This is a transcript from our podcast episode published September 5th, 2021. The podcast episode is offered for .1 ASHA CEU (introductory level, related area). This transcript is made available as a course accommodation for and is supplementary to this episode / course. This transcript is not intended to be used in place of the podcast episode with the exception of course accommodation. Please note: This transcript was created by robots. We do our best to proof read but there is always a chance we miss something. Find a typo? Email us anytime.
A special thanks to our Contributing Editor, Caitlin Akier, for reviewing and editing drafts of our transcripts. Her work helps keep our material accessible.
[00:02:03] Kate Grandbois: We're so excited for the topic of today's episode. This is an area that's very near and dear to us, and we get to welcome a woman who we've worked with before and collaborated with before who we've learned so much from already. Welcome Tanna Neufeld. We're so happy to have you here today.
[00:02:20] Tanna Neufeld: Yeah. Thanks for inviting me.
I've been excited to join you guys for a while. I'm glad to finally have the chance.
[00:02:27] Amy Wonkka: We are too. We are so happy that you're sharing your time with us now, Tana, you are here today to talk to us about AAC and complex communicators in early intervention. But before we get started, can you please tell us a little bit about yourself?
[00:02:41] Tanna Neufeld: Yeah. So I live in Seattle, Washington, um, and my primary job is working as a clinical instructor at the university of Washington. So I get to work with graduate students, and I love that. Um, I also get to teach their AAC class, which I really love. Um, and I think that it has [00:03:00] really become, uh, evident to me how important it is to improve our pre-service education through my role in that class.
So I'm excited to talk a little bit about that today. Um, in addition to that, I do some private work as an AAC consultant, um, with children and families over telehealth. And I am the founder and director of accessible.org Accessible Foundation, um, where we provide low cost and free resources to the community around AAC.
Um, yeah. Other than that, I'm a mom. I have two kids who I love and who teach me all the time about how to be a better person and a better therapist. I might be leaving some things out, but, but these are the broad strokes, right?
[00:03:43] Kate Grandbois: I'm just going to be the first one to say that you do so many things and you've contributed so much to this field already.
So hats off to you, um, especially your foundation, the Accessible Foundation, accessible.org is so full of [00:04:00] resources and webinars. Anybody who's listening, we haven't even gotten into the topic of today's episode, but if you want to learn more, or join a community, around AAC education and support then that is the place where you need to go. And you guys have a conference coming up, right? You're doing like an actual conference.
[00:04:18] Tanna Neufeld: Yeah, scary. Right. So we're taking a stab at what I believe is the first conference of its kind, really, um, coming up in February on the 16th and the 17th. We're going to be hosting two full days of an online only live conference on the topic of early intervention for complex communicators.
So it's called the AAC early starts conference. Um, and you can see some workings of the initial information on that conference, on our website. Um, we have a call for papers open for that as well. We're looking for presenters. We really want it to be a conference for families and professionals across disciplines, uh, to come and present and share their knowledge and experience, and [00:05:00] also attend, uh, to learn how to support these really young, early communicators who have these complex needs a little bit better for longer term outcomes that really helped them be independent members of society.
[00:05:12] Kate Grandbois: I'm incredibly impressed for a variety of reasons. And I think it's a great segue into today's topic because as you and I were having conversations about, about AAC and early intervention, having not worked in early intervention, it became abundantly clear that this is really, um, an area that deserves a spotlight and deserves more discussion and continuing education.
Um, and I'm so excited that you're here to give us a little, give us a little sneak peek, give us a little preview and teach us all the things. So before we really jump into it, the powers that be require that I read our learning objectives and disclosures, um, I will get through them as quickly as possible, and then we can get onto the good stuff.
So here we go, learning objective number one, identify at least two barriers to AAC implementation in an early intervention setting, [00:06:00] learning objective number two, identify at least five strategies to overcome barriers to AAC implementation in an early intervention setting, and learning objective number three, identify at least two resources for expanding scope of competence in AAC for early intervention clinic.
Disclosures Tanna Newfields financial disclosures: Tana receives a salary from the University of Washington and receives donations for consultation services, mentoring services, course offerings and products on accessible.org. A portion of these donations is used to subsidize overhead costs for an organization, which she founded and direct.s Tanna receives honorariums for speaking, at conferences and workshops in the Seattle community.
She is a paid advisor and consultant for goalie and assistive technology company. She is also a seller on Teachers Pay Peachers and Boom learning for which she receives funds for her products. Tana Newfields nonfinancial disclosures. Tana is a member of ASHA and ASHA SIG 1, 11 and 12.
She is president on the board of accessible foundation and a volunteer [00:07:00] contributing editor for SLP nerdcast, Kate, that's me financial disclosures. I am the owner and founder of Grandbois therapy and consulting LLC and cofounder of SLP nerd cast. My nonfinancial disclosure is I'm a member of ASHA, SIG 12, and serve on the AAC advisory group for Massachusetts advocates for children.
I'm also a member of the Berkshire association for behavior analysis and therapy, Mass ABA, the Association for Behavior Analysis International and the corresponding speech pathology and applied behavior analysis special interest group.
[00:07:27] Amy Wonkka: Amy that's me. My financial disclosures are that I am an employee of a public school system, and I receive compensation as co-founder of SLP nerd cast.
And my non-financial disclosures are that I'm a member of ASHA, SIG 12, and I serve on the AAC advisory group for Massachusetts advocates for children. All right, we've done it. We've made it through the learning objectives that disclosures onto the good stuff. Tana, why don't you start us off by just telling us a little bit about the barriers to AAC in early intervention.
[00:07:57] Tanna Neufeld: Yeah. So I have been so fortunate to [00:08:00] spend a good part of my career working in early intervention, even though that's not really where I am exclusively right now. And so some of the thoughts I'll share today are coming from my own experience in that setting. Um, and also from the collaboration and consultation I do with a lot of the EI providers here in the Seattle area who, um, really struggle to feel confident in the care that they're providing for complex communicators.
Um, and rightfully so. So I think that the first barrier that I, that I kind of discovered myself as an EI provider and also through my support of others, um, is that really these really young little guys and early intervention are so, complex some of them. Right? So in addition to being young infants, toddlers, and preschoolers, um, those with complex needs are still developing all of their skills, right?
