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 . [00:00:00]   Intro Kate Grandbois:  Welcome to SLP nerd cast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy  Amy Wonkka:  Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each  Kate Grandbois:  episode of this podcast is a course offered for ashes EU. Our podcast audio courses are here to help you level up your knowledge and earn those professional development hours that you need. This course. Plus the corresponding short post test is equal to one certificate of attendance to earn CEUs today and take the post test. After this session, follow the link provided in the show notes or head to SLP ncast.com . Amy Wonkka:  Before we get started one quick, disclaimer, our courses are not meant to replace clinical. We do not endorse products, procedures, or other services mentioned by our guests, unless otherwise  Kate Grandbois:  specified. We hope you enjoy  Announcer:  the course. Are you an SLP related [00:01:00]  professional? The SLP nerd cast unlimited subscription gives members access to over 100 courses, offered for ashes, EU, and certificates of attendance. With SLP nerd cast membership, you can earn unlimited EU all year at any time. SLP nerd cast courses are unique evidence based with a focus on information that is useful. When you join SLP nerd cast as a member, you'll have access to the best online platform for continuing education and speech and language pathology. Join as a member today and save 10% using code nerd caster 10. A link for membership is in the show notes Sponsor 1 Announcer:  This episode is brought to you in part by listeners like you and by our corporate sponsor, Ventris Learning. Ventris Learning's culturally and linguistically responsive teaching resources help speech language pathologists, reading specialists, and teachers more effectively meet the assessment and instructional needs of [00:02:00]  all students, including those who tend to become underserved in language and or literacy. To learn more, visit www.ventrislearning.com .  Episode Kate Grandbois:  Hello, and welcome to SLP Nerdcast. We are so excited For today's episode. We are here to talk about a topic that is very near and dear to our hearts. Collaboration is something we talk about on the podcast all the time. And today we have the pleasure of welcoming two expert guests. Welcome, Becca Sylvia and Christy Stearns. Kristi Stearns:  Hi. Thank you for having us. We're thrilled to be here.  Becca Sylvia:  Hello. We are.  Amy Wonkka:  Now, Becca and Christy, we're excited to have you with us here today, and you're here to discuss, like Kate said, how to effectively collaborate with other professionals as a speech language pathologist. But before we get started, can you please tell us just a little bit about yourselves? Kristi Stearns:  Sure. So this is Christy speaking. Um, I am a speech language [00:03:00]  pathologist. Becca and I, um, well now I'm bringing Becca in, but Becca and I met, um, I think that's important to the story, Becca and I met as, uh, First year grad students in Massachusetts, and that's how we became friends and also co founders. Um, but as for me, I'm originally from Florida, um, went up to Massachusetts for grad school. I did some work up there, um, worked at schools for, um, autistic children and individuals with developmental disabilities. Um, did a high AEC concentration. I really enjoyed doing that and also working with, um, that upper school age. So like 14 to 21. Um, and currently I'm back in Florida and, um, Yeah, I have a little three year old and, um, back where my husband and I are from. So it's been, it's been very enjoyable and it's been really nice to be able to maintain such a nice friendship and collaboration [00:04:00]  with Becca once we started communication community. So happy to be here.  Becca Sylvia:  Yes, so I am Becca. I was born and raised in Massachusetts. As Christine mentioned, we met in grad school. After grad school, I moved out to Colorado and started my career in speech language pathology, doing a lot of AAC, high tech AAC. And then moved over and did some stuff in the schools and, um, Christie and I started communication community, our blog originally with the main focus on a C, but then kind of a little bit of everything. And so it's been awesome working together in this kind of professional capacity for a number of years while also being really good friends too. Just great.  Kristi Stearns:  I'm sure the two of you can relate in a way, you know, working with a friend and also, [00:05:00]  um, you know, someone who holds you accountable, at least for me. Yes,  Kate Grandbois:  definitely. There is nothing better than having a partner in crime, a partner in nerds. A nerdy kindred spirit. It's good. Yes. Yes, to keep moving, you know, moving things forward and having another brain in the room. It's just so great. And we're So glad that you have agreed to share your, your hive mind, your, your knowledge, your shared knowledge with us today as it relates to collaboration. Um, I do need to read our learning objectives and disclosures before we get started, so I will do that as quickly as I can. Learning objective number one, list the six competencies for interprofessional collaboration. Learning objective number two, describe generational communication styles. And learning objective number three, describe collaboration through personality awareness. Disclosures. Becca's Financial Disclosures. Becca is a co-owner of Communication Community, LLC, and an employee of a health tech [00:06:00]  company, Becca's Non-Financial Disclosures. Becca is a member of ASHA and Co-managers, the Communication Community blog, the Circle, community and Social Media Accounts. Christie's financial disclosures. Christie is a co owner of communication community LLC. Christie's non financial disclosures. Christie is a member of ASHA and co manages the communication community blog, the circle community and social media accounts. Kate, that's me. My financial disclosures, I am the owner and founder of Grand Bois Therapy and Consulting LLC and co founder of SLP Nerdcast. My non financial disclosures, 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.  Amy Wonkka:  Amy, that's me. Uh, my financial disclosures are that I'm an employee of a public school system and co founder of SLP Nerdcast. And my non financial disclosures are that I'm a member of ASHA Special Interest Group 12, which is AAC. Uh, and I [00:07:00]  participate in the AAC Advisory Group for Massachusetts Advocates for Children. All right. Learning objectives done. Disclosure done. Um, Becca and Christy, why don't you start us off by telling us just a little bit about why you're here? interprofessional collaboration is important for SLPs? Why is this something that we should care about?  Becca Sylvia:  Yeah, I mean, I would say there's a lot of reasons why you should care about it. But I would say the number one is like collaborating effectively can lead to better outcomes for clients. So that's kind of what we're here for. We want our clients to have good outcomes. And there's lots of things that go into having good outcomes. And one of those things is that collaboration with clients. the clients, their families, but also like the team and other professionals. And so, um, we believe that by understanding different communication styles, collaboration methods, different things like that, can improve collaboration and then [00:08:00]  therefore outcomes across disciplines. Kristi Stearns:  And I think that's reflected in some of the studies that we'll reference today as well. You know, the objectives that Kate outlined at the beginning of the podcast. You know, we will talk about competencies for interprofessional collaboration, generational communication styles, and collaboration through personality awareness. We pulled from different research that, um, hit. Several different collaboration areas. Um, so yeah, the competencies generation, then also, you know, those personality assessments and we thought it was an interesting area to explore because for such a. deeply personal field where we have, we're on so many different teams. I don't know a lot of other professions where we're operating in so many different groups. [00:09:00]  Even though you have these, uh, other professionals that you work with day in and day out, and whether it's a healthcare setting, school setting, you also, there's that component of adding, you know, a whole other client and their caregivers and families. And so, operating in a very healthy, constructive team environment, in a collaborative environment, is so, so important, I think, for our, for our clients. Um, professions specifically. Becca Sylvia:  All right. So we can start by talking about the six competencies for interprofessional collaboration. Um, this was, um, there is an article by Bainbridge et al that discusses essential competencies required for, uh, effective interprofessional collaboration in healthcare settings. So, um, there was a framework developed by the Canadian Interprofessional Health Collaborative, also known as the CIHC, that basically their [00:10:00]  goal was like, we want to enhance teamwork among healthcare professionals so that care is efficient, coordinated well, and patient centered. So all those things that were like, these are all. Great things, you know, um, and so frameworks can be helpful sometimes because it could really kind of lay out very specifically like here are some kind of areas to focus on, um, and, you know, they're kind of can be refined over time. But I think it's we thought it was really helpful. And we really liked how they kind of laid it out. Um, and so we can talk about each of those six ones. So, Chris, if you want to start with the first few Okay.  Kristi Stearns:  Yeah. Um, so as part of, um, as part of these competencies, one of the main competencies, um, is role clarification. So, um, you know, with your team, what is each person on the team going to do to support the client's overall goals? So what are. Essentially, what out are your, [00:11:00]  um, roles and responsibilities on this team? Um, so it's incredibly important that while you understand your role and what you will bring to the team, um, and those, and those responsibilities clearly, clearly outlined, you're also aware of the roles of others, kind of like the, Okay, once you know your role, you know what lane you're staying in and you know if maybe you're getting too close to someone else's lane. Um, so that gives you the ability to recognize boundaries and, um, the scope of practice for each professional. And I think when those are outlined, um, we can perform our best and, uh, our strongest for our clients.  Kate Grandbois:  I just want to make a quick comment based on something you shared earlier about how unique our field is because we're touching so many different aspects of student care, client care, patient care, whatever word you're using. We also have such a shared scope of competence. We share our [00:12:00]  scope with, uh, special educators. We share some scope with literacy specialists, with behavior analysts, like it or not. Um, if you're working in a hospital setting, you might share, you know, some aspects you might be having. disagreements with your ENT over, over something that you're seeing or whether or not to recommend a bedside or I don't know, I'm not, I'm at SLP. So I don't really know what I'm saying, but my point is, you know, we share our scope with so many other professionals that understanding your role, I have to assume is a critical piece of being able to collaborate effectively without getting grouchy because sometimes you feel grouchy.  Kristi Stearns:  You're, I mean, yeah, you're absolutely right. And I think that, um, also considering that each setting may be doing something different. Um, and those roles may look a little bit different within each setting. Of course, we have our, you know, our specific clinical roles and responsibilities that we can't waver from [00:13:00]  too much. But, you know, you think about some of that. Um, I know you were mentioning the feeding and swallowing piece. You know, there is. There's a lot of overlap in health care settings in that, um, in that space. So making sure that whatever setting you're in, that those roles, um, are Very explicitly clarified and that can that's also a prevention measure for some of the that conflict because maybe in another setting you were way more hands on with that particular role that maybe the O. T. is taking more of a lead on and that's more of the general team expectation. Um, so making sure that that is clearly outlined is what's going to be. Healthy for collaboration with the team and then also, um, that it obviously reflects on the client as well.  Amy Wonkka:  I'd imagine too that when you're clarifying your role, that in and of itself could be promoting collaboration because hopefully [00:14:00]  you're having a conversation with these other providers and talking about the overlap and talking about what's going to happen. So just by the nature of that conversation, you're sort of setting the stage for some collaboration there.  Kristi Stearns:  Exactly. Um, and then that kind of leans into, um, another competency, which is team functioning. And that's essentially looking at how will the team function together to support one another. So we definitely need that role clarification to be able to understand how the team as a whole is going to operate. Um, So this is very important for working effectively within those all of those different team environments for all of those different clients and families. Um, and when you have those roles in place and when you understand the different team dynamics that fosters more of a sense of mutual respect and promotes, um, that positive [00:15:00]  collaborative atmosphere.  So in essence, um, having the role clarification contributes to team functioning and that continuous collaboration that it's important to check in, um, on a continual basis versus just establishing those roles at the beginning of the school year, so to speak. It's important that we continue to check in, um, to ensure that continuation and the team, the maintenance of the team functioning.  Becca Sylvia:  I also think, too, if you have good role clarifications, it can be helpful on a team if, say, someone is out, then you can know, okay, well, this person normally is the one who makes sure that this student's AAC device is out and charged in the morning, but I know that they're absent today, so someone else can kind of fill that team member's shoes for this instance, and so that's a way to kind of, you know, support the team, support each other when [00:16:00]  someone Can't fulfill their role for a day for a specific reason. Kristi Stearns:  Um, and another area of, um, the six competencies for interprofessional collaboration is that interprofessional communication. So we've covered the role clarification. We've covered, you know, roughly how the team is going to function and check in with one another. Or I guess more of the frequency, right? We want it to be continuous, so that interprofessional communication, that's what that collaboration is going to look like in essence. How will the team collaboration be maintained? So, um, whether that be You You have a meeting at the beginning of the year and outline what that might look like for you and your team. Do you want to meet on a weekly basis? Do you want to meet in person? Do you want to have, um, email, slack, [00:17:00]  messenger, whatever? You're using check ins, um, but making sure that that interprofessional communication, everyone is on the same page with as well. So making sure that, um, this communication is clear, respectful, um, you know, there are timely exchanges of information, um, because this is, you know, timing is everything in our profession in a lot of ways. Um, I think I was listening to One of your podcasts earlier this week, and, um, I know that in different states, certain evaluations have, uh, uh, one time frame, and then in other states, it may be a longer or shorter time frame, so making sure that those time markers are also there because, you know, say you're submitting information for an IEP, for example, um, okay, well, if you're submitting that information on the last day, But you have five other members of the team who also need to look at that documentation and make their, um, [00:18:00]  edits or revisions or what have you. Um, that's incredibly important.  Kate Grandbois:  I want to make one comment about interprofessional communication. And wanting to make sure that one of the things that I found to be most successful is bringing humanity into those conversations and into that communication. So the colleague that you're communicating with is a human first and a professional second. Um, I've had, I have found that a lot of friction in interprofessional communication can stem from not having that human connection, so not understanding that someone is having a really bad day, or maybe didn't sleep, or is having a crisis at home, um, or even approaching communication with this underlying sense that your objectives are more important, or your objectives are more urgent, and you, you might end Talking about this later. So I don't want to, I don't want to put the carpet for the horse, but I just think I, I so value you bringing up the competency of [00:19:00]  inter interprofessional communication because it isn't just about timeliness of, uh, your workplace or, or, you know, the word, whether or not you use an exclamation point in your email. I mean, there are so many layers to making sure that that goes well. And I think so much of that is rooted in, in being a person, just being a human being, connecting with a human being.  Becca Sylvia:  Absolutely. Absolutely. You know, there's so many times where, like, you might get an email that's like, you're like, are they being a little stucky? Am I reading this the wrong way? And as much as you want to say, like, it's fine, I'm just going to, you know, forget about it. It can impact you when you're going into your next session, you're thinking about it. And so, and that. can impact, you know, outcomes in general. So yeah, having that like frame of mind of like, let's have strong communication because that does touch everything, whether it be directly or indirectly. Kristi Stearns:  Yeah. And approaching. Yeah. [00:20:00]  Like Kate was saying, um, each person as another human, you know, you're not just this bot on the other side of your email screen, you know, they entered this profession to what I would like to think it You know, to, um, you know, care for clients and make sure that they receive the best outcomes and care. Um, and a lot of this too, I know that these six competencies are a little bit more, um, uh, I don't want to say the drier area, but these are a little bit more clean cut guidelines, so to speak. And they're very important, but I think the big picture too, with all of this discussion about collaboration is that, um, All of these objectives that we're going to discuss require perspective taking. And it seems so, um, it seems so basic, but it's not, you know, it's important that we have that awareness and we can perspective take [00:21:00]  not only, you know, have that knowledge for teaching our clients in some respects, but we need to practice that and model that as clinicians and, um, professionals and when we're working with others. So,  Amy Wonkka:  well, and I have to imagine that perspective taking also. Slides into the next component when you're thinking about your actual clients and their caregivers Um, I don't know if you wanted to talk to us just a little bit about what are some of the components there That come into play when we're thinking about this interprofessional practice. Becca Sylvia:  Yeah, I mean A big one that I know people hear about, we talk about is that patient or client or family community centered care. So at the end of the day, like the, the needs and the preferences of the client, like that is what's most important. And so understanding their perspectives and their values. In this decision making process is [00:22:00]  really important. Um, and that may mean that like roles may shift a little depending on a client themselves because of their situation because of their preferences. Um, different, you know, different scenarios and so understanding what like their goals are cultural considerations their interests. Um, you know, if say for example. They are, they primarily speak Spanish at home and there's one member of the team that doesn't do a lot of the daily communication, but they speak Spanish and they can say, you know, I can take on this role for this family because it's important to that. They have we have daily communication with them because we know that's important for this family and I can. Do it, and I can speak to them in Spanish or communicate with them in Spanish versus another family that might say, I do not need daily updates unless it's an emergency. You know, like, I prefer weekly updates and someone else can give me those weekly updates. [00:23:00]  That is when those understanding of working together as a team of doing one person's doing one of the other. But at the end of the day, it's so that the clients are centered. Um, and so another competency, and I think this is something that is, can be difficult, but I think it is important to, to kind of have an idea about, is that interprofessional conflict resolution. Because as much as we would love to not have conflicts, conflicts, Are going to come up. And again, this might be complex within the team itself, or it could be there could be a conflict with a client because something is going on that they there's a conflict that needs to be resolved. So being able to address conflicts rather than trying to kind of sweep the munch of the rug, I think is important. Um, and then kind of also being able to understand of [00:24:00]  recognizing sources of conflicts to say like, does this happen because the communicate, we're not meeting regularly enough? Is this, is conflict happening because the roles aren't clarified well enough and there's some overlap or there's an important Job or test needs to be done and no one's assigned to this role. So it's just keeps getting missed. Um, kind of trying to figure out, like, why is this conflict happening and what can we do to address it and try to mitigate it so that it we do not deal with it again, or it's, you know, lesser, I think, can be, um, is helpful. Um, and I think kind of what you had mentioned earlier to key about like, these are humans. So like, let's try to stay positive. We are all humans. Let's be want to stay positive. We want to offer constructive feedback. We don't need to, you know, do the blame game pointing fingers all the time. Um, because that doesn't really, you know, that can hurt rapport, it can hurt [00:25:00]  collaboration. And so Um, being able to kind of find ways through conflict resolution is an important piece of being able to collaborate effectively for sure. Kate Grandbois:  What you all are saying about This these components of humanity is making me think of a little story I heard once called the baby in the backseat. Have you heard this story? I swear. I'll make it very short. No, I'm so intrigued. But essentially, Amy, have you heard the story? Have I said this to you before?  Amy Wonkka:  Yes.  Kate Grandbois:  Yeah. Okay. So hopefully our listeners and you all will get something out of this and it's not totally off topic, but essentially the story goes where imagine you're in your car, you're driving to work, you are late, you've got coffee that you've spilled in your lap and you, you, uh, you end up hitting every red light on the way to work and you're sitting at a red light and the light turns green and the car in front of you doesn't go and you're like, what is going on? And you get so frustrated and [00:26:00]  you start laying on your horn and you're like, I am so late. The light cycles to green, the light cycles to yellow, and then to red again, and you're like, I can't believe this, you become increasingly more enraged. The light cycles to green again, the car still doesn't go, you can see the person in front of you fiddling around with something in their bag or something in the back seat. And you decide that you've had enough, and you're so angry, so you get out of the car, and you storm right up to the front door, or the window, to yell at the person, why aren't you moving? And you see that the woman is stuck and can't get her seatbelt open, her seatbelt off, and her baby is choking in the backseat, and there is an emergency. And all of a sudden, in that moment, Your anger goes dissolves immediately and you are, Oh my gosh, this is a person who needs my help and you go right in to help the baby in the backseat. So the point of this little story is you never know when someone has a baby in the backseat. And I, I carry this with me as a little story of if someone is being grouchy at you, if there is a conflict, if someone is being snarky, You never [00:27:00]  know what someone else is dealing with in their personal life and trying to remember that there could be a baby in the backseat. There could be something going on instead of taking it immediately personally and retaliating or talking to your supervisor or. Sending a snarky email back that doesn't have any friendly exclamation points. You know, there are so many ways that we can handle ourselves in conflict, holding space for what someone else might be experiencing that we just don't have visibility to. And that's my story. I won't take up any more airspace, but hopefully that was helpful. No,  Becca Sylvia:  I think that's good. And it made me think of a time when I had a supervisor who said it in a different way, but basically was like, You're there are going to be times where you can't give a hundred percent. So, or like your team members can't give a hundred percent. And I think of it in the sense of number one, okay. Recognizing yeah, that my coworkers or other people I work with, they, because of what's going on in their personal life, they have a baby in the backseat. They can't deal with it. I guess for me, and we'll go into, I guess, like personality [00:28:00]  styles a little bit later. It gives me permission to also to say, okay, sometimes I have a baby in the backseat and it's okay if I can't. Give my a hundred percent because we are humans and like, that's okay too. Kristi Stearns:  Yeah. The, the lack of, uh, you know, I'm putting quotes around this, but the lack of effort, so to speak, is not coming from a place, you know, I don't want this client to succeed, or I want our team meeting to start 10 minutes later. Um, you know, when we can stop and pause and think about, um, like the two of you were saying, you know, think about, okay. I don't think that this is an attack on me. I think maybe, maybe they had a stomach ache. Maybe they needed to take a little bit more time before the meeting and that's why they were late. Um, I've had stomach aches before. I'm sure other people have too. You know, I, I think it's important to stop and actually consider like, how involved are you personally in this matter, for sure. Becca Sylvia:  And [00:29:00]  that leads well into the final competency, which is collaborative leadership. So the idea that leadership roles can be shared within a team, it's not up to one person to be the leader. And so that way, if that one person is, you know, Can't give full effort for whatever reason or has a bigger role to fill one day, other people can kind of take the lead. So, you know, an example of this is if you do have a standing, you know, weekly meeting or monthly meeting where you talk about the clients, the plans, You know, action steps, all of that. Different people on the team can kind of be the person who leads that meeting and, you know, organizes it together or kind of summarizes the meeting minutes at the end and leads out to say, you know, after the meeting, you know, it's my job today to say, okay, [00:30:00]  Christy's going to do this, and Amy's going to do this, and then the next month comes around, and Christy's that person who does it. So kind of understanding that leadership roles can kind of change, and other people, people can take different leadership roles or different times, I think is also helpful to know that like, yeah, we're not stuck in like a, we made this decision once, and now it's going to stay like that. Until the end of the year or the end of whatever. All right, so those were the six competencies, the kind of that overall framework. So the next area we're going to talk about is the generational communication styles. And so it's important to understand that generational differences can affect communication. With the caveat caveat that like we're talking about generational trends, not like prescriptions of saying this is what it's Gen all Gen Xers are like this or all boomers are like this because that's not true. And we know that, but there are [00:31:00]  trends and these trends come from, you know, surveys reports, um, based on things like significant global events, cultural, cultural shifts, development of technology. You know, we're saying that a lot of. You know, the Gen Z population is really into technology versus maybe boomers aren't well, guess what? Like the technology wasn't around when boomers were growing up. So it's not that it's not that they're choosing it's that they just, it's kind of based on cultural and life. Um, but that being said there, you know, certain trends and we think just kind of having that awareness of that. There are some generational trends can be helpful. So again, seeing that humanity. And the people you're working with, um, is helpful and kind of understanding why they may think things a certain way or might approach things a certain way or have different opinions may be impacted. By the generation that they grew up in. Um, [00:32:00]  so, you know, we'll talk about kind of the overarching trends of the generations that we would see in the workplace today and kind of their, you know, rough age. We also know that like, if you're kind of right on the cuffs, you might feel like, Oh, I really belong to this generation or whatever other generation, but more or less. Um, the first two we'll talk about are baby baby boomers, which are around age 60 to 78. Um, and for communication styles, they tend to favor the face-to-face communication. And then like more, um, you know, like formal. respectful interactions, more of that like traditional communication style. Um, the next generation, so generation X or Gen X, roughly ages 44 to 59, um, less of that like face to face traditional communication and tend to perform more of the concise [00:33:00]  communication, efficient communication, let's kind of like get the job done. Kristi Stearns:  Um, yeah. That's about right. What would you say,  Amy Wonkka:  Amy? That resonates for me as a, as a, as a Gen Xer.  Kristi Stearns:  Yeah. Well, and it's, it is interesting because the information that we're reviewing and these communication styles that we're discussing across, you know, boomers, Generation X, Millennials and Gen Z, this is polled, what was the survey? It was like over 400, 000, um, individuals. So like, these are self reports of, you know, um, You know, this is my age range. You know, they're circling their age range and this is their preferred communication styles. And again, I think for me, um, you know, I would fall personally into the millennial range, but I see different, um, communication trends from other, um, generations that I, that I also, um, would subscribe to. So again, these are, these are more of just trends, but by, [00:34:00]  um. Understanding that these different preferences do in fact exist, it gives us a little bit more of that exposure and awareness that, okay, if I'm someone who only wants to chitchat via email or via workplace digital messaging, and somebody else really wants to meet with me once a week in person, I'm not taking that as, wow, This person has no respect for my time. You know, I know that this is more efficient, but, you know, why do they want me to meet in person, you know? And there's so many more layers than that. Um, and that's not really true to me because I, I love meeting in person. So, um, yeah, I actually do. Becca and I differ in that respect and somewhat. Becca can do more on, um, uh, my, I need more in person accountability and Becca likes that. Corresponding via email and in messages. But anyways, um, [00:35:00]  so yeah, Becca covered Baby Boomers and Generation X. Um, so Millennials, that's, uh, another generation that is roughly between, uh, the ages of 28 to 43. So this is the generation that's a little bit more comfortable with digital communication. Again, a lot of that has to do with cultural shifts in the development of technology. Um, You know, we tend to, we Millennials tend to value feedback, um, and collaborative approaches. Um, so this might look like, uh, higher energy collaborative environments that appreciate real time feedback, often communicated through digital platforms. So, um, I can say for myself, I really, like, I think back to grad school, and I loved the immediate feedback. I walk out of a session, and my supervisor is holding up a list of things for me to improve, like, I [00:36:00]  really enjoyed that, um, while I know that there are other individuals who want to wait till the end of their week so they can get all of the rest of their Um, documentation done without distractions, and that's not something that they need to consider. Um, so roughly that's, you know, Millennials, and then our last generation that we explore is Generation Z, Gen Z, which is, um, 27, roughly 27, um, years of age and younger. So this is more of that, um, Technology has, from a cultural perspective, has really evolved, um, for them as compared to, you know, Millennials, Gen X, and Baby Boomers. So, Gen Zs are described as highly digital, um, they're a little bit more accustomed and have the expectation of multitasking, um, Generations, you know, Gen Z might expect a little bit more of a fast digital communication is and is adept at navigating multiple [00:37:00]  communication channels simultaneously. Um, I, I. You know, I'm making a generalized statement, but, um, I know several different business professionals that they have someone who is, falls into the Gen Z generation, um, managing their social media profiles. Um, you know, I think of some of my younger cousins who are in their early 20s and they also are starting a business ventures with the interest of doing that. Um, whereas I don't. personally have that type of capacity. Um, but I love to see it, you know, and it just goes to show that within each of these, you know, uh, rough generational ranges, there is so much that each can bring to the table in different ways and to kind of highlight those strengths more than see them as differences. But it is important to be aware [00:38:00]  of. Maybe some of those preferences, whatever it may be, whether it's generalization, general consistent with the generation or not. Um, you know, it can help you with, uh, that teamwork and collaboration. And maybe, you know, maybe you're taking a, uh, approach where, um, we have one, uh, colleague who really prefers those in person meetings. We have another colleague who, um, You know, wants to do a little bit more messaging and emailing. Okay, maybe we work with a hybrid approach. Maybe we meet in person once a month and then we have those digital weekly updates at the end of each week. So again, just meeting. Your team where they're at and, um, having that mutual understanding,  Kate Grandbois:  I think mutual understanding there is key because I can already hear the voice like, Oh, boomer or Oh, God, what a gen gen Z, you know, rolling there, [00:39:00]  rolling your eyes or making the assumption that the way that someone else prefers to communicate is in a front somehow to you or disrespectful. And I think the point here is understanding. that other people have preferences and it's your job as a respectful colleague to acknowledge those preferences, maybe not accommodate those preferences all the time, but not take it personally and sort of look at it through a lens that can diffuse any of any of that conflict. Becca Sylvia:  Yeah, I know, you know, Kristi and I had talked about it a little bit, especially in, I would say, our field, whether you're in a school on a special education team or you're in like a SNF and you can have a rehab team, you may have, you know, co workers who are, you know, on the same level as you in terms of like, same degree, same credentials, same like general responsibilities, and you could have, you know, You can have an OT who has been practicing for over 30 years, and you can have a speech [00:40:00]  therapist who just finished their CF and are, you know, one year out of practice, and they're kind of, you have to, in collaborating together, in a sense, and I know, um, so my mom is, has been a school based OT for over 30 years. When she first started, like, there wasn't email. So, you know, obviously, things have evolved. She uses email all the time, but that's not her first thing. method of communication necessarily. Maybe it is. Sorry, mom. But you know, in the terms of versus someone of her, you know, newer OT or a new speech therapist who is Gen Z and is, you know, just finished, just graduated school and that's all they know. And so the sense of like this, we have to kind of collaborate and work together and know that. There are that someone what someone might prefer or go to is based on their experience rather than trying to be like, this is the best way that's just like, this is what I'm doing, what I'm [00:41:00]  more comfortable with. Amy Wonkka:  Well, and I'd imagine it really, really connects to the interprofessional communication component that you guys were talking about. You know, I think when you're building, uh, When you're identifying the roles and you're, you're identifying whose, whose scope is what, um, and you're figuring out, okay, what is the best method of communication? I think maybe having some explicit conversations just like you did about the roles would be helpful in terms of what is your preference for communication style? Um, because all of these are areas where, you know, I think, I think about some of the collaboration that I've done in, in my role in schools and in outpatient settings. And, um, Do you sort of just go into the mode? Okay, this is how we do this. This is how we do this. And I've never even paused to gather information about how the other people I'm collaborating with would actually prefer to meet or receive information or communicate. So it's also very connected to that for me and hearing you guys talk about it. Becca Sylvia:  Absolutely.  