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!

Well Rested? 

Hello again. Although I try to get a decent amount of sleep, I can’t say that I feel well rested lately. I often find myself tossing and turning, partially because of my bad sinuses, partially because of anxiety. I usually wake up throughout the night as well. For example, this morning I woke up at5 ish and started thinking about my to do list, what time I should get to campus, my upcoming Praxis exam for speech path, and then randomly started to contemplate how long it’s been since I watched Snow White. I have no clue why I would have thought about a movie, let alone this title, but I did. Then when it is time for me to actually get up, I sometimes argue with myself. It may go like this:

Anxiety: get up lazy bones we have lots of work to do and not enough time as it is. There’s no way you’re going to get everything done today. 

Me: but my bed is so comfy. I still feel sleepy. Plus I’m always plenty early for everything.

Anxiety: but you have lots of little errands piling up…you need to get them done ASAP so that you can start working on all those projects and studying for exams. 

Me: 5 more minutes

Anxiety: no you’re gonna be late

Me: but I don’t have a client til 3 this afternoon

Anxiety: but you have to GA before that and what if you don’t have enough time to do that and your work?

Well you get the point. On that note, I’m going to go start working on my to do list. Good luck to those of you with finals coming up. We know more than we think we do. 

I will survive!

so I’m blogging from my parents house… It’s the final countdown of grad school, not that I’m graduating this semester, but I will be out on externship full time next semester. I return next week for one week of clinic and then a week of finals. This means I will be returning to my parents’ full time to save money after finals. I have been attempting to move my belongings of my apartment back into my bitty room. Needless to say, I really need to sort and donate in all my spare time. 

Anyway, for those of you just starting out/one semester down of grad school, it doesn’t get easier necessarily, but you will survive! You will put in the work, stay up late finishing group projects, get up early to plan therapy, and even (gasp) laugh with classmates so hard that you cry. You will make friendships that can never be replaced. You will learn so much in such a short amount of time, which will make you realize how much you do not yet know. You will wonder how you will survive in the future without your library’s databases to research EBP and without the close comradery of your classmates. You will have challenging clients that make you rethink everything you know and get more creative than you ever thought you could. You can do it! Yeah you. You can do it, even on those days where it feels like you’ll never make it. You will. You will be great. :) 

Jeepers Keepers

Although many people may think this is strange, I would like to dedicate this blog post to my Jeepers, Dirty Diana. She is still going strong after over 223,000 miles. She would probably prefer a new coat of paint as opposed to a blog in her honor, but I think she understands since I’m a poor college student. We have been together for 7 years, and she has never let me down.

Dear Jeepers,

It hasn’t always been easy, like that time your muffler dragged up a hill, sparked on the road, and people yelled at us or when you needed a new exhaust manifold. However, I really appreciate times when things conveniently  happen close to home, like the time when  one of your tires had a screw in it and became flat or when your battery died. Things like that could have been so much worse if we weren’t close-by. You have been a tank in the snow/ice and I really appreciate that. I always feel safe with you. You have been a great, dependable vehicle, and although I get annoyed when your dash lights flicker at night or when you don’t want to play my CDs, I love you. I hope you live forever, and if not forever, at least until after I graduate with my Master’s. That would be super awesome.