This is a transcript from our podcast episode published December 13th, 2021. The podcast episode is offered for .1 ASHA CEU (introductory level, professional 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: While our intro is very long. We're really glad that everybody listening, stuck, stuck with us because we're super excited for today.
And I have a little story to tell. You ready for some story time Amy?
Amy Wonkka: Yes, please.
So once upon a time, I worked with a lady who was a lovely lady. She was a fellow AAC person and she moved away and in her new state and her new job, she met someone who was another AAC person. And they, this woman that I worked with got us together.
It turns out it was Vicki Clark, who we have seen speak at conferences. Um, and we're so familiar with her work. Um, and so we got together over zoom and had a conversation and two and a half hours later, we decided that maybe we should collaborate and record a podcast episode. So here we are. After that long journey of friends introducing friends, Vicki, we are so excited to welcome you [00:03:00] today.
Welcome to the nerdcast.
[00:03:02] Vicki Clarke: Hi nerds. I'm glad to be here. I've been listening to you for a long time. And, um, I was really excited to get the chance to make that connection. I was a little freaked out, to be honest, when I was, I was telling this young lady that I worked with a sec, oh, I love this podcast. And I was telling her all about it.
And she was like, oh, I know those guys. And I'm like, what do you mean? You know, those guys? Right?
[00:03:23] Kate Grandbois: We’re nobody's, that's why we just sit here in a zoom room and have conversations with each other. But regardless, we're very, very excited. We're excited that she got us in touch.
[00:03:32] Vicki Clarke: Yeah, me too. Me too.
[00:03:34] Amy Wonkka: you're here to discuss AAC implementation in schools. And before we get started, can you tell listeners who haven't been going to your conference presentations and kind of following you around virtually a little bit about yourself
[00:03:47] Vicki Clarke: well, I am an AAC specialist, SLP AAC specialist. And, um, this year I hit my 30th year in the profession, which is, it makes me sound horrifically old, but anyway, [00:04:00] um,
[00:04:00] Kate Grandbois: Golf clap for those of you who can't hear.
[00:04:03] Vicki Clarke: Right? Right. So, um, I have a, I started my, my career in the schools. I worked for about five years, um, as a SLP. And then I was fortunate enough. I lived in Raleigh, North Carolina, and I was in a hotbed of AAC and literacy at the time and got hooked in to that part of the field. When I was in Raleigh and looking to do something different, I went and did an interview with a, um, a psychologist who had a clinic.
Right. I wanted to go get this job, um, as a speech pathologist. And I told him, I said, what I really want to do is I really want a job where I can work on working AAC. Like that's all I want to do. Just AAC. And he said, Vicky, that's admirable, but there's no way you're going to have a practice fully involved with AAC.
So now I have a practice, Dynamic Therapy Associates that's been in place since 1997. We have, um, 11 employees. We have six full-time [00:05:00] AAC, specialized speech pathologists. Um, in our clinic, we see patients, families in the clinic. And then in addition to that, we have DTA schools, which is our school-based program, where we support individual students.
So we go out, we do evaluations, um, and help kids get equipment and, uh, do programming customization. And then we also do training with, the entire team. So SLPs and teachers on AAC implementation. So that's about it. I do a lot of other stuff too. I consult and train and speak and stuff too, but, um, I'm kind of dabble in everything AAC.
[00:05:42] Kate Grandbois: That's awesome. We're very excited because as, um, many of our audience members know Amy and I are also employed as quote AAC specialists. And we put that in quotes. I think every time we say it, because it is the job, it's our job title, but it's not really a real [00:06:00] certification. It's not really a real thing.
So as to people who are trained in AAC and do nothing but work in AAC all day long, we're very excited for this conversation and to not to overuse the term, but you know, nerd out with you and stuff, it's going to be super fun. Um, so before we jump into, um, the meat of the episode, if you will. Um, we are, and you know, before we really sort of unpack the AAC implementation in schools, component of this, I'm going to read our learning objectives and financial and non-financial disclosures.
Some people, sometimes people write in and ask us to skip this part. I can't skip it. ASHA makes me read it. We'll try to get through it as quickly as possible. So hang in there
[00:06:40] Vicki Clarke:
[00:06:41] Kate Grandbois: Learning objective number one, listeners will be able to identify the two primary categories of barriers to AAC implementation in schools as defined by Buechel men and Miranda's participation model. Learning objective number two listeners will be able to identify three specific barriers faced in their setting. And learning objective number three, listeners will be able to identify three [00:07:00] solutions to explore, to address barriers present in their setting, financial and nonfinancial disclosures, Vicky Clark's financial disclosures. Vicki is a co-owner of dynamic therapy, associates and DTA schools. She's also the owner of AAC chicks at teachers pay teachers except she's an exceptional education leader and is a paid speaker at state and national.
Vicky Clarks non-financial disclosures. Vicky has a nonfinancial. Vicky has a nonfinancial working relationship with SGD manufacturers, AAC, app developers, and materials and materials developers for students with special needs, including news2you, Tobii Dynavox, PRC-Saltillo control, Bionics Forbes rehab services.
AbleNet iTech and Avaaz Vicky consults pro bono for various speech generating device manufacturers, app developers, including educational AAC and speech pathology related. You might win the prize Vicki for a long disclosure. I'm just saying. Kate that's me. My financial disclosure is I'm the owner and founder of groundwater therapy and consulting LLC, and co-founder of [00:08:00] 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.
[00:08:17] Amy Wonkka: Amy that's me. My financial disclosures are that I'm an employee of a public school system and co-founder of SLP nerd cast. And my non-financial disclosures that I am a member of ASHA, SIG 12, and I serve on the AAC advisory group for Massachusetts advocates for children. All right. Now onto the good stuff.
Vickie, why don't you tell us a little bit about kind of how this, how this talk came to be? Kate gave us the nice backstory, but how we all connected. Um, why, why barriers? Why is this an important thing for us to talk about or think about?
