of 2-4 words/photos
    • You can introduce the idea of using weird associations to remember two targets (example: chunking together a picture of a guitar and a picture of strawberries by imagining throwing a handful of strawberries into the center of the guitar – you would most likely never do this, but it definitely helps a lot of patients remember the two photos better than if they try to recall them as two individual pictures)
    • I like expanding this eventually to a more functional activity such as having the patient remember a short list of items to find at the gift shop/cafeteria/etc. or having them tell another person (example: OT) a certain funny fact or story  the next time they see them.
  • Recalling targets from an earlier therapy task (example: if I asked the patient to name some items from categories, I may ask them to recall some of the categories I gave them)
  • Association cards (object to color for example – I cannot remember where the set I like to use is from right now, but if I do I will add later) – I will introduce about 5 sets earlier in the session and (depending on the patient’s level) may work on other tasks then ask them to remember the objects from the color or vice versa at the end of the session.
  • Tasks with distractors – You can tell the patient you want them to remember the final answer is _______ (the sum of 4 +6 for example) and then ask them to do another question/task that hopefully is relatively easy for them (what is the first vowel after F?) and then ask “What was the answer I wanted you to remember?”
  • Prospective memory for higher level patients – I really enjoy this one and can explain to the patient why this is so important. We use prospective memory every day, especially when we’re rehearsing things we have to do later in the day at work. One example task for a following directions pen and paper activity – “I want you to stop when you get to number five.” and see if the patient remembers to stop at the target. If you’re doing a word association activity back and forth with them, you can tell them to stop after you say/write a color. You can also ask patients to remember a few things and tell you them at a specified time – “I want you to stop me at 1:43 and tell me your wife’s name and favorite TV show. It doesn’t matter what we’re doing, you’re going to interrupt me and tell me these two things at that time.”

I can definitely not take credit for coming up with all of these on my own – my wonderful supervisors have set examples for a lot of these. I hope that someone else finds these helpful in planning therapy.

What about you? What are some of your favorite memory tasks/activities for therapy that I haven’t mentioned?

Thanks for reading!

Week 7 Reflections

I’m currently at a medical externship placement (7 weeks in, 11 weeks to go) where I get to work with the geriatric population every day and I love it. I have a lot of pondering throughout my day regarding different issues in the field, so I figured ‘why not ramble about them on a blog since I haven’t blogged for a while?’ – here ya go. It may not end up being the most organized blog, but hey, my brain is not always that organized either so it may up being a true reflection of my thinking.

When I originally thought about becoming a speech therapist, I thought, “Wow, we get to help people eat again too? This is awesome! They must love us!” Now I see the downside of that as well – that we also sometimes have to recommend thickening people’s liquids or downgrading their diet.

I have been told over and over how people dislike (ok, more like hate) drinking thickened liquids (especially water, which a lot of places still thicken although there is some evidence for a free water protocol, but that’s a whole other story altogether). My current externship placement does NOT allow thin water if a person is on nectar or honey liquids by the way. Anyhow, I hear the complaints regarding patients’ thickened drinks, I re-educate them why they were placed on that (the explanation usually including safety issues/delay in swallow/etc.), but sometimes, I can tell by the disgust in their face that they really don’t care – but they don’t state so. They miss their thin liquids. I can’t say that I blame them; I’m definitely not judging them. I’ve also told many patients that I’ve tried all the consistencies (thank you thickened liquid lab night!) myself; however, I leave out the part that I haven’t drank them for every drink, every day, over a period of weeks. I have not had the same experience as them and do not know exactly how I would feel in that situation (but I have an idea that I would probably give a lot of protests and ask to see a VFSS of myself).

Regarding another subject, I’m still a student and want to stress to other students that it is important to show respect for your supervisors’ decisions (I don’t have a lot of clinical experience), so even if they thicken someone’s liquids that I would not necessarily, I ask for their rationale in a respectful way (some of the time it is because the person is at RISK of aspiration even if he/she didn’t necessarily aspirate on the VFSS). This can be very important since a VFSS is just a short period of time and we can’t be positive that the patients who are at a high risk of aspiration would not during a taxing meal (depending on their other swallowing issues as well). At times I feel that I may not necessarily thicken certain patients’ liquids to the same extent as my supervisor, but I also realize that again – I do NOT have a lot of clinical experience and am trying to gain as much knowledge from this current experience so that I am comfortable and confident on my own if/when I do my own videos/diet changes/etc. Every day is an amazing learning experience in all field aspects that I come into contact with.

I also want to stress to other current students to go out of your way to be nice and show respect to ALL of the staff and disciplines you come into contact with – it really makes a difference, especially when you need something from that person in the future. Try to meet with them so that they can tell you a little bit in detail regarding what they do (example: respiratory therapy). You will then have an idea about what to ask them regarding a patient you share or if you have a certain problem if it is wise to get their advice.

That is the end of my rambling for now – to be continued at a later time. Thanks for reading! Take care!