Kristi Stearns:  And I think just [00:42:00]  as a closing consideration, um, again, your personal preference or maybe a colleague's personal preference may not be consistent with their quote unquote generation, but so it's important to not generalize or stereotype entire generations. Um, but, you know, this data that we've shared is from a student. very big survey. So these preferences do exist. Um, and that I think is the most important to recognize that people will just have different preferences. And, um, just, Use respectful language, you know, use neutral, respectful language when describing generational traits. Um, you know, rather than saying older generations are out of touch with technology, you know, you can say different generations may have varying levels of comfort with technology. You know, I think of my parents, my dad has always been ahead of the curve. You know, he would fall into that boomer range, but he is incredibly, incredibly, incredibly tech savvy. And what, [00:43:00]  whereas my mom. Who falls into that range. She needs support with opening up her Outlook and email and that sort of thing. So, um, again, there's You can't just fully full on stereotype and focusing on those strengths and emphasizing the different strengths that each, um, colleague or, you know, um, each generation, so to speak, um, contributes, um, is very important than perceiving things as differences or weekend weaknesses and that, um, you know, and this also applies. We talk about, um, You know, successful collaboration. But again, this also goes back to when we're collaborating with clients and their families. We're working with, um, a very wide age range, um, of clients and family members. So, um, make sure to also include if this is something you're exploring in your workplace, um, how generational diversity can enhance that collaboration and creativity rather than just [00:44:00]  you know, framing them as differences or feeling like you have obstacles when you're working with certain clients and families. Um, so all starts with communication. Just have, have conversations about it. Yeah. Um, and I think we're ready to talk about, um, the ocean framework.  Kate Grandbois:  Yeah. I'm really curious to hear these about these components of personality awareness.  Kristi Stearns:  Yes. So I think, you know, we, we went back and forth how we wanted to structure these different objectives and I think that the personality awareness using the big five ocean framework, which is what we're going to talk about ties in nicely at the end because you can look back at some of those six competencies for inter professional collaboration and some of these generational differences. And you can. A lot of that will interweave with some of these, um, big, some of this big [00:45:00]  five framework, um, and we'll talk about what that is, and we're digging a little bit more into the, the personality of, um, different people, so that's, that's fun. Out of curiosity, Have any of you taken a personality test before you either applied to a job or during like a workplace, um, like seminar or workshop? Kate Grandbois:  I have. I'm, I'm like the rare psycho killer one. Every, every time. No, I don't  Kristi Stearns:  think  Kate Grandbois:  that one's in here, but. It's not a psycho killer one, but I, I, I can't remember the acronyms, but I'm the, I'm the, The really rare personality type that makes people look at me weird. Like  Becca Sylvia:  when I took my Harry Potter sorting and I was a Slytherin. Yeah. That I don't know how, um, valid that test that I took was, [00:46:00]  so, yeah, I think it's more valid than my, than my personality test.  Amy Wonkka:  Has the Harry Potter sorting test been empirically validated this year?  Kristi Stearns:  Wow, we submitted the wrong paper, everybody.  Kate Grandbois:  Yes.  Kristi Stearns:  Wouldn't that be fun if we were all indifferent? A different house. That would be it. That would be fun. I feel like I  Kate Grandbois:  can feel like a live podcast recording coming on speech pathology and the Harry Potter sorting tat sorting hat research. There's going to be some good research coming out of that. But anyway, I didn't mean to derail you. I have I have taken one of those tests. Kristi Stearns:  Well, maybe some of the questions or some of the findings. Let us know if any of that is consistent with some of these areas that we're describing. I know that there are, there are a lot of different workplace personality assessments. I know like Myers Briggs is a really common one, and I know there's like 16 or something. Um, but the big five ocean framework, which we are going to talk about, [00:47:00]  um, There are five personality traits. And so, um, let's talk about how some of these personality traits can further enhance collaboration. So, uh, the big five personality traits, uh, also known as OCEAN. Um, that's an acronym for each of the individual personality traits. Um, it's often used by psychologists and offer a comprehensive framework to understand individual differences. Um, again, understanding and awareness is, um, There's a theme here. Um, I believe, uh, this framework has been around since about like the 60s or 70s, but in 1981, psychologist Lewis Goldberg coined the term, um, coined ocean the big five and has been further refined and accepted over the years. So, um, the, the big five, the BFI consists of a series of statements that respondents rate on a scale, typically from strongly disagree to strongly [00:48:00]  agree. Um, I know that we've all taken, uh, little assessments or filled out questionnaires like that. Um, so this, the BFI helps to identify where an individual falls on each of the five dimensions. And, um, this can provide insights into their personality characteristics, which can be useful for personal development, career planning, and improving interpersonal relationships. Um, So an example question might be, um, uh, or an example statement would be, I see myself as someone who is dependable and self disciplined. And then you would rate yourself on a scale, um, from strongly disagree to strongly agree. Um, so the first The O in the ocean traits, um, is openness. And so that is the personality that is, uh, uh, willing to try new ideas and practices. Um, so this [00:49:00]  personality type might encourage creative problem solving and, um, Is very open to the ideas and perspectives of others. I think in our field, we all, um, it's important that we all have a sense of openness. Um, because we, you know, a big part of our, um, our ethical requirements as our cultural sensitivity and responsiveness and, you know, that requires a sense of openness. You know, not every client is going to, um, live, um, you know, Or have the same cultural values or beliefs as you do. Same thing with your colleagues. Um, so it's important that, you know, that's not something that we take into consideration when we want to provide our clients with the best care. Well, we do take it into consideration, but it's only to provide our clients the best care. Um, without any sorts of, um, judgment. So, um, that's openness. So team members and high openness, uh, I [00:50:00]  think I mentioned this, bring creativity to the table, but you know, maybe they need a clear structure to channel their ideas effectively. Um, I'll give myself as an example and my partnership with Becca. I love trying new things, changing things up. Um, maybe, you know, that's why I love to do design. I just I'm always like, should we change our logo? Should we do this? Um, and, you know, Becca's that channel for me, which we'll get into the conscientiousness. Um, Becca's that channel for me where, you know, she's very open to hear some of my ideas, but she might, you know, she's there to filter them and say, okay, well, A, B, and C look good, and we have time for that, but you know what? Maybe we can put these other on hold. Um, So, openness, as I was starting to say, conscientiousness, that's the personality trait that's a little bit more self disciplined, [00:51:00]  um, meets and exceeds expectations, that little bit more regimented personality, which, uh, Becca, thank you for being there for me. Um, while I do feel like I, um, have a, strong sense of conscientiousness. I still think that that is one of those personality traits that Becca really contributes positively to our duo. Um, so that's also the person that is establishing clear expectation responsibilities with the team. Um, highly conscientious professionals tend to be organized and reliable, um, making them ideal for the roles requiring, um, Planning and follow through. So, and that's, you know, it's very important to have that type of personality on a team. Um, and then another personality, um, in the OCEAN framework is extraversion. So, we all know those We all know extroverts. Um, you know, uh, they're [00:52:00]  energetic. They enjoy working with people. Um, they like to facilitate opportunities for social interaction and teamwork. Um, extroverted team members often excel in roles that require frequent communication. Um, again, hi, I'd love to meet with you in person, Becca. Um, and so, what was that? No, I just was laughing. Um, and, uh, appreciate social interaction, um, such as client facing positions. Um,  Becca Sylvia:  I  Kristi Stearns:  would  Becca Sylvia:  just to kind of add in and thinking about the differences and how things come together with a team and the sense of when we look at, you know, some of that role clarification or the leadership, um, trying to, you know, trying to figure out how a team can kind of work together. I, as Christy mentioned, I definitely am like high on the conscientiousness side of things. Like I can keep track of due dates and I can make sure things are submitted on time and uploaded on [00:53:00]  time and we have it all, have all of our I's dotted, T's crossed, um, what have you. But then less on the extroversion side. So if there is a role that says, okay, this person is going to check in with the client's parents every week and have that face to face conversation, I'm not going to volunteer myself for that role. I can do it, but I'm not going to volunteer myself for that role. But I will take the role of Organizing and filing the paperwork and all of that. And so that's kind of looking at like, okay, this is where my personality lies. And so this is kind of how we can decide that role and work together as a team. And as we'll go into a little bit more, Christie and I are very similar in some ways, but also very different and other ways. And we kind of have learned how we can collaborate effectively in a sense of like, We can take on different jobs because it [00:54:00]  fits our personalities better. Kristi Stearns:  And, you know, it's again, it's not something that happens overnight, obviously, you know, back and I've been collaborating for a really long time. Um, so I think that exposure is important, you know, and going back to the human piece of interacting with your team, you know. You'll learn a lot, not by just having structured team meetings, but by having conversations and learning a little bit more being open, right? And learning a little bit more about who exactly you're working with. Um, you know, we also have a sense of inferencing skills. I would like to think that we also could. You know, based on our just our casual, maybe nonprofessional interactions would be able to get a stronger sense of, um, some of our colleagues preferences and, um, you know, just their, their sense of self. So I think, uh, [00:55:00]  Yeah, tying in these ocean traits to some of what we talked about before, um, this is kind of like a, uh, tying all these pieces together can help achieve the most successful collaboration. Um, Becca, do you want to go into talking about the other two parts of the ocean framework?  Becca Sylvia:  Sure. So we covered the O, the C, the E. Now we'll go into A, which is agreeableness. So basically it is what it sounds like, getting along with others, being agreeable, um, you know, really promoting that culture of empathy, cooperation, wanting to maintain harmony, you know, all really Good things. I would say what could be difficult is if someone is highly agreeable and there is a conflict and not wanting to sort of kind of address the conflict or try to get to the root of it. And that can impact that collaboration and they had a effective work down the line. [00:56:00]  Um, but people who are highly agree. So people who are highly agreeable may not want to be the person to kind of. Address a conflict, whereas someone else who says, I. Doesn't it doesn't impact me as much to not get along with someone or to have a dissenting opinion. I am more willing to do that. They can might be someone who can kind of manage conflicts or kind of take that role. Um, when you're working together on a team. Thanks. Um, and then N is neuroticism. So this is kind of having a tendency towards stronger, let's say negative emotions, but kind of emotions such as like being prone to anxiety. Being prone to prone to getting angry easily. And, you know, this can be a situation. If we go back to the baby in the back seat, someone who is just like, I'm mad because this is not getting done and quick to [00:57:00]  being like, they're not doing this, so and so is not doing their job. And then someone who might be lower on their neuroticism scale might say, you know, that person, I'm going to let them sit through five red light cycles before I even, you know, bring it up or get angry about it. Um, but at the same time, someone who maybe is higher on neuroticism may get stressed easily. So I think that I know you can think about probably people on a team. Maybe yourself who was like, I get so stressed in these situations and I look around and so and so is not stressed or a situation where I'm not stressed that this didn't, this plan we had did not work out well at all today. Whereas someone else might be like this plan didn't work and now I am not going to sleep tonight. So kind of understanding that some people may respond to the same situation. In a more heightened way, or in a less [00:58:00]  heightened way, it can be helpful to know, okay, this is not because they don't care about it as much, or they, it's because of like, this is kind of more of their personality is they're not going to jump to that anxiety or the worry as much. And so, being able to kind of support other people is helpful so that we can kind of, yeah, move the path forward.  Kate Grandbois:  Would you recommend for anyone listening who's maybe thinking about personality tests for the first time or reflecting on how this intersects with their current team? or even how this is reflecting on themselves and what personality traits they may have. Are there certain things that in your reading of the literature and reviewing all this material, um, Are there, is there one that is more beneficial over the other? So in other words, is it, is it more helpful for a clinician to reflect on their own personality and what they're bringing into the table versus [00:59:00]  making assumptions or pigeonholing a colleague? Well, they're very neurotic. So I'm just going to X, Y, and Z. How does that, what would, what would be your thought there in terms of what a clinician can actually do with this information for themselves and for others? Okay. Thanks. Becca Sylvia:  That's a great question. I would say, I think it's been helpful to think about how I think about certain situations and respond to certain situations and might say, okay, um, you know, I, the reason why I, um, Um, less eager to get on the phone with this client is because the extraversion is like harder for me, and it's not in, you know, or, um, the reason why I'm really struggling to change my plan is because, oh, I tend to be a little bit less open. And [01:00:00]  so I guess for me, it's helpful to know that, like, just because I think see things from a certain perspective. It's not how everyone else might see something from a certain perspective. Um, I don't know what you think, Christy, but I think it's been helpful for me to kind of think about where do I fall on these scales and how I can think about other people might fall in a different place and how they might respond or act. Kristi Stearns:  Yeah, and I agree in that sense. I think that, um, where I haven't Taken one of these formal personality assessments in any of my workplaces. I think now that we've read some of the literature about it and we've Um, examined it that, you know, doing the work, so to speak, kind of starts with yourself. So I think even if I didn't have colleagues that were looking at the same information, um, but I've been able to look at this information and kind of, um, do a self [01:01:00]  assessment. I do think that, um, you know, I'm avoiding labeling other people, so to speak, but, um, it helps me understand myself and what. I have the power to change because, you know, you know what they say. You can't change other people. You can only control what you can control. And, um, I think it also helps you put into perspective what you can control. Um, but if we were, I think perhaps some of the most beneficial uses of some of these personality assessments, though, is that, um, you know, you each complete the questionnaire assessment or what have you. And then. Should you feel comfortable in your workplace. Um, that opens up to sharing and a collaborative discussion. Um, so, and then usually I would imagine if this was, uh, during some sort of a workshop that they would go into how the different personality strengths can, [01:02:00]  um, support one another or if maybe if there are certain limitations with different personalities. personality types that, um, uh, where, who can kind of, what other team members can help out in the areas that maybe someone isn't, I don't want to say performing the highest, but, um, you know, like for me, who doesn't meet like the highest bar of conscientiousness, um, You know, Becca shares her questionnaire, and she has a higher level. Okay, great. What can you do? Let's chat. What can you do to contribute, um, to what, uh, to some of the areas that I may need support with? And I think that having this framework, um, It helps take things a little less personal and it helps this whole topic be a little bit more approachable that it's coming from, um, actual literature, you know, self reporting. I think that that helps. Um, but. I think that using this framework and then also [01:03:00]  considering the other frameworks as well that we talked about the competencies and the generational differences, um, can really, can really help with collaboration as a whole. And, um, and again, the ocean traits, you're not just one. full trade and that's all that you are. Obviously these traits exist in ranges. Um, and some folks may be a little bit more on the, you know, the strongly agree side of that range, um, than others. If that answered your question,  Kate Grandbois:  no, it did, um, it, it really did. I, you know, we've talked so much about collaboration on this podcast, but we've never really looked at it through a generational lens or a personality lens. And I, I think that these two components are very helpful in terms of what we bring to the table, the lens that we're looking through when we're interacting with colleagues, um, thinking about our role on the team, what we can contribute areas where we might need more support, or we might need to advocate. For more support. [01:04:00]  Um, this has all been really incredibly helpful. I'm wondering in our last few minutes, if you have any final suggestions or thoughts for our audience.  Becca Sylvia:  Yeah. I mean, as you heard, we did, we kind of, we covered a lot of different things and we just kind of, you know, Um, and we've kind of, um, Dipped our toes into some of these things in terms of dip, the competencies, the generational trends and different personality types. So we wanted to provide a broad overview to say like, these are different things to kind of think about. Um, And when you're thinking about collaboration and you're trying to maybe establish. Good collaboration on a new team or improve collaboration. It can be helpful to think about, okay. Different areas of. You know, interprofessional competencies. Generational trends, personality types, and how they kind of all come together. Um, so our goal was to kind of, you know, increase that awareness of it. And you may [01:05:00]  find like taking bits and pieces of each of these can be helpful for you and your setting. Um, you know, and as you mentioned at the beginning, The reason why we feel so strongly about effective collaboration is that we really do believe that it can improve client outcomes. And so that's what we're here for. It's like when we, when the team collaborates together, the clients went out, um, and it also can be helpful, you know, in terms of having a more inclusive and productive work environment. So saying, you know, like, this is, you know, We can get things done. We can be efficient, but also we can be inclusive and understand that we're all different and being different is not bad. Being different is just being different, you know? Um, and everyone brings their own strengths to work together on a team, whether it's you're working with other health professionals, you're working with a client, or even if you as a speech language pathologist, you are in the same [01:06:00]  setting, and there's two or three of you in the same setting, that intra professional communicate collaboration can also be really helpful. Um, and you know, we just, we want to. As we mentioned before, like understand and respect differences, um, and think about that rather than being bad things that there are strengths that everyone has. And we can, by thinking about strengths, um, that can help with that collaboration and therefore our clients.  Kristi Stearns:  I agree with what Becca said. And, um, you know, you may find that there are certain, uh, maybe personality assessments, maybe, uh, workplace frameworks that are more suitable for the place that you're working. Um, yeah, which is why we wanted to give you, uh, a little bit of an array, but, um, yeah, what Becca said about how just, being inclusive to those differences and having some awareness, um, [01:07:00]  can, you know, just decrease you taking things personally, which can, you know, deter from you doing your best. Um, and the You know, there's a reason why, you know, in the nineties, I think about those posters that say teamwork or, um, you know, all of those like very morale boosting types of, I think of those morale, uh, types of posters on, uh, you know, workplace walls, whatever, but, um, they're reminders, right? Um, and I think that some of these frameworks and assessments Bye. Can give you exposure and reminders, uh, just ways that you can improve your own collaboration, looking inward and, um, and all in all to support, yeah, your, our clients and their families.  Kate Grandbois:  Thank you so much for sharing your time and your hive mind, your collaborative hive mind with us [01:08:00]  and our listeners. This was really wonderful. We're really grateful. Thank you so much.  Becca Sylvia:  Yes, thank you for having us. We enjoyed this a lot.  Kristi Stearns:  Yes, we really appreciate it. Thank you so much for your time.  Becca Sylvia:  Yeah, thank you both so much. This is great. Sponsor 2 Announcer:  Thank you again to our corporate sponsor Ventris Learning, publisher of the Assessment of Literacy and Language, or ALL, and the Diagnostic Evaluation of Language Variation, or the DELV. SLPs, school psychologists, and reading specialists use the ALL to diagnose developmental language disorder and to assess for emergent literacy skills, including dyslexia, for children ages 4 through 6. The DELV is appropriate for students ages 4 through 9 who speak all varieties of English. To learn more, visit www.ventrislearning.com . Kate Grandbois:  Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, [01:09:00]  depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study. Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. 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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 . [00:00:00]   Intro Kate Grandbois:  Welcome to SLP nerd cast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy  Amy Wonkka:  Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each  Kate Grandbois:  episode of this podcast is a course offered for ashes EU. Our podcast audio courses are here to help you level up your knowledge and earn those professional development hours that you need. This course. Plus the corresponding short post test is equal to one certificate of attendance to earn CEUs today and take the post test. After this session, follow the link provided in the show notes or head to SLP ncast.com . Amy Wonkka:  Before we get started one quick, disclaimer, our courses are not meant to replace clinical. We do not endorse products, procedures, or other services mentioned by our guests, unless otherwise  Kate Grandbois:  specified. We hope you enjoy  Announcer:  the course. Are you an SLP related [00:01:00]  professional? The SLP nerd cast unlimited subscription gives members access to over 100 courses, offered for ashes, EU, and certificates of attendance. With SLP nerd cast membership, you can earn unlimited EU all year at any time. SLP nerd cast courses are unique evidence based with a focus on information that is useful. When you join SLP nerd cast as a member, you'll have access to the best online platform for continuing education and speech and language pathology. Join as a member today and save 10% using code nerd caster 10. A link for membership is in the show notes Episode Sponsor 1 Kate Grandbois:  Welcome to SLP Nerdcast. We're so excited for our topic today. We are here to talk about something that is under discussed in the field of speech language pathology, and yet at the same time, something that is critically important [00:02:00]  for every single thing we do as speech language pathologists. We're here to talk about counseling, and we have two content experts here with us to make the conversation even better. We're very excited to welcome Dr. Corrie Clark and Kate Mellillo. Welcome Kate and Corrie. Hello. Yeah. Thanks for having us. We're very excited to be here. I was thinking why I listened to this podcast. Amy Wonkka:  We're so happy to have you here. Thank you so much for sharing your time with us today. Um, like Kate mentioned, you're here to discuss counseling with a focus on children and adolescents and executive functioning and relationships. But before we get started, can you please tell us a little bit about yourselves? Kate Melillo:  Sure. I'll go first. Okay. So, um, I'm Kate also. Um, I am a speech pathologist in North Carolina. Um, Cori and I co own Be a Problem Solver Services, which is our private practice. [00:03:00]  Um, and my focus is on executive functioning and social skill building. Um, and our practice is actually both mental health. and speech services. So it's a little bit of a unique combination. You don't see that a lot. Um, and I'm, I also write a lot of social emotional learning content as my other job. So I'm, I'm in this world all the time. And I'm Dr. Corey Clark. I am, um, a licensed clinical mental health counselor. Um, I specialize in working with, uh, children and adolescents and, um, I also teach, uh, a, a clinical mental health counseling program, uh, called the Chicago School and I, I am also the president elect of the Association for Child and Adolescent Counseling, um, and so a lot of my focus is on, you know, the unique work with, uh, counseling children and teenagers. Oh, and we're also married. [00:04:00]  We are also together. So if you hear us having a marital argument, that's great. That's what podcasting is the perfect platform for side chatter. Um, so that's, that's wonderful. And I, I want to circle back. I were tickled that you listened to this podcast. It's always funny for Amy and I to hear that kind of thing because we hang out in a zoom room and then we send these off into the ether. Kate Grandbois:  So it's, it's always nice to hear that. Um, and we're, as I already mentioned, we're so excited to have this conversation, it, you know, counseling touches everything we do, and your practice is unique, and it sounds wonderful blending these two areas of competency, um, and we're very excited to get started. I do need to read our learning objectives and disclosures. I will try and do that as quickly as possible. Learning objective number one. Describe key knowledge areas, attributes, and skills of child counselors To incorporate into speech sessions as they [00:05:00]  intersect from the competencies for counseling children and adolescents. Learning objective number two, describe three relationship based counseling strategies that can be easily included in speech sessions. And learning objective number three, Identify how the mental health strategies discussed intersect with executive functioning treatment in the relationship based model of executive functioning. Disclosures, Corey's financial disclosures. Corey is the co owner of Be A Problem Solver. Corey is the co owner of Be A Problem Solver Services, PLLC, which is a mental health and speech therapy practice, and Be A Problem Solver Education, LLC, a parent education service where Corey received a salary for a speaking fee. Corey is a faculty member at the Chicago school where he receives a salary. Corey is non financial disclosures. Corey is president elect of the association of child and adolescent counseling. Kate's financial disclosures. Kate is the co owner of be a problem solver [00:06:00]  services, PLLC and be a problem solver education, LLC, where she receives a salary and a speaking fee. Kate is a research strategist at 3C Institute where she receives a salary. Kate's non financial disclosures. Kate has no non financial relationships to disclose. Kate, that's me, Kate Granbois. I am the owner and founder of Granbois Therapy and Consulting LLC and co founder of SLP Nerdcast. My non financial disclosures, 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. 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 Nerdcast, and my non financial disclosures are that I am a member of ASHA Special Interest Group 12, which is AAC, and I also participate in the AAC Advisory Group for Massachusetts Advocates for Children. All right, we've made it through the disclosures and the learning objectives. On to the actual content. Um, [00:07:00]  Kate and Corey, why don't you start us off by telling us a little bit about the first learning objective? So I guess both what are some clinical competencies for counseling children and adolescents, but also why is it important for SLPs to be aware of and to develop these competencies? Cory Clark:  Yeah, so I'll start. Um, this really, for some context, this really started in the last five years where I, as a, um, counselor saw that counselors were being trained to treat adults from a more general model. And I found that working with, um, and teenagers was a very unique process. And I think that really started from working, uh, Kate and I met, uh, working at a preschool and, um, I had a, you know, background in working with kids in that way. And, and I saw that a lot of people were going into the field, just kind of treating kids like little adults, you know, and it was, there was an [00:08:00]  incongruency there. So I was really interested in what makes working with kids and teens unique because I knew there was. A uniqueness there, but I wasn't quite able to pinpoint it. And so, the last five years, I've really been focusing on interviewing experts in the field of, uh, child and adolescent mental health and identifying what makes working with kids and, and, and teens unique and what are the basic best practices and working with, with that population. And so, that is, is where I, um, published and, and, and focused a lot of my dissertation research. best practices for working with kids and teens. Um, and really what it comes down to is really the foundation around child centered therapy. And so what that means is child centered therapy is in its nature very non directive. Um, it is very much based on the Carl Rogers, uh, person centered counseling [00:09:00]  model, which is unconditional positive regard, having congruence and empathy for the, for the person. And And because of that, there's not really a lot of, like, specific behavioral goals in, in, um, child centered therapy, um, but a lot of research supports that a lot of behavioral change and, um, good, uh, coping skills and good development happens from that. Uh, play based child center therapies. So, um, that is sort of the foundation of, of a lot of the, the, um, best practices for working with kids and teens. And so, you know, looking at, uh, What kind of the model that I came out with initially, um, there's attitudes, actions, knowledge and skills. And I broke it down to those four kind of domains. Um, and so go ahead.  