They have not had a chance yet to have a foundation in anything. So [00:09:00] these providers who are supporting these little ones are supporting them at the beginning of every journey that they are on. Right. And that's a huge, huge job. Um, one that we're, we're not very prepared for, I think, as providers across domains, but obviously as SLPs.
Um, so I think for that first, and that leads me into kind of the second one where I think that despite our efforts to acquit our professionals with the skills, they need to be good at what they do when they graduate, our pre-service education, still tremendously lacks the skills and experiences needed to really serve birth to three populations in general and let alone birth to three populations with complex needs.
Um, you know, we don't even have coursework in many of our programs that talk anything about parent coaching or partner involvement. So I think our, our SLPs operating in these contexts are really, um, trying their best to do what they need to [00:10:00] do when they've been thrown into the deep end of the pool pretty much, um, on two fronts.
Right. Uh, so those would be my top, my top two barriers that I see. Um, I also think that in these settings, um, because early intervention is wonderfully, uh, programed that serves all families, right? No matter what their background, um, we do have a lot of families and areas in early intervention on districts, right?
So early intervention is usually assigned to a certain part of the community. Um, and in certain communities, technology is not available. Um, resources are very limited. And so our EI providers are really trying to create, um, access to technology that will support the needs of these really complex little guys with very minimal budget or, or opportunity to do so.
Right. Um, so we have limited access to technology. Um, and I think we also just have limited access to training that’s specifically around how [00:11:00] to implement AAC in this very unique and special setting.
[00:11:05] Kate Grandbois: I was going to say, you know, this is something that we've discussed a lot in previous episodes that we've done, that access to AAC, content knowledge, and then confidence and competence in applying those skills is something that is an issue.
It's an issue because there's these, you feel like you have to be a specialist. You feel like you have to have your ATP. There are a lot of barriers just in general to implementing AAC. And when you look at it through the lens of early intervention, I love how you laid that out. That these, these tiny, these little people are at the beginning of this journey and you're right.
We don't get a lot of structured education. I didn't have a course in early intervention, actually. As a matter of fact, I didn't have any clinical experiences in early intervention either. Did you Amy?
[00:11:54] Amy Wonkka: I mean, I feel like it was tied in, we had some child development courses, but no, there was nothing [00:12:00] dedicated to EI. And I also did not have experience working with that population until my CF year. So it was not something that I encountered in grad school at all.
[00:12:12] Kate Grandbois: And to, to sort of piggyback onto that. I think you're right.
There are so many components of early intervention that are separate from working in a school and separate from working in an outpatient clinic where you're really wanting to focus on, not only person centered care, but family support and, and caregiver training. I mean, these are such tiny little babies.
They're, they're a little tiny baby. I keep saying tiny, they're physically small, you know, they're, they're really young. Um, and supporting them in that environment is such a diff, I have to assume a very different skillset. I've never done it myself. Is, would you agree?
[00:12:49] Tanna Neufeld: Yes. It's a, it's a super different skill set.
Um, and in my experience, it's, it's a, um, a work setting that's highly protected in a lot [00:13:00] of ways. Uh, in some districts it's, it's protected, right? So similar to maybe if I’m a grad school graduate, and I like want to work in a NICU. Right. And, and the NICU people are like, yeah, you're gonna have to pay some dues before you get to do that.
Right. Because it's a very coveted, you know, protected area of our field. And in some areas in some places, EI is like that too. And so you'll have some EI providing companies that are very particular about training their providers, but then there's also a shortage of SLPs willing to do a job that requires them to learn, really spend the majority of their day in their car.
Right. So I think you've got this weird contrast that, that makes this the services, obviously not very uniform where you may get some younger providers who are just getting their feet out there. Right. Getting, hitting the ground running. Um, and now they're in their car, in the homes with minimal mentorship, from anyone who knows [00:14:00] anything about what to do with some of these more complex cases. So it's just a lot to, um, to learn on the job, I think. And, uh, I think a lot of providers get a little, um, burnout by the feeling that they're not doing what they should be doing or could be doing, learning, or they don't know what to do, mainly because of all the reasons we just talked about.
Right. Just lack of support, lack of training, lack of time. There's high productivity demands in the EI setting because there's always kids waiting and they're not allowed to wait for very long because there's mandates on how long they can wait. And so, you know, all of that indirect service stuff, you guys talk about so much on this show, it applies here too.
There's just, there's not enough time to create, you know, to build an iPad in your garage because the family doesn't have the means to do it. You know? We need to have that. We need to be able to build stuff, 3d printing time and that sort of thing. Well, [00:15:00] then you talked about
[00:15:01] Amy Wonkka: Well, then you talked about not just knowing what to do with your client, but also in EI.
So much of it you're in somebody's home. You're working with families, the entire family unit is your client, essentially. And I think that that adds, that must add another layer for the clinician who not only has to learn what to do with the actual child on their caseload, but how to best support that family in that context.
Um, so there are, there are almost two layers of clinical skills, which you may or may not find as a demand of some other work settings to the same degree.
[00:15:38] Tanna Neufeld: Yeah, absolutely. I mean, I remember as a CF, my first experiences were a clinic where the families never even came into the room. Right. And that was the way I learned in graduate school too.
And so when I went and started a job at a really family centered practice, I was like, wait, they're going to be in the room with me. [00:16:00]
[00:16:01] Kate Grandbois: As a grad student. Oh my gosh, please don't look, I'm making a mistake. You feel like such a, so under a microscope, your supervisor is there. And then the, you know, the parents and it's a really intimidating, setting.
[00:16:14] Tanna Neufeld: It is. And so, you know, I mean, we haven't gotten to this part in our talk yet, but I think speaking to what you asked Amy about this, this big job of not only learning yourself, but teaching families. I think one of the things we need to do as a, as a field is assure that our pre-service experiences for graduate SLPs include families being in the room and it is harder and they're going to mess it up.
I've seen it, it, they just, they get so nervous, but you know, they, I think you have to learn by doing and what better place in your career to do that. Then when somebody is right there to help you be better at it. Right.