[00:08:50] Vicki Clarke: Well, I think that, you know, when I first, when I was working, I worked in my clinic for a number of years, and then I started getting involved in the school districts.
They called me [00:09:00] because they wanted to get equipment funded. Literally. They said they saw, okay, we can, we could get these, you know, 5,000, $10,000 devices funded and we don't have to pay for it. So they called me because we're pretty good at that in our clinic. And I would go out and do evaluations and then we would get the devices.
They would magically appear, hand them over to the families in the schools. And then that was it. That's all they want. And not because we thought that was the best thing to do, but that's what the school was willing to pay for. And after a couple of years of this, the schools came back and they're like, Hey, this isn't working right.
Thanks for the device, but it's not really working. And we, and which opened the door really nicely for us to go. And there's more to this, right? We need to be, um, planning, implementation. We need to be training the teams. We need to create an environment that supports the student using their system. Um, and I, so I started really doing more of this, kind of wraparound services, right? So we [00:10:00] support, we felt, I feel like that there's two, two things that I have to do in the schools. I have to support an individual student. Um, and then I have to support the actual staff members, the teachers, the SLPs, the administrators, right. It's tough to do both of those, both of those things.
Um, and when I began this process, I actually had a conversation with a, um, a gentleman who used to do this job at the state level in Georgia. And, you know, we were talking, we met at a conference and he said, so, so what are you up to? And I told him, you know, I'm all excited. I'm getting ready to do more of this work in the schools and all that.
And he laughed in my face, like laughed at me. And he was like, good luck with that. And I thought, oh my gosh, he's crazy. Cause this is going to be super easy. Right. Okay. So it's not, right. And anybody that's listening to this, that's working in schools or in humans working in AAC in general, who's trying to do a good job implementing, making it work, knows what I'm talking about.
Right. It's [00:11:00] not the easiest thing to do. And so, you know, I start looking at, you know, when things don't work, I want to find the solutions. Right. I start looking for what are the, um, the ways to solve the problem because I don't give up very easily, you know? So here's a problem. I'm like, this definitely can be solved.
Right. Um, but it turns out, you know, I didn't create this concept of barriers to communication. And I don't know, maybe, maybe I think about this a lot, because early on I was influenced, um, I was really fortunate in my first year as a therapist to, um, to get to go see Pat Miranda talk, which was amazing.
Right. And, um, she blew my mind, but she talked about, um, her participation model. The participation model said basically that the way we judge success in AAC is how much the person's participating, able to participate in their environment and [00:12:00] that she and, um, David Bucholman identified two main barriers to communication success in AAC.
Right? The first was access barriers. And, um, the second one is, um, opportunity barriers. So. Looking at that. It really, it really match, and this is a long answer to a short question. I'm sorry.
Kate Grandbois: No, no, no. I love it.
Vicki Clarke: So it matches my ideas about, um, that we need to address both the individual students. So that's those access things like, how are they they're they're struggling to speak, right.
So is it due to a, um, cognitive challenge, a learning challenge? Is it due to language impairment? Is it due to, um, um, a motor impairment? Right. Um, so that's kind of our access, right? Opportunity barriers are, what do you, what happens when you take that child and you put them into a classroom that has maybe staff that doesn't know how to support them in communication, that doesn't know strategies, right.
[00:13:00] That, um, maybe doesn't give them the materials that they need to communicate. So, or an administration that doesn't pay for devices, you know, Or doesn't, um, doesn't feel like that they need to, um, give the teachers in the self-contained classroom access to a smart board where we can put communication programs.
Right. So all of those things come together to cause challenges with our students, um, gaining AAC, gaining skills and communication. Um, and I think that, so that, that's why I kind of bumped back into it because we can't do anything. If we don't address those barriers, we can not be successful. So
[00:13:41] Kate Grandbois: I love that you've thinking of it through that lens because you're sort of backing into the problem, right?
So instead of having the focus be on the AAC user, oh, I need to teach you this. I need to teach you this. I need to teach you this. You're really looking at the, the whole, the whole environment, all of the aspects that have [00:14:00] a role in communication. I love that approach
[00:14:02] Vicki Clarke: Right. Not my approach, obviously, but you know, that's why I followed around pat Miranda for a long time.
Like I think that, I think that this concept was brilliant, you know? And I think we make this mistake all the time with students who use AAC is that we put so much of our focus on the child or the individual, right. Adults too. Right. I just deal with children a lot, but, um, we put all the focus there and the problem, there's a big problem with that.
When it doesn't work, what happens is people say, well, this child is in special education. And they struggle with learning. And so the reason that they're not successful is that they do not have the quote unquote capacity to use the system. And then that's the end of it. Like, sorry, that's the deal. You know, and [00:15:00] really what I will say is that when I look at problems with getting AAC implemented in all environments, and it's not just in the schools, but in homes too, the issue, and I'm just going to totally make up a percentage here.
But the issue in my mind is about 15% related to the student and about 85% related to the environment around the student. So. I've been trying to solve that problem for a long time.
[00:15:26] Amy Wonkka: And this, this construct works so well for thinking about those, those problems. And you can't really identify solutions until you identify the problems.
And so if you're trying to find all of these solutions that are centered on the communicator, and you're not zooming back, I mean, we talk on here all the time about the SETT framework from Dr. Zabala, which is such a contribution to the field and completely has changed my practice.
So this really makes me think about the SETT framework, which is just an invaluable tool from Dr. Zabala, [00:16:00] um, that looks at all of these factors, looks at the environment, looks at, you know, the communication tasks and recognizes those as is true variables that you need to be cognizant of and plan around as a clinician.