Kate Melillo:  Oh, so before we jump in, because are you about to jump into those domains before we jump into that. [00:10:00]   I just want to touch on why this matters for SLPs and why we see like a really big crossover with executive functioning skills. So, you know, I think like if you're listening to this, you're like, well, what does that have to do with what I do on a daily basis? Um, however, like at our practice where. Counseling and speech therapy all the time. I mean, and I think a lot of SLPs, especially when you're new, you go in and then you're like, Oh, I didn't like now a kid is crying in my office. And I didn't expect that. Right. Like, or they're dumping out like, Oh, well, my home, my mom told me this, like, they're just telling you everything. And actually, it's funny. I remember in grad school, I had this one professor who's like, you're going to be so surprised. They're going to come in and tell you everything. Cause you're like the sort of, you know, side person in their life. A lot of times, like you're like this extra [00:11:00]  support person. Who's not the parent. And there's no other, like, side person. Like, you don't have this other, um, stake in the game at, like, you know what I mean? Like, they are kind of coming to you, like, friendly, right? Like, I think, like, the SLP role tends to be really, um, warm, empathetic. The things that Corey just described, but like Kate said, like, we don't get a lot of this training. Um, even though we're doing this relationship based therapy. All the time. Um, and so in terms of where we see it a lot is this like crossover with executive functioning and that's a lot of times because, um, executive functioning at its core is really regulation, right? It's, it's how our brain can regulate itself so that it then can like plan tasks, organize tasks, um, Execute tasks, right? Like impulse control, working memory. Um, [00:12:00]  and a lot of that comes down to emotional regulation. Like I always say, like I describe to my clients, like when you're in mental health. is not in a good space, like your executive functioning skills become scrambled eggs. And so it's really hard for, for students to be regulated, right? Like cope and release emotions and then be like, okay, let's, let's work on pronouns. Like it, it, it just doesn't work like that. The human brain doesn't work like that. And I think a lot of times we go into sessions and we have an agenda where like, these are the goals. That's what you learn in grad school. You're like, these have to be like good functional goals. They must achieve them. The insurance company must approve them and you must do them like, you know, and then we skip over this other stuff. Meanwhile, like, you know. Little Johnny comes into your office and he's like, Oh, my [00:13:00]  grandma died this weekend. Like, you know, I mean, and you're like, but he's the, like, you're the person he trusts. And so he's told you this information. And then you can't be like, well, let's do some grammar, you know, like it, it, it doesn't jive.  Cory Clark:  Yeah, and I, I often say that, um, I am a, I'm the person for a lot of kids, right? And teens. And what that means, what I mean by that is, is a lot of times a kid will have a person that they deem supportive and safe to say those things to. And it might be a counselor, but it might not. It might be a speech therapist and, um, or another professional. And when you're the person, right? Or one of a few persons, um, it's a. Really big responsibility and as far as how you handle those moments where they say, my grandpa died or this and that happened, or I'm feeling X, Y, Z. And so it's important to capitalize on, on creating that space, um, for, for young people. [00:14:00]  And, you know, so, so that's where I'm, I'm going with a lot of this is these best practices, um, are not just. Really just counseling. It's cross discipline in that way, so that you can hold that space. wherever it comes as a professional.  Kate Grandbois:  I also want, I want to piggyback on some of what you've mentioned. It's making me think of a lot of the content that we've produced recently, particularly as it relates to self acceptance. Uh, for example, this has come up a lot in our conversations related to stuttering therapy, uh, or self advocacy. Um, and, You can't really work on self advocacy and self acceptance without counseling and this is what we are now considering to be best practice based on evidence in the field of speech pathology and you cannot uncouple those things. I think there's a specific. Uh, flavor to working as a speech language [00:15:00]  pathologist because you are working closely with someone who is, their existence is living with a communication disorder. That is a communication disability of some sort. That is, that's why we're in their lives. So I don't, I, I wholeheartedly, I'm thrilled to hear some of this, you know, some of these threads being woven together because it is so ingrained in the fabric of what we do. Did you like that little, that little similarity there, the threads in the fabric? I just came up with that on my own. Yeah. Yeah.  Cory Clark:  So going into kind of my, um, more into the background around attitudes, actions, skills, and actions. Um, I think. I looked through the best practices that I've been working on over the years, and there's a few that I want to highlight today that are really relevant, Kate and I feel, to the speech therapy world. Um, and so, Starting with attitude, um, [00:16:00]  specifically, there's three that I want to highlight and, and they are the, the first one is something that a lot of experts mentioned, uh, when asked about, you know, what's important when working with, with children. And that is to meet children where they are. And I heard that over and over again over the years. And I was like, what does that mean? And essentially what they're saying is. You can't go into a session, a speech session, therapy session, um, with a item by item, minute by minute, breakdown of here's what we have to do, here's what we're going to do that entire time. Because kids will come in and throw a curveball or a wrench in that plan real quick. And it's important to be able to be flexible, um, to what, flexible for what, The child or teenager needs to work on or needs to address right like Kate just said if they come in and mention something about their, you know, family member passing away. You can't just be like, well, we got to work on preposition. So we're going to move past that. Right. [00:17:00]  Um, you have to, you know, And, you know, like I say to a lot of my kids, like, think like a palm tree and say, all right, I'm going to bend to this and go, okay, uh, let's pivot. Let's hold some space. Let's reflect and, and, and be supportive and empathetic. Um, so it doesn't mean throw all plans out the window, but it means. meeting children where they are and what they're giving you that on any given day. Um, that attitude is, is very important. And secondly, um, all behavior is communication.  Kate Melillo:  Wait, I want to go back just for a second. So I wanted to say about that mean children where they are, the, you know, we said a couple of negative, really negative examples, but actually The positive example can also help propel your goals forward. So for example, if a kid comes in and they're like, Oh, I'm actually going. You know, like miss Kate, I'm going camping this weekend. Well, I, you know, [00:18:00]  we'll take that and make my examples and therapy about the campaign, right? Like it becomes more relevant. Um, and so it, it doesn't have to be like a big, catastrophic, traumatic event that you're kind of being empathetic to. You're really just like tying into the kid's life and like, great. That's a vocabulary builder. I can talk about planning, right? Like there's executive function. We're going to do working memory. Like there's so many things that can be based off those examples. And I think that, you know, interestingly, I've, I've had the experience where I explained this kind of model to like a newer clinician. And, you know, like I've had job interviews and stuff, like interviewing people to come and work at our, our practice. And they're like, I don't think I can do that. Like, I don't think yet I can, I can, like, that seems like an advanced skill. Um, now granted, I like what Corey and I are saying is, is a clinical, [00:19:00]  is your clinical judgment, like your clinical sense. And that does come with time. So I don't want to make it mean like, this is so easy on the fly. Think of 10 examples that you can use when the kid says one sentence like that. I get that that is like a really hard skill to do. Cool. But I think as SLPs, we can kind of hold this in our mind. Um, and we'll talk about at the end, some examples of how I incorporate, like how I get this going. All of my students know, um, what I'm going to ask at the beginning of every session before they come in. So they're ready and I'm ready. Right. So I've primed it so that like the structure of my sessions is ready for that acceptance, right? It's, it's, ready for whatever's snowballs come my way. Um, and we can talk about that a little later on, but I just wanted to say, I just wanted to note that I get that this is like, uh, takes a little bit of practice, especially if you're used to going in and being like, you know, this is what we're doing today. Um, it's [00:20:00]  definitely a change in that. And you're in your own attitude, which is also what Corey's found in the counseling world as well.  Cory Clark:  Yeah, I think, yeah, I think everyone has their own, uh, uh, preference in terms of how they want to go into a session. And also it's based on what your, um, specialties are and how you run your, your practice. Um, for me, being flexible is just, that's what I prefer, you know, and I, I don't have a lot of agenda in, in, um. A lot of my sessions don't  Kate Melillo:  like to plan anything.  Cory Clark:  I don't. I'm just like, I just want to walk in and say, how's it going? Yeah, I love it. But there's plenty of professionals that I work with that are like, no, I need I need an agenda. I need this. It's very structured. Um, so, you know, for some, it'll be natural. Some not as much. Um, but. The, the second thing I, I want to highlight is all behavior is communication and um, that sort of attitude and understanding is important with kids and teens because there's a, there's a saying in the, in the child [00:21:00]  counseling world, um, so it's important to listen with your eyes because when you're working with young people, they're going to be giving you a lot of information content wise, particularly when how they talk, what they're saying, um, what it's about, you know, what you're working on, but also, um, Non verbally, what are they giving you? What are they saying? Um, what is their body doing? And both of those things have to happen at the same time, listening with your ears and with your eyes. Uh, because kids communicate so much, in particular, and teenagers for sure, um, with how they're, how they're sitting. Are they fidgeting? Are they, You know, do they need to move? Um, do they need a break? Are they listening? Are they focused? Um, what is their affect? All of these things are happening in real time. And it's important to be attuned to that because otherwise you're going to miss really important cues as far as how they're able to be present with you and how they are in that moment. And if you can reflect some of [00:22:00]  that, That's really, really valuable learning for them and awareness. What does  Kate Melillo:  reflect some of that mean?  Cory Clark:  Um, I noticed that, you know, you're, when I ask you to do this, you start to fizz it around in your chair. It seems to me like you may be a little nervous. You're not sure what to do, right? That's a reflection of like, Maybe they know they're doing that, maybe they have no idea. But, and sometimes it's, you know, not accurate. Maybe it's a reflection that they'll correct me on. It's also a good opportunity for them to advocate and say, No, it's this or that. Um, but regardless, you know, listening with your eyes involves that real time kind of, interaction where you're listening to what they're telling you without words. Kate Melillo:  I also think it's ironic because it is what like we teach when we're teaching perspective taking skills, right? And social skills were like, look at the other person. What are they telling you? You know, like look at their body language. Like what did that, what did it mean when they started to walk away when you were in the middle of your sentence, right? Like it's so I think too, like [00:23:00]  we're sometimes go into the sessions, like not doing the things that we're trying to teach. And I, I, I like that, you know, in the counseling world, there is this piece of reflection because it, it, it brings everybody together, right? Like you as the clinician and the student, right? So you've got both parties being like, Oh, I recognize there's a behavior here. And I I'm, what am I trying to say or communicate to this other person?  Cory Clark:  Yeah, and the third aspect of sort of attitudes and understandings that I want to highlight is that all children must be and teenagers must be viewed holistically. And what I mean by that is sometimes it's easy to fall into kind of a The trap where you are looking at one particular aspect of development, whether it be, you know, from the counseling world, like a emotional development or something with relationships, um, [00:24:00]  but you have to think about young people in terms of all aspects of their development and, you know, in particular, I often kind of. Disregard or discredit certain things, not intentionally, but be like, oh, that, you know, looking at how they're doing emotionally at school is very much tied to their social life and their social development and also what's going on at home, right? And also physically, um, their physical development, how is that impacting their social life, especially with like tweens and teens and all of that, right? So you have to consider all these, you know, domains when you're working with, with young people.  Kate Melillo:  I think we hear this all the time. If you have a middle school student with articulation errors, you are not just like, Hey, let's fix those errors. It is impacting them socially, right? Like those friendships are coming into play. Um, and I, so I think this like core best practice of the [00:25:00]  holistic child is so important because, and I think, I do think like Some of these things are becoming more mainstream in SLP, where we are starting to look at, hey, how does this affect you in these ways? And maybe you're making, you're working on some like, um, social, like, strategies to, you know, help, not just with the articulation disorder part of it, right? So like, you're, you're, you're using multiple domains there, um, to help that kid. But I think that, It's different than what we thought of as like the traditional Western medicine model where we're like, let's just treat these one this one symptom and make it better. Like we really actually need to be looking at everything because that's going to round out a kid's mental health, and the way they interact with the world. Cory Clark:  And I, so the next. area, the domain that I want to talk about are knowledge bases [00:26:00]  and understandings, um, of counseling with children and teenagers. Um, and the first one I, I really want to focus on is, is the most common, um, issue I hear. And when people come to see me in counseling, they will say that, um, they've tried counseling before or they've tried some sort of, um, therapy service before. And the parents or guardians or caregivers were left feeling like I had no idea what was going on. Uh, they never told me, they just kind of went back into the session and I didn't know what was happening. And then they were left frustrated, like, I don't know what the goals are, what's going on, right? Or they didn't understand them. And so they come to me, like, will you let me know, like, what's going on, like, you know? And, um, I always tell them that although I'm, you know, I'm not going to say exactly what the content is of the session, like there's privacy there. You will always know what my treatment plan is and what my background [00:27:00]  is and what my training is and how I intend to use that to support your child or teenager. Um, so the, the first really knowledge base that I wanted to focus on is, um, how to involve family or caregivers or guardians in therapy services. Um, it's so important to involve. Other stakeholders in a sense, but family members in, uh, as appropriate, because kids and teens operate in a system, uh, they're part of a system, and you have to be able to translate what you're doing to, um, how it can be reinforced at home and other settings, um, so that involves communicating a lot of those goals and a lot of those things to parents and to, to, um, family members. And that can be tricky, um, depending on what the situation is in, in your service, um, but you have to be able to, to translate that, um, or else you risk losing the [00:28:00]  connection you have, um, with, with the family, um, and they'll pull, you know, maybe prematurely pull them from services or feel like it's ineffective. Or, in a lot of cases, think that you're not doing effective work because they don't really understand what, what the goals are.  Kate Melillo:  Well, and I was also going to add, because a separate, a separate best practice is also the developmental models and how to apply them, and I want to just integrate this into the sharing with the family, because the other thing we hear quite a bit is, you know, families will come and say, Like, I didn't know what was going on and not really for, for speech. I actually have a lot of parents in my sessions. I, I, I just prefer that. Sometimes if it doesn't work with the kid, I'm like, okay, you got to get out because you're, you're entering this session parent. Um, but I like the parents to hear because a lot of times I'm giving homework to the family and which is more counseling ask, right? Like, I'm like, this is how we're going to integrate this because we do hear a lot. Oh, I've tried that before, and it doesn't work. [00:29:00]  Um, Cory hears that in counseling all the time. Yeah. And the, uh, the developmental piece that I wanted to point out is, you know, we are in this field, we're experts at these developmental theories. Like, we know all of this, like, background information that a layperson parent doesn't know. So a lot of times parents will come and say, like, you know, Oh, my kid is like now climbing the bed with me. It, they don't sleep anymore, blah, blah, blah. And maybe that in that kid's life, you know, they're going through a developmental transition, which we know about. And we have other parents come and tell us like their eight year old did the same thing. And we're like, okay, now we can show that that's fairly common, but not every. You know, person is going to know, like Erickson, Piaget, Bandura, like they're not going to know that. And a lot of times SLPs, uh, we get like a little bit of that. And I feel like it also depends on your grad school program, right? Like where the focus was on those things. And they're so varied that maybe you [00:30:00]  don't know as much about that. Which is why it's like, we're talking about this because that's something to share with parents. Um, hey, let me find out more information about that for you. That's helpful. Or make a referral, which we'll talk about at the at the end here, but I I'm pointing that out because I think that there's times when families feel like they're just. navigating this alone. They're the only person that it's happened to. Um, and that it's just, that's just usually not true, actually. Like usually it's happening to a lot of people, but nobody's telling them that. And so when they come in your office, they're like, hello, professional person, do you have the answers for me? Um, you know, and so it's a good, it's a, it's always a good idea to involve the family as much as you can.  Cory Clark:  Yeah, and the next, uh, understanding that I want to highlight, I just want to have a caveat about, um, and that is, it's important to understand the basic foundations of play therapy, and the caveat there that I want to [00:31:00]  distinguish, I do not expect this. I did not expect every therapist to be a registered play therapist. I did not expect speech therapists and other professionals to be play therapists, um, that has a separate and distinct, uh, licensure and, and process and credential. But, the foundations of play are important to consider in working with kids and into teenage years, um, because they allow, um, Young people to express themselves in their natural, in the natural form, which is play. And, um, and so a couple of important points about play therapy, um, they, it's important to accept children exactly as they are and allow themselves to express themselves freely, um, and have a sense of permissiveness to do that. So, you know, thinking about where your, your practice is, whether it's telehealth or, um, an outpatient setting or a clinic somewhere. You have to think about what is that setting doing for them to be able to express themselves, [00:32:00]  um, and you have to ask yourself, like, what, what does that look like for you and your practice? Um, it's important that they have that space. They feel free to express and be themselves with whatever they're, you know, intending to do. Um, and as a therapist, you reflect what they're doing, like listening with your eyes, and um, allow them to gain insight into their own behavior. So that looks like, it can feel very, um, odd at times, because, you know, you're almost like narrating their life, like, like a, you know, bird's eye view, if you will. You know, someone's like playing and they're like, they hand you something rather than just, you know, like they're handing you a figure, you know, and they start, they want you to play with them. My instinct as like a father is to take my son's, you know, figure that he gives me and then I'm going to create like a game with it or a story or whatever. Let's play therapy a lot of times in most modalities. You're not going to do that. You're not going [00:33:00]  to direct them and, you know, say, Oh, now I'm going to create a story. You're going to say, Oh, you want me to play with you. You're really excited for me to play. No, you're giving me that. Okay. And then you sit down and you let them dictate what the play is. Because they're communicating that way. Right. And so in, in a, in a speech sense and that speech therapy, in a sense, it's being able to reflect what, um, your client, what your, your person is, is giving you in a way that allows them to gain insight into their own behavior and their own affect and feelings. Um, and that's really, really healthy and important for their development.  Kate Melillo:  Well, and I think speech therapists, speech therapists are doing this, right? Like if you think about like. the fundamentals of like early intervention really, you know, here's, you're at a kid's house and you're like, here's the farm that you have. I'll just use the good old farm example, where, you know, you're like, Here's the cow. What does the cow say? Right. So you've got a lot of opportunities there for [00:34:00]  like vocabulary building and all of that other like syntax stuff that you want to target. Um, and I, I, I wanted to point out that so play therapy gets the rap of being for little kids. Um, but court. So we haven't mentioned this yet. We didn't say this because this isn't really that relevant yet, but so we're also both trained improvisers. And so we do a lot of improv with our clients, especially tweens and teens. Because I think that the other thing about play therapy is that it's about that acceptance. And those improv games, that is what they are, right? Like if you've ever heard the concept of yes and it's, I accept the idea that you've just given me and I'm going to build on it. And that is what, that's actually what you're doing when you're in your little farm scene. That's what you're doing, right? It would be weird if the kid was like, here's my cow and the cow wants to drink. And you were like, [00:35:00]  ah, that cow's actually on a rocket ship going to the moon like that. Right. And that doesn't make any sense. That is one of the fundamentals of improv comedy. And so we use that a lot. And I think, um, it's confusing to parents, parents will, how many times have you heard, Oh, all they do, they go to that therapy and all they do is play. Um,  Cory Clark:  It's like saying, oh, I went to therapy and all I did was talk. And it's like, that's, that's right. You know, playing is communication. But, but that's not a common, I don't think, understanding that like, You know, and play therapy is very evidence based, and it's very, um, it's very clear how to do it once you learn it, um, but it's very misunderstood because we use the word play all the time, like, let my kid play, and my kid's playing in the other room, um, but, you know, I use so much improv with, with kids and teens where, you know, I'll have a figure and it looks like a superhero to me, like, But they'll hand it to me and say dad or whatever. I'm like, okay, this is [00:36:00]  dad, right? Like you accept what they're giving you and in that way They're telling you their story and you get to hear it from their lens not you know What your instinct is tell you like no, this is a figure of Batman, you know, whatever, right? So you have to be able to roll with that again be flexible and meet them where they are and reflect And I think that's essential  Kate Grandbois:  I, the only thing I have to add to that is some of my own experience. I've been trained. I had to go through this very specific training in child led play and it was hard. It was so much harder than I expected it to be because of exactly what you said. I'm like, Oh, playing. I can get on the floor. I can do some Legos. I can get out the cow and the chickens and you know, make some animal noises and make it fun. I can play. I know how to play. I'm a pediatric therapist, but really taking the child's lead and filtering your own responses and not coming up with [00:37:00]  directives and not asking a ton of questions and really letting them direct where the play goes is a Harder than you think. So if anyone is listening, and I just, I think it's a, it's a great exercise. What you're, what you're proposing is a really great exercise to really think about what play means from a therapeutic evidence based lens, because it might not be That colloquial casual. Oh, we're just playing. We're just on the floor. It's very different and it's gonna feel hard It can feel challenging. That was my experience  Cory Clark:  It's and it's so hard that I mean it's important to note There are some modalities that are more directive play therapy but You know, without getting into the nuance of that, um, there's a misunderstanding that like, oh, if I play UNO with a child, that's play therapy and that's, that's free play. That's, that's playing a back and forth game that has set designed rules. Um, so that's not play therapy. That's playing a game, right? So there's all these. You know, misunderstandings [00:38:00]  based on the language really. Um, and play therapy is, is a distinct process. Um, and I always say the most exhausted I am after a session is a non directed play therapy session because, uh, 45 to 55 minute session is, It goes by, you know, it's, it's exhausting. Kate Melillo:  Well, and I would say too, like, I don't know if you guys, have you read the Declarative Language Handbook by Linda K. Murphy? I love that book. It's a really good resource. It's not a play therapy book, but I use it a lot. And Cory mentioned terms that were declarative language. Like, I see you're doing this. What happens next, you know, um, Tara Sumter, too. She has her reflexive questioning guide. Like, those are also those reflexive questions. And it is, Kate, like, to your point, so hard to, like, bite your tongue and be like, But didn't you mean this? You know, and, or, like, weren't you going to do this with this? Or, like, you're trying to guess the kid's plan. And that's actually not teaching [00:39:00]  them the skill for that, like, future thinking, right? Those executive functioning actions of, like, Oh. You wanted to see what I was going to do. And then when they make a choice that's like, I don't, I don't know if that was what we were going for here. Then you're, you have the opportunity to discuss it and see how you could have done it differently. Whereas if you had done the directive play, you would not have gotten to that point. Um, it's also why we love those improv games because they're They're totally impulsive. Like you don't actually know what the kid's thinking. We can't know what anyone is thinking, you know, um, which is a big, that's a big like nugget there between the counseling and SLP world because we, since we do tend to go in with like, here's our strict, you know, plan that we've got, here's our goals and counseling. It's a, it's really a free for all. You're there to share what, It's going on with you. Um, and as [00:40:00]  SLPs, I think we, we tend to, I don't want to say like disregard it, but we're just not as, you know, it's not our area. We're not as skilled at looking for those clues. But when we do something like a child centered play therapy session. We open up the door, right? If we, if we allow kids to kind of lead, um, and also not tell them what they're supposed to do,  Cory Clark:  what we thought they were  Kate Melillo:  going to do,  Cory Clark:  right. And if, and if you're listening like, well, I'm not a play therapist, how would I know how to do that? And I do not expect even every therapist, every counselor to be a play therapist again. It's about. Um, understanding the foundations of what, what play can mean in counseling or can mean in therapy, um, and what it looks like and how you can reflect in a way that allows for that development, right? That's, that's incorporating play in, in therapy. That's, that's what this is about. Um, and the last kind of thing I want to mention about understandings and, um, knowledge bases [00:41:00]  is atypical versus typical child development. We all learn development of models in school and we learn, you know, the basics, but it's easy to forget some of the more kind of subtle pieces of development. For example, you know, someone will come in. And I'll hear, um, you know, uh, concerns from a parent or guardian around how their child is just so rigid about, you know, a sense of justice, like, it's not fair that my sibling gets this, or why does this peer or classmate get to do this and I don't, and it causes problems, and I'll have to kind of remember, oh, there's a very specific point in child development where that is just front and center in their development, like, I, this, deserve this, and this, and like, and there's very black and white thinking that is common, uh, as part of development. So, sometimes, you know, the therapy session involves me kind of walking through [00:42:00]  typical kind of phases that, that kids are going through that is commonly seen in certain ages. Um, and so it's important to kind of think about, okay, Is this behavior or is this issue, um, part of like common social development or is this something that's like, ooh, that they're 14 and still kind of chronologically still kind of struggling with this thing that is usually seen chronologically at age 8. And, um, we're doing that a lot as professionals in speech, I'm sure, but it's easy to kind of get lost in the nuance of that. Mm  Kate Melillo:  hmm.  Cory Clark:  All right. So, um, moving into. best practices and skills from a counseling sense. Um, I've mentioned a lot of these before, but the first one, you know, basic counseling micro skills is what, what I'll say. Um, what are micro skills? These are the little, not little, but subtle behaviors that a counselor or a [00:43:00]  therapist does in sessions to allow someone to feel heard, to feel supported, to feel that they're not judged. And so, you know, the main things I want to highlight are It's important to reflect, like I've mentioned before, um, what you're, what you're getting and, um, encourage rather than praise, uh, so, you know, I always have to stop myself from saying like, oh, that's  Kate Melillo:  good job,  Cory Clark:  good job with that drawing you made, right? And that's, that's praise. Um, encouragement is your work. You worked really hard on that. You were so focused when you were doing that, right? That is encouraging them and their behavior in the process rather than the end product. Um, so, uh, another important piece is being creative, um, and in sessions. Um, so. You know, being able to tailor what you're working on, um, as far as your goals and sessions to be, you know, being creative around how that looks. Um, we get, we settle into our, our favorites kind of [00:44:00]  activities or interventions. And sometimes we can get frustrated when we're like, oh, that didn't, it's not working. Right. And it's important to be creative, um, as far as how you. adapt to, you know, what a, a young person is giving you in sessions. Um, and, you know, staying up to date on, on the, um, at most evidence based practices in your field, I think is another piece that you have to always incorporate, um, like doing this, like staying up to date with, with your, what you listen to and, and trainings and, you know, specialties. Um,  Kate Melillo:  I would say like, so this like resonates with me for my just SLP practice where. I get in like ruts of I use the same material or there's a trend I'm seeing with a lot of kids at the same time. And so I'm like saying the same thing over and over or something like that, right? Like you're just like, you get in these like cycles of like, oh, I'm really hot on this game right now or [00:45:00]  whatever. Um, I don't know if that resonates with everybody. Maybe people are just like way more creative than me, but I don't think that it's, it's not just about like, there's some really creative, like type B SLPs. You know, like if you like a teacher's pay teachers who make like amazing materials and I'm like, wow, that's incredible. But beyond that, I think it's about creativity in the way you think like using. practices that you wouldn't normally do or even like leaving the room that you're in. Like, you know what I mean? Like just thinking outside the box a little bit, um, which again, I know is a stretch because sometimes they're so limited and what the timing that we have for a session, like the space that we're in for a session, those are all realities. So I'm not trying to like, give you a blue sky pipe dream here, but I think that it's, That's where it really resonates with me because I feel like I, I personally, I feel like I do a good job keeping up with evidence based practice. And then I'm like, how can I even implement this? Like, this is going to be hard for [00:46:00]  me to do, even though I know it's the right thing. Um, yeah. Yeah.  Cory Clark:  And that sort of leads into my, my last kind of domain around. Clinical skills, and that is, you know, actions in and out of sessions. And the first one is about, you know, again, making sure you're have the right supervisor, the right CEUs, the right education over time to match what your people are giving you, right? What they're presenting to you. Um, and then making referrals appropriately as, as you need to. Um, we see it a lot with our practice with it being a speech and counseling practice. Um, know, What an appropriate referral to counseling looks like, or to OT, or to physical therapy, or to feeding therapy, or, no, makes sense, speech therapists, but, um, other professionals. Because, you know, for example, a common kind of stuck point is, if a young person's anxiety has gotten to the [00:47:00]  point where it's so severe across settings, they can't really learn very effectively at school, or in a speech therapy session, because they're so Uh, and a heightened state of tension and anxiety. Uh, they need more support and getting to a place where they can, you know, be regulated to learn. Um, and so knowing how to, to refer, knowing where to refer, getting to know your area, I think is really important. Um, so, you know, researching that and, and kind of making a few calls if you need to, to see what's open in your area, what's appropriate referrals is important. Um, and then I've mentioned this before, but the last one is, you know, empowering others to have a larger role in their child or teenager's life. So again, that's involving family as needed, um, as appropriate. To, you know, allow them to reinforce the things you're working on, um, is, is really important in working with young people. [00:48:00]   Kate Melillo:  Um, okay. So I wanted to talk about like, we just, Corey just told us like so many things and there's actually like a billion other best practices that he researched. And those are like just the highlights. So I realized if you're like falling asleep now, you're like, okay, thank you. That's enough. Um, yeah, yeah. Sorry. You're boring. Nobody's falling asleep.  