[00:16:53] Kate Grandbois: Totally. We're like high-fiving Tana through the screen. This is just so brilliant. I wonder if you could tell [00:17:00] us a little bit about why it matters and stick with me for a second.
Right? So. You have a person, a child. Um, I wanted to say tiny child again, but I stopped myself, uh, a young child under the age of three, who is, um, possibly medically complex or has a complex developmental profile who presumably you're working in a team environment. You have, potentially OT, PT, working on some basic skills, focusing on sitting, crawling, trunk support, walking all of these kinds of things.
And at least, I don't know if this is true, but my, what, in many areas, but in our area, what I hear a lot is that there are not, SLPs aren't assigned to the team until later because of these, and I'm putting these in quotations, “developmental norms”, it's in quotations of not needing access to communication [00:18:00] support until they're 18 months or two year or whatever the cutoff is.
I'm not really sure I'm speaking out of turn there, but, but in terms of AAC, knowledge and application of AAC knowledge, can you tell us a little bit about how important that is and, and why that matters, how that paradigm should, might need to shift a bit?
[00:18:22] Tanna Neufeld: Yeah. And I can tell like a little bit of a personal experience too.
When I first started in, in true EI in, in Florida, EI was a little different, which is where I started my career was in Florida. EI was not mandated to be in the home. And so I worked at a multidisciplinary center at the time where I was seeing little guys, little, little cuties and helping them in the center.
But then when I got here, Seattle, I started in a home-based center and, um, they did something called a primary service delivery model. I don't know if that's a thing, other places. I've lived here for a while now, but anyway, primary service delivery is kind of what you're [00:19:00] talking about, Kate, and this idea that if I'm a little baby and I have just been born with cerebral palsy, for example, and I go to an early intervention setting and I get an evaluation, um, despite the fact that everybody on the team acknowledges that I am at risk for long-term speech and language challenges, the likelihood that I will have an SLP assigned exclusively to me as part of my care team is very small because for some reason there's a need a desire or a thought that the needs of every young communicator can be met by a non language trained professionals.
So, although they're not clearly stating that, you know, they don't lead communication intervention, they're not, that's not the question or the key point here. The point I believe is that, well, of course they need it, but it can be provided by another professional. And I always had a hard time with that because, [00:20:00] um, I used to say to my superiors at the time, well, but you wouldn't look to me to help him walk.
Right. So why are you looking to my wonderfully talented, amazing PT colleague to help him learn how to communicate? So, you know, I think the importance here starts and we need the best skilled professionals for each domain intervening and, um, and, and we know how essential birth to three is. This is, this is the window for language, for sure.
Right. So why do we wouldn't have then a language expert on the team? Uh, just seems to, in my opinion, to be frank, another situation where limited resources and such and such are kind of interfering with care provision, right. Um, so, you know, in perfect teams that works really nicely for the SLP to push in and help.
But I think what we're missing then is we're missing [00:21:00] all of this immersion in particularly AAC that needs to happen. From the time the child's born, right. We need to immerse them if we want them to learn any language. So whether they are actually going to use an AAC system at all themselves, before they exit EI, they need to be exposed to models, um, and PTs, OTs, and education.
They don't normally have the skills to do that, to provide that service. I don't know if I answered your direct question or if I just got onto a little miniature soapbox?
[00:21:34] Kate Grandbois: No, no, it was, I, I wanted you to get on the soap because I think it's such a great point. And I think Amy can probably speak to this a little bit more based on her experiences in the school.
But my assumption is that without those supports and without that immersion and without that foundation you it's, I'm assuming you're at high risk for quote, graduating from [00:22:00] early intervention or transitioning into a preschool system without the communication system or supports that you need to continue your language learning journey.
[00:22:12] Tanna Neufeld: Yes. Yes. And one of the hugest challenges for preschool teachers when they receive children who don't have a solid functional communication system, is that they're now have shifted from being a preschool teacher to the person, does the, who is, who is in charge of now teaching our child language that their peers have entered into that setting already having, right?
So no wonder our preschool teachers and developmental preschool and our kindergarten teachers, even when children enter public school at that point are so overwhelmed because it's not, they're not trained to teach children language. That's not their job. I mean, they, I think they, many of them embrace it and want to do better, but, um, it's no wonder, it feels overwhelming and hard because, that's not really the way that [00:23:00] school was designed to be. So I think that we do a better service to our teachers and our teams, families and kids when we try our best to see into the longer-term future and think about things in terms of typical development. Right? So if I am a 12 month old child, I have, um, I have some skills that I need to develop around communication.
And if I'm not doing those with speech or sign, then I need to have the ability and the opportunity to build them some other way, even at 12 months old. So I don't know, it seems like a no-brainer to me, but, um, it's hard sometimes to get people to see it that way. Um, and I also think a lot of the time we're just waiting for skills to be present, right. Prerequisite skills to be present. Um, and, and that's where the myth comes in, right? Yeah. Kate's doing a fist bump, fist bump
[00:23:55] Kate Grandbois: modeling. Enthusiastic. Yeah. Fist bump. There you go.
Fuck. Bump
[00:23:59] Tanna Neufeld: Yeah. [00:24:00] So yeah, you know, the prerequisite skill myth, even though I think that if you get a bunch of us in a room, we would all say how we don't think about that anymore.
We know that that's not true, but our practice is not following that. Right. Because we're still waiting for these kids to show some magical unicorn cognition skill. Before we say, Hey, let's just do this. Let's just for lack of a better analogy. Let's throw some stuff at the wall and see what sticks, right?
Like this is the time to do it.
[00:24:33] Kate Grandbois: I go ahead, Amy.
[00:24:37] Amy Wonkka: Oh, I would say, you know, and it all, it makes me think about something, we've talked about a fair amount on this podcast before, but the idea of a communication system, also, it doesn't just have to be this one high-tech thing that we bring in. And that seems like maybe it's too much for the situation. Just like you just said, Tana, you know, you could, if you give yourself permission to try these different [00:25:00] things at an early age, you can get a better feel for what is, what works best for the child, what works best for their family. Maybe something works best in certain situations, but not in others, but if you don't have the opportunity to model and give that exposure and also give that practice for everybody, you're not, you're not going to have any of that information.