[00:16:13] Vicki Clarke: Right. Uh, you know, Amy w when I, um, I first learned about the SETT framework, um, I I'm. I, I was, I think I really, it really stuck with me because that's exactly what it does. It says, you know, and I think like, I think that, um, that, um, Joy Zabala was just really a visionary, right? She was able to kind of look at this and go, Hey, guess what?
It's not, it's not just about this piece of equipment. Like I'm saying, it's not just about this kiddo, this, the student it's it's, it's about more than that. Right? So the SETT framework for those of you who maybe haven't used, although so many people have heard of it, but if you haven't go look it up, it's S E T T framework go look that up, Google search it, you'll find all the information about it, but it stands for, um, student [00:17:00] task.
I mean, I'm sorry, student environment, task and tool. And what it asks to do is look at the student. We look at the student first, when we're trying to decide what kind of assistive technology would help them. We look at the student's strengths first, right? We look at the environment around them, meaning their whole context of the people around them, in the family, the school team, the context, the, the classroom, the home.
Um, and we consider the things in that, in those situations with, um, in those contexts that, that help the student and the things that are challenging. Right. And then we look at the tasks, that's the first T that the student has to, um, accomplish. And then for our purposes, um, the communication task, what do they have to be able to do?
Do you have to greet people or they have to be able to ask for things that they want, or they have to be able to offer their opinion. Right. And then finally, once we look at all of that, then we pick out the piece of equipment. And I think so much, like when you look [00:18:00] at, you know, you listen to people talk about, about AAC.
They, they go first to the child. And they look at all the child's challenges. And then the second step, the second stop is at which, which app is the perfect app for this particular status.
Kate Grandbois: That is absolutely what happens.
Vicki Clarke: And it should be totally the opposite of that. We have to look at the student. Absolutely. But not just their, their, their challenges.
Right. We're looking at their strengths. And then, then we go at environment tasks. And finally, after we've done all of that stuff, finally, we get to what is the tool that will help in this circumstance with this child accomplish these tasks. Right. Um, and I think we, we have to like constantly go back to that.
And it's funny when I do, when I do set, set. Meetings, I guess, with our teams. And when I do those, you would not believe how often I have to pull people back, like, like throw the rope around them and yank them [00:19:00] back away from the discussion about the tools. Right. And get them back to the discussion around the environment and the tasks and the demands on the student.
[00:19:09] Kate Grandbois: One of the things that, I mean, I know where this episode is not, excuse me completely about the set framework, but one of the things that I learned from, from Amy, let's be honest. And the set framework is, um, related to the role of the communication partners in that environment. Um, and I think that's, you know, very directly related to this, these concepts of the participation model that you were, that you were talking about.
Um, and again, you can Google the SETT framework. Um, Joy Zabala also has a website that's full of information and we'll list everything in the show notes for anyone who wants to go find more, um, in case you're driving and you can't Google something, don't worry. We'll write it down for you.
It'll be there. Um, I wonder if you could hop back if we could hop back for a second, at some point [00:20:00] in, earlier in the episode, you mentioned the term wraparound services. And I wonder if you could elaborate on that a little bit in terms of like, what are you wrapping the, who are you supporting? Nobody can see me.
I'm making this ridiculous circle gesture with my hands. Like, what is the, what is, what are you supporting when you're talking about wrapping around serving wraparound services?
[00:20:22] Vicki Clarke: Okay. So that term is something that as, as I, you know, when I started working in the schools, um, like I said, I originally really thought I was just working with this child.
I was just evaluating this child and finding the perfect solution for their, you know, their communication challenges. And, um, so it was me and the child. And then I realized, okay, I need to get the family, obviously the family involved. Right. So that's another, another personal, kind of, to work with me, with the child.
And then we, then I thought, well, that's great, but they're in the classroom 30 hours a week. So we got to get the teacher involved. So now we have me, the [00:21:00] teacher and the family, and then, oh, by the way, the parapro is the paraprofessional is also teaching. So now we gotta have me, the teacher, the family, and the paraprofessional.
Oh. And the kid, the child is also surrounded by their peers. So now we have to have me, the teacher, the parapro, um, and the peers. Oh. And then there's an SLP that shows up a couple of times a week. Right. So it's me, the teacher of the family, the SLP and the peers. Right. And then all of us are plopped in the middle of this context of the school, where everything that we do is in somehow, somehow managed by the administration.
Right. We have that. And all of the things that go along with the administration, you know, what they do and don't do to help, to, to help support us. Right? So we have to have all of these people and this environment kind of surrounding the student to help them. But the problem is when, when you have all of these people in this environment surrounding the student with all, with good intentions to help them, but you have a lot of the [00:22:00] people around the student who don't have the knowledge or the skills or the attitude that is necessary in order to make this work.
We don't, we have kind of, we have, we have little holes in our dam, right. That's helping this kid. Right. So I think. What we do. So our services in the schools it's called DTA. We call our services, DTA schools. And so I started developing these little supports within the content, within DTA schools. Right. So it was me, the AAC specialist who came out and did the evaluation.
Um, then I started training the teachers. Um, then I started training the SLPs. So we started training the supports around the student, right then. The administration kind of caught wind of what was going on. Of course they were paying for it in the first place. So they were a little bit aware, but, but you know, sometimes administration, you, you, you tell them what you're doing and they they're, it all sounds good.
And they're like, okay here, fine. We'll pay you. And then they kind of check out, well, I was lucky in, [00:23:00] um, most of my school districts to have administrators that really actually wanted the information and wanted to participate. So I started training the, the, the lead teachers, you know, so in some, one of my districts, I have an amazing lead SLP.
I have a lead, um, intellectual disabilities teacher, lead autism teacher and assistive technology specialist, um, OTs and vision, um, vision and hearing, um, professionals who all work together. So we train, train those lead teachers as well. So now, now our little, our little circle around the student where we're filling in.
Those tolls are in, in our little circle. Right. Um, and then recently we just started last year providing contracted speech therapy services to the schools. And what I'm doing is I don't, I don't want to be like a placement service. You know, I don't want to be one of those people that you call when you need an SLP.