Kate Grandbois:  We're on the edge of our seats over here. We're listening  Kate Melillo:  with our eyes. Yeah, there you go. There you go. There you go. Um, but I think so taking all that I've mentioned it before. Um, I, I read this, I think it was, I'm in Tara center's community for executive functioning and I, somebody posted like something. It was like, um, once you see executive functioning, you can't unsee it. I don't know who said it. So I'm trying to give credit to the person who said it, but that, that is like, My whole life because a lot of times really every session kids are coming in and I'm like, oh gosh, like there's so many, it's not just those like surface [00:49:00]  goals, those symptom things that I need to address. It's really how the entire brain is functioning as a whole. And that's why I mentioned at the beginning that like, when your mental health is, is not in a good. space, your, your executive functioning becomes scrambled eggs, then you can't do a lot of other things. Right. So there's sort of this like hierarchy, um, where you, you're needing, like Corey just mentioned, making those referrals appropriately so that you get services in an order that makes sense to you. Like there's a lot of times where I get parents coming in and saying, Oh, I want executive functioning therapy for my kid. But then I learn like, The parents are going through a recent divorce and, you know, the kid lost a bunch of friends because he had to move due to that, right? Like, so there I'm like, Oh, let's pause this for a minute. Like, I get that. Maybe he's not firing on all cylinders, but there's other reasons for that. And so we see this crossover with counseling and executive functioning all the time. [00:50:00]  Um, You know that exact. Oh, I haven't even mentioned the word anxiety yet. I don't know. Have you, have you guys see this? I see, I, I work with a lot of teenagers and like tweens and the level of anxiety that I see on a daily basis is, is really striking. I mean, and there is also new literature about this, right? Like we know that the mental health stigma. Um, state of tweens and adolescents in the past five to 10 years has significantly, anxiety has significantly increased. So it's, it doesn't surprise me anymore, but it's almost like I immediately have to take that consideration into my treatment plan. Um, because honestly, sometimes I have to parse apart with parents, like, Ooh, this trouble with executive functioning is actually anxiety, right? And, and they go, so they're so closely related that what the behavior looks like, right, [00:51:00]  that what the kid is doing, um, that the parents like, well, What do you mean? Like if he, okay, prime example, my kid doesn't want to go to school in the morning. And I'm like, yep. Okay. So what, why is that? And they're like, well, they, because they're ADHD. And so they don't like, they can't get their backpack together. They can't do this. They can't do that. Well, few sessions in, then I'm finding out like their first period is math. They don't want to go be going to math class. They are procrastinating for that and that is actually a symptom of anxiety. And so I'm having to like really juggle like this. We have to address that anxiety piece because yes, they probably do need help getting that backpack organized. Let's be honest. Like a middle school boy backpack. I don't know if you guys have seen them, but they're a nightmare. Um, there's a lot of crumbs, unexplained crumbs and crumpled papers. As a parent  Kate Grandbois:  of two tweens, I can confirm the crumbs.  Kate Melillo:   [00:52:00]  It's a real  Kate Grandbois:  problem. It  Kate Melillo:  is a huge problem. It's not always like the kid has, you know, this like severe executive functioning disorder. Sometimes they do. Um, and every middle schooler could use executive functioning help. Let's be honest. But the, the brain regions between, um, That prefrontal cortex and limbic system, like they're going, you know, I don't know if anyone wanted a brain review today, but executive functions live in that prefrontal cortex and those emotion responses that emotional regulation lives in the limbic system and they interplay, right? And so if the kid is having a ton of anxiety, uh, or. Depression, a lot of fear, a lot of times, a lot of fear in the tween space, right? Because it's a new, you've got hormones, you've got new friends, you've got transition to middle school, like there's so many factors at play. Um, so to bridge this kind of gap, we try [00:53:00]  really hard in our practice to like, build on these relationships, which goes, this is where those best practices that Corey talked about come in. Those are all relationship building practices that I think we need to do a little bit better job of incorporating into our speech sessions so that we can parse apart. Is this anxiety? Is this actually executive functioning? Is this, you know, a pragmatic language disorder? Right? Those, those kids with, um, ASD, ADHD, you know, disruptive behaviors a lot of times, like if you have kids on a BIP, or you know, does everyone know what a behavior intervention plan? You don't know sometimes, like, what's the origin? of this, right? A lot of times, um, on my case, so to get kids who are just like simply misunderstood, uh, and some of their behaviors are, they are from ADHD, but they have never been addressed with actual executive [00:54:00]  functioning strategies. They are often just like, go in this other room, be pulled out to this other class that will help you. And then they throw a chair in that other class. And they're like, why didn't this help? You know, like, Ooh, well, what, probably if you, you can't unsee the executive functioning. So part of the relationship building is also getting that team. Corey and I just talked about this with the family. The other thing we didn't mention is like related caregivers. You know, um, we, at our practice, we have it so that like, if. A lot of times, Corey and I will see the same client for different things. And so, like, we're talking to each other with permission, right? Like, getting those, um, other providers on the phone sometimes can be really helpful. Because I've also found that when I have a kid come to me for executive functioning therapy, but they're also receiving counseling somewhere, they, a lot of times, tell me things that they don't tell the counselor. And I'm like, You know, and [00:55:00]  it goes back to what I said at the beginning, where like, the counselor seems more threatening, maybe, right, like, I'm supposed to go there and tell them all these deep, dark secrets, but if I go to Miss Kate, I'm just like, well, you know, like, I stole a candy bar, you know, like whatever it is, like, I don't know. I live in like 1955. So like, I'm like, go to the corner store. Yeah. And I love that milkshake. I don't know. Um, but we're trying to like get the everybody on the same page. Um, So when we're trying to bridge these gap in sessions, this is what one of the things that I do at the beginning of every session. I, and some people I've heard a couple of people mentioned this, like in my SLP circles, I do a high low and a Buffalo at the beginning of every single session. Um, so. My kids know that I'm going to ask this. I actually love it. It's great working memory. It's like excellent working memory. That's right off the [00:56:00]  bat, like executive functioning, and they don't even know I'm targeting it. And I'm like, what's your high, low Buffalo? So high, something good that happened to you. A low, something not good that happened. And a Buffalo's weird, funny, silly, interesting, kind of out of the ordinary. And I, you know, every single tween or teen will be like, I don't know. Whereas I've seen this kid for a year and they know exactly what I'm going to ask at the beginning of the session, I'm like, nope, we've, we've got a good thing going here. You're going to tell me all about your life. Um, you know, I've heard like there's some, there's like a rose and a thorn is another one that people use. So that's like a good thing and a not good thing. I, I tend to like the buffalo just because it makes a little more fun. Um, I like the buffalo. I've never heard the buffalo before and I like that a lot. But I set the precedent that the session is going to be about the kid, right? So like, those kids know that they're one going to be asked that question. And two, that I kind of expect them to to share [00:57:00]  something meaningful because like I said earlier, I will take that information to inform how I target those goals that day. And I, again, realize that that's, this is a little bit of an advanced skill. You do have to have like kind of a lot of things in your toolkit in order to be able to do that. But once you get good at it and make that the expectation, it becomes easier, right? You've got. This opens the door for like all of that play stuff. Like our first example of a strategy is small world play. I don't know if you guys call it small, small world is kind of like the dollhouse or the farm or in there. I've never heard it called small world play, but I like that. I used to work at, Corey and I, another fun fact, I used to live and teach abroad, and I worked at the British School of Beijing for a couple years, and in the UK curriculum, that's what they call it, is Small World's Play. So you're a little. I love it. I know, it's such a good little name for that.  Cory Clark:  Right.  Kate Melillo:  Um, that, and, and Corey too, we [00:58:00]  haven't talked about SANTRE, which is a whole other certification for, for counseling. But SANTRE is basically miniatures.  Cory Clark:  Yeah, a lot of minifigs.  Kate Melillo:  Yeah, like minifigs in the, in a SANTRE. And that is like a, cause, The reason they do that is it's a blank slate  Kate Grandbois:  like  Kate Melillo:  we were talking about earlier with play therapy. It's like a totally there's no predetermined thing. It's just whatever you're creating that sand tray. So when you're one, I start the session with this high low Buffalo. And then if we're using this example of small world play. I, this leans into heavily what we were saying earlier, you've got a lot of improvisational problem solving and perspective taking. I tend to, um, I, I really love the phrase reading the room. I use it a lot. Like, I try to give my, and we'll talk about this with social dilemmas too, but I try to make sure that like, Even if my kids like my students on my caseload don't have like [00:59:00]  glaring pragmatic issues. I'm still incorporating this in a small world scenes because they're just there. There's that is like the integration of life, right? Like that is taking the communication skills that you've been practicing and and throwing them into some sort of like realistic scenario. Um, so I love small world play for, for those social nuances and targeting some of that. And then you get that extra piece of counseling where you can reflect and empathize, right? All the skills that we just talked about before.  Cory Clark:  Yeah, and I want to talk about one exercise I love to do that's, it's more of an art therapy blend, but it's an excellent crossover between mental health and executive functioning kind of therapies. So what I do is, I saw it from an exercise for particularly with those with ADHD, but it can work well with any, any young person. Um, [01:00:00]  So I, I get a video from YouTube, just find something, a short, maybe five minute ish, uh, video of how to draw a basic. thing, right? Like how to draw a dog, how to draw an elephant, or a house, whatever. And I will put it on with the instruction, uh, that me, myself, and the, um, child or teenager are going to draw it together. Um, we each have our own paper. We're going to draw this house or this elephant together. And that's it. I'm not going to stop the video. We're just going to draw. And I, at that point, I've done it, uh, a bunch of times, right? I do it over time. And so I, can just do it, or it's, it's, I'm not great, it's not perfect, but it's, I can do it. Um, but it's their first time ever seeing this video. And so, we just draw it, without stopping, and then when it's over, it's done, right? It's simple, right? Like, we're just drawing an elephant, for example. But what we do is, in processing it, it's important to then say, Okay, a lot of [01:01:00]  kids, for example, will get frustrated because it's too fast. And so what do they do? They either quit, or they start purposely messing up, or they put an X through it, or they're scramble the crumple the paper, right? Um, or maybe they do it, but they're working through a lot of, um, frustration tolerance or a lot of negative thoughts during, right? And that mimics a lot of school, a lot of school behaviors where if they get lost in math or lost in something, um, it mimics that process. And so it allows me to work in real time to process. Okay. What was going on in your head when you started to, you know, get, get behind and drawing that elephant or, um, what do you think I was thinking while I was doing that, right? Perspective taking. Um, what kind of allowed you to keep drawing even though it was getting harder and harder to keep up, right? Um, I noticed you put the pen down and quit after about three minutes. What was going on? What happened, right? Um, it allows you to [01:02:00]  process with them. Kind of what barriers they had, um, you know, what kind of thinking traps they had or distortions, um, and kind of really make a plan for, okay, next time, what can we do that where you can work through that? And then we'll do it again, right? Um, either next session or whatever, um, to, to work on that process so they can translate that across settings.  Kate Melillo:  Well, and that's executive functioning one on one, right? That second piece of like here, next time we're going to make a plan for how to do this and we're going to apply these steps So that you can be successful because then, you know, maybe the kid has an issue with initiation, right? Like you're making a plan to get over that hump. Maybe it was the emotional regulation or making a plan to get over that hump. Those are all those executive functioning skills that a lot of times we see behaviors for, and they're misconstrued or misdiagnosed as possible language disorder. Or Pragmatic disorder when in fact, like they're really lying executive functioning. [01:03:00]  Um,  Cory Clark:  although one time I did that and uh, This is teenager. No, they drew the most amazing elephant i've ever seen in the entire world And I was just like, uh, let's process it. That was just amazing. Good job I didn't know what to I don't know how to like do my process after that. They just  Kate Melillo:  Great artists. Yeah.  Cory Clark:  Yeah  Kate Melillo:  So the last, the last kind of example here, which I think a lot of SLPs use, and there's, there are a lot of resources for this, are social dilemmas. You know, any of these like social cards, we also have, um, like some of the teen talk cards. We really liked those at our practice too, which are a little bit more open ended than the dilemma itself. Um, and I'm sure every SLP has seen these vignettes of a social dilemma. Like, what would you do? The. The thing that I think makes it a little bit lean into the mental health piece more is if you can start incorporating more of the emotional language that goes along with these, [01:04:00]  because sometimes we're focused on the problem solving outcome. And so we want the kid to quote unquote do the right thing. Um, and I know in like the neurodiversity world we're, we're, Leaning away from that and saying, like, well, what is your perspective on the situation? What was the other person's perspective on the situation? As opposed to this is the right way to do it. This is the wrong way to do it. Um, but I think that one of the important things is pointing out those emotions that come with what happens with the social dilemma, right? Like, um, There's that the concept of those like upstairs downstairs thoughts, which I think is Dan Siegel. I want to say it's Dan Siegel who it could be. I would have to check that. But I think that's because that's on the what's that workbook? Yeah,  Cory Clark:  it's upstairs and downstairs brain.  Kate Melillo:  Yeah, yeah. Um, so if you're not familiar with his work, that's a he's a really good resource. He's got like workbooks that go along with those. [01:05:00]  Like emotional thought processes, and in the SLP world, we're, we do tend to look at that perspective taking piece, um, but there's more involved in it than that, right? Like, why did that person, like, why did that person do that action? Well, they were feeling XYZ, right? And so I think that there's a really big crossover opportunity there. Um, and also we have not talked about this, which is self monitoring. And self advocacy. So self monitoring is like, well, what I would do in this situation is this. Um, and then I'm like, how do we feel about that choice? Right? Like providing that, or we can give social dilemmas, have them play them out, role play, and then self monitor. Those responses. Um, I use a scale of negative two to positive two. In my practice, I do not like a scale of one to 10 when I'm self monitoring, um, because [01:06:00]  the one to 10 I feel like what's the difference between like six and seven. Right? Like to me, there's like not really a difference. Like, how well did I do on this scale? Six or seven is kind of the same thing. Whereas in the scale of negative two to positive two, a zero is actually meeting the expectations. A one is doing better than that. A two is doing like amazing. Negative one is like, I did not meet the expectations and a negative two is like, I totally blew it. And so that scale allows a lot of my students a little bit more. One, wiggle room, right? Because they're not like judging between a six and a seven. But two, they're like, well, now I know I didn't actually do the thing I was supposed to do, right? Like, or what I did was unexpected. Um, other people might think that the, their perspective is that was a little strange and maybe that's okay for them. Like that, that's, maybe that's fine for them, but it, it is a, an actual skill to be able to go back [01:07:00]  and self reflect and then use the self advocacy to say like, Hey, next time I needed X, Y, Z, right? Or I would prefer if you said something like this to me, whatever it is, I'm in this social dilemma. So the last part is when to refer. Cory Clark:  Well, we've covered a lot of this. I don't want to kind of go too far into it that we've already done, but it's just really important to know your area. Like I said before, to know how to know where to refer. Um, for things like when the anxiety is getting too heavy to really, you know, carry out sessions. Um, when trauma has been noted that you didn't know before, you know, early on. A lot of times you don't know, um, when you start services with someone and then it comes up, you know, throughout. Um, or if, you know, someone's behavior is, you know, Getting to the point where they're so aggressive or disruptive at school or at home to where it becomes unsafe to, you know, to, um, [01:08:00]  do therapy services or, um, you know, just hearing about unsafe things at home. Um, it's important to refer. So, you know, connecting with local counselors in your area is important. Um, creating relationships, creating a referral list if your practice doesn't already have one. Um, of where, you know, you can refer to where they won't be turned away, right? And it's really hard, um, nowadays to, to. To find places that are accepting, uh, new, new clients, uh, that see kids, aren't  Kate Melillo:  full.  Cory Clark:  Yeah, they accept the insurances they need, you know, so it's important to know what's available, what's possible in your area.  Kate Grandbois:  You've shared so much with us. I could talk to you for a whole other hour. I already, I'm already thinking of all of these additional questions about how to approach this in a school environment, about, but we don't have time to go to any of these, these Avenues that my brain maybe that's my executive functioning really failing me here wanting to go off on all these tangents You've just shared so much helpful [01:09:00]  information And reaffirmed so much of of my own personal perspectives of how important counseling is So much of what we've said on this show in the past in our last few minutes Do you for? For the SLP or the special educator who's listening who might be somewhat familiar or somewhat new to this general area, do you have any, you know, final thoughts or words of, of, um, words of wisdom and, and suggestions for next steps?  Kate Melillo:  I, so I think the biggest takeaway here is to, for SLPs to like, I challenge you kind of to go into your next session and change the way you think about how you deliver the session, right? Like, change your mindset around like how you're going to approach those goals today and make it more about the relationship with that student and not about the goals. Um, because that that's really like the crux of what we're saying [01:10:00]  here, because I think you'll see things like the executive functioning stuff like bubble up, like, you'll see things like the other goals, um, come into, you know, in front of your face. If you just made it about the kid and the relationship that you have with them, which I think is definitely. A mindset shift. Um, it's not the way that everybody approaches their session. And yes, it could be your, you know, maybe it's preference, but the evidence actually does lean this way. Um, and a lot of new research and social skills and social emotional learning. So that would be my challenge to everybody after today.  Kate Grandbois:  Thank you so much for being here. We really appreciate all of your time. I have learned so much. Um, I'm sure our listeners have too. Everything that you've mentioned today will be in the show notes. So anybody who's listening while they're driving, walking, whatever, what have you, um, all of those links will be there. Thank you again so much for your time. This was really awesome. Thanks for having us. Thank you. [01:11:00]   Amy Wonkka:  Thank you.  Kate Grandbois:  Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study. Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com thank you so much for joining us and we hope to welcome you back here again soon. .

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 . [00:00:00]   Intro Um, jobs. I mean, there aren't. Too many jobs where there's no reading required. So, um, civic life, you know, understanding different opportunities for your community and things like that. I mean, literacy is very much embedded into all of that, even navigating your way across town. Um, so it, it's really hard to over estimate how important literacy is for someone's daily life. Kate Grandbois:  Welcome to SLP nerd cast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy  Amy Wonkka:  Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each  Kate Grandbois:  episode of this podcast is a course offered for ashes EU. Our podcast audio courses are here to help you level up your knowledge and earn those professional development hours that you need. This course. Plus the corresponding short post test is equal to one certificate of attendance to earn CEUs today and take the post test. After this session, follow the link provided in the show notes or head to SLP ncast.com . Amy Wonkka:  Before we get started one quick, disclaimer, our courses are not meant to replace clinical. We do not endorse products, procedures, or other services mentioned by our guests, unless otherwise  Kate Grandbois:  specified. We hope you enjoy  Announcer:  the course. Are you an SLP related [00:01:00]  professional? The SLP nerd cast unlimited subscription gives members access to over 100 courses, offered for ashes, EU, and certificates of attendance. With SLP nerd cast membership, you can earn unlimited EU all year at any time. SLP nerd cast courses are unique evidence based with a focus on information that is useful. When you join SLP nerd cast as a member, you'll have access to the best online platform for continuing education and speech and language pathology. Sponsor 1 Announcer:  Join as a member today and save 10% using code nerd caster 10. A link for membership is in the show notes This episode is brought to you in part by listeners like you and by our corporate sponsor, Ventris Learning. Ventris Learning's culturally and linguistically responsive teaching resources help speech language pathologists, reading specialists, and teachers more effectively meet the [00:02:00]  assessment and instructional needs of all students, including those who tend to become underserved in language and or literacy. To learn more, visit www.ventrislearning.com . Kate Grandbois:  Welcome to SLP Nerdcast. We are very excited to welcome our two guests today to talk about a topic that is very near and dear to our hearts. We are here to discuss literacy and AAC with two expert guests, Tim DeLuca and Christine Holyfield. Welcome Tim and Christine. Thanks.  Tim Deluca:  Thanks for having us.  Amy Wonkka:  We're really excited to have you here. Um, and today you're going to talk to us about AAC and literacy development, but before we get started, can you please tell us just a little bit about yourselves? Christine Holyfield:  Yeah. Hi, I'm Christine Holyfield. I'm an associate professor of communication sciences and disorders at the University of Arkansas, and I do research and teach classes on augmentative and alternative [00:03:00]  communication and language learning, literacy learning, social communication development for individuals with developmental disabilities of all ages, including individuals with developmental disabilities who are, you know, In the emerging stages of building symbolic communication or really emerging literacy skills. Tim Deluca:  And my name is Tim DeLuca. Um, I just finished my PhD this past year, um, beginning a new position as an assistant professor at UMass Amherst in the fall. Super excited about that. Um, I had the great pleasure of working with and learning from the phenomenal Amy Blanca, Back in my clinical days, which, um, really got me interested in this topic of AAC and literacy, we did a lot of work related to supporting our AAC users within our school district to access a lot of different reading skills. My PhD work so far has been thinking a lot about systems in schools, how we can leverage things like interprofessional practice and collaboration in order to support all learners in [00:04:00]  gaining different language and literacy skills. I've had the chance to meet Christine working on different projects that we'll talk with you about later today, but really thinking about. Um, emerging communicators and how we can support those emerging communicators and accessing literacy skills, which I think will hopefully make the case for today is an extremely important direction for people like speech pathologists, educators, caretakers, and obviously as users to be thinking about in the future. Kate Grandbois:  I love that shout out to Amy. That was so nice. And to second that, she also taught me everything I know. So here's a little shout out to my co host, my, my brilliant partner in crime. Um, and that's, that was very nice. And it's really lovely to meet both of you. I'm very excited to hear about the projects that you all are working on. Um, and before we get into the exciting stuff, I do need to read our learning objectives and disclosures. I will try to get that. Let's get through that as quickly as I can. Learning objective number one, describe why literacy is important for all, especially [00:05:00]  AAC users. Learning objective number two, describe the two primary components of reading comprehension. Learning objective number three, describe three strategies to support word identification for AAC users. Learning objective number four, describe three strategies to support language comprehension for AAC users. And learning objective number five, list strategies to embed literacy supports within AAC users systems. Disclosures. Tim's Financial Disclosures. Tim is an employee at a university, Tim's Non-Financial Disclosures. Tim has no non-financial relationships to disclose Christine's financial disclosures. Christine is an employee at a university, Christine's non-financial disclosures. Christine has no non-financial relationships to dis. Kate, that's me. I'm the owner and founder of Grand Bois Therapy Consulting, LLC, and co founder of SLP Nerdcast. My non financial disclosures, I'm a member of ASHA SIG 12, and I also serve on the AAC Advisory Group for Massachusetts Advocates for Children. Amy Wonkka:   [00:06:00]  Amy, that's me. You guys, like, Really filled my bucket. Also. Thank you. Um, my financial disclosures that I'm an employee of a public school system and co founder of SLP Nerdcast and my non financial disclosures are that I am a member of ASHA, Special Interest Group 12, um, and I also participate in the AAC Advisory Group for Massachusetts Advocates for Children. All right, we've made it through all of the disclosures and learning objectives, all of those bits. Now we're on to the good stuff. Um, Tim and Christine, why don't you start us off by introducing yourself? Just talking to us a little bit about literacy. What is literacy? What is incorporated in that when we talk about literacy skills? Tim Deluca:  Great. So, literacy, big word, means a lot of things to a lot of different people. Also, that word reading, right? We hear the word reading a lot, but that's another word that can hold a lot of different meanings depending on how we're using it, who we're using the word with. So, what is literacy? When I first learned about reading, one of the ways it was explained to me [00:07:00]  was through a quick story where, um, a grandfather can't quite see books anymore, uh, really loves reading German literature, and his grandson got in trouble, had to go help him out, and so the grandson was a pretty good, fluent decoder. So Never understood German, but was able to go and kind of decode and say the words out loud from the German books to his grandfather. And then the question is, which one of those two people, the grandchild or the grandfather, which one of those two is reading? Does anybody have any, like, feels, thoughts?  Amy Wonkka:  I love this question. Kate Grandbois:  I'm grimacing. I don't know.  Amy Wonkka:  I, I think if I had to guess, I would say the grandfather is reading because the grandfather's interacting with, interacting with the content, whereas the grandson is decoding, but that's part of reading. I don't know. Feels like a trick question. It is a trick question. Nailed  Tim Deluca:  it. Trick. Exactly. Wonderful. So, but that's, that's what's important, right? Because when we say [00:08:00]  reading, we're often meaning a lot of different little skills that have to come together in a meaningful way to really not only see and understand, um, see and be able to produce the words that are in text, but also understand the words meaning, understand how those words go together in the text, and then, you know, Use our background knowledge, activate all that information to really make sense of the text as a whole. So when we say reading, and when we're thinking about teaching anybody how to read, we're not just thinking about how to identify words, but we're also thinking about that overall language comprehension piece.  Amy Wonkka:  So just to say back to you, when we're talking about reading, when we're talking about literacy, we're really talking about the process of integrating multiple different types of skills all together. Tim Deluca:  Perfect. Yeah. And the simplest way to think about this is often called the simple view of reading. Came out in the 80s, used all the time in research still, and it's the idea that reading comprehension is often what we're aiming for when we're thinking about educating individuals. Reading comprehension is that distal measure that we're often looking for in [00:09:00]  a lot of our assessments in education. And reading comprehension is just the product of our ability to identify words and our ability to comprehend language. Right, so we need both of those things to be intact in order to comprehend text. Simple view. Simple way of thinking about it, but there's more that we'll, I'm sure, dive into today. Amy Wonkka:  Okay, so why is literacy important, especially for AAC users? Why is this skill such an important skill and something that we should be, as speech pathologists or special educators, um, why, why should we make that a primary  Announcer:  focus? So  Tim Deluca:  literacy so important because one thing I just mentioned is a lot of times when we're thinking about educational progress, we're measuring reading comprehension, regardless of the content area we're testing students in, whether it be science, social studies, math, word problems, right? A lot of times, reading comprehension is the thing we have to be able to do to show what we know. Um, and then when we think about AAC users and thinking about the modality of communication, um, if we're using symbolic learning, Systems with that are maybe more icon picture [00:10:00]  based. There's only a certain set of things that we're able to stay with those systems. But if we have access to generative text and are able to spell decode fluently, then that expands what we're able to communicate tremendously. Christine Holyfield:  Yeah. And just to add, um, about the importance of literacy. I mean, Tim, Tim talked about the academic piece, which is so important. And we talk about, um, Tim, correct me if I'm wrong, but in third grade, the shift that occurs from learning to read to reading to learn. And so if you're not someone who has functional literacy skills, you're missing out on a lot of learning opportunities that other people are getting. Through reading books and reading materials in in school. So that education piece is huge. Um, there's also a social component. I mean, starting from a pretty young age. Now kids text each other. Adults text each other all the time. [00:11:00]  Social media is often not all social media, but a lot of social media has text components to it. And then, as Tim said, you know, for individuals who use AAC, it's got that added potential of allowing them to communicate anything that's in their head with 26 letters. And that means that if the SLP doesn't know what they want to say and hasn't programmed a word on their device yet, that's okay [00:12:00]  because they're able to type it out. Kate Grandbois:  I feel like we can't really have a conversation about the importance of this without also acknowledging the barriers in terms of the communication partners or individuals within certain settings being very dismissive. So, for example, saying things like, they're not ready for that, or particularly for a complex communicator or an emerging communicator they're not going to read, and kind of automatically placing that that ceiling. What can you tell us about how to combat that? I think our field has come a really long way in shifting away from that mentality, but I'm not sure that other, other domains have, have, have shifted away from that. What can you tell our listeners about, um, about how we can kind of push, push back against that expectation or that, that ceiling? Christine Holyfield:  Thank [00:13:00]  you for asking that, Kate. I think that's so important. And, um, I can definitely relate to that. I was an SLP in schools, and I remember adding literacy goals, um, to, for the students on my caseload. And I remember a parent saying to me, You know, why are, why are you working on this? My son's never going to read. And that parent got that message from someone, right? Someone before me in the school system, most likely. And so, um, it's, it's a huge barrier and adults who use AAC, who are literate, they talk about it as being a huge barrier, um, that they had, had Based it had to overcome. So it's a really important thing for us all to think about in some ways. I think there's probably potential to do research in this area to find the best answer to your question, Kate. And, um, we need that research to figure out how do we change people's attitudes? How do [00:14:00]  we raise expectations? One of my favorite things to say when I worked in the schools was, well, let me just try it. And. A lot of times, um, I would try and people would see success and when success happened, it could kind of show people what might be possible in terms of someone learning literacy skills and expectations can start to shift. Um, I mean, that's just one small example. I think another one is. For everyone to truly understand and Tim, you can speak more to this, but what is literacy because it includes the language comprehension piece. So if you're working on language comprehension, you're making strides towards literacy and, um, why not try some of the word identification side of things as well.  