And then the child's going to have a transition out of EI and the people who are familiar and do know the child aren't going to have been able to gather that information, to share with their receiving placement. And that's, that's another piece that's really unfortunate.
[00:25:38] Kate Grandbois: And I think this is a great segue into our second learning objectives in terms of what we can do.
So instead of waiting for an arbitrary developmental milestone or cognitive skill or arbitrary timeline, so, we provide speech therapy at 18 months just because, um, what, what can we do? I mean, what are [00:26:00] some proactive things that SLPs who are listening in an early intervention setting or interested in an early intervention setting, or maybe frustrated with their current early intervention setting, what are some shifts or different lenses that we can look through to improve on, on this problem?
[00:26:18] Tanna Neufeld: Yeah. And I, I just thought of another barrier, so I'm going to like, go back. It's not really going back more that it’s just like nudging another little one in between before we start talking about solving the barrier. But, you know, so when Amy mentioned this. The idea of multimodal communication rates.
So not really being so narrow-focused on the AAC device as the system, but realizing that all this funky hand stuff that I'm doing right now is AAC. My vocal tone, my gaze, um, even my quirky behaviors, right? Those are all part of a system, but an EI team should be building. [00:27:00] And I do a lot of trainings on intervention.
Um, and I think people get a little frustrated when they sign up at first, because they're like, why don't you talk about the actual devices? And I think it's because in my perspective, when I'm working with emerging communicators, the technology is like 10%, 90% has all the other things. And I think sometimes the EI providers have this barrier self-imposed or otherwise where it's like, well, we got to just teach them to use this device.
Whereas they might feel more successful if they were thinking about typical development and what children need to gain in order to have better success with the AAC device or book or whatever we're doing. So teaching intention, I can't even tell you how many times I've gotten reports from EI and school districts.
“This child has no intention, so we're not going to call in speech yet because they have no intention.” And I felt like well last time I checked, babies aren't born with [00:28:00] intention and it shaped through interaction and that's AAC like that is complex communication therapy, right? It's not an AAC device, but it's part of this little niche of our field of providing services to children who don't talk and don't have all of the precursor skills that we feel they need to have verbal communication that we expect.
So, yeah, I think that barrier of just having that blinder on really limits the programming, because then what you see is goals that are just like jumping canyons, right? A child has no intention, but they want them to use a big Mack to say, “ore”. Big Macks are great. The word “more” is great. However, there's probably about 800 skills that you also should be working on to help that child actually have a strong foundation to move to symbolic communication.
So on that note, I would say my first, my first strategy would be, um, recognizing the strengths in the child [00:29:00] and I, and I think it kind of not just the child, the child, the family, and the team. So starting with the child, I think recognizing strengths means focusing on goal setting and intervention strategies that really truly scaffold.
And don't just say, you're two. So you should be making sentences. So I'm going to give you a pecs book that says, I want goldfish, because you're two, and you shouldn't be making sentences. So rewinding and saying, okay, well, what do you do really well? Well, you're really intentional. You have great gestures.
But you only say “more” with your sign, right? So going from this to, I want goldfish, huge canyon leap and goal setting an introduction, but thinking about early childhood language development, we know, well, I really need to be building your single word vocabulary to a Brown stage one so that you have the building blocks that you need to make sentences and actually have that skill [00:30:00] stick.
Right? So I think recognizing strengths help us not say, well, this is what you can't do. So I need to teach you this. It says, this is what you can do. And this is the next step. So I'm going to teach that so that I can get you to what you can do. Um, okay. I'm seeing excitement. So I don't know if I should keep going or not.
[00:30:22] Kate Grandbois: I think, I think that this is a really wonderful and important lens to look through. It's critical for early intervention. It's also a really important piece of being a person centered therapist in terms of looking at, per individual strengths and choosing targets and writing goals that are empowering and appropriate.
Um, based on, you know, the individuals presentation, not because you just chose it because you think that's what they should do. And I think that that's a really important distinction and I'm really glad that you brought it up.[00:31:00]
[00:31:03] Amy Wonkka: I also feel like when you're note-, when you're learning about somebody's strengths, you're also learning about who they are and all of our clients are people and everybody's different. And we all, you know, even, even down to, you know, some clients really appear to enjoy like high affect and, you know,really exuberant interaction style. And for some folks that's just the worst. Right. So I think that that's gotta be a piece that, that kind of tags along with that, recognizing the strengths, you're also kind of figuring out a bit about who your client is as a person and that'll serve you well with all of your, you know, later therapy with that individual and their family.
[00:31:51] Tanna Neufeld: Absolutely. And I was just giving a training yesterday because I'm preparing to do some talks in the future [00:32:00] on the power of joy and learning in general, but really just the power of joy and learning AAC because we have children, right, who are complex communicators that don't have typical sources of joy.
And so. It saddens me sometimes, not just for the child, but for the professional. When I have a mentoring relationship with professionals where they're like, I've got this student and they just don't like anything. They don't like anything. And we know that that is not true. It is completely not true, but what a, what an overwhelming place to be as a professional when you got into this field and you know, how important joy is to children and learning, but you just can't tap into it.
So, yeah, I think you're right. Making sure you're looking at those strengths. What across all domains, right? Like what are their sensory strengths? Meaning what are their preferences, right? What are their motor strengths? What are their cognitive strengths, social strengths. Right. We have a lot of kids who have social strengths, but [00:33:00] don't seem to have a lot of other skills, like good vision or good motor, um, as part of getting to know them and knowing what brings them joy so that you can model the right words at the right time.
Um, so I've been encouraging my students and my families that I work with to really try to think beyond the traditional stuff that we think is supposed to bring joy. Right. Um, I was just doing a training yesterday where I challenged the audience to think about what core language could you model for a young one who likes to stick their head on the fan?
Right. Like blowing their hair in the wind and brings them joy. Like what could you target during this activity rather than just saying, that's not play, let's come over here and do that. They came up with like 50 words.