And I just slapped my, my most recent graduate into your, into your position. Um, I [00:24:00] wanted to be able to provide SLPs, who I trained, who I supported, who I gave materials and equipment to, to go into the setting. So we've actually had now, um, we now have two, just two, um, AAC SLPs that are, are filling, um, positions in, uh, two of our school districts, um, as just the regular SLP on site, which is the coolest thing.
So now I have, I feel like I have everybody involved. Um, and the piece that we're really trying to do better at this year is really getting more involvement from the families. That's the tricky part in the schools I think.
[00:24:36] Kate Grandbois: Uh, you said so many things I want to touch on Amy. When I can see you're raising your hand to you.
Go ahead.
Amy Wonkka: Are you sure?
[00:24:46] Kate Grandbois: Yeah. Go for it. Go off on the whole thing.
Like the long grocery store line, where you're like, I got so much stuff in my cart and you let someone go in front of you
Amy Wonkka: just get a quarter pound of cheese.
Kate Grandbois: Exactly.
[00:24:56] Amy Wonkka: SoI had a couple of thoughts too. I think number one, and somebody that Kate will [00:25:00] talk about is the need for indirect services in schools.
So I'll let you save that. I'll let you save that. Get it all.
[00:25:06] Kate Grandbois: Hold it. No, go ahead.
[00:25:11] Amy Wonkka: No, whatI, what I was hoping you would talk a little bit about is, I've seen you speak, um, recently through an asynchronous conference presentation, and you talked a little bit about having, helping people who are stakeholders to have realistic expectations about outcomes and about the kind of effort and changes needed.
Th that people need to implement the work that people need to put into expect those outcomes. And it, as you were talking about the training, it just made me think, I would love you to speak a little bit about that because I think sometimes we hear training and we think just procedural training, we think just that we're training people.
This is how you do aided language stimulation. And this is how you program the kid's device. Um, but I'd imagine you also do some pieces around, like, everybody's got an important [00:26:00] role to play here. I don't know if you could talk about that a little.
[00:26:02] Vicki Clarke: Absolutely. Absolutely. So I think so if we, if we go back to Beukelman and Miranda's participation model, um, we're talking about, I think we're talking about, um, um, changing people's attitudes, right.
About what AAC means and what AAC will do for them. Right. And it is, this is not just a school district thing at all. We have to do this with our families, too. People call us, we used to have this running joke in our office. People will call and, um, you know, we were in Georgia. I don't know if you can hear the accent, but, um, we're in Georgia.
So I had this woman call one time and she goes, I need one of those Dinah boxes for my kid. And I'm like, okay, let's back up a little bit. We could help you potentially with one of the Dyna boxes, but, um, but let's actually look at what, you know, what's going on with your child and why, why, you know, obviously you feel like that they need some [00:27:00] supports and all that, but you know, I think people look for the bandaid, right?
They look for, um, the, the, you know, the, the tool that we're going to slap on the, on the problem and it's gonna, it's gonna miraculously be solved. Um, and everyone who is not involved in the AAC field, I think feels that way, right. Teachers feel that way, SLPs feel that way that aren't working in AAC. A lot families feel that way.
Right. Um, administrators feel that way. That's what people were hiring me to get devices for people. Right. And it's just utterly not true. Right? So we have to do a lot of, um, um, we have to do a lot of expectation setting at the beginning. When people come, people call us and come into the office. We start right there.
We used to do, um, we used to do single shot A, we call them single shot, AAC evaluations. And I know a lot of people still do that. Right. Where the, [00:28:00] the child comes to you or the, the adult comes to you. And, um, we do an evaluation. We decide what is going to be the perfect fit for them in two hours because we know them so well.
Right. And then, and then we buy the equipment and then hand it to them. Now I've never just shipped the device to people, but I know people that do that too. They do the evaluation and then the device met miraculously gets funded and appears on the family's doorstep. Craziness. I mean like, and
[00:28:29] Kate Grandbois: we're making very angry faces for people,
[00:28:32] Vicki Clarke: but here's the thing. Some of the people that I know that do that they do it not because they know, they think it's right, they do it because their setting will not allow them, does not fund them to do more than just that. Right.
[00:28:52] Kate Grandbois: This is what I was going to say. You've teed me up beautifully here.
Vicki Clarke: You're welcome. I'm here for you.
Teamwork makes the dream work guys. So this is, this is where I was going to go with the indirect service. Grumpiness [00:29:00] is that indirect service. It has a place across the continuum of our entire field, no matter what population you're working with, no matter what age you're working with. And I, I have evidence for that across the board.
However, when you were talking about prescribing equipment and you are talking about a service delivery, that is, as you so beautifully described, wrapped around a student that where the success is defined by the environmental changes as much as if not more than the student or client changes, how are you possibly going to do that without funding for indirect service?
And if you're in a school, you might have a little bit more flexibility with being able to put indirect service on your grid, but you might not have, you might have a caseload of 115 with no time to really communicate with the family about what's happening outside of your school setting. Conversely, if you're in a hospital setting, which is where Amy and I met, you're in an [00:30:00] outplacement, in an outpatient setting, or you're like me, and you're technically in private practice and your funding is insurance.
That's not even a choice. There is not even a choice for that. So that is in terms of like in terms of identi-, I am looking at our second learning objective in terms of identifying barriers in your setting, the lack of funding for indirect service is a massive, massive barrier, depending on your setting, to be able to do the kind of intervention that you're talking about and do it sic- And so that this, your client, student patient has success,
[00:30:32] Vicki Clarke: absolutely creating
[00:30:34] Amy Wonkka: we need to have advocacy in our field around this, we really do
[00:30:37] Vicki Clarke: every time we do this, now we do, and we need little signs to, to March around with, right. Um, I'll tell you,
Kate Grandbois: I want to make a t-shirt that's what I’m going to do , that's what we're going to wear a t-shirt to link in the show notes
Vicki Clarke:now. I mean, you know, but talking about, so I think like, thinking about this, this, so this is a. [00:31:00] Policy and practice problem. Right. Which are also by the way, goes back to the participation model with Beukelman and Miranda because they talk about policy barrier, part of access up access. I mean, I'm sorry.