Tim Deluca:  I love that you said that piece. I think that's so important and so relevant that we're thinking about both parts of that simple view of reading, [00:15:00]  not just the word decoding, but also the reading cover or the language comprehension piece. Um, I think, I'm thinking back to the beginning of my clinical career, and I was working in a school, um, not with anybody here, don't try to figure it out, um, but working in a school where, where students were just having literacy goals removed from IEPs because educators weren't sure quite how to teach, especially the word identification piece, um, and then I realized, oh my gosh, somebody's gotta do something, and then I realized, Oh, no, I'm the one who's supposed to be doing something and I realized I had no idea how to teach reading, um, based on the time I had gone to school and what my clinical training looked like. I never really learned about the whole picture of reading, the many different skills we're putting together to help support fluent reading comprehension. And so. I had to do a lot of extra work to think about how I could, um, what, what typical instruction for word and word reading looks like, and then thinking about, okay, I have [00:16:00]  these students in front of me who access these modalities of communication, have these different preferences, interests, how can I take what I know about what typically works for word reading, and how can I adapt that to meet these students where they are? Um, and I think. One of the big takeaways that we could always go to is in AAC so far there's much more research in the language comprehension piece of reading development than there is in the word reading piece. Uh, but we can take what we already know and adapt what we already know for Our learners who might be AAC users. And so the big takeaways from a whole whole large body of research across multiple fields right now related to word identification or word reading is the idea that we need to be systematic and explicit within our instructions. So not just trying something for a little bit. If it doesn't stick. Moving on, but rather really sticking with teaching certain skills and slowly building those skills together in meaningful ways, having a really clear scope and sequence of how we're moving through. Um, and also having a really clear way that we're monitoring progress in a way [00:17:00]  that's valid for our learners. If we think about working in a typical public school system, we're probably, we probably have access to a lot of, uh, typical tier one General education classroom instruction, and we probably have access to progress monitoring tools related to either that curriculum or just general progress monitoring and we're greeting. However, if we use those same tools for users, the users might not be able to show what they know with those tools. So how can we adapt those tools? How can we think about building our own curriculum based measures to think about how students are progressing through? Our systematic and explicit instruction to gain access to that word identification, word reading piece. Amy Wonkka:  I think you, you both have referenced a little bit the interconnection too, between language comprehension and reading comprehension. So I don't know if you want to talk to us a little bit about two primary components of reading comprehension, but maybe also connect that back to some of the more traditional language comprehension approaches that SLPs may be [00:18:00]  feeling more familiar with. So maybe making that connection, um, for listeners.  Tim Deluca:  Perfect. So I love that you, you talked about this when we think about the language comprehension piece of the simple view of reading, we can think about that Blum and Leahy model that we all use. No one use all the time is SLP is right of form content use of those areas of language. Um, if let's start with content, teaching vocabulary, teaching semantics, there are a lot of different strategies, curriculum, um, and specific protocols that exist to teach different vocab. Um, and I think what's important for our users, maybe individuals who have complex communication needs, maybe individuals who are, um, Who have neurodiverse neurodiverse identities, thinking about how we can leverage their interests and what their background knowledge already is in order to make connections to learn new words in a deeper way, so I think a lot of times, especially in special education, we get really stuck and creating IEP objectives related to vocabulary and saying the students going to [00:19:00]  learn this many words and then they learn that many words and we move on, but we're not really being thoughtful around the depth of vocabulary knowledge as well as thinking about it. generalization of that vocabulary knowledge. So when we're teaching the meaning of a word, we're not just teaching one meaning of the word, we're maybe thinking about how it's used across different contexts. We're connecting it to content knowledge that that individual can see this word in certain content and understand what it means within a science unit versus within a social studies unit. And, um, we're revisiting that word over and over and over. So it's not just a one and done thing, but really something where we're building depth of that vocab, right? So Taking those traditional goals that we always use, taking those traditional teaching methods of thinking about the word and its definition, but then using it across multiple different opportunities in multiple ways, um, thinking about how it could be used as a noun versus a verb, right? Uh, building that, that meta linguistic knowledge, which for some of our users is not quite where they [00:20:00]  are yet, but we can still provide opportunities, still provide models and access to those types of learning opportunities. From there, we can think about our morphosyntax, right? So if we're teaching word identification, the phonics or decoding piece, we can also, along in the same lesson, teach, hey look, here's a prefix, here's what that prefix means. So we practice sequencing the sounds, then we connect it to meaning, so we learned a little about morphology, we learned a little bit about semantics, we learned a little bit about decoding, and we did it all in a single lesson. Then we connect that into a sentence and thinking about how that prefix is being used in a sentence, how it can connect to some of our different vocab words that we just practiced for our science unit the day before. So really thinking about integrating our instruction so that students are getting multiple opportunities to build breadth and depth of vocab and seeing vocab, not just in individual as individual words that [00:21:00]  are being used to show mastery towards an IP objective. But really thinking about aligning. Our instruction to the curriculum and, um, aligning across different content areas across the day. I don't know if I even really answered your question there, Amy, but hopefully we're getting in the right direction.  Amy Wonkka:  No, I think you did. I think that you're building a base, right? We're building a base when we're thinking about our vocabulary intervention and ways that we can connect that to literacy. Um, and then I think the other piece of the question, because I asked you like a multi part question, so. Sorry, was just thinking about what are those primary components of reading comprehension, right? So what are the big pieces that a student needs to have in place for that reading comprehension to happen?  Tim Deluca:  Perfect. So thinking again about the language comprehension, we just said form, content, use. All are going to be relevant. Um, we've talked a little bit about form. We've talked a little bit about content so far. Use, right? So when we're thinking, we've touched upon this when we think about words [00:22:00]  with multiple meanings or words that can be used as both nouns and verbs. That's part of language use as well. How we're being flexible with how we're understanding how words are used within different sentence structures within different content areas. That is, um, maybe something that When we're writing IEP objectives, when we're working with students, we're not always zooming out and thinking about the big picture of how each of those three areas of language are working together, or how we can integrate them within our lessons. But in order for somebody to achieve reading comprehension, we need to be flexibly thinking about language, thinking about how it's being used, meaning how it's, how it looks within a sentence, in order to really understand it. So, um, Building off that simple view of reading there, there are always researchers proposing new models for how we're thinking about reading comprehension, how complex it is. One of my favorites is, is a kind of a newer summary of a lot of the emerging research by Duke and Cartwright. It's [00:23:00]  called the active view of reading, and they have a ton of podcast episodes. I think it's a free access article, so it's a really nice usable tool, regardless if you're a clinician researcher, however you're coming to this topic. But they break down that language comprehension piece a little bit more, thinking about really putting form, content, and use together. And they also add something to the model called bridging processes. Um, and again, some of the research that they're pulling from here is more emerging, not as much evidence that this accounts for a lot of the variability in reading comprehension, but some promising areas, right? And one of those bridging processes is a super long phrase, uh, grapho, phonological, semantic, cognitive flexibility. So too many things, right? But if we break it apart, grapho, the actual letters we're seeing, phonological, how those letters might sound different depending on the sequence that they're being put in, right? So if we put an s versus an sh, s is not saying anymore, it's saying sh, right? Um, so [00:24:00]  grapho, phonological, and then semantic, thinking about how a word like wound how it's gonna maybe look the same graph Graphenically graphologically, what word, whatever word I should use there, right? And then how the phonology of the word might be a little bit different. And that phonology maps onto different semantic meanings. We have to be cognitively flexible to think through. All of those pieces together to really understand what we're reading. So that's a lot for us as educators to be thinking of, and that can be a little bit daunting, right, to hear all of this and think, how am I ever going to account for this? But what we can do is just add on little by little. So maybe you feel really confident. You guys always talk about, um, your scope of competence, right? So maybe your scope of competence is super strong in, in vocab instruction. So how can I now add or embed some more morphosyntax into my vocab instruction? How can I embed some phonology into my, into my, uh, vocab instruction, right? So start with little [00:25:00]  pieces and work your way up to thinking about how all of these skills are becoming aligned to support that end goal of reading comprehension. Amy Wonkka:  I think that that's such, such a nice way to think about it though, Tim, like you said, I think, you know, think about what feels comfortable for you, what you're already doing that feels comfortable, that's working and then how you can add one small piece into it. I think that that's like, Always helpful because we, we do these podcasts and we talk to experts like you guys, and it feels sometimes like it's just so much, it's so much and it's kind of overwhelming and you get this sort of like paralysis around, like not quite knowing where to start. Um, I do feel like, you know, for me, I could say vocabulary was always an area where I felt a little bit more comfortable working with that intervention. Um, some of the other pieces, like word recognition, I think have been an area that for me has felt like I need to learn more about, um, And I don't know if you guys want to talk a little bit about that. So talking about some of that word identification, I know, Tim, I saw you speak at a [00:26:00]  conference, um, I don't know, maybe it was a year ago, but I felt like you had talked about some apps and some different strategies that you were using to help support a C user. And some of them like were. Pretty emergent communicators in, in this area of word identification. So maybe you guys could talk to us a little bit just about how we could get started there.  Tim Deluca:  Yeah. So I actually recently joined on to projects that Christine's been working on for a number of years related to supporting these word identification pieces for emerging communicators. So I'll, I'll hand it off to Christine to share a little bit about some pretty cool work. Christine Holyfield:  Yeah, so I mean, I think and relating it back to these two components of the simple view of reading. I think it's It's reasonable for us to say that for every student or, um, you know, client, there should be at least one goal, of course, hopefully more related to the language comprehension side of things. And then at least [00:27:00]  one goal related to the word identification side of things as well. And, um, we talked about the attitudes at the beginning that. Maybe we shouldn't be focusing on word identification with someone who's more emerging on the language side of things. Maybe we should be focusing on language and probably we should be focusing on language, but that doesn't mean we can't add in opportunities for the word identification learning and and those two goals don't have to be competing goals. They can be complementary goals. Um, so, One thing, um, that we've worked on related to that is making a a c systems more supportive of literacy, um, through use of the a a C systems. And I wanna be very clear that, um, Tim mentioned that we need explicit systematic instruction, and that's absolutely true. We should, um, not just hope that [00:28:00]  someone learns, identify words, we need to make sure that they have. Instruction that's appropriate for them with opportunities to participate that are accessible to them. Um, if we truly want to build. Word identification, but, uh, why not have increased opportunities through a so a lot of the work, um, related to that has been. Tim and I work together on the Rehabilitation Engineering Research Center on Augmentative and Alternative Communication. And that's a research center housed at Penn State University led by Drs. Leighton McNaughton. And for, uh, close to a decade now, there's been work making AAC devices more supportive of literacy. So one example of that, um, is Rehabilitation This class of features called the transition to literacy features and the idea is just to promote extra [00:29:00]  opportunities for learning. And so, um, one of those is a site word feature. And with that feature, uh, someone can. Select on their AAC device, whatever they would typically say. And in addition to the voice output coming out text output is dynamically displayed along with it. And so Tim can explain this better than me, but someone's, um, you know, more likely to learn to recognize a word if they're seeing, um, the orthography. Orthography of the word paired with the phonology of the word being sounded out, or it being spoken aloud. Um, and there's been a number of research studies with children and adults with developmental disabilities, including down syndrome, autism, cerebral palsy, and most of the participants do increase their word. their recognition of words through use of the feature with [00:30:00]  interacting with researchers, um, using the AAC technology. Another version or another feature of the transition to literacy suite that's newer is the, a feature that supports decoding as well. So, um, Tim touched on this a little, but in word identification, there's sort of. Different ways to recognize the word. But if you're learning to be functionally literate, you have to learn to sound out words. And the T12 decoding feature is designed to support that by when you make a selection, not only does the text come up while the whole word is spoken, but it sounds out the word. So if the child were to select cat while reading a Pete the Cat book, the AAC device would say. Cat and the letters corresponding to those sounds would be illuminated, um, as the AC device was sounding that out. [00:31:00]  So that's a newer feature that still, um, we're still doing a lot of research on, but it's just an exam. These are just examples of ways that AC technology can be set up to support literacy. Another example is, um, I've done some research, um, around picture symbols versus text learning and, um, in the field of AAC, you all know we love picture symbols and it's kind of the default for every word for everyone all the time. And, um, there really isn't research to support that. And we have More research coming out to set to show that there might be other representations that might be more meaningful to someone. So if we're thinking about the language comprehension side of piece side of things, um, color photos are very powerful  Announcer:  representation. Christine Holyfield:  So nowadays with AC devices or tablets or [00:32:00]  phones all having on board cameras and with Google image search options, there's really not a reason not to use color photo representations for those high meaning, uh, high image ability words. We know that. Children who are learning language might be more likely to find meaning from those photos than from the picture symbols. And there's some emerging research, um, I've done one study and a colleague of mine, Lorne Marie Pope, has done another to show that, uh, for low imageability words, so words that are more abstract, things like go or want or, Come, um, these words, um, the research, the limited research we have shows that children don't learn the picture symbols for those words any quicker than they learned the text for those words. And so I feel very strongly that if, if we have to teach a representation, right, if it's [00:33:00]  not just going to be transparent to the person and we have to spend time in a session teaching them what that representation is. Why not teach them the orthographic representation? Because, as we talked about, that's a representation that they'll see all throughout. Life. Um, it's text is everywhere versus a symbol on an AAC device that's abstract and we spend time teaching and then it doesn't even help them if they decide to use a new app in the future and they, and it has a different symbol set. Kate Grandbois:  That makes so much sense. I mean, you know, thinking about what. Providing individualized instruction is like, right, we're all, we have limited resources, we have limited time. So we need to be putting our instruction to where it counts most. And if, if it is more meaningful to a learner to have the orthographic representation, to have that sight word, then let's teach that instead of these two random [00:34:00]  squiggly lines with a dot on it, or whatever it is. So that makes a lot of sense to me. Amy Wonkka:  It also makes me, this is sort of like outside of the scope, so feel free to shut down this question, but it does make me think about, I've often gotten a lot of questions about picture supported text and whether, you know, using something that creates a long line of symbolated text, should I be putting that symbolated text into the customized books that I'm creating for my students? Or is it better if I Print out this recipe using symbolated text versus regular text. I don't know if you have any thoughts on that or any, um, information from the research that would help guide somebody as a clinician who's sort of being asked those types of questions.  Christine Holyfield:  Tim can probably answer this more on the literacy side, but my guess is if you're trying to help someone become literate, maybe not. Um, but I think, again, going back to the individual, um, side of things, That it's within the realm of possibility that someone has already learned those [00:35:00]  picture symbols, right? And they've not yet learned to read. And if that's the case, like they've gotten instruction in those symbols and they haven't gotten instruction in the, in orthography, then perhaps that might be useful for someone, right? Where they can recognize this picture symbols that they've been taught. Um, again, we would never want to You know, not provide someone access to understanding if if these are symbols that are already meaningful to them. Um, I don't know of any research that shows that that's a helpful approach. Um, It's possible that that research is out there, but outside of the field of AC, because honestly, if it's outside of the field of AC, I don't know it very well. Um, Tim, I don't know if you know more.  Tim Deluca:  No, I totally agree with everything you said, Christine. I think what I always go back to is what's my goal within an activity, right? So, [00:36:00]  if I'm working clinically with somebody, what is my goal here? Am I hoping to provide opportunities for decoding? That I'm not going to have. Those images that might help the individual, quote unquote, guess what the word, the orthography is there. If my goal is for somebody to demonstrate comprehension, and I know that they have a certain level of language comprehension, a certain level of orthographic knowledge, then I'm going to adapt that activity to meet them where they're at. So if they could show me what they can do related to that, integrated skill of reading comprehension. So that's why it's so important to understand these component skills that go into reading comprehension, so that we can be prescriptive with how we're adapting lessons and activities, how we're providing instruction for learners. Christine touched on something earlier that I don't feel like I was clear about when I was thinking about that word identification part of reading comprehension, the simple view of reading. And it's the idea that, um, I think a lot of commercially available curricula for AAC users or for individuals who have limited [00:37:00]  access to verbal communication or speech, a lot of those curricula do a lot of whole word instruction where students are getting multiple repetitions of seeing a word and hearing the production of that word. And what we talk about there is that that is the skill of word identification, right? It's being able to map sounds. onto the orthography of a word. And that is in of itself a skill that can support reading comprehension. It is word identification. But what we see is that for, um, if that's the only form of instruction you're getting, if you're not learning the code, the phonics code of how Sounds and symbols can be put together within a word to generate novel words so that you can spell words independently in the future. You're probably, the individual getting that instruction is probably not going to progress past just being able to identify these whole words that they're being shown over and over and over. We're not seeing generalization of that skill into fluent. Reading, which therefore doesn't allow us to support that [00:38:00]  individual in developing that reading comprehension skill. So I think it's easy. A lot of times to take these out of in the box or out of the box curriculum and implement them. But we have to think about how, um, what we might expect is outcomes for that type of instruction, and we would probably expect that those outcomes would be fairly limited in supporting future independence for that. That individual so understand the components understand how we have to. Speech. Systematic. Explicitly. phonic skills, if our goal is to support fluent decoding and fluent reading in the future. Announcer:  And that  Tim Deluca:  eventually will help word identification. So that all comes together, we build our orthographic memory after we see and understand the code a bunch of times. So it does help us get to that more quick, accurate, recognition of words.  Amy Wonkka:  I don't know if you want to talk to us a little bit about what that might look like. So for those of us who do work in [00:39:00]  schools, we might be more familiar, um, with some of the curricula. I'm thinking of things that might be used in the general education classroom in like kindergarten, first grade, and to, to work on some of those, um, decoding and encoding skills, right? So not just that sight word identification. And a lot of that involves like Call and response. And so I think that that is one area that becomes really complicated for AAC users and the people who are trying to support them in learning to read, because it can be confusing to think about how to bypass that element that seems like such an ingrained piece of that instruction in gen ed. Tim Deluca:  Love it. So there are some curricula that are directly related to AAC. Um, and I'm going to let Christine talk about that. But before we even get there, if we're thinking about, I'm in a school, I don't have access to any materials other than what's happening in the Gen Ed classroom, we'll go back to that set framework, right? That common assistive tech framework of thinking about who is [00:40:00]  my learner, what is the task that they have to do, and what are the tools I have available, and what is the environment that it's happening in. A little out of order there, but we're all on the same page. And thinking about, okay, if I know this individual can't do that call and response piece, they have an AAC system, that AAC system probably has a phonics keyboard on it that's going to allow them to participate. in a way that matches their modality of communication. Perhaps they don't have that. Perhaps we're then just having to start with demonstrating knowledge through receptive opportunities. So we're practicing the sound,  Announcer:  um,  Tim Deluca:  and they're shown a number of, of graphemes and they have to choose the grapheme that corresponds to the sound. It looks different. It doesn't demonstrate that expressive knowledge as quickly, but it's our starting point. It's using what we have and it's beginning to build those important phonics skills. And I think the other positive thing we could take away from what's in general ed is that a lot of times there is a specific scope and sequence of instruction. [00:41:00]   So it gives us that really great place to anchor our work and to make sure that we're monitoring progress and then adapting when students are not making progress and thinking about, am I measuring their progress in a way that's valid for that individual? They can't call and respond. I've worked with teams that are like, well, they're not making progress. I'm like, well, how are you seeing if they make progress? And they're. Like, they can't read the word, of course, right, so we have, we have to think about giving access to tools that are going to allow the individual to demonstrate what they know. Christine Holyfield:  Yeah, it's really important, you know, when we're We need to be able to measure progress meaningfully if we're going to teach someone and, you know, um, support them down a path toward literacy and, um, that I think I agree to my think that's a gap really in what's available. And so, um, people, you know, don't never really learned how to make those adaptations and so they're [00:42:00]  not making those adaptations and. Um, you know, that's, that's more work that we have to do on the pre service and service training and even on the research side of things. But, um, the what, uh, the way Tim described, you know, providing visual options. For responses is typically what researchers have done. Um, when researchers have evaluated skills for word identification, such as letter sound correspondence or single word reading or, um, even encoding, so typically how, uh, researchers have approached it and what's been found to be, um, effective in the research is to provide. Choices a set field of choices for responses. So like Tim said, you know it rather than showing the, um, the orthography for a and then expecting the child to produce a were saying, ah, And the child's [00:43:00]  either pointing to the A or the M or the T or the P. Um, for example. Uh, same with words. You know, if we're wanting them, wanting to know if they can read the word cat. We're showing them the word cat in orthography. And we're showing, for example, For photos. Um, and this is where it can get really interesting to think about the photos that we show. Um, because for instance, you don't want a photo of a cat to be the only photo that starts with the letter or with the sound. So you might have cat as another option as well. Um, so you can think strategically about what the different choices are so that you can do an error analysis and. Be even more precise in the instruction that you're providing. Um, because, um, Tim could tell you better, but I know that good [00:44:00]  readers don't get. And so we don't want kids guessing based on the 1st letter. And so, if we're, if they always have the opportunity to just. Pick the word with the correct first letter sound. We're not really building them towards good reading with sounding out all the word. Um, an important thing to think about when you do that is to make sure you do some pre teaching of the representations that you use if you're. Um, so again, Tim said something really important earlier. He said, we always want to make sure. That we're measuring what we're think, what we think we're measuring. And we want to make sure that we're measuring the specific literacy skill that we're testing. So if I'm trying to test if they can read the word truck. I don't want to show them a photo of maybe a truck that they wouldn't recognize or a truck that they might that to them, they might call a semi or a pickup [00:45:00]  or whatever. So, um, it's just as easy as. You know, labeling each picture before you are testing in this way. Um, you can even, if these are pictures you're going to use over and over again, you can even do some testing to make sure they recognize just the pictures on their own. And then when you go in to test the word by putting the word that they are paired with picture options, you know, that. It's not just that they don't see a picture of truck. It's that they're not reading that that word is truck. Tim Deluca:  I really appreciated that. I think the other thing we could think about too that I think Christina and I get us questions a lot is how much time we should be spending on this kind of instruction, right? So that's a really tricky thing because we know that a lot of students On caseload to our users might have a lot of different goals that they're hoping to target within a given day have a lot of different needs within a given day, and therefore, time is limited. So, the [00:46:00]  national reading panel, which. The report was published in the early 2000s, but the. Work there is still pretty relevant The recommendation there for emergent readers is that we're doing about 30 minutes of phonics instruction a day Um for really early readers, right and christine mentioned this earlier Are any ac users getting even close to that amount of word reading instruction? Probably not Um, and maybe that's not feasible right now, right? We have to find the balance that works within That individual's day, and we don't necessarily have the research for people who use AC for different reasons. The exact amount of time that they need for different skills. That's probably going to happen on individual basis, but we know what the general guidance is, and then we make adaptations based on the learner that we're working with the system that we're working within and also maybe thinking about how we can leverage other professionals. So if I'm the speech pathologist, I'm embedding some products opportunities within my Okay. Vocab and more person text [00:47:00]  lessons. If a special educator is working with them on word reading, they're embedding some of the language language comprehension pieces within their phonics instruction later that day. So kind of almost thinking about how we can double dip within services across the day to get that integration and alignment of knowledge building.  