[00:33:46] Kate Grandbois: And I mean, who are we to say? What brings someone else joy? That's just the most, I don't know.
That's clinician centered, not person centered that has nothing to do with you. You are there to support the other person, [00:34:00] not make decisions for them. I mean, think about how we would receive that as individuals. I love reading science fiction and fantasy. It's my jam. If someone came along a teacher or I don't know, I was taking some sort of cooking class and they were like, that's not really okay.
I would, I would say forget you, I'm not speaking to you anymore. That's mean, why would we do that to children?
[00:34:22] Kate Grandbois: Sorry, maybe that was a weird personal soapbox to get on for a second. But I had to say it!
[00:34:27] Tanna Neufeld: Well, you're right. And I think to be clear, I personally don't believe we do this on purpose, but I think that one of the things I've learned about myself and I've learned about several other people that are SLPs, if I'm being gently honest is we tend to be a little controlling in our personalities.
Um, and when you. When you don't feel confident doing something, I think you tend to be even more so. Um, and so I think it's harder to truly follow a complex communicator's lead, right? A [00:35:00] child who likes to play with vacuums. It's really hard to figure out how to make that work. It's a lot easier to just teach them not to play with vacuums and to play with something else.
Right. So, you know, I think that we don't do it on purpose, but we do it. We all do it. Educators do it, everybody. I think OTs are the only ones who don't really do it, honestly, because I think OTs are like magical. I want to be an OT when I grow up, but you know, we do it and it's so crucial. So I'd say one of my strategies would be, and it wasn't even one I planned to share, but I think you're so right.
The joy in getting to know the clients still applies when you're teaching them hard things like AAC. Um, that means we can't make every AAC practice opportunity contrived and boring. How many goldfish can I ask for? Right before I'm just over it, right? That's not an interaction or an experience. That's a ritual and a behavior practice.
Right? So I think all this beautiful skill that a lot of our EDI providers bring to [00:36:00] naturalistic intervention for children who are not complex communicators, it's harder to translate to children who have complex bodies, visual impairments, sensory differences. And so bridging that gap, right, somehow by recognizing strengths, recognizing preference, and then figuring out how these skills can, can bridge that for these kids is, is a huge strategy. Um, it's an idea. I didn't really give you any actionables on it, but it's, it's, it's an approach that you can take.
[00:36:32] Kate Grandbois: I think it, it creates a lot of really important self-reflection too about, you know, how you approach and what your guiding principles are in therapy.
I think it's, it's, it's a, it's a covert actionable it's there. It's definitely there.
[00:36:47] Tanna Neufeld: It's there. You had to dig it out of the cracker Jack box there. Um, but yeah, I would also say, you know, it's really important in this setting to recognize strengths in everyone. So I think a lot of the [00:37:00] time what happens right, is, um, and I get this a lot in trainings where I'll ask people what they want to learn, SLPs educators and stuff in the room.
And I want to learn how I can get this classroom teacher to follow through and how can I get this parent to actually follow through. Right. And so I think we spend some time really focusing on what parents and teammates are not doing. Um, but maybe we could spend a little bit more time figuring out what the strengths are.
And so like at the beginning of a consultation for a young child's family, what I will do is observe what the parent's doing well. And the first piece of home program I give is to have them do more of it. Right? So it's like, you do this really well. I love how you give him choices. Your homework is to give him even more choices.
Right? So taking what they already do really well and building confidence through having them recognize how it's [00:38:00] helping, recognize how their child is showing them that it's helping them feel empowered. Right. Because so much of this AAC game is like all work, very little instant gratification. So you're asking a team to do really hard work.
With very little instant reward. I think it was David Beukelman who quoted in a book somewhere. I read that, um, AAC is like putting money in the bank, right? Like much of what we do is just investing, investing, investing, and our EI providers don't even get to see the benefits usually because the child goes on, right.
So thinking of money in the bank, money on bank, and then that return on investment, that's going to happen in the long game. Um, but it's helpful to help parents and teachers see, well, what does the little in return look like? Right. Helping them figure out what is it that happens in my child when I do this thing that I do well.
And then building on that with, with other skills that [00:39:00] are not as easy for them to do. Um, yeah. So, and then thinking also, in terms of strategies, I think supporting those challenges, um, I think a lot of the time it's, it's tempting to want to wait for things to develop. Like we talked about in the beginning of the call, but we have to consider how to set the learning environment up to support challenge areas in order to have any sort of foundation for language learning.
Um, and I just gave a talk yesterday to an EI center specifically on this. So no AAC device even considered, are we doing our best to support this child's ability to move around their environment? Right. Are we teaming enough to make sure they have some sort of mobility because mobility drives cognition.
So if we're waiting for cognition to come to the table so that we can get going with the AAC, we've gotta be doing something to help it along. And that means urging mobility, right? Give them a little ride on car advocate [00:40:00] for, you know, um, we used to use a wagon or use some other form of mobility in their day, or how are we adopting their play materials?
So I'll often support families and providers who have, um, bright children with really impacted bodies. And they've got their big macks out in there and they've got their iPad that they're playing with, but none of their toys have been adapted for them. They can't even reach them from where they're sitting and it isn't because they don't want to give the child toys they can play with.
I think they just don't think about it. Like how can I help you as a two year old, do what other two-year-olds do that, help them learn communication language and social skills. How do I help you draw? How do we help you paint? There's tons of beautiful adaptations that can be made to just set the stage for learning.
And I think that's a huge piece of what EI needs to do is really have that family understand. This is a lifelong differentiated [00:41:00] instruction job, where this child is going to need us to, to help them access their worlds so that they have something to talk about.
[00:41:08] Kate Grandbois: I love that you are considering and continuing to remind us how important some of these other aspects are.
I mean, they're important for our school aged kids and our high schoolers and our, even our adults, but it's, so it's so critical in these early years and to consider all of these other aspects of development and how they may be strengths, or there may be barriers there. It also makes me think of the importance of collaborative relationships because you're working so closely.
I think I'm going to go out on a limb here and say, you're working more closely in early intervention with these collaborators. Then you are in a school setting or in a hospital setting where you all have your separate rooms and you just like maybe live on the same hallway. You know? So I love the picture that you're painting of this multifaceted approach and, and how important it is.