Opportunity barriers include policy barriers and practice barriers, right? So when you have an ed at administrative level, you have someone saying, um, this piece, this indirect service, this consultation and training is not really a real service, right? Not right. Not
[00:31:34] Amy Wonkka: a billable code. It's
[00:31:35] Vicki Clarke: not, there's no code for, right.
Exactly. And I'll tell you, when you have it at an administrative level, nationally, you have leaders in national organizations saying things like. SGD modification. So device communication device modification is a lesser service than speech language therapy, and therefore should [00:32:00] be charged less true. Yes.
[00:32:04] Kate Grandbois: I’m becoming enraged, as you are speaking, I did not know that.
[00:32:08] Vicki Clarke: So, so that was there, there was an issue around that with how so in, in the AAC world. And this is kind of, I'm kind of going off into a, a little rabbit hole here, but, um, in terms of AAC services, there was a question there are two codes that, that we predominantly use in AAC world.
Um, and so th this is skews us school people, excuse us for just a second. Okay. But we're sliding over into billing insurance. All right. Um, there's two codes that we use, uh, a speech language therapy code and the speech generating device modification and customization or modification and training code. And there's been a lot of discussion about whether you could do use that SGD speed sharing device modification code for customization and training.
Right. And, um, when this, we, we first started asking about this many [00:33:00] years ago, we were told that at that, um, our large organization. It's said that it was, it might be considered a lesser service. So, and you know, in my mind, one of the primary services that we provide for people is we individualize, customize their communication system, which is imperative for them to be able to use it.
Well, you cannot buy something off the shelf and slap it in front of a kid and say, here, use this, right. It has to have their favorite stuff in it. You know, it's got to have SpongeBob, it's got to have puppy pals or whatever. Right. I'm so old. I don't even know the cool things anymore. Right. But it's got to have those things in it, whatever.
I don't know. Paw patrol there. I don't know
[00:33:42] Kate Grandbois: what, I don't know what any of these things are. I just thought
[00:33:45] Vicki Clarke: my kids are older than you. I mean, my Barney is my era. Okay.
[00:33:51] Kate Grandbois: Sesame street, Sesame street.
[00:33:55] Vicki Clarke: Yeah, no, you're, you're not cool either.
[00:33:59] Kate Grandbois: [00:34:00] Sorry, I'm just going to stay quiet over here, it’s fine.
[00:34:01] Vicki Clarke: If those findings aren't there, it matters for whether the child is going to accept the piece of equipment.
Right. That matters. So if we say it's a lesser service and it's not paid for. Okay. So there's that rabbit hole. So pulling back from that rabbit hole, back off into the school land, right? We still have those policies or those policies in place that say, okay, on the IEP, when it says speech language therapy services, you must be in the classroom in front of the student to provide those services.
When we all know a lot of times what we really need to do, and probably more than that is we need to be sitting in the corner with the parapro, helping them understand how to use the device or behind the parapro, coaching them while they're using the, working with the student. And so we have that expectation that our, what happens is we go into their classrooms and I know Amy's like chomping at the bit.
I'm watching her. Right. I'm keeping on talking just to see how long she'll not interrupt me. Right.
So true. Right? It's [00:35:00] look, she still hasn’t spoken, but now I have her dad. That's fine. Um, but you know, you go, I think the teach the teachers now, a lot of teachers fully expect that if you don't pull the, go in as a speech therapist and grab the student, take them away to your magic therapy room, wave your wand and sprinkle your fairy dust and fix them and bring them back, it's not speech therapy services. So we have a lot of education to do, um, to help people understand what that is. Right. Go Amy. I know you've got to say it.
[00:35:29] Amy Wonkka: Well, obviously I agree based on my face, but people can't see, but just picture an enthusiastic agreement. Um, I would say too, I know you've said, you know, the school-based people, the billing and the coding piece doesn't really apply to you, but it does.
It applies to all of us because in a field where we are allied health providers, All of all of those administrative and policy decisions in Medicare, Medicaid trickle down and influence our ability to practice in whatever setting. So even though a school [00:36:00] environment is not the same thing as you know, a hospital environment, our practices are influenced.
I, I really have big feelings about this. I do think it's something that we should advocate for because it's a way to advocate for our clients because what our clients need is exactly the wraparound service that you're talking about and that you're describing. And if we don't make broader change as a field to shift the value and the perceived value of those essential services.
Then we're going to be stuck in a place like we are. And in some places we'll be able to do this amazing wraparound service that you're describing, but there will be so many places that aren't able and just
[00:36:41] Kate Grandbois: guys I'm having, I feel like I want to say something, but I shouldn't say it, but I'm going to say it a little bit and then I'm not going to say anymore.
And I hope nobody gets frustrated with me. Do you know what this is making me think of? Guess who has codes for indirect service and billing.
[00:36:59] Kate Grandbois: [00:37:00]ABA, this whole issue of encroachment is extremely related to policy barriers, because there are other professionals who we share a scope of practice with, like it or not, who may or may not have the content knowledge and the competency to do this, but they are given a significantly different model to operate in to support students with communication disorders like it or not. So this is a legitimate, this issue of not having indirect service touches our field in so many places. And for individuals with complex communication needs, who are minimally speaking or non-speaking, and our AAC users are impacted tenfold by this issue.
That's my opinion. And then I will not, I will say nothing else and I hope
[00:37:48] Vicki Clarke: I'm going to second, that opinion wholeheartedly
Amy Wonkka: third, really.