Christine Holyfield:  That's a really important point, Tim. I think collaboration is really critical here to make sure that students are getting the minutes that are required in literacy instruction for them to make progress because what we don't want to happen is. Um, to kind of create this self fulfilling prophecy where we don't give them that many opportunities to learn literacy because we don't think it's a good use of time. And then they don't learn literacy because they haven't been given enough opportunities. And, um, you know, it's just this Self fulfilling prophecy that really doesn't serve anybody. Um, and so collaborating is really important. And I remember when I was [00:48:00]  working in the schools, there were teachers who had set literacy blocks for a certain time of day. And I asked them, could I, um, work with you and help make it so that, you know, the four students in the room who use AAC can participate meaningfully in those literacy blocks as well. Or can I just have a table on the other side of the classroom and I'll just come in and I'll, um, do work at the same time, uh, that's been adapted. So, um, collaboration is, you know, I think that's an important piece of it. And I think it's an opportunity for us, um, to advocate as well. Um, for maybe this is a student who should have more minutes, uh, every week for services. And if we really want them to make progress in a timely manner. Tim Deluca:  One thing I think about there related to the more minutes, because I'm working with a lot of teams who are like, I don't have more minutes. And if you say that again. I [00:49:00]  Throwing hands. So the thing that we could think about when we're when we're coming to a team and we're saying, Hey, as a member of this team, I think this student needs more time to access this skill, really thinking about. I, this is my, my scope of competence. And here's also what my role can look like, what my time available is to teach this skill. But can it, just like you were saying, Christine, how can it then compliment the other things that are happening throughout the day? So that nobody needs to necessarily add minutes, add to their workload. Rather as educators, we're effectively sharing information, effectively sharing knowledge with one another. If we're putting those B grid minutes collaboration or, uh, a good minutes collaboration time on the grid. Like, how are we using that effectively to share our knowledge to make sure that our services are super aligned so that that student is getting the same language intervention or the same way of talking about [00:50:00]  skills, the same way of getting input about skills across multiple different professionals so that we're maximizing each individual's time with that learner. Christine Holyfield:  I know you're right, Tim. I, I'm a little idealistic on this, but I do think that SLP should feel confident in what they know about, um, what a student needs and. Um, you know, try to advocate in the sense of, you know, that might mean telling an administrator for me to effectively serve all this for us to effectively serve all the students in this school. I'm not enough, and it's our job to teach them to read teach them language do all these things. And we could do that job more effectively with more. So, um, I know that's not an easy thing and I know that there are a lot of people I'm sure who've tried that and heard too bad. But, um, I think we can try to advocate because [00:51:00]  Um, you know, it's right. Amy Wonkka:  I agree. We talk a lot on this show about like we get on soapboxes about the importance of advocating for better working conditions for ourselves and for our clients. Um, and while it may take years and years and years to have that conversation, and we may end up at a different workplace entirely where they have more open ears to hear our, to hear what we have to say. I think it's an important thing. Um, to state that, you know, it is, it is definitely something that we should, that we should make sure we don't back down from doing. Um, you both said so many things that I think were really helpful, uh, in terms of being thoughtful about just going back to, um, teaching some of those. those sound skills and how you might construct those tasks and being thoughtful about the materials that you're using so that you can do an error analysis, that you can really think about what patterns may be [00:52:00]  present, what error patterns might be present in your learner. Um, I wonder if there are similar examples that we can sort of picture as clinicians when that comes to language comprehension. So, um, How might we structure some of our comprehension interventions so that we're doing the same thing, right? We're not just showing this one picture and then the student learns, like, this is what I do when I see this one picture or this one string of text. What are some strategies that we could use as clinicians to sort of help support that language comprehension that are unique to students who are also using AAC? Tim Deluca:  That's such a good point. I think for a long time we were monitoring progress by having students read the same story, read quote unquote the same story over and over and over and asking them the same questions over and over and over and then teaching them specific responses and saying, hey look, they've moved up a level or whatever it might have been. Um, and we know that that is not a valid way of monitoring progress towards the skill of reading comprehension, but rather is just showing that the [00:53:00]  individual learned a response to a specific You ABA people know all about the words there. So, um, we really need to think about Again, I go back to this word alignment. When students are in school, our role as special educators is to support access to the curriculum. Um, and this is obviously going to look different for different learners, but if there is a science unit, this individual is interested in. That aspect of science. How can we provide a different short story each day that maybe has some of the phonics elements that we've been teaching, right? Maybe they're working on CBC, consonant, consonant words. How can we take what the class is reading about in science, maybe make a quick adaptation with AI now? These things are Not easy, but easier to at least get a starting point for how can we adapt so that they're getting access to the content knowledge of science. The topic they're interested in. They're motivated to learn about it. [00:54:00]  Um, and they're also getting practice with the word reading instruction. And then because it's an area of high interest, the individual maybe has some background knowledge of it, we're actually able to see, like, are they comprehending the new information we're providing in this text? So are they able to answer a question that reflects new knowledge presented in the text versus their background knowledge? Or Are they often answering questions in a way that shows that they're relying more heavily on their background knowledge rather than the new information provided in the text? That now gives us some prescriptive information about, okay, perhaps they decoded the words for me here, but the comprehension wasn't there, whether it be because of fluency, whether it be because they weren't thinking about the text, right? That, that monitoring we all have to do when we're reading to make sure we're making sense of what we're reading. Those might be why they're not demonstrating knowledge, or it could be because The fluency in the actual decoding the CBC words was more challenging, but that kind of integration, um, I think is [00:55:00]  becoming easier and easier with updated technology. But the big takeaways for me always are, how can I make sure it's high interest? And how can I make sure that there's motivation to participate in this activity? Because if somebody is not motivated, they're not learning, they're not gonna be able to show or demonstrate progress in that skill. Announcer:  And I think you said so much  Christine Holyfield:  important stuff in there. I agree. I think, um, you know, bringing in someone's interest is really important, particularly someone who has yet to really make meaning out of text at all. Um, we need to bring that meaning in somewhere for there to be a motivation to learn. And if there, if they have a favorite character from a TV show, then I make adapted books with that character. Holding all kinds of different, you know, CBC words that I can, you know, have them read book after book, uh, that's of interest to them. Um, even if the target words that they're working on might not be as exciting. Uh, I think also, [00:56:00]  you know, This can be an opportunity to collaborate with families as well to find out what is meaningful to them. What experiences have they've had, have they had that have been, um, you know, particularly impactful and providing opportunities for learning around those experiences. Um, For individuals who are really in the more emerging language learning stages, it's important to think about the words that they're hearing and and are meaningful to them most often. So, you know, we, everyone learns words by someone else saying those words and that being paired with a referent or an experience out in the world. And so. If we're trying to build up someone's language, the more, as Tim said, we can align the words we're working on with the words that they're more likely to be hearing and experiencing elsewhere. That's important. I can give [00:57:00]  a silly example, but, um, my sister, for some reason, decided to teach her, uh, daughter, um, The word pup instead of dog. Right? And so that's a silly example. But if I were at school and I was her SLP, I would never assume that she associates that picture with pup and not dog. Um, but that's just one example. But in general, you know, um, just like we talked about, uh, before. We want to make sure we're providing language that is giving someone the best opportunity to learn as possible. And a lot of that is going to be learned through individual assessment about  Announcer:  what's meaningful to them. Christine Holyfield:  Individualized assessment is really important to know for each student what type of input is most meaningful to them. So, there are some students who might, Have a bottleneck or barrier and understanding spoken input, but they [00:58:00]  understand input that scaffolded with visuals more effectively. So we want to make sure that they have the opportunity to learn language with those maximal support. Um, In the field of AAC, we talk about something called the input output disconnect, um, for communication language learning. So, for an individual who uses AAC, um, they're in this unique position for learning language where they're expected to express language one way and everyone else is Giving them language input through a different modality. Um, and so that's where things like aided input become really important to try to address that disconnect. So we're using the child's AC device when we're reading the books with them. Um, so that they're getting input. In a modality that matches their output and they have, um, more opportunities to learn language in that way. Amy Wonkka:  I I think that that [00:59:00]  is all really helpful to think about I know you've both mentioned Customized or adapted books and I think that that's something You know that can be so powerful because you can hook on to what's interesting for your student or what, what is just a life experience that they've had. Uh, I think about some of the early like A and B level readers and they're not particularly riveting texts, right? Like, like there's one page, there's an apple, it says apple, there's another page, it's a cup, it says cup. Um, so the idea of, you know, taking a character that they like and then putting those kind of mundane items like in the book with this fun character is, is just a really nice example. I don't know if you had any other tips for SLPs who might be hearing this and thinking, oh my gosh, I would love to make some adapted books for my student. What are some things that that SLP should be thinking about?  Tim Deluca:  First and foremost, thinking about the goal of those adapted books. Is it to build language [01:00:00]  comprehension knowledge or is it to build opportunity for practice for word reading? So if it's Opportunity to build practice for word reading, making sure that the words like we see in those level texts, a lot of times like apple is not a word that there's a closed consonant or closed syllable and then a consonant l e syllable in there. That's not a, uh, early in our phonics scope and sequence typically, right? So that would not be a good word if our goal was to practice these early phonics skills. So making sure whatever adapted text we're we're building, if we're expecting the student to be the one decoding, making sure the things that they're supposed to decode match what they've been taught so far. Otherwise we're just asking them to guess and good readers don't guess.  Christine Holyfield:  Yeah, so I think one strategy I've used, you know, if their favorite character has a name that's It's going to be difficult to decode, and I don't know why I'm struggling to think of one right now. Um, but, you know, that character might be up [01:01:00]  here on every page of an adapted book, but the last word on every page that they're expected to read is a CVC word, and that, you know, like I said, that character might be holding a cup, or, you know, one of those boring words that, um, they're trying to, you know, build in their decoding repertoire. Tim Deluca:  Christine, you and I just used a lot of Clifford, the big red dog, right? So Clifford, not an accessible word for an early, early reader, but big red dog. Those all, those all could work, right? So, maybe I'm always saying Clifford, but they're expected to read Big Red Dog.  Christine Holyfield:  Big Red Dog.  Tim Deluca:  So, that joint effort there can also be a useful way of working through it. Amy Wonkka:  I think that's really cool. Yeah, that's a good example. I wonder, do you use any conventions? Like, I remember. Many, many years ago, going to an all curriculum training and they were using like a yellow highlight. So in the example that you gave where maybe the partner is reading Clifford, that word might not be highlighted, [01:02:00]  but cup might be highlighted because that's something that we want our student to decode. Do you ever use any, any strategies like that?  Christine Holyfield:  I do, um, part of it is I've learned to do this from the people who created the all curriculum.  We should also mention that the All Curriculum is a curriculum that's available, um, in printed and app form, I believe, where, um, that can be helpful to people who want to spend less time adapting things on their own. Kate Grandbois:  In our last few minutes, are there any additional pieces of information that you would really, you're just dying to get off your chest that our listeners might benefit from? Your, your final words of wisdom, your parting words.  Christine Holyfield:  I'll say mine's going to come a little bit out of nowhere, but I want to say it. Kate Grandbois:  Um, now I'm very curious. Go for it.  Christine Holyfield:  So, uh, what I would like to beg people to do for Kids Use [01:03:00]  AAC is Teach letter sounds, don't teach letter names. I've met so many kids who can learn, who know their letter names, but they don't know any letter sounds. And it's letter sounds that help you read, not letter names. If someone can learn letter names, they can learn letter sounds. There's nothing more difficult about a letter sound than a letter name. So, let's just teach letter sounds instead, and then while we're at it, let's also teach decoding. Thanks for watching!  Tim Deluca:  That's a good one. Um, I think I, I have two, two quick ones. One is, I think it's Kathy Binger, who's been on your show before and always talks about when we're teaching AAC users, we often forget that we're still just teaching language, right? When we're, when we're trying to support AAC users, we're just, Teaching language the way we typically do just through a different modality. And I think that's an important takeaway from everything we discussed today. There's a lot of research about how to teach word reading. There's a lot of research about how to teach language comprehension. [01:04:00]  A lot of us have a lot of clinical knowledge about how to do both of those things. So now we're just thinking about how to adapt it to meet a certain modality. And then the final takeaway for me is that I think you've heard both Christine and I say a few times now that the research is emerging or there's some research. This is The topics we discussed today are relatively challenging to study, um, and I think Christine and I are both interested in continuing to build on the body of evidence that already exists. So, um, one way we're working towards doing that is building more research practice partnerships. I know both Amy and Kate, you've been part of papers about Thinking about the power dynamics of different research teams and all things like that. And that's that's an area of huge interest for me is thinking about how I can be more effective moving into a role as a researcher in better partnering with clinicians to do the work and answer the questions that are clinically relevant for specific teams and then working to generalize out from there. So quick plug to reach out to me if you're ever interested in doing more of this work and building more of this, this evidence base [01:05:00]  together.  Kate Grandbois:  That just made me so happy. I can attest that Tim will answer your emails, and he's a very, very nice human being. So if you are listening and you are interested in reaching out and just saying, Oh, he's just saying that. No, really? Well, put your email in the show notes. How about that? That was a wonderful thing to say. Uh, it's so important for us at the Nerdcast to really continue to focus on bridging that research practice gap, reducing power differentials between researchers and clinicians, bringing clinicians into the fold. Um, the analogy that we use a lot is a lot of times, You know, there's no seat for us at the table, but it's not just that there's no seat for us at the table. It's that the table is in an office with a door that's hidden and we don't even know where the door is. So it really means a lot that you're extending, um, extending that and, and bringing that up. That's, that's really wonderful. That's my nerdy soapbox for another episode. Another time. Um, thank you both so much for being [01:06:00]  here. This was really, really wonderful. And we're so grateful for your time. Everything that you mentioned, all of the References and resources will be listed in the show notes for anybody who is listening while they drive or fold laundry or what have you. Thank you again so much for being here.  Sponsor Post-Roll Announcer:  Thank you again to our corporate sponsor Ventris Learning, publisher of the Assessment of Literacy and Language, or ALL, and the Diagnostic Evaluation of Language Variation, or the DELV. SLPs, school psychologists, and reading specialists use the ALL to diagnose developmental language disorder and to assess for emergent literacy skills, including dyslexia, for children ages 4 through 6. The DELV is appropriate for students ages 4 through 9 who speak all varieties of English. To learn more, visit www.ventrislearning.com .  Kate Grandbois:  Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this [01:07:00]  episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study. Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com thank you so much for joining us and we hope to welcome you back here again soon. .

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 . [00:00:00]   Intro Kate Grandbois:  Welcome to SLP nerd cast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy  Amy Wonkka:  Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each  Kate Grandbois:  episode of this podcast is a course offered for ashes EU. Our podcast audio courses are here to help you level up your knowledge and earn those professional development hours that you need. This course. Plus the corresponding short post test is equal to one certificate of attendance to earn CEUs today and take the post test. After this session, follow the link provided in the show notes or head to SLP ncast.com . Amy Wonkka:  Before we get started one quick, disclaimer, our courses are not meant to replace clinical. We do not endorse products, procedures, or other services mentioned by our guests, unless otherwise  Kate Grandbois:  specified. We hope you enjoy  Announcer:  the course. Are you an SLP related [00:01:00]  professional? The SLP nerd cast unlimited subscription gives members access to over 100 courses, offered for ashes, EU, and certificates of attendance. With SLP nerd cast membership, you can earn unlimited EU all year at any time. SLP nerd cast courses are unique evidence based with a focus on information that is useful. When you join SLP nerd cast as a member, you'll have access to the best online platform for continuing education and speech and language pathology. Join as a member today and save 10% using code nerd caster 10. A link for membership is in the show notes EpisodeSponsor 1 Kate Grandbois:  Welcome to SLP Nerdcast. We're very excited for today's episode. We are here with Laura McWilliams, who is going to teach us all about learning health systems. Welcome, Laura.  Amy Wonkka:  Happy to be here. Thanks for having me. Thanks for joining us. [00:02:00]  You're here today to talk to us about patient safety and quality for allied health professionals. But before we get started, can you please tell us just a little bit about yourself?  Laura McWilliams:  Yeah. So I am a medical speech pathologist. I, um, I talk about this a lot. I'm, I'm from Appalachia, um, and I'm interested in how care can get into places of marginalized and, um, communities that don't have as much support. Um, so I'll start and end there. Um, and I went to the university of South Carolina, go Gamecocks. I did my fellowship in Seattle at the Seattle VA. Um, I have special interests in leadership, head and neck cancer. And startup culture, actually, when it comes to speech pathology practice, and I, um, love everything safety and quality. Kate Grandbois:  That's awesome. Well, [00:03:00]  we could probably have a million sidebar conversations being part of a startup, but that's not what we're here to talk about. And I am going to read our learning objectives and disclosures before we learn more about, um, Learning health systems and why they're important and why we should care. So without further ado, let's get through some of this boring stuff. Learning objective number one, define a learning health system. Learning objective number two, define PDCA cycles. Disclosures, Lara's financial disclosures. Lara receives a salary from her primary employer HCA. consultant of Laura McWilliams, LLC. Laura's non financial disclosures. Laura is a member of ASHA SIG 13 and is co leading a membership advisory group for patient safety and quality. Kate, that's me. I'm the owner and founder of Grand Bois Therapy and Consulting, LLC, and co founder of SLP Nerdcast. My non financial disclosures, I'm a member of ASHA SIG 12 and I serve on the AAC Advisory Group for [00:04:00]  Massachusetts Advocates for Children. I'm also a member of the Berkshire Association for Behavior Analysis and Therapy. Thank you.  Amy Wonkka:  Amy's financial disclosures. That's me. I'm an employee of a public school system and co founder of SLP Nerdcast. And my non financial disclosures are that I am a member of ASHA, Special Interest Group 12, um, and I participate in the AAC advisory group for Massachusetts Advocates for Children. All right. So we've made it through all of the obligatory pieces and onto the good stuff. Um, Laura, why don't you start us off by telling us a little bit about that first learning objective? Uh, what is a learning health system, but I think also connected with that. What sort of, what got you interested? In your in your current role.  Laura McWilliams:  Um, so learning health systems, um, found me and I found it simply. Well, not simply we all we all experienced coded in different ways and I [00:05:00]  think we all are still emerging from. That initial trauma where we were in our lives, how we were to show up professionally and personally and at work and at home. And 1 of the things about covet that excited me out of all the things that were scary about it was, um. How rapid we were getting information and how every day we would show up to work and there would be new guidance or new information coming. And really those first few months of my day to day is influenced by what researchers are doing in the field today or yesterday. And that period of time where we were shifting and adapting so quickly was just one that. It was scary to a lot, but really felt amazing for me. Um, so I hung on to that feeling and I realized I had special interests in how to get practice change and information in the [00:06:00]  hands of clinicians quickly to, um, modify what we do on a day to day basis and also to inform the future. So, uh, you know, as hard as covet was, it, it definitely. Brought forward this idea of rapid change and rapid implementation of literature and research. And, um, then also, uh, kind of compounded with technology, which, which it just grew insurmountably more so during those 2 years, but also leading up to that point. So from there, I went on a journey towards quality and safety because I started looking into cultures of continuous quality improvement. That was really the only term that I walked away with from, with my early COVID experiences that a culture of continuous quality improvement. It is saying something to me about [00:07:00]  bigger system change and, um, I was just in awe that our health systems responded not perfectly, but in, in one, in some ways, you collaboratively to shift and modify towards a really challenging time. So learning health systems, it's a. It's kind of, it's a, it's a, it's a very big concept, but when you break it down, it is essentially pairing knowledge generation with care connection for implementation of change. So we are using our knowledge, and we are using that knowledge in practice, and then we're generating data to inform how we're going to care about change. For our patients and do the things we do moving forward. So there's other definitions out there, but that's how I see it. An info technical human connected, uh, quality improvement, continuous [00:08:00]  improvement process.  Kate Grandbois:  I have a question. And I don't, I hope that this isn't considered like a bad, I know there's no such thing as bad questions, but as you were talking, I was thinking about, you know, how you've described COVID and the silver lining of being able to get information at our fingertips, straight, hot off the presses, right out of the researchers, right off the researchers desks. And I'm wondering if you could tell us a little bit about why that was a big deal. So what is the regular everyday culture of Of how that process happens. I know we've talked a lot about this on the podcast previously, and I can put some additional references in the show notes, but what was the regular everyday context that made this feel like a shift? Why was, why was this a new thing? Yeah,  Laura McWilliams:  so I think that the, uh, a number we all hear is it takes 17 years to get something from research to practice and that's a huge gap. But really, when you break it down and you look at the actual system, um, [00:09:00]  adopting and understanding what happens when it's in practice, it actually takes about 35 years for it to be. Um, with, with, we have a new, new research article that informs how we should be caring for congestive heart failure. It takes 17 years to get that in. I have a one year old, so that would be like when they graduate. Right. So I'm, I'm, I'm not okay with that when it comes to my day to day practice. So what COVID did is it brought out the potential that if we have new information. We started to develop information sharing highways to implement it tomorrow and then modify it as we go. So it became a stark contrast compared to new literature and public health safety information that could be adopted within 48 hours. And I think there's something really beautiful to that change. It showed me the possibility.  Kate Grandbois:  I also think, you know, there's [00:10:00]  a lot of context and, um, culture surrounding why that happened, right? I mean, this was a state of emergency. Everyone was staying home. It was, you know, it was a matter of, of fear and, and safety, I think is like the, is the big, uh, You know, word that you've used several times and I'm sure that created a lot of motivation to get that information out of the researchers hands right into the clinicians hands within 48 hours instead of 35 years. Um, and I'm wondering if this. Phenomenon has opened up new vehicles for things that are not safety related. So we're speech pathologists. Let's take articulation. There are, there aren't our emergencies that I'm aware of, um, that maybe there are out there. I don't want to belittle anyone's articulation emergency, but how, how are these vehicles of, um, information dissemination been translated into work that is not safe? a safety or emergency related issue?  Laura McWilliams:  Yeah. So [00:11:00]  I think in my, also in my learning about learning health, health systems, um, it could be something big or small, um, that, that just needs attention. And when I look at speech pathology practice, you mentioned articulation therapy, um, or articulation, uh, research whenever we are in clinical practice. We need to realize we, as the end user of the therapy strategies, can be data capturers when we are, uh, using different strategies for articulation, forgive me. I don't know many because I'm an adult speech therapist, but let's just say that there's 1 that is commonly known, and you're using it with this patient and you're not documenting or capturing the data of how this patient is progressing and then feeding it back to a place where data is captured. housed and kept to then see, is this informing? If this is working, you, you are not connected to a larger system. So let's think about like [00:12:00]  L VADs, right? We have, um, LVAD devices where you have, uh, left ventricular heart failure and you have an external device, uh, supporting your cardio, your your heart rate. Your heart work, your heart flow. Sorry.  Kate Grandbois:  Um, no, it's fine. I was going to ask you what an LVAD device was. So I'm glad that you're explaining it.  Laura McWilliams:  So those devices are built to capture data to send to a central source to inform what the patient needs to modify the device so they can then live healthier, perform better, not be as tired. Um, so those devices are built to From a technological standpoint to inform a doctor this is or isn't working, you need to change these settings. And then the doctor modulates the device to then help the patient improve. So then imagine if you had 10 people all with LVAD devices, very similar health histories. That is a pool of information [00:13:00]  that is getting captured to then potentially inform the next generation of LVAD technology. That can improve the life of people who need it. So, go back to that articulation example, if you are using a specific treatment, uh, uh, approach, and you're capturing data for you for the patient, but you're not, you're not capturing it in a manner that's informing researchers or informing leaders, or you don't even need to be a researcher, let's say it's your group of pediatric speech therapists that just want to Want to do better with articulation and understand if it's working. Um, if you, if you have a uniform place to capture it, review it, say, hey, this therapy really isn't working that well, or it is working, but 1 therapist. Her data looks a little bit different. It then starts to show you patterns to push into continuous improvement with this tool that you have. So, um, you know, [00:14:00]  I think. When you, when you pull back one of the most exciting things. In a learning health system is you can have a learning health community, a learning community anywhere. And that is something that I continue to invite speech therapists to think of. We don't need to go to the research meccas to change practice. You actually can be in your practice in the community now, forming your own learning health system to continuously improve what you're doing. And, um, since I've taken that approach. I actually know that my conversation with researchers who are studying very aspect, very various aspects of it have strengthened and actually it's influenced. Maybe their approach for more places where more funding comes for practice change and literature to inform our care. So,  Kate Grandbois:  and I think that, you know, that feedback loop of our, um, data informed practice, which by the way, is part of our evidence based practice triangle, [00:15:00]  right? So we should all be doing this as part of our regular everyday jobs. We should be using our internal evidence or the data that we collect to inform our treatment and in combination with what we know from external literature and. patient and center values, clinical judgment, etc, etc. So, but that feedback loop of the data that we collect in our sessions, going back to the researchers to help inform research questions, to help provide additional analysis is a critical piece of improving so many things, right? Yes. I'm, I'm wondering if you could talk to us a little bit about, so you work in a hospital, Amy and I are pediatric therapists, Amy works in a school, I'm in private practice, different workplace settings have different infrastructures and what you're talking about in this learning health system is a system, right? It's an infrastructure. What can you tell us about, you know, for those people listening who are thinking, oh, this is kind of, this is kind of cool. This makes a lot of sense. Sure. What [00:16:00]  infrastructure needs to exist for a learning health system to be adopted or created or, or implemented?  Laura McWilliams:  Yeah. So, um, this is why I love patient safety and I love learning health systems because it talks a lot about culture. And you have to start putting words to the culture that you want, right? You, um, inpatient safety practice, I know we're not there yet, but I love it. You have to have a culture of, I care about what happens to my patient. And I care that if I notice something is wrong, I feel safe in reporting it. That's called, that's a just culture. That's a big to do on the, um, just patient safety and quality, uh, goals for our country. So it starts with culture. So also in this culture for a learning health system, you have to have people committed. To the problem you're noticing, or the challenge you're noticing, or the, um, something that is [00:17:00]  not in line or aligned with a good outcome to say, we all sit in different roles, but we're committed to improving this thing. I'm going to talk about Drake teams, because that's. My wheelhouse, and I think that's a really good example of a learning community because you need strong leadership. What do you need? You need strong leadership committed to a common goal, not the same professionals, but committed to improving this thing related to your, your role or your involvement. You have to have a good understanding of what are your data capturing tools. How are you using your EMR? How are you not using your EMR? How are you not using your EMR? Um, some other tools where you could develop a platform to capture data. So we talk about EMR, but there's also a good opportunity to use an Excel spreadsheet. It's on a shared drive to capture data related to this thing. So I don't want to complicate that. And I think that when [00:18:00]  people hear data, they think, Oh, this big nerd sitting in a corner looking at a spreadsheet, but really there's just easy ways to get people capturing data about what we're doing in a day. And we're kind of already doing it. Right. Um, And then back to that culture, the culture that's committed to, we're never going to find perfection here, but we're going to keep getting better at this thing with every cycle that our team or our subgroups in this learning community goes through to improve. Amy Wonkka:  Well, and just to, like, jump in with a completely different system of public school, I actually think a lot of, if you zoom back and think about it super broadly as just creating a system of shared goals, there are a lot of mechanisms in place in a lot of schools. where people could leverage that. So we have a lot of like professional learning communities or things like that. We have student data that we're already collecting as part of our, you know, literacy programming. [00:19:00]  So there are places as I'm hearing you speak, just as somebody who's in a really different work environment, I'm getting excited about what you're talking about, because we do so much of the individual, you know, how is this working for my client, but the idea that We, especially as speech pathologists, who I feel like in schools don't have this opportunity that often, like we could feed that information back into a bigger system. It's just, it's super exciting. It's really exciting. And  Laura McWilliams:  you captured something that is kind of the precipice of it is technology changes so fast that if you find a tool that's capturing information in 1 way, unrelated to what you're doing, copy that. That data capturing tool and. Use it for your purpose. So I started talking about covid. I have young kids. I'm very interested in the R. S. V. like increases throughout the year. We have such amazing infrastructure data capturing and communication related to covid. What about R. S. V. Why [00:20:00]  can't we take those same, um, concepts of how we track and test and get information related to that? COVID and use it with other common colds that really strain our health care system. So I'm out of the speech realm and more in the public health realm, but you've hit on a very important topic that you don't need to recreate the wheel. There's already really good systems out there that can be adopted to the purposes of speech therapy or your educational pediatric adult workplace within the multidisciplinary realm. Kate Grandbois:  I think something that you've hit on that's really important and you, you mentioned it earlier is Looking at your workplace culture and as you're thinking about all these things, what infrastructure do we already have? This is kind of cool. I might want to think about talking to my boss about this or thinking about leveraging some systems that are already in place. I think it's critical to also think about Your workplace culture and that underlying those [00:21:00]  underlying values, values, those implied shared ideas and values about caring. I know it sounds so simple, but if you have a shared understanding with the rest of your coworkers, with your bosses, with your company's mission statement, with your state regulations, right? Your shared understanding about caring about your students, caring about your patients, caring about your clients, that is the foundation on which to say, okay, if we care, if we collectively say that we care, then we should be leveraging what we have to improve what we're doing. Right. I mean, there's like a really, I know that's so obvious, but I think it's a really critically important connection because if you do want to take any action steps, you have to have that shared understanding and it's not budget or. I don't have, we're all working with limited time and money. That's like half the problem in our post COVID world. But I think that having that understanding of we are doing [00:22:00]  this for a reason. And it's because we are here for patient safety. We're here for student outcomes. We're here for improvement. That is, that is the reason. That's the reason. And that's what we have to leverage. Right. Tiny soapbox.  