Um, and I [00:42:00] wonder if you could tell us a little bit about what other things SLPs could do to sort of expand on that.
[00:42:07] Tanna Neufeld: Yeah, I love that EI teams have this built-in collaborative kind of approach. Right. And I I'm going to allude to the training I did yesterday because it was an EI training, but it was, you know, that's one of the things they bring to the table as this beautiful capacity to work with one another and not just do it on a lunch break, but actually like push in and jointly treat right in the home with everybody, with grandma, with uncle so-and-so, with the dog.
Um, so I think one of the things I would consider hugely important is to make that a habit, not an exception. So if you have a child with complex communication needs, you absolutely should be prioritizing joint treatment with a motor therapist and a vision therapist, at least on occasion once a month in your service delivery.
Um, it's only through partnering with them that we're truly treating the whole child in that moment. But also [00:43:00] what I learned is by pushing in or having others join my sessions, I learned so much about other stuff that I didn't get taught in school. Right. So I learned about vision and vision approaches.
I learned about OT stuff, sensory processing, and motor support. And so then I just became a more well-rounded therapist by being able to tap into the genius that was happening in front of me. Right. I also felt that I, that was an opportunity for me to share, um, what I thought could happen in that moment to promote communication.
And my PTs and OTs, were, were so grateful that I was there to not only tell them what I'd like them to do to help communication, but to actually show them how to do it. Um, so yeah, I would make that a priority pushing in and joining each other's sessions for sure. I also think that one of the demands placed on an EI provider, um, whether they like it or not is the need to learn about things outside of speech pathology.
Um, and [00:44:00] so I think that when you're serving complex communicators, it really behooves you to seek continuing education outside of just speech and language. Um, vision, motor, obviously sensory integration, um, even relationships and infant and toddler interaction, all of these things that are really going to help you be more well-rounded in solving these really complicated problems.
[00:44:25] Kate Grandbois: And just for the sake of plugging this, if you do see continuing education outside of speech pathology, it will still count towards your ASHA C’s. Because ASHA's definition is anything where you are the learner. You have proof that you attended the event and you have a certificate and it makes you a better speech pathologist will count and you can quote me it's on their website. So don't feel, I just want to second that, because it's so important and there are so many things that other fields have to offer that still make us better at our jobs. We are not disciplinary centers, centrism is real speech pathology doesn't know everything.
There [00:45:00] are lots of other wonderful resources out there. And so thank you for mentioning that.
[00:45:04] Tanna Neufeld: Yeah. And thank you for plugging the fact that it still counts because I know that's really important to a lot of us that it counts, and it's also can feel a little bit like stepping on toes to go into other realms.
But remember that, just getting knowledge to make you a more well-rounded therapist doesn't mean that you now become the fine motor expert. That's not a burden you need to carry, nor should you right? Um, I'm not an OT and I don't pretend to be one. Um, however, I do realize that this is a whole child with a whole brain, um, and I can't just treat one piece of it.
And, and I found in my practice just getting to know other aspects has really made me feel more empowered and confident, um, and really has helped me understand my clients so much better. Um, and I would also say another place to kind of address this collaboration piece. Um, is to really [00:46:00] make sure that you are involving the parent as a true member of the team.
So I think in EI, it's kind of assumed, well, yeah, it's, it's family centered, but there, there are family centered sessions and then there are family centered sessions. Um, and I think we recognize how this work is largely to be done by families. So I think that to set the stage for longer-term progress in, in success for families, you have to set that precedent at the beginning.
You have to go in,
[00:46:34] Kate Grandbois: I was going to say, and this brings us to a point you made earlier about how, you know, the early intervention provider doesn’t stay with the child for more than 18 months, two years, maximum three. So by really making the family and the caregivers and the parents an integral part of therapy, you are empowering them to be there for the child for their life.[00:47:00]
And that's so much more than we can do.
[00:47:03] Tanna Neufeld: Absolutely. And I think that that takes considering the long-term pie in the sky goal, for sure. But remembering that not all families are ready to bite off a full AAC device. It doesn't mean you can't follow a best practice and development and give them the right tools and multimodal system that they need.
Sometimes you've got to compromise what you think might be ideal because ultimately your job is to leave the legacy that this family is going to be able to carry into the next phase of that child's life.
[00:47:34] Amy Wonkka: And it's not ideal if it's not meaningful and doable and what works for the client and their family.
[00:47:40] Kate Grandbois: Also as the speech pathologist, it's not your job to decide things for people. It's your job to facilitate decisions that are in line with other people's values and perspectives. So I think, you know, taking that as a lens, and I think a lot of times AAC has this [00:48:00] connotation of an iPad and it's not, you know, so you think, oh, we need AAC.
So we have to go get this other thing. But you're talking about tiny young babies who are maybe going to be working on gestures or other, you know, conventional or unconventional. It doesn't necessarily, which is, you know, completely appropriate. It doesn't necessarily have to be this new app that you found that you think is going to be great.
And therefore you spend all of your intervention time convincing other people that you're right. And I feel like that that doesn't help anyone.
[00:48:37] Tanna Neufeld: Yeah. And I'd say, you know, at the end of the day, um, we need to provide exposure to the language. So the platform upon which we do that can really look differently depending on all the other variables pressing in on the situation.
Right. I would not hold back in providing technology just because it's a young child, obviously, but we have to realize that there's other things going on in this environment that may [00:49:00] prevent that and that there are other work arounds to help you provide robust language when you don't have an iPad at your disposal.
So, you know, obviously we don't have time to talk about all the strategies, but I think that the big part of EI really is tackling buy-in. How do I help the family and the child buy into this idea of communicating differently, right? And keeping demands, low, keeping naturalistic, joyful interactions paramount, and really that means modeling, modeling, modeling, modeling all day long.
However, we can, even with all my hands, which I do a lot with my kids. Right. And, and realizing that your job is, is to keep learning about this stuff. You're the first person, a lot of the times that these complex communicators meet, and I think you have a role to play, a huge role in setting a legacy for them.