[00:37:54] Kate Grandbois: Because I'm having some insecure feelings about it. Somebody driving in their car, listening to this, getting enraged, we're going to [00:38:00] try and do something about it. You can't fix it unless we know the problem.
Let's start there, the barriers so that we can try and move forward with some positive solution.
[00:38:09] Vicki Clarke: Exactly. And so there's barriers, there's big, big barriers, right. At a big, broad national level, right then that we need to talk about. And so talking about it, I think is a really good thing, and this is a good place, you know, a good place to continue the discussion.
Cause I know other people are having this conversation as well. Um, so anyway, policy barrier, right? So what do we do now? That's another thing I think, you know, we said, we're going to talk about solutions and not just barriers. So what do you do about this? Like that's a big barrier, right? So that's something that I think, uh, talking about it at this level is good.
And continuing to talk about it on a national level at conferences is a really, really, really good thing. Right? I think we need to continue to have that conversation and make sure that we,who are in the field or educating the people that are making policy decisions, for sure. Right. I'm now pulling it into a school in this school environment.[00:39:00]
Truthfully, our SLPs down here in Georgia, bill Medicaid. So it is actually an issue for our schools are our SLPs in the schools here too. Right. So that is a part of it as well. Um, I do think too, for us, with DTA schools, I think one of the things that we do, um, is we come in and we say the things that, um, maybe the SLPs have been saying, but they need a little backup.
Right. It's hard to be, you know, you can't be a visionary in your own backyard. Right. We know that, right. That's why I drive 50 miles away. And then I'm the expert, right? You're right.
Kate Grandbois: I love that expression. That was amazing.
Vicki Clarke:The further away I am, the more expertise I gather. Right. So, um, I think, you know, I think that, that it does help the SLPs that the SLP that's in the, in the school environment to have this other person coming from.
An hour away, come in and say, actually, you know what her job really is, is to be training of the pair of professionals. But, you know, I told you before, I'd had some really good, um, I'd had some success really [00:40:00] working with the, um, the administrative, the leads, right? The lead SLP, the lead OTs, the lead the AT specialist.
That's been really, really great because those people set policies, right. So if by working with them and kind of helping them to see the vision that, that I have about what the, what wraparound AAC services is explaining that to them. I've I have had so much positive response. I've never actually had anybody that was a lead SLP or, uh, in a, in a lead instructional role ever go, oh, you know, that really that's the stupidest thing I've ever heard.
I've never had anybody respond to me negatively. Everybody has been very, very positive once we talk about it. So I think there's one of the solutions is go to these people and work with administrators to get them to understand why we're doing what we're doing\. Right. Um, so, you know, I think that that's one, one solution because those people will carry it on.
Even when you're gone, when you've left that school and you've gone to another school, the [00:41:00] people that are still there they'll carry on what you started. So that's that's, that is something that's really positive to do. So anyway, we had these, meetings, You know, we, you know, we do think, we talk about things, like find your why, right? What is the why behind what we're doing. Right. And we talk about, about people's rights to communication and, um, and how communication impacts everything that they do in academics and have those conversations with teachers.
Because that really helps. Cause I think when teachers have curriculums that they have to follow, so they have to follow the math curriculum and social studies, curriculum and science curriculum. They have all these standards that, that they have to follow and they have English language arts, which by the way, is where communication fits on those ELA standards.
Right. Um, I think that, um, there are, they have programs that they can use. They have curriculums that they can use to teach social studies and science and math, and it offers legitimacy to that instruction. And you go, go find yourself a communication [00:42:00] curriculum. Go ahead, go find that. Okay. So I can't, I have not been able to find that, right.
So of course, because it's a problem, I had to go find that solution. And so that's what we've been doing. That's what's been going on at DTA schools for numerous years, as we've been trying to build something that gives us a, a scope and sequence of communication instruction. Um, so on part of our DTA schools, trainings, and our website, we have, um, we have tools to assess a child's communication in the classroom.
In a context of the classroom setting. We have checklists for teachers to look at their communication supports in their classroom. So they're the materials that they have and the training that they have and the, the, um, the, um, supports that they're sending home with the children, to their families, the equipment that the students have, their big smart boards.
We have a list of all of these possible [00:43:00] supports that you can add into your classroom to make your classroom really focused on communication, uh, so that they can now have for themselves some sort of rubric of what makes a good communication classroom. So. Go ahead. I saw Amy pause. She looked like she had something to say.
[00:43:20] Amy Wonkka: It was just, it was making me think. So we've talked about policy barriers, right? Policy barriers are a type of barrier. And I feel like now what you're talking about are sort of invited potential environmental barriers and the possible solution to sort of shift toward a UDL type model and UDL being universal design for learning and just making everything more accessible for everybody.
[00:43:44] Vicki Clarke: Right.
[00:43:48] Amy Wonkka: So policy environmental, I'm feeling good about like right.
[00:43:51] Vicki Clarke: Attitude barriers, for sure. That's
[00:43:56] Kate Grandbois: I have a lot of experience with that one. I have, I have found that [00:44:00] sometimes that is the one that is most resistant because what we do as clinicians I see often is we try to teach, we try to over teach.
We try to give information and there is a component of counseling involved in meeting a learner where they are and getting buy-in and changing someone's attitude. I mean, think about how difficult that is. If they have strong feelings about maybe it's their child and they have, you know, very strong feelings because they're a parent and this is really going to have a big impact on, on their daily existence.
Or maybe they have strong feelings because they think that they know better than you and they have different ideas about this is the wrong device and there's an ego component. So when you start talking about solutions to attitude, barriers that for, for me personally in my practice has been. Something that it's taken a lot of professional growth because I have to check my ego at the door.