Laura McWilliams:  Well, and no, I love that. So I love that. And you also touched on something that I think in this learning helped me be okay with not necessarily, uh, always asking for full permission because I am the person that's connected to the outcome of my patient and better understanding, understanding my leadership and my manager. Is here to support my, my resources, my needs, but they aren't necessarily consistently interested in the same things that I might be connected with somebody outside of my direct leadership change. So that is why the foundation of the learning community. The multistakeholder multidisciplinary work is so important because I think we've [00:23:00]  all been in jobs where finally you get some of that respect and autonomy to just go and start selling solving problems. That's the beauty you need to leverage that and that's the perfect time. To create, um, a learning health system to improve something. It might be big. It might be little, um, or at least to implement practice change. Um, I also figured this, um, you know, so Charles Friedman, he's in the, the resources, he's a, um, an amazing researcher at University of Michigan. And he's kind of like, 1 of the grandfathers of learning health systems. Um, and he. He says it best, and I'd like to read a quote just that that helps bring innovation to the, to the foreground. So he describes it as a system in which science informatics incentives and culture are aligned for continuous improvement and innovation with best practices. Seemly seamlessly embedded in the [00:24:00]  care process. Patients and families as active participants in all elements, and new knowledge is captured as an integral byproduct of the care experience. And when I read that, I get chills because that's, that almost encompasses everything we, as clinicians, providers, community members want for us, for our clients, and for our communities. So, um, yeah, so I'd like to give an example or any other questions before I go into that.  Amy Wonkka:  Now I was going to, I was going to ask you to give us your, kind of walk us through your trach example, which Kate and I will know very little about actual, about the actual clinical skills related to that, but we will, we will look at it big picture. Yeah.  Laura McWilliams:  So, um, maybe so, so, okay. So you have a multidisciplinary trach.  Announcer:  team. [00:25:00]   Laura McWilliams:  And that is the perfect example of a learning health community. If you are a speech therapist, a critical care doctor, um, a care manager, a nurse, a respiratory therapist, um, or an administrator. So there's there's six groups that are in your learning health community. You're all committed or interested in how can we manage and support traits better in our hospital to help them. receive better care. When you look at a health care problem, surgical airways are very unsafe in the community. So the goal is to rehab them, decannulate them, get the trick out of their neck, reduce the line and tube, improve their communication, improve their swallowing quality of life. Um, and it also makes their risks in the community less because they have a lower bounce back to the hospital rate. So everybody's interested, but we all are very different. So what you [00:26:00]  do is you form the learning community, you align with capturing information on what is your current state. What do we know about trachs? How informed are we? Do we have updated materials? Do we have good documentation to capture the data we want to capture? So, is a trach present? Are we decannulating them? How quickly is it happening? What are the barriers to discharge? So you have to set the scene to make sure you know your current state. You assemble your data. You analyze what it's telling you, which it kind of shows you the gaps in all of these different roles. So, I'm talking about this as if we're all sitting down at a table and reviewing it. We're not. That respiratory therapist is looking at their own EMR and saying, these are my gaps. That speech therapist is looking at their own EMR. These are my gaps. Administrators. Oh, wow. Length of stay. These are some big things that are important to me. So, when you look at the. [00:27:00]  Cycle of, um, planning, doing, assessing, um, our PDSA cycle, I think about this back, backwards. Um, each group is doing their own PDSA cycles to take a look at what is in place. To then try something different to improve the care they're providing all in their own, uh, cycles of improvement and then coming back together at a touch point to say, are we seeing improvement collectively as a group? What is this data? That we're putting in, changing us, informing us with the changes that we are making. So, at the end of the day, what it really is is we kicked off a quarterly meeting where we sit down and say, we are the airway task force. This is going to be. This is what we need to be [00:28:00]  more informed. These are some changes we need in EMR. These are some specific practice approaches we need to do. So for us, it was meeting more frequently, engaging care management, working with stakeholders for discharge planning, and capturing, um, length of stay a little bit better. And so after we implemented those four changes across our learning community, what we saw is our length of stay reduced by about six days. And that's now informing us something, something worked, something changed. And after we go through a learning cycle together as a group, which could be a year, six months, however long, that gives you an opportunity to sit down and say, we've made these great improvements. What next? And you continue the cycle of continuous quality improvement. So I'm going circles like this, but really what it is is it's a tornado because [00:29:00]  you have the cycles more horizontal and they're all the groups are cycling together to improve what is in front of them. I want to take a minute and just talk about, I think the problem with project management and big scale system change is we have a really bad practice of waiting for the meeting to do the thing. You know, you wait for that meeting to tell everybody what you've done and then you leave the meeting and say, well, I don't know what I need to do in between. So, the difference in the learning health system is. You're forming the learning community and empowering with the autonomy to improve what is in front of you with the role that you're in. But the biggest thing is you have to have that common goal and you have to be committed and you have to have strong leadership to allow and support this, this, um, science practice change, this PDSA cycle to, to unfold.  Kate Grandbois:  So to say this back to you, the PDA [00:30:00]  cycle stands for plan, do, check. Act, right? And this is a, it's a, I mean, we keep saying circle. It's a cycle for everybody listening. It doesn't have a visual can't see us moving our hands around. This is a, this is a circular experience where presumably after you act that last component, you've circled back to planning again with the new information that you've learned and a PDA cycle. This is a, I'm not a hundred percent sure I have this correct. The PDA cycle is a. Unit of or a component of a learning health system. Is that correct?  Laura McWilliams:  Yes. So the speech therapist, our plan do study or check and then act in that learning health cycle is speech therapist. in the trick team are assessing. How are we aware of tricks? What are we doing with tricks? What's our foundational knowledge of tricks do we need? And then you [00:31:00]  move into the do what we've identified. We need updated competency. We need updated supplies. We need in services. Um, and we need a better approach to how we're managing patients in the day. And then You do that, you study, or check, depending on who you are, it's check or study, um, if it, what the outcome was. Did it work? Did it improve anything? Did we learn something? So you're using that analytical skills that all speech therapists have, but more in a programmatic mindset. And then you modify. So you've learned what works, you embed it into your team culture, or you identify, we still haven't hit the mark on how we approach patients in the day or how we plan our day, we're going to modify this, and then you've kicked off another learning cycle. So, you know, I, I follow Simon Sinek, he talks about the infinite game, um, you know, [00:32:00]  learning and growing is an infinite game. You're never really there. And I think sometimes clinicians get bogged down by that concept of like, Oh, we're never going to be there. We're never going to, but that's, that is healthcare. That is quality improvement. I never want to be bored. I never want to run out of things to continue to improve. Because if I do, I'm likely not paying attention to how the info technical highway of health care is changing and I'm not a part of it. So, that's also the other side of this is getting your groups more engaged with learning communities and the learning community mindset will naturally start. Embedding speech pathology practice into our systems better and that is 1 thing. I think it's a whole other podcast that I get. I get concerned about is. speech therapists and allied health not being fully implemented into Big data capturing vessels, um, [00:33:00]  because insurance companies, payers and, um, risk analyzers, big data, people who are looking at what is being put into these systems are modifying our approach to care based off of the information that they're getting. So, now is the time everybody is a speech therapist to ask what is my data footprint in my workplace? And is it informing what is good for my patient? And that is the essence of a learning health system and learning health community.  Kate Grandbois:  I love all of us is making me very excited and intimidated and overwhelmed, but excited all at the same time. It's a lot of feelings. But as, as you're talking and Amy, I'm sure you can talk about this more, but. It's making me think about systems in a school. You know, you've used this wonderful example of trach care, um, and hospital systems, which I, I think the, the two settings are just so different, but when you talk about using data to inform the system [00:34:00]  and using data to inform policy or procedure at the administrative level, Amy, it's making me think about the role of the speech pathologist in a school for all of these things that are shared across like Like literacy, for example, that you're sharing with so many disciplines and how our I love the term data footprint. I want to highlight that for a second to how our data footprint can help inform all of the other professionals within a system. That have that shared scope with us. I don't know if, if you agree being the school person on the, on the call here,  Amy Wonkka:  I mean, it did. It really resonated with me, Laura, when you said, you know, you're worried that the allied health providers aren't being captured, um, in that aggregate data. And I think that's true. Probably in. I haven't worked in a million schools, but I've worked in a few, um, and I think that that's generally true for us as well. Like, we aggregate big data around curriculum content areas. Uh, but even though [00:35:00]  speech language pathologists as allied health providers are part of that shared, Mission for our students. Um, we're not necessarily captured in that data footprint. So I think it's a really, I mean, I've been, as you've been talking, I've been reflecting, you know, on all of the systems where I've worked and just kind of what was my larger data footprint outside of my individual client interactions. And I've got to say, like, I don't, I don't think it's much, if it's a footprint at all, it's a very tiny, faint footprint. It is, it is not a big, robust footprint.  Laura McWilliams:  Yeah, I think even just starting there and saying, how does my work show up and what informs. My company, my business, my school system of what I'm doing, if it's working or how I need resources is a question we all need to be asking in the workplace. So, um, aside from continuous quality improvement, I think it also that's [00:36:00]  part of that is resource needs. So if you're not capturing data when you do or don't have resources, there's no, there's no tool to help your leadership get them for you. A  Kate Grandbois:  hundred percent. A hundred percent. I agree with that. And I think this is also making me think about the technology that we interact with in terms of leveraging the data we collect. So on this podcast, we talk a lot about how data is not scratch, you know, tally marks on a sticky note because that sticky note is going to end up in the trash or it's going to end up, it's going to end up somewhere. You mentioned earlier. EMRs, right? So I'm thinking about my own practice and the different EMRs that we've had exposure to and how some of them capture information and some of them don't capture critical information and how different they are. What can you tell us about leveraging software, technology, Interfaces, other, other aspects of logistics and infrastructure that might be really important to think about in terms of how we improve our digital, our data [00:37:00]  footprint, you know, for those of us who may be, I don't know, aren't maximizing those tools. Yeah,  Laura McWilliams:  so I think speech therapists, we type a lot. And I used to lead or manage a team of clinicians who really got used to using smart phrases where you would just dot and put in all your information or copy of your word documents, and I think that's everywhere. What you're accidentally doing is you're taking away your digital footprint because you're not asking the software company to embed. the information in the, um, in, in the tool. So very basic. I give a, an eat 10 with all of my patients, which is a, a, uh, patient, um, reported symptom questionnaire of how you're doing with swallowing. It's pretty standard in adult swallowing care. Um, and If you get a score above [00:38:00]  three, you should get a dysphagia diagnostic. You should get an instrumental, but if I'm putting in a smart phrase and there's nowhere for a data capture to pull that from a query from where it pulls boxes and information, I can never show that my outcomes are good when my patient scores go from 30 to two. So when we use these tools or we have these new things or these new scores and You really should be strengthening your connection to the software companies, to Cerner, to Epic, to Meditech, to say, I need this embedded because they're waiting for consumers to say, everything seems good in allied health. You know, you all aren't asking for much. And as I started asking questions to get these built in, I found myself in places like the Cerner think tank. We use Cerner where, um, they would say, okay, well, if you need it, we're going to put we're going to put this need on a message [00:39:00]  board. And if this need is recognized across the country. We're going to vote it up, and then we'll start building it, and then we'll put money into coding it, and then eventually we're, we're going to get this in your update, right? Gosh, that process takes so long, but that in and of itself, if all of us all over the country and our own learning health systems are making steps to ask our software companies to put these things in, we all are moving forward with the, um, Uh, data into a technical highway infrastructure building, uh, across the country because it makes you feel small. You feel small when you start thinking about this, we'll get somewhere, but what if we all just did it?  Kate Grandbois:  I also make, I want to make the comparison when you say we feel small. I have done that. We use an EMR and they're very, you know, their customer service is like, Oh, well, if you want a feature added, you know, just, you know, Send us an email and you're like, it kind of feels like calling the cable company and being like, [00:40:00]  have a problem. And like, they don't care about me. You know what I mean? Yeah. But I think, I think what's interesting about this particular suggestion is that a lot of these message boards are public. They're public. So if you are asking for a feature or you want some specific measurement added, or you want a specific phrase added, and you do Post it on a message board or you post it in like a general forum. You can also show your request to your administrator and say, look, this is important to me. Even if so, even I guess what I'm saying is even if the big EMR company, you feel like a tiny fish in a big pond and Oh, what is my tiny request going to do? You know, you can still show your needs, your documentation, because that's data. Yeah. The fact that you asked. For something is a data point that then you can go to your administrators and say, I can't do my job without X. I am advocating with software to do X, Y, and Z for me, but there's still a footprint. Even asking is a footprint is my [00:41:00]  point.  Laura McWilliams:  Have you all ever worked anywhere where, essentially, the, the company's documentation for speech therapy looked like a Word document? It looked like a Word document, but then, I mean, it was just basically like free type. And then it just was saved in the dark. And to me, that, that is, that is very scary. Because it is not connected to a nurse screening or a parent questionnaire, and there's no information guiding should this person be in or out. And when you look at the big machine of health care and, you know, education is a little bit different. I'm the daughter of two educators, so I like, I'm with you just sitting in a different table. Um, but I, um, I think when you think about it, patient health care, quality and safety really is a new is a new field. So, 20 years ago, they published the book to air as human, and there [00:42:00]  was recently an update on it of have we moved the needle at all because really, when you look at the quality data, you see that we've become more aware of the health care acquired conditions. But they theorize that the, uh, data capturing tools and what we're, what we're doing to show improvement is still not hitting the mark. And when you look at where healthcare often has to first get it right, it's nursing practice because they're the biggest body of healthcare and then it's the biggest footprint on caring for people. Um, so just because we are a smaller subset, I think that we as allied health professionals can have a bigger imprint. On what happens with people in our communities, if we start pushing into these. bigger systems, or like you said, even our local EMR, just getting something updated in our local version of the EMR, because you can start showing your worth and you start showing your improvements. You start showing your value. So [00:43:00]  my Traik team, we're through our first cycle and saying, we're going to do these four things. And now we need a form. We need a way to document We need a way to document and pull this patient's discharge was impacted by our rounding. We need a way to better document the materials that were different in their care for setting them up for discharge. So that right there is embedding you more in the multidisciplinary team to show your worth, your value, and will future proof you when insurance companies start looking at what things impact care. I love,  Amy Wonkka:  I love all of this. I guess I have a question that's maybe bringing us way back to the beginning, but I'm thinking about, I'm thinking about my actual workplace. I'm wondering about listeners who may also be feeling like they want to get started and do something. And I had a question around the work that you've done on your [00:44:00]  trach team. How do you, so knowing that there's so much information out there, there's so much research, um, and staying on top of that research as a clinician is. is impossible, right? So when we, when you first started meeting as a group, how did you filter through all of the information that was out there in terms of best practices to figure out what the changes were? That you were going to make like is, do you have any helpful tips for people who are sort of feeling like information overwhelm?  Laura McWilliams:  So i'm going to give it a different example because once I started to learn about learning health systems I realized my team was accidentally already in a lot of learning cycles and then I put shape to it so My team a few years Go really, we were at a standstill with evidence based practice and implementation. We were not aligned. We didn't have a good foundation. Um, so what we did is we broke out into, um, I think, [00:45:00]  12 evidence based practice groups where you were tasked with 1 question and you were to look at the literature and you were to look at what we were doing and make recommendations. Back to the team. So that plan do. And then we're trying to figure out what to do. So we brought all this back to the team and said, these are the simple changes we're going to make and we're going to put them in place. And then we're going to see how we feel. And the good I, the thing about that is. We were presenting so there was opportunities for feedback. There was opportunities for questions that, um, whole concept of moving together, not informing and telling what to do is really important here. So, I challenge everybody who's having journal clubs and in services to start taking the shape of the cycle. We're not here to just. Client, we've identified this as a challenge. We are here to leave with actionable steps. And [00:46:00]  then the follow up is going to be, how did it work for you? And is there anything bigger we can do to improve the systems that we work in journal clubs are things of the past actionable learning cycles. Is where we need to be pushing. I hope that helps to. Amy Wonkka:  Yeah, I love that. I think, I think that really is, I mean, that really is the key difference is that it's gone from gathering, gathering, gathering information and the gathering and sharing of that information is the focus to gathering information in a focused area with the actual goal, not just being sharing that information back out, but collaboratively developing action steps. That are informed by that information. Yeah,  Laura McWilliams:  I love I love in services and learning about something very different. So, I think the learning cycles, or the learning health communities should really be focused around. This is intentional work to improve what we're doing and make our [00:47:00]  footprint better because I have suspicions. If we avoid this type of work. It's going to have tangles with compensation, with job satisfaction, with resources, because we're not showing our value. So, this work is more important than ever, and I hope you guys join the learning health, uh, movement.  Kate Grandbois:  Well, after this, I'm not sure we have a choice. I feel, I feel very compelled. You at least take a, you know, do some of that self reflection, reflect on some of those foundational things, the culture of your work environment, the infrastructure that already exists, the support that you might have of leadership, the conversations you can have with your leadership to shift some of that support. And how, what small steps you might be able to take to demonstrate your value, increase your data footprint, and kind of implement some of these systems change. Yeah, and  Laura McWilliams:  I think it also [00:48:00]  brings forward people who have really good ideas that might not be in a place that they could share them when you start parsing out this work and putting intention for improvement. So you're already getting ahead of some of the things that plague our toxic workplaces, right? That there's these hierarchy of information that has to go to leads and then bosses and then this. If you're just taking ownership that I'm in this role to improve where I am, and I am appreciated and respected that I'm going to do this work and it's going to inform a simple change in practice. Man, that feels good. And, um, you know, I think the second example of having the teams break out and improve, take a look at one thing specifically to our practice. So, um, we had, we took a close look at spinal cord injuries. What we do. The question is, what do you do with an acute spinal cord injury? What do you do? So we tasked a group to take a look at that. We came up with recommendations, simple practice changes. And when you [00:49:00]  break it up into bite sized things, Once you get those improvements going, that existential feeling of we have so much to do in this workplace starts to get smaller because you have, you are trusting your, your team, your learning community to help improve your practice because we cannot do it all. When you look at the, please Google, the learning health system cycle, it shouldn't be one cycle. It's turned into a tornado, so we all need to be cycling at the same time. I need my airway people. I need my literacy people. I need my pediatric people. Everybody doing learning cycles to improve the field of speech pathology together. And quit giving it to the, The meccas are the research places, I mean, inform them, but they're not going to save you. So  Kate Grandbois:  I love that. And usually we end our episodes with final thoughts, but that was just so beautiful. I'm not even, do you have anything else to add? That was very  Laura McWilliams:  inspiring. Um, and I, [00:50:00]  No, no, I mean, I want to hit on that high note, but, um, this is this is truly the foundation for innovation. This is where we change our field. Um, it is it is continuous quality improvement where you are. And when you can get that just concept embedded in your workplace, no matter what system you work in, if it's good or bad or challenge, you're going through a merger, just tough times. You have a pocket of growth and that, that helps to give you, um, some of the feelings of why you, why you entered this field back. Kate Grandbois:  Thank you so much for being here and teaching us all of this. I am feeling like I have a lot of, I have a lot more work to do than I thought. My own practice, um, but this was really, really wonderful. Thank you so much for sharing your time. I feel very inspired. Amy, I'm sure you do too. Yeah,  Amy Wonkka:  I do. I do. I'm energized about it. Thanks for having me. Thank you.  Kate Grandbois:  Thank you [00:51:00]  so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study. Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com thank you so much for joining us and we hope to welcome you back here again soon. .

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 . [00:00:00]   Intro Kate Grandbois:  Welcome to SLP nerd cast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy  Amy Wonkka:  Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each  Kate Grandbois:  episode of this podcast is a course offered for ashes EU. Our podcast audio courses are here to help you level up your knowledge and earn those professional development hours that you need. This course. Plus the corresponding short post test is equal to one certificate of attendance to earn CEUs today and take the post test. After this session, follow the link provided in the show notes or head to SLP ncast.com . Amy Wonkka:  Before we get started one quick, disclaimer, our courses are not meant to replace clinical. We do not endorse products, procedures, or other services mentioned by our guests, unless otherwise  Kate Grandbois:  specified. We hope you enjoy  Announcer:  the course. Are you an SLP related [00:01:00]  professional? The SLP nerd cast unlimited subscription gives members access to over 100 courses, offered for ashes, EU, and certificates of attendance. With SLP nerd cast membership, you can earn unlimited EU all year at any time. SLP nerd cast courses are unique evidence based with a focus on information that is useful. When you join SLP nerd cast as a member, you'll have access to the best online platform for continuing education and speech and language pathology. Join as a member today and save 10% using code nerd caster 10. A link for membership is in the show notes EpisodeSponsor 1 Kate Grandbois:  Welcome everyone to SLP nerdcast we are here today with a whole panel of people to talk about a very timely topic, advocacy and change in our field. The title of this course, advocacy and you be the change. [00:02:00]  We are really excited to have this discussion. I am not going to bother introducing everyone because I will do a terrible job. There are so many people here. So everyone on our panel, why don't we start this conversation by having everyone introduce themselves. Thanks so much for having us. So I am Jessica Linden Holt. I have been a speech language pathologist for 17 ish years and served in a number of settings with both pediatric and adult clients. Jessica Lenden-Holt:  I am currently the chief clinical officer for Sidekick Therapy Partners, which is a private pediatric practice serving school and outpatient clients in Tennessee and in North Carolina. I also serve as the vice president of legislative affairs. For the Tennessee Association of Audiologists and Speech Language Pathologists, also known as TASLP. Shequria Williams:  Hello, my name is Shakiria. I am a school based SLP and I've been in practice for 14 years. I am currently [00:03:00]  serving as the SEER representative for the state of Tennessee and the SEER champion for the southern region of the United States, in addition to my role as Senior Director of Clinical Services at Psychic Therapy Partners. And I'm super excited to be a part of this presentation today. Hi, I'm Casey Hammonds. I have been a school based SLP for seven years and I'm currently serving as the State Advocate for Reimbursement or STAR for Tennessee. I am also a clinical lead for Sidekick Therapy Partners and I am so looking forward to participating in this podcast today. Kacey Hammonds:  Thank you all. Hello, I'm Jennifer Henderson. Thank you for having us today. I have been an SLP for about 15 years working with both pediatric and adults. I am currently a clinical lead at psychic therapy partners as well as I lead our quality assurance team here and I currently serve as the state advocate for [00:04:00]  Medicare policy for the state of Tennessee. Kate Grandbois:  I think that's everyone. It's so fun to have such a great group of people here. Before we jump into this presentation, we do need to go through our learning objectives and our financial and non financial disclosures. I am going to read through them as quickly as possible, and I appreciate everyone bearing with us. Learning objective number one, define advocacy and the importance of state level and national level efforts on the field. Learning objective number two, identify four advocacy roles that exist at a state level for speech language pathologists. And learning objective number three, outline five ways SLPs can get involved with advocacy at a state and national level. Disclosures, Jessica's disclosures, Jessica received an honorarium for participating in this course. Jessica's non financial disclosures, Jessica currently holds an advocacy leadership role at the state level.  Shakira's financial disclosures, Shakira [00:05:00]  received an honorarium for participating in this course. Shakira is nonfinancial disclosures. She currently holds an advocacy leadership role at the state level. Jennifer's financial disclosures. Jennifer received an honorarium for participating in this course, Jennifer's nonfinancial disclosures. Jennifer currently holds an advocacy leadership role at the state level. Casey's financial disclosures. Casey received an honorarium for participating in this course. Casey's non financial disclosures. Casey currently holds an advocacy leadership role at the state level. Kate, that's me. Uh, my financial disclosures. I am the owner and founder of Grand Blot Therapy and Consulting LLC and co founder of SLP Nerdcast. My non financial disclosures. I am 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 the. Amy Wonkka:  Amy's financial disclosures. That's me. Um, I'm an employee of a public school system and co founder of SLP Nerdcast. And my non financial [00:06:00]  disclosures are that I am a member of ASHA, I'm in Special Interest Group 12, and I also participate in the AEC Advisory Group for Massachusetts Advocates for Children. Alright, we have shared our objectives and all of our disclosures. Um, I'm excited to hear. Kind of what brought all of you into your current roles in advocacy, but before we talk about that, what is advocacy? Can you guys define for our listeners just what that means in the scope of speech language pathology? Jessica Lenden-Holt:  Absolutely. Uh, I can give you the Oxford Dictionary definition as well, which is just Public support for or recommendation of a particular cause or policy, and advocacy can look like so many different things. I think most of the time people think of advocacy and they think of the day on the hill events and going to the Capitol and talking to legislators, but it can be so much more than that. It can be. As simple as having a conversation, uh, with a colleague, with a principal, with an administrator, or with a legislator. It can be writing a [00:07:00]  letter, sending an email, presenting information on policies, um, or procedures to others. It can be meeting with state legislators. It can even be helping draft policies and bills. Serving on committees and so, so much more. And so throughout our career as speech language pathologists, we're going to need to advocate for ourselves, our profession, our clients, our patients, our students, and, and our families. So it's just super important that we embrace our roles as advocates and a speech language pathologist.  so How comfortable do you feel to advocate on behalf of yourself, your clients, and your profession? Uh, in a survey of 194 school based SLPs, researchers found that only 15 percent of respondents had received training in advocacy, and only 14 percent had participated in an advocacy event, and 45 percent reported feeling ill equipped to advocate, but viewed advocacy roles as important. So 45 [00:08:00]  percent of SLPs saying that they feel ill equipped, I mean, that's almost half. That's, that's a lot. So a few questions we would like you to ask yourself right now. Have you ever received any formal advocacy training? Do you have resources, or mentors, or even know where to access information if you would like to learn more? Do you consider yourself to be an effective advocate? Hopefully you leave today feeling more equipped, as the goal of our presentation is to share information related to local, state, and national advocacy roles. Opportunities and ways to engage in advocacy at a state, local and national level and share advocacy resources in order to educate you as an SLP on advocacy and hopefully improve your perception on being an effective advocate. And often we stop ourselves from getting involved with advocacy due to feelings of inadequacy or the imposter syndrome. I'll definitely share a personal experience of [00:09:00]  mine. Um, We just kind of start to think I can't do that. Or there are people out there doing it better. They don't need me. So we would like to really encourage you all to change that thinking. I think each of us on this call felt this imposter syndrome when we first stepped into our roles. And so we really want to encourage you to think instead of why me, Ask yourself, why not me? If not you, then who? Um, I know that when I was originally asked to consider the VP of Legislative Affairs role, I did not have any formal advocacy training. I had not attended a Day on the Hill event. Or let a letter writing campaign before there was so much that was that was new and honestly incredibly intimidating, but I was willing to learn. And so that is what I did. I met with other advocates I networked I researched I asked a lot of questions. And I was passionate about helping our profession and our clients. And that's all you really need to get started. [00:10:00]  So your goal is not to be the person that knows everything about everything. That's impossible, right? Uh, you can't be the person who is best at everything in the room, but your goal can be to be the best learner in the room. So we really want to encourage you to be the change that you want to see in the world. So if you're listening to this podcast today, then you are already taking the first steps in being the best learner in the room. And we want to share specific ways you can plug into advocacy. So let's get started as Shakira shares more about state associations and advocacy.  