Um, that doesn't mean you fix it, but you, you help their family see hope, you help them see a path. And you [00:50:00] give them hopefully a good foundation to enter into preschool and go on.
[00:50:04] Kate Grandbois: Can I ask you a question that I have to assume you get this, or you've dealt with this question a lot, either with your mentees or in your own practice, how to counsel a family who is extremely resistant to AAC of any kind, or do you have, you know, suggestions or, or strategies to, to get people on the same page, even if it's not anti AAC, but there are some other, um, conflict.
I'm only thinking that because you've, as we've described a lot of times in our complex communicators at a young age, there's a lot going on. So these families are emotionally continually processing. They have lots of people in their house. They have work schedules. They have, you know, they have lives as well.
So some of those communication skills can, they must be really important. What, what can you tell us about that.
[00:50:59] Tanna Neufeld: [00:51:00] Yeah, I think the first step that I take is trying to understand where the resistance comes from. So you described a couple of situations, right? Sometimes it comes from grief or fear, um, that this means you're giving up on my child's ability to speak.
Sometimes it comes from conflicting information from other providers. And like you said, the family is just trying their best to take all these conflicting opinions in mind and make these big decisions. So I think it really behooves you to take the time to develop a trusting relationship with the, with the family, um, and gradually start chipping away at this facade of, of, you know, rejection to the technology.
Um, I don't think dropping it ever works. Right. I think a lot of, um, clinicians get a little hesitant to have conversations when a family has expressed a dislike or, or a rejection of an idea. But, um, I think [00:52:00] that you can gently work with the family without trying to convince them or persuade them when you just take the time to try to understand why.
So just first of all, why is this happening? Uh, once you understand why I think a lot of solutions unfold that you can explore, um, but they're not always going to fix the problem. So I think, I think you really need to hear what families want for their child. Even if it isn't exactly what you want for their child, right.
And some families are perfectly capable and fine with their child communicating and using nonverbal communication right now. They just can't take in anything else. So I would take that strength in that goal, and I would just make it explode with positive outcome. Right. So if you, if this is the way you prefer let's work on partner assisted scanning, let's get your kids to be the best.
yes/noer on the face of the earth. Right. And all the while in your discharge at EI conference day, I'm going to put a handout in there [00:53:00] about an AAC device. Right. But I think that our job has really, we've got to help them reach their goals for their children.
[00:53:09] Kate Grandbois: That was so well said. I wonder if you could tell us a little bit more other strategies for helping a family who might feel very overwhelmed. So I don't know how to use the technology or, uh, how can I possibly model all day long or I'm supposed to do this, but we're have a wheelchair fitting. And I mean, in terms of, we've already discussed, how AAC gets a bit, could, has is at risk for being somewhat overlooked in the early intervention years.
How do you navigate that conversation about prioritizing exposure when you have a very complex child with a whole lot of people trying to do a whole lot of things at once, because you're right. We know how important those three years are. [00:54:00]
[00:54:01] Tanna Neufeld: What I've found through experience. Um, and I would say just to preface this, that aided language modeling is number one strategy.
If that's all you teach the family to do, I think you're doing a really standup job in the EI environment. And so if we throw all the other demands away and that's the skill we focus on, what I have found is the more confident the family gets at that skill, the more they will do it without you imposing arbitrary goals on it.
Um, so I would suggest going back to the other strategy that we talked about in meeting a family where they are in their strengths. It's the first place that I introduced the concept of modeling is when they're already having a successful interaction together. Because if we ask families to model during something that is already feeling hard, 9 times out of 10, it isn't going to feel successful to anyone, including the child.
Right? So if we take our example of the choice-making, which I think a lot of families feel really good about their ability to do [00:55:00] that, um, that may be a, an environment where I would say, great. So during this choice making, I want you to find one word on this page, usually the front page of the system. So they don't have to do a lot of digging.
One word that we can talk about during this routine either while they're making their choice or after they've made their choice. So trying to kind of expand it away from requesting, because what I see happen when we make it about requesting something is they think they're going in to model and it ends up just saying, what do you want?
And then they feel unsuccessful because the child's having a huge meltdown. Um, and everybody just cries and it's not fun. So I think, um, you know, understanding that starting with something that feels good, where everybody's happy and things are happening anyway, and then just adding one little step to.
You can slowly build a repertoire around that and then keeping them on the first page is sometimes helpful or going with really [00:56:00] powerful words that the child already loves like a personal core word or a core word, a general core that happens to be really versatile, even if it's deeper into the system can be a good place to start.
Um, and then I would go from there to say, um, each week I check in on how things are feeling. I keep everything very small. Um, so if that's the one skill we're working on and we don't come in next week and work on the new one, we build on the success right. Until I get the sense from the family they're coming to me and recording that something's going better without me asking, then I feel that they're ready to take more on.
Um, so that might just be let’s do more words, or it might be, let's now bridge into more interactions.
[00:56:46] Kate Grandbois: I wonder if in the 10 or so minutes that we have left, if you could tell us a little bit more about how, how a clinician can increase their scope of competence in this area, because we've already outlined [00:57:00] the many, many barriers that clinicians face in this realm and our strategies.
There are a lot of them. So I can imagine that this is, you know, and I'm so glad you guys are putting on a conference about this, because if there's, obviously, this is just the tip of the iceberg. And I wonder if you could, um, give us some additional resources or discuss other, other ways that clinicians could improve their scope.
[00:57:26] Tanna Neufeld: Yes, I can. So, um, the first thing I would suggest is getting a mentor, um, and that is likely not going to be somebody in your EI setting, or it might be. Um, but you, you need to have somebody that you can check in with. So, um, I think there's lots of places to connect with mentors. Um, I have an accessible, a directory that, uh, people have submitted their information because they are, um, specialists in AAC and are willing to connect with families and providers who want to learn more.[00:58:00]
ASHA has, um, their pro-find and pro-find can be a great place to go in and type in your state. Um, and look at people who specialize in the AAC. Uh self-proclaimed right. So, you know, buyer beware, you got to make sure not everybody has the skills to give you as a mentor, but you're going to shop around and you're going to find someone you click with, but super, super essential to have a mentor.