I had to [00:45:00] embrace more of a counseling strategy. I have to make myself a positive reinforcing presence to get my foot in the door so that I can then slowly educate someone at the rate that they are comfortable with. I think as a younger clinician, I would walk into that, into that interaction and say, well, you're wrong.
And this is why this is why. And this is why, this is why this is why. And that still might be true, but it doesn't matter because you're just talking to a wall. If you don't have someone. Open and willing to learn based on, on where they are. I'm sorry. I just want to find them a whole tangent. I'm not even sure if anybody agrees with that. I could be alone.
[00:45:33] Vicki Clarke: I'm so glad you said that because it really real, it just like queues up the whole conversation about, um, people's teachers, special education teachers, thoughts about AAC implementation in their classroom, which is what I've recently been reading a lot about. Um, I mean, I'm so glad you brought this up cause I was going to totally forget to talk about it.
But, um, so I read, uh, I do, I read, um, [00:46:00] a lot about AAC implementation and listened to a lot about AAC implementation, but I recently pulled out Gloria Soto's, um, article from 1997, she wrote an article. I think it was actually her doctoral project. I'm not sure about that, but anyway, and what they did is they did, they did a survey looking at what do teachers believe about, um, what do teachers believe affects successful implementation of AAC in their classroom?
And they had all these questions and, and kind of figured out what they, they believed in what they said. And I thought this was a really positive thing. They said, the teachers believe that I'm going to read this. So I'd say it right. The teachers believe that communication training for students is positive.
That's a positive thing. And teachers believe that communication training is a collaborative, um, uh, collaborative effort between the SLP and the teacher themselves. So they all that, that was very clear that that teachers have a pos, they, they come at this with a positive attitude. [00:47:00] But then there's a big, but here, their willingness to use AAC in the classroom is based, and I'm quoting this on their perception of their students' ability to learn to communicate effectively. So if they do not believe their student can learn to communicate effectively, they will not implement AAC in their classroom. Okay. So now our first thing is to get ourselves all up in a wad about this and go those teachers!
[00:47:27] Kate Grandbois: your expressions are fantastic.
[00:47:29] Vicki Clarke: Sorry. I've lived in Georgia way too long and I'm holding down the accent. Okay. All right. But anyway, so, so we first get like really excited. We're like, oh, golly, you know, these, these, these teachers don't, they don't believe in their students, you know what terrible teachers that don't believe in their students.
Okay. But that's not actually what's going on. So they dug a little deeper into that. Cause that sounds, that sounds terrible. Right? Who wants to say they don't believe their students can learn? Nobody wants to [00:48:00] say that. Right. Um, but what they, what this survey did talked about is they said, well, actually this teacher's belief that their students could learn was less about the student and it was highly dependent.
And I'm going to read this part too, on their perception of their own skills and responsibilities and their ability to teach their students to use AAC effectively. So it's not really that they don't believe in our students, it's that they are nervous about their own skills and ability to teach their students.
So now that now comes back to us. Right. We need to figure out how we are, we're not going to come in punitively and say, why aren't you doing this? Like Kate young, Kate would not have been allowed in the door. So, you know,
[00:48:46] Kate Grandbois: guys, I just made so many mistakes. It's okay.
[00:48:48] Vicki Clarke: Oh please. I think we all did it. We all were like, you know, on our bandwagon.
Right? Exactly. I think all of us, I think we've all made those mistakes of trying to, um, [00:49:00] trying to go in and tell people what to do. And assuming that, um, that this kind of, mal-intent why people weren't just didn't believe what we were saying about, uh, about AAC.
And if you want to, I mean, you go, go hang out on social media and you can see people get all, all dramatic about, well, these teachers won't do this and you know, they get very upset about it. But I think we really have to look at now, not what do we, what do, what are the teachers not doing? What are we not doing?
In supporting the teachers, we need to help them. They be it's because we know it goes back to that first conclusion that, um, Gloria Soto’s paper said that teacher believed positively, that children can, can learn to communicate. And this is a positive thing. So if that's, what's at the, at the, the, the kind of back of the brain, right, then we gonna have to get back to that.
They want the support, they want to make this work. So what can we do to make it [00:50:00] better for them? So one of the things that I do, and I think you said this really nicely, Kate, um, w I, we want to meet them where they are. Right. We want to see what is it that they're doing successfully. And we want to build on that.
So that's been one of the things that I've done. Over the past few years is I've gone into the classrooms and I've watched what the teachers are already doing. And then I've been sneaking AAC into it. So you tell me that you're, that you want to do, um, that you want to do, um, interactive PowerPoints.
That's your thing. You love interactive PowerPoints. So what, what I did this past year, cause every, all the special ed director said, okay, we're all on zoom. Just give us interactive PowerPoints. So we, I made interactive PowerPoints, but in the interactive PowerPoints are screenshots of Touchchat and screenshots of Snap+Core and screenshots of LAMP.
And we're finding and learning vocabulary by looking at them on our, on our device pages. Within this PowerPoint, the teachers are [00:51:00] willing to use it because they know how to use the interactive PowerPoint. And we're starting to make, we're starting to normalize the instruction of AAC, they're starting to, they see these boards and they're like, and they become comfortable with the boards.
So when we pull the device out, it's not so scary. Cause it looks like the thing that they've been working on with their PowerPoints. Right. Um, so that's kinda, that's been one of the things that I've been trying to do. We had another teacher that, that really liked literacy. She wanted to do literacy units and she was buying them all on teachers pay teachers.
So I said, all right, give me the, tell me what you're buying. I went and bought it myself and said, all right, now, how can I take this literacy unit and add AAC into it? So we started, we started inserting AAC into this literacy unit that the, that the teacher was already using. Um, you can go, we have, um, teachers using, um, unique learning and we go into unique learning and we, and we, and we add supports into that, that add more communication as well.
So trying to embed, um, and normalize [00:52:00] the instruction of AAC into something that they already know how to do.