Kate Grandbois:  I have a question first. Am I allowed to ask a question? I'm, I'm wondering, about the feelings that come along with advocacy and some of that imposter syndrome. And maybe while we'll talk about this a little bit later, and I'm jumping the gun, I'm just wondering in your experience, if this requires a tremendous amount of. Vulnerability. I mean, in terms of fear related to [00:11:00]  rocking the boat or getting critical feedback or quote unquote stepping out of your lane, right? We are, you know, stay in your lane kind of feeling. Is that something that you've encountered as, as something that you've had to overcome?  Jennifer Henderson:  I'm, I'm going to say for me personally, that's exactly what I thought, like those questions that Jessica asked at the beginning, my answer was no to all of them before I like got into advocacy, but then, like, I had all this fear and anxiety when right before day on the hill. And what you find is when you go out there and you start talking with other, like, SLPs and audiologists, like everyone is learning together and they share some of the same experiences and goals and ideas that you have. And I'm telling you, for me, like, just having that experience that day on the on the hill really kind of changed a lot for me because I'm like, oh, we, we all kind of share it. Some of the same similar goals. And so [00:12:00]  stepping out there really is kind of what helped me like get over my fear because you have all these ideas. Like I can't do this. Like, where am I supposed to start? And it really can be just as simple as like sharing your own stories with someone else. Whether it's like, I thought legislators were going to be like big and scary. They're not, they're like people just like us. And it was so easy to talk to a lot of them, actually.  Shequria Williams:  And I completely agree with everything that, um, Jennifer has said as well. Um, imposter syndrome definitely is, is real. There is definitely fear. Um, anytime you step into something that is new and into something that is different. But in addition to all the things that Jennifer has explained that actually helps with those things, I think it's also important for you to surround yourself with the right people. Those people that are going to. Going to be encouraging. It's going to be uplifting. Those people that understand the feelings that you're feeling, because they have also felt that way, because those are the [00:13:00]  people that you want to surround yourself with, connect with, because they're going to be the people that are going to actually help you to also ease some of that fear that you're experiencing. Jessica Lenden-Holt:  Creating that network. Like I sort of said early on was so key for me. So all of these incredible women, uh, female leaders and advocates on this call, We help each other, right? So there is a level of vulnerability. There is a great learning curve sometimes. And yeah, sometimes you're getting feedback that, that kind of doesn't feel the greatest or maybe, um, you know, you feel like you're just not doing your best. And so I think surrounding yourself with others, learning from others is really key, uh, in embracing an advocacy role and getting started. And also just like they've said, just jump in and do it and try it. And you'll kind of be surprised with what you can accomplish. Kate Grandbois:  Thank you for answering my question. You're welcome. And so now I am going to share with you the importance of state associations. Um, so let's talk a little bit about why they're important. [00:14:00]  So our state associations are important for the advancements of the fields of speech language pathology and audiology. Shequria Williams:  Our advocates are on the ground working to improve matters in the areas of public policy, popular opinion and political action. at a state or local level. Oftentimes, a lot of the changes that we see, observe, and experience as SLPs, um, in our day to day work are the products of advocacy efforts at the state level. And so some keys to successful advocacy include membership and active participation, which is a topic that we will discuss in detail a bit later. Collaboration, because you will oftentimes have to brainstorm and consult with a variety of individuals that work alongside you within your state organization and other SLPs and audiologists throughout the state. It requires a lot of patience. Because we, as we've all heard throughout some time about in our lives, slow and [00:15:00]  steady wins the race. And then it also requires persistence. There will be times that you will be on the ground advocating for this, you know, something. And it just seems like such a difficult task. But no matter how difficult the task, May seem, you know, I want to encourage you all to keep trying. Use ASHA as a resource to learn about what it means to be an advocate for the professions of speech language pathology and audiology, in addition to learning about advocacy efforts at a national and state level. ASHA has many great resources to keep you informed about how you can get started in your advocacy efforts. And you can find information and websites related to your state association. All you have to do is visit ASHA. org. You can scroll to the bottom of the page and click Become a Volunteer. Under State Association, Volunteer Opportunities, click State Association Member Benefits. This is a website that contains information related to benefits of [00:16:00]  advocacy at the state level. It also contains clickable links under the heading join that allows you to access the websites for each state association. If you wish to become a volunteer or if you're interested in knowing What openings your state organizations are looking to fill, you can do so by clicking open volunteer opportunities with state associations located on the volunteer under the volunteer heading on the same webpage. Feel free to utilize websites or reach out to your members of the state organization for which you wish to participate in for more information. So I have provided some images of what the website that you will access for each state associations webpage looks like. Again, it is the State Association Memberships Benefits page that you can find on ASHA. org. So you can use this site to learn about how to become a member of your state organization or to simply see what [00:17:00]  advocacy efforts have been put forth to advocate for SLPs in your state. Each state association has a name or an acronym that they identify with. So for example, in Tennessee, our state organization is known as TASLA. which stands for the Tennessee Association of Audiologists and Speech Language Pathologists. In Illinois, the state association is known as ISHA, which stands for Illinois Speech Language Hearing Association. And in addition to visiting the state association sites, I want to also encourage you all to also follow your state associations on their social media platforms. We're familiar with Facebook and Instagram, so definitely check them out there because you can find lots of great information there, too. So, you may be wondering, does it cost me anything to join my state association? The simple answer there is yes. Each state organization has a fee associated with becoming a member. Your annual dues for membership to your state organization support [00:18:00]  payment to lobbyists, and lobbyists are extremely necessary as they keep the organizations up to date with happenings on the Hill in addition to presenting bills created by state organizations to legislators. Thank you. Your fees are also used to support hosting of the annual virtual or in person conventions where you get the opportunity to network SLPs across the state. In addition to networking opportunities, your fees also give you access to many other perks including discounts on convention attendance, CEU opportunities, updates on legislation and advocacy efforts via the e news and other sources, and so many other wonderful things. Membership fees and types can vary from state to state. So for example, annual fees for full membership for these states are as follows. In Alabama, the annual membership is 55. But over in California, they're 180. Down in Florida, they're 125. And here in Tennessee, they're 85. [00:19:00]  New York actually has a couple of different options. So for a one year membership, it's 100, but you can buy two for 180. So that's kind of a discounted rate there if you go ahead and purchase the two year membership. In Texas, active membership is 130, but in the state of Washington, they're 70. Many states also offer a variety of membership opportunities, including student memberships, associate memberships, Affiliate memberships. and lifetime memberships. Information regarding membership fees can be found by viewing state association member benefits on ASHA's website asha. org and you can click the state you wish to view the information for and then you can click membership or join now on your state organization's web page to kind of learn more about those fees. Now Jessica will start us off with telling you about what advocacy roles exist in each state association. Jessica Lenden-Holt:  So, um, I mentioned earlier, I'm the Vice President of Legislative Affairs. Most states have a VP of Legislative Affairs or a VP of [00:20:00]  Advocacy or a similar title, um, so we're sharing some general information about the state of Tennessee's VP of Legislative Affairs role, but please reach out to your state association to ask how this role might be different, um, or similar for your state. So the VP of Legislative Affairs is a state association. board member role. It is a two year term. Um, you attend monthly meetings and provide updates to the board on any advocacy efforts. You stay up to date with legislation and advocacy, usually using ashes website. Some of the network, um, networking opportunities I've mentioned. We have, um, state level meetings and national meetings as well. We set strategic plans with the State Association Board, the Advocacy Committee and with our state lobbyists. We organize and attend the State Association Day on the Hill. Ours is typically in February or March. We organize letter writing campaigns for the State Association members and non members, and that is sort of an ongoing effort [00:21:00]  throughout the year. We work on newsletter and social media write ups related to state or national advocacy and connect with ASHA leaders. The Department of Education, the Department of Health, and other organizations as it relates to advocacy. And we connect very often with the state SEAL, STAMP, and STAR representatives. And Jennifer's going to share a little bit more about the STAMP role. Yes, so the STAMP is the acronym for State Advocates for Medicare Policies. And state, um, stamps basically help provide leadership, guidance, and support on matters that affect coverage reimbursement and the delivery of services under Medicare funding. Jennifer Henderson:  So each month, I basically attend meetings with stamps across the country to learn. More about Medicare related issues that affect the service delivery of speech pathologists and audiologists. Um, we basically discuss the topics that are related to caregiver training codes, value based care and other [00:22:00]  Medicare reimbursement related topics. So now I'm going to throw it right back over to Shakiri to talk to us about the SEALs. Shequria Williams:  Okay, so SEAL is the acronym for State Education Advocacy Leaders. by providing leadership guidance and support on matters that affect funding and delivery of services of SLPs and audiologists in the academic setting. In our state, I am the SEALS representative. I am also the SEALS champion for the southern region of the U. S. I have had the pleasure of connecting with the SEAL representative across, uh, with SEAL representatives across the country to learn of policies that are currently affecting our professions in addition to learning about all of the actions that the representatives in each state are taking to try to overcome some of those issues affecting our professions in the academic setting. So each month I attend meetings to connect with others and talk about ways to make, uh, service delivery in the academic setting better. Some topics that we discuss include caseload and workload [00:23:00]  caps, which is a big topic of conversation right now. Um, because so many SLPs are experiencing shortages in the schools, that is another topic that we discuss. We also talk about salary supplements, um, state tests and licensure, um, that, uh, SLPs also require to work in the academic setting. And we even brainstorm ways to increase membership in each of our state organizations. I've had the pleasure of connecting with therapists within our state that seek support and information necessary to learn how to advocate for themselves on matters that affect their ability to provide or supply faith to their students, which is free and appropriate, um, education. And now Kasey will share with you information about the STAR role. So STAR is the acronym for State Advocates for Reimbursement. STARS aid by providing leadership, guidance, and support on matters affecting coverage reimbursement and the delivery of services [00:24:00]  under both Medicaid funding and private commercial pay. Kacey Hammonds:  In Tennessee, I am the STAR representative. So each month I attend meetings with STARS from across the country to learn about Medicaid and private pay related issues as well that are affecting the service delivery of speech pathology. pathologist and audiologist. I have had the pleasure of discussing topics related to developmental coverage, F code issues, habilitation exclusions, and telehealth coverage fee reducing in some states, as well as network adequacy among a bunch of different things. We touch on a lot in our meetings, they're very informative. And so in this slide, If you're looking on YouTube, we've included a link from ASHA that takes you to the state based advocacy network page. This is a really handy page on ASHA's website because it contains your contact information [00:25:00]  for the various state based advocacy representatives, as well as the ASHA liaisons for those advocacy networks. Kate Grandbois:  And for anyone who is listening, all of these links will be in the show notes as well. So most state associations have advocacy committees. These committees are comprised of practicing SLPs and audiologists from various settings. Like in the STARS network, I personally am school based through a contract agency, but we have a lot of private practice owners, some SLPs and audiologists that are medically based, a few other school based SLPs. Kacey Hammonds:  It really varies widely in that network, which is great. The requirements for becoming a state association advocacy member are pretty simple. One is being a member of your state association. So, for instance, in Tennessee, I am a member of the Tennessee Association [00:26:00]  of Audiologists and Speech Language Pathologists. Um, So if you're interested in participating more in your state's advocacy committee, your first step would just be checking on that ASHA link that we shared, like you said it was going to be in the show notes, um, to get in touch with your state's advocacy committee and just emailing them, calling, seeing what positions might be open or maybe what positions need a little bit more help. So in summary, what does a state advocacy member do? They help with a number of different things, like Jessica and Shakira and Jennifer have already mentioned. Maybe we're doing a letter writing campaign. We're organizing surveys. That's something I'm currently working on now as the star representative for Tennessee. Maybe we're doing day on the hill preparations, getting ready for your state convention, etc. There are a number of different opportunities based on your availability. your interests, and what motivates you. [00:27:00]  If being a state advocate is not something that interests you, just being a member of your state association might be a good alternative. Active membership in your state association could look like attending your annual conference, which in Tennessee, I really can't recommend enough. If we have any other Tennessee audiologists or speech pathologists listening, the TASLIP convention is wonderful. I loved it last year. Um, it could also look like meeting your legislators on day on the hill or just sharing an advocacy post that means a lot to you on social media, your membership dues primarily go to advocacy efforts and to pay your state lobbyists so that they can advocate for you. Jessica will now, now share some ways to get involved at the national level. And I just want to say before we move on to advocacy at a national level. I know we hate paying dues. I know we hate paying extra. I feel like we're always paying something. I totally get it and understand it. I will just say that lobbyists are not cheap. Jessica Lenden-Holt:  And a [00:28:00]  lot of times we hear all these changes we need to make, all these things we need to do, and it is very hard to do those things without support. a lobbyist. So I promise that your dues go to great things at the state association level. Um, almost all of our dues go straight into paying for our lobbyist. So just wanted to put that little plug out there. I know we hate paying for dues. It is truly how we get things done. And we're able to take all of the things that you all bring to us at a state level and work, work to get those needs met. So just wanted to put that plug out there. I know none of us want to pay more. Um, but now onto advocacy at a national level. So ASHA has the public policy agenda that is available to everyone. You, it identifies the public policy issues that are of particular importance to the profession and they send out a survey to members to complete so that you can weigh in on issues that are important to you. So make sure that you are [00:29:00]  responding to those surveys and let your voice be heard. You can view ASHA's public policy agenda on their website. site at ASHA. org backslash advocacy. You can also follow them, um, ASHA advocacy on Facebook. So at ASHA advocacy, you can sign up for ASHA headlines to receive your 60 second advocacy update and learn more about letter writing campaigns that they have going on again at that ASHA backsplash backslash advocacy. It will get you there. You can learn about ASHA pack. Which is the political action committee for ASHA. And if you are listening right now, we would love for you to take a brief pause in this podcast And go ahead and do an action item so you can already say that you are on your way to participating in advocacy I love this quickly or if you really can't maybe you're driving. I don't know take a note for later But sign up for the advocacy alerts It takes just a minute and you will stay up to date on advocacy issues. [00:30:00]  So again, if you visit asha. org backslash advocacy, it will take you to all of these great links. Um, so take a moment, sign up for those so that you can know what's going on at a national level. Uh, and Jennifer's now going to share some specific additional action steps that you can take to get started on your advocacy journey. Yes. So we're going to talk about 12 actions that you can take to get involved in advocacy. You're probably thinking, what can you do? Okay, what can you do? The first thing you can do is staying informed about current legislative issues and debates that impact our field. Jennifer Henderson:  You can achieve this by regularly reading news and research articles. Keeping up with the latest studies and reports can provide valuable insights into Everything that's going on, anything that's developing. Casey mentioned earlier, like attending conferences and workshops, that is also highly beneficial because [00:31:00]  it does allow you to learn about the latest trends. And also it just allows you to network with other professionals in our field. So. Who doesn't want to do that? Um, another effective way is just to stay informed by becoming a member of both your state and national organizations and by participating in advocacy committees. These organizations, they do often offer resources and updates on all the important issues that are going on. So staying updated on state and national level issues is very, very important. Um, you can accomplish these things by just subscribing to your state association's email listserv or the ASHA Advocacy Update newsletter. All right, what else can you do? Well, very important to help others understand the importance of speech language pathologists. Um, when we share with our friends, family, and our community about what we do and how we are impacting the lives of [00:32:00]  others, We can get more support for making important changes. Sometimes people don't really realize just how important our roles are, but when they do, they're more likely to stand with us in our advocacy efforts. It's also great to just reach out to your legislators. Um, we can share our concerns and show our support for needed changes by writing those letters, making calls, or even taking the time to schedule meetings with some of them. Um, when we talk to legislators. Sharing personal stories when discussing issues and trying to think about potential solutions can really make a difference when we're talking to them. Very, very easy to find out who your legislators are and keep up with relevant bills. Basically, all you have to do is visit your state government's website to get more information. Now, on our next slide, if you're watching this on YouTube, I am going to give you an example of how, um, to search for that on our state [00:33:00]  organization's website. So, I've gone to tn. gov here. I'm going to go to government, and then I can go down to legislative bill search. That is going to take me to the bill search page. On our government page, you can type in either the keywords. Or if you know the bill that you're searching for, you can type in the bill number, HB just stands for House Bill. So the bill I'm pulling up here is in regards to extending the interstate compact for the state of Tennessee. Um, on this page, you can see all the actions that were taken for this bill. You can see when the governor signed. You can see when it went into effect. If I want to find out who my legislators are, I just go up to find my legislator, and it brings up the map, the state of Tennessee map, and then I just put in my address there. And when I put in my address, it will bring up my legislators for my district. And when you go to search for your legislator on our intent in the [00:34:00]  state of Tennessee, you can click on the their name, and it will open up a separate page that will give you more information. Um, information about that specific legislator and most, uh, state government websites are similar. So you just, again, just have to visit your government state website page. All right. So, so far we've talked about staying in the loop, joining advocacy committees, spreading knowledge, and getting in touch with lawmakers. So, what else can you do? Well, one more powerful move is teaming up with other professionals, um, by uniting with OTs. PTs, other educators, other, like I stated before, just others who share in some of our same goals, we really can make our efforts even stronger. So just remember that working together often has a bigger impact and it does boost our chances for success. So when we team up guys, like [00:35:00]  our collective voice is so, so much louder. Get involved in grassroots campaigns. Also very important. These efforts are a great way to just raise awareness and advocate for the change that we are seeking. It can be just as simple as sharing our needs with our state advocacy leaders. Filling out those surveys that we talked about earlier or taking part in any rallies that might be going on in your area. Um, also arranging local events or getting involved in advocacy campaigns that are led by your professional state organizations or advocacy groups are awesome ways to get in on the action. All right. Still chatting about a bunch of ways to advocate. There is still so much more that we can do. We talked earlier about social media. Social media is a huge help. Especially in this day and time. Alright, everybody's online, everybody's on social media. Um, basically it's a great way to help spread info, sharing resources, and getting support for making [00:36:00]  laws. We can join online groups. Plan digital campaigns and use those hashtags to get our messages out there. Don't forget guys, go to your state organizations, um, Instagram, Facebook, whatever, social media, go ahead, like comment, share those advocacy posts from groups like Asha and your state associations, because every, every interaction really does help spread the word. Another important way to get involved is just doing research and using evidence based practices by doing research or using evidence based practices. It really does help back up our push for the laws that we're wanting to change, right? So, when we show, like, what we find and what we've done, we are able to raise awareness and influence policy decisions with solid evidence. So, research and evidence can make a strong case for why certain changes are needed. It makes our, just our advocacy efforts. It just makes it more believable when they can see [00:37:00]  like what we're doing is working. All right. I know we're still talking about like advocacy actions, right? So I don't know what number we're on. We're on number nine. Okay. So let's talk about two more important ways to get involved. Um, again, like just sharing personal stories can be super powerful. When we gather and share stories of children and families who have benefited from our services, it really does bring our work to life. These stories can raise awareness, and they also just inspire support for legislative change. People are really Often moved by like just real life examples. Like, I mean, a legislator that I spoke with during our day on the hill, just talked about the services that he was receiving after, um, having had a stroke. So just like being a part of it and understanding what we do really helped him understand [00:38:00]  and really helped him want to advocate for. advocate for some of the things that we were wanting to advocate for. So that goes down to just building those relationships with policymakers, legislators, and their staff. All of that is very important. If you ever have a chance to just attend a town hall meeting or any committee hearings, um, or other public events, I strongly encourage you to do so because this gives you a chance to meet and engage with your elected officials. Building those relationships really can help you become a trusted resource and advocate for legislative change when legislators. Like know you and they understand your passion. They're more likely to listen to you and. support your cause. All right, we've already covered a lot of fantastic ways to get involved in advocacy. Let's just go ahead and wrap all of these up with two final action items. [00:39:00]  Join your state and national day on the hill events. These events are awesome opportunities to meet with your legislators and talk about important issues just face to face. It's a chance to make your voices heard directly. Where decisions are made, but being there in person also shows our commitment and helps us build strong relationships with the policymakers. And again, like this was like a game changer for me, honestly, just attending our own state day on the hill. It was, it was so fun. It was very important, informative, but it also made the legislators to me, like more human, like I was stating before, like, because to me, for me personally, it was like, Scary people in this, you know, on the hill, right? Like making decisions about things that they really don't understand. But that's why it's important for us to educate them. And it turns out like, at least the ones that I talked to just, they were so nice and really wanted to listen. So I definitely encourage you to [00:40:00]  attend your day on the hill events. Um, and then the last thing, another powerful advocacy tool and participating in state and national level is just participating in state and national letter writing campaigns. Um, letter writing campaigns are a great way to share our concerns and express support for legislative change. Listen, these letters are impactful, especially when so many people are sending those letters into your legislators. So, By joining your Day on the Hill events and participating in these letter writing campaigns, we really can make significant impact on the legislative process. And Jessica is going to talk more about what Day on the Hill looks like, but she's also going to talk to you about how you can do those letter writing campaigns. Like I said, I'd never been to a day on the hill. I'd never participated or led. I guess I'd never led a letter writing campaign at this point. Jessica Lenden-Holt:  So there was a lot of mystery behind [00:41:00]  it. And mysteries can sometimes be scary and intimidating, and we can come up with all these reasons why we shouldn't do it. So we want to kind of like, Take the veil away and kind of show you a little bit about what it looks like. And this is an example from Tennessee. Of course, your day on the hill might look a little bit different. Um, but really it's a, just an interactive event. So you heard a little bit about Jennifer and her experience. Um, they're really true. It's just a fun, interactive event where you have a lot of different professionals or graduate students coming together during the legislative session. To advocate or to share stories. And so again, ours is typically held in February or March. We have professionals and students that, um, that come and we first educate them on what are the current legislative affairs that may potentially affect our profession and our clients. Like what is the background on some of these bills? What are the things that are on the table that we need to discuss? And we provide members with a one pager that they give legislators. That contain all the talking points regarding [00:42:00]  our advocacy agenda and professionals meet with Tennessee legislators, their state legislators to advocate on behalf of our profession and clients. And these are scheduled appointments that we schedule ahead of time. And during those meetings, the participants will not only review the current issues with the legislator, but also just describe how it impacts our field, what we do, like Jennifer sort of mentioned, like some of them know what we do, some of them have no clue, right? So you're kind of sharing a little bit about. who we are. Um, and then we just advocate for our desired outcome. And a letter writing campaign typically occurs around the same time as Day on the Hill, but they can also take place throughout the year. Uh, we send ours out via email to all of our members, as well as post them on social media. Um, and when individuals are not in a meeting for Day on the Hill, we usually ask them to participate in some of our letter writing campaigns. So the day on the Hill concludes with a meeting between all of the participants where feedback from our meetings are discussed, and we just plan for actions moving forward. And [00:43:00]  again, this is, we typically are going around in small groups. There's usually a leader who knows a little bit more about what's going on, who's helping kind of guide the group through. Legislators are just always excited to meet their constituents and especially students. They love meeting students. Um, and they really just want to learn more about our field. They often share personal stories, like Jennifer mentioned, of how an audiologist or a speech language pathologist has impacted their life or the life of a family member or a friend, so it's truly just a great opportunity to connect with lawmakers and start building a relationship with them. I did, we've mentioned letter writing campaigns so much, but this is such an easy way to connect You know, in between Netflix shows or whatever you're doing, you can write this super quick letter and participate in advocacy. So we are going to show you just how simple it is. This is another one of those do it along with us. So if you need to click pause or jot this down as an action item to take letter later, you're going to go to asha. org. [00:44:00]  Backslash advocacy. So state associations may send out their own letter writing campaigns and templates. We are going to show you a quick way walking through ASHA's website just because we can all advocate together with this one since we all come from different states, but we would love for you to pull this up and follow along with us. So when you get to the website, you'll see lots of great advocacy information and updates. If you look on the right hand side, you'll see a box that includes the public policy agenda and right below that there is a take action link. So if you click take action, you're going to be taken to the ASHA take action page where you can sign up for alerts. Find your legislator, read about all the bills going on. Uh, and if you look on the left hand side, that's where you're seeing all the different advocacy agenda items. Click one that you're interested in learning more about. And once you click on that topic of interest, that's where you're going to see additional information about the issue, any bill information. You can also download the full issue [00:45:00]  brief. And then on the right hand side, You'll see where you can enter your name and information to send a letter to your legislator explaining and supporting the bill. So if you're already signed in, ASHA will automatically include your legislator so you don't even have to look them up. Um, and they provide a template for you to use. You can choose to make edits or add in personal stories or notes or you can choose to send as is. And that's it. So it literally only takes a few clicks. a couple of minutes to participate in a letter writing advocacy campaign through ASHA. So I would really, really like to encourage you to pause this podcast, take notes, participate in at least one. Pause it, pause it, pause it. Yes. Pause and come back though. Um, so that you can participate in at least one letter writing campaign today. Um, cause it really is that easy and that simple. All right, Casey, over to you to share more about volunteer [00:46:00]  opportunities. All  Kacey Hammonds:  right. Thank you so much, Jessica. So, one of the most fun and rewarding ways to get involved with advocacy is to seek out volunteer opportunities. So, let's take a few minutes to explore what these opportunities could look like for you and how you can advocate for the prevention of speech language pathology or audiology through volunteering. You can find some of the most fun fun and engaging leadership and volunteer opportunities by, again, attending your state convention. I mentioned before, and I'll say it again, that I particularly, particularly enjoy the TASLIP convention that's held every September. State conventions in general are a wonderful source of education, connection, and networking. Conventions provide an opportunity to meet SLPs across your state, many of whom will have very [00:47:00]  similar advocacy concerns. For example, the private practice SLPs in your state might be worried about a new private payer in the state that's taking months to authorize treatment and then getting a lot of denials. Maybe your medical SLPs are worried about the new Medicaid or Medicare policies and your school paced SLPs. Desperately need a caseload cap, let's say, everyone has something to advocate for and your state conventions are a great way to get a feel for what our colleagues across the spectrum of speech language pathology are needing, are wanting. Serving on committees and being involved in your community are both essential for knowing the why behind your advocacy. I know personally for my advocacy as the state advocate for reimbursement, knowing the why and my recent efforts for trying to get us increased reimbursement for Medicaid in the state of [00:48:00]  Tennessee has really just lit a fire under me and trying our best to get those reimbursement rates. Elevated. I'm trying Tennessee. So again, attending the ASHA convention and your annual state conventions are great opportunities for diving into advocacy. The convention setting gives