And then I think on top of that, um, as I said before, attending CE opportunities that are related specifically to other, um, domains, not speech-language pathology is really going to benefit you. So I would say things like seating and positioning, um, Closing the Gap has a bunch of conference sessions coming up on that.
Um, there's a conference locally here with Karen Kangas. I don't know if anybody in the room has ever been to the Karen Kangas training. She is. Um, it's actually virtual this year. It's the Northwest augmentative communication society conference. And Karen is [00:59:00] presenting, um, and just getting a better understanding of how the body impacts communication and learning can be a game changer for you in this EI realm.
So anything in seating and positioning, I would suggest anything on vision, soak up the vision, uh, Perkins School for the Blind has this branch called CVI Now. So good. So good. So good. And some of their stuff is free, even if it's not free. If you see any majority of, or any portion of your caseload of children who have neurological insult, they probably have cortical vision impairment, even if they don't have the diagnosis yet.
So just get in there and get educated on it. And I think, uh, Perkins School is a, is a really great place to do that. Um, I also think if you're working with children on the autism spectrum, which, who isn't right. Then it really serves you well, to get trained in things like DIR floor time or any relationship based intervention that feels like it matches your philosophy.
Um, just [01:00:00] learning how to support engagement and social interaction and respecting sensory accessibility is huge for working with little ones on the autism spectrum. What am I missing? Um, anything that helps you figure out how to play? Because I don't know about you guys, but we think we know how to play when we graduate.
We don't know how to play. We don't know if it makes me so tired.
[01:00:27] Kate Grandbois: I’m too old to play. Which is why I don't work in early intervention. I feel completely comfortable saying defend, just defending myself here for a second.
[01:00:33] Tanna Neufeld: Yeah. You know, Amy mentioned that idea of high affect earlier in our call. Right? And I, I learned this concept from an OT colleague when I got here to Seattle, she's, in OT, they call it therapeutic use of self.
Right. I don't know if you've ever heard that sounds real fancy. Um, but really it's using yourself as an extension of the play to entice and engage and provide joy to the child. [01:01:00] Um, and man, that goes a long way. When, when you think it's an attention issue, it's usually an engagement issue. Um, if they're not paying attention to you it is because something else is more interesting and as your problem, not their problem.
So, uh, anything that helps you learn how to play better, um, learn how to, um, think about play differently. Anything from Hannon on play totally worth reading. They have these books called Let's Rock Play. Um, and they talk about people, games and people, toys and
[01:01:35] Amy Wonkka: super accessible books too. They have like cute little cartoon drawings.
Like they're just a fun.
[01:01:41] Tanna Neufeld: You do. And they're great for parents because Hannon is just great for parents, right? But I think a lot of the times in EI, a huge struggle with complex communicators is figuring out how to help their family interact with them. It's hard to play and talk to a child with so much going on.
You don't get the natural [01:02:00] reward, right. That you get from interacting with a child who has more social strengths or more verbal strengths. So I think a lot of our work, even though it's not really AAC, right. It is, because they need to be able to have joy. Otherwise they're not going to have any time to model all the things you're asking them to model.
So yeah. Anything around play, social engagement, um, huge, huge importance. I don't think I left anything out.
[01:02:24] Kate Grandbois: Well, you, when you and I were talking before we started recording, you had also mentioned some, some literature. Um, and we will have, um, at least one of the references that you mentioned listed in the show notes and article by Light and McNaughton from 2015.
Um, I don't know if you want to talk a little bit specifically about that article, but I also wanted to make sure you mentioned, um, the research library that you have available on accessible.org for people?
[01:02:55] Tanna Neufeld: Yes, absolutely. So, um, because the Light and McNaughton article is like a [01:03:00] novel written for researchers and not practitioners.
I still, I still recommend that you read it because my philosophy on how to kind of approach improving our service delivery really is rooted in these gurus of the field, their perspective. So it is in the show notes. I really highly recommend you read it, but I wanted to really direct you also to, um, we have a section on our website called the stacks like library stack, um, and we have tons of stuff in there, but, um, what I'm really excited to keep building is a research collection.
And one branch of that research collection is specifically on early intervention with AAC. Um, and I think some of the prominent names in the field like Romsk and Sevcik, um, are noted quite a bit in that research collection. And they talk a lot about the importance of EI, uh, including AAC, but also how to approach the myths that are still very pervasive in that field.
Um, so check it out. You can see it on our website, accessible.org under the [01:04:00] resource tab, uh, stacks, um, lots of research in there and, um, anything that is by Romsk and Sevcik, I think is worth reading also anything by charity, Robin. It's worth reading in this field of early intervention, just to give yourself a framework for coaching assessment.
I could go on, but they're all in there. Just read them. We all have them.
[01:04:20] Kate Grandbois: This is a wealth of resources and we're so grateful in our last minute. Do you have any, any words of wisdom or closing remarks?
[01:04:33] Tanna Neufeld: So I would say,
[01:04:33] Kate Grandbois: that was a really good sigh. Just letting you know,
[01:04:37] Tanna Neufeld: Dear EI SLP, you are doing a good job.
You really are. Um, this is hard, hard work, some of the most rewarding work, but so, so hard and you're doing awesome. So be gentle on yourself, be patient on yourself, be patient with your families and your clients, um, and do your best to keep [01:05:00] learning, knowing that every kid you see, every complex communicators is going to teach you volumes.
Um, so that, that would be my, my word of wisdom to
[01:05:08] Kate Grandbois: That was wonderful thank you so much for sharing. This was so great. I mean, we've worked with you before on a variety of projects, but you are always just such a wealth of information and I love listening to you and we've learned so much from you. Thank you so much again for coming on and chatting with us today.
[01:05:27] Tanna Neufeld: Yeah. Thanks so much for having me.
[01:05:30] Kate Grandbois: And anybody who is listening, Tana is so accessible. You should find her on Instagram, send her a message, send her an email. If you're listening and you have questions, um, you are not only a wealth of information, but incredibly collaborative and supportive of other SLPs on their learning journey.
So don't hesitate. Um, and again, Tana, just thank you a million a million times.
[01:05:54] Tanna Neufeld: Thank you.