[00:52:03] Kate Grandbois: And I, I just, for the sake of saying it again, everything that you're saying is so critical and, and robust and dynamic and it's, but it's making me think of the, the level of vulnerability that a person has to feel, to feel comfortable coming to you for help and how critical those working relationships are and how we so often I've had, I've mentored many SLPs over the years.
And one of my mentors said to me once, but I don't want to, I brought up the issue of working relationships as a consultant, um, as an area to sort of work on with her. And she said, but I don't want to be friends with these people. I said, well, that's fine. You don't have to be friends with any of it. You can do whatever you want, but you need to have some sort of respectful working relationship with your coworkers.
Because in all of the examples that you're just sharing that teacher who had vulnerable, uncomfortable, insecure feelings, right? [00:53:00] We've all had those. Those are not happy feelings. Those are uncomfortable feelings. And if we're trying to meet our learners where they are. Who are our peers in age or education and educate them and support them.
We have to also create a safe place for them to feel vulnerable and seek you out for help and feel. I feel comfortable saying, you know what? I don't know how to do this. And it's, I am the barrier to this student. I think that they are doing great. They can do great, but I am the barrier that takes a tremendous amount of professional maturity.
And as the SLP, it's our responsibility to check the ego at the door, do the work on ourselves to make sure that we can create those safe spaces for those working relationships to improve and create education.
[00:53:50] Vicki Clarke: Yes. I totally agree with that. And I think that, you know, if you're, if you're coming at this and you're saying, I don't want to be friends with these people, it's not really about friendship.
It's about respect and, and [00:54:00] not an authentic respect. Yes. You have to be able to look at what you have to be able to look at what they are, um, what they're doing well. Right. What are they doing really, really well find those, you know, I think that those shining moments, right? Those things that they do well and, and, and, and authentically, authentically appreciate that about them and let them know that, let them see that you appreciate the things that they're doing. And by adding in your, your supports, your materials to what they're already doing, you're doing that you are providing that, that, that respect for them. And it's not just us saying that too.
Like, I, I, I spend time reading books by people who work on helping people make changes right across all industries and the Heath brothers Chip Heath, and Dan Heath are two of my favorites. They did a book called, Made to Stick, which is still of all the books I've read on the subject. One of my [00:55:00] most favorite.
And it talks about how you help people make changes, whether it's changes in their diet or their exercise, or change just like this, like by providing AAC supports for your classroom. And one of the things they talk about is being able to recognize when someone is at 5% towards the goal, right. Giving saying to them, you're, you're, you're doing this thing right now we're going to do is add one more thing onto it, you know, giving them little bitty successes and genuinely, genuinely, um, celebrating those successes with people. Right? So, um, all the things,
[00:55:35] Kate Grandbois: all the things, all of the things. So in our last couple of minutes, I'm wondering if, um, we've already just to sort of quickly recap, we've reviewed the participation model.
We've reviewed several barriers and strategies to those identified barriers. So we've thoroughly unpacked a lot through these learning objectives. I'm wondering if in our last minute you have any final resources [00:56:00] or words of wisdom that you want to leave our listeners.
[00:56:04] Vicki Clarke: Well, there's so much to say, right?
And I will say this, we do, we do have, we do have a website. DTA schools is our website it’s a membership based website. And pretty much everything I've ever done is on there. And all the things that are on there are my attempts and my team's attempts to solve some of these problems to meet some of these barriers.
Um, so that's certainly a resource right, for people, but, but truthfully, um, if you're willing to go look, there are resources everywhere. There's so many, there's so many materials out there. There's so many people that are, that are working really hard in this field. And finding those leaders I think is really important.
Good people to follow. Right. I know what I know because I followed pat pat Miranda. Right. I, you know, I follow Carol Zengari. I consider a friend and his is amazing with her resource collecting, you know, aggregating information following people like that [00:57:00] price. So Carol's and Gary's on practical AAC.
It's P R a C practical AAC. Fantastic website, perfectly free. Everything you could ever want to know is on there. It's amazing. I think falling what, webcasts, like what, I mean podcasts, like what you all do is really good. Talking with tech. Another really good one. Um, so finding those people that will, then you start going down that rabbit hole, one person connects you to the next person who connects you to the next person.
And I think honestly the best, probably the best piece of advice that I could give anybody that's really trying to build their AAC skills is to recognize what you don't know, know what you don't know, and be willing to live in the messiness of this. It's going to be messy. It's not going to be great at first. And that's okay.
You take something, you take your mistakes, you learn from them and you move forward and that's okay. And acknowledge that, know that you don't know at all in the age of where you can Google search anything in the world. That doesn't mean you have knowledge. So sometimes what we need to do is shut [00:58:00] up and listen to people, right?
I'm just sorry. Like we need to listen.
[00:58:04] Kate Grandbois: It's like aggressively hand pumping over here with them and support. Nobody can see us, but I had to say that.
[00:58:09] Vicki Clarke: Right. So there you go. That's all I got.
[00:58:16] Kate Grandbois: I shouldn't interrupt your, interrupted your amazing stream of consciousness. Well, this has been so chocked full of resources and knowledge, and we're so grateful to you for coming on here and sharing all of that with us and our listeners.
Um, so anybody who is listening and wants to learn more or check out any of the resources that were listed, everything will be in the show notes with hyperlinks. Um, if you would like to use this episode for ASHA CEUs, you can do so by finding the episode page on our website, www.SLPnerdcast.com.
If you feel so inclined, please scoot on over and leave us a review or send us a note. We love hearing from our listeners. And I think that's pretty much it. Thank you so much for joining us Vicki and thanks everybody for listening. [00:59:00]
[00:59:00] Vicki Clarke: My pleasure. I'm ready to come back. I think we could do this for another six or seven hours.
Amy Wonkka:Oh my gosh, we definitely could 100%.
Vicki Clarke:Thank you again. Thank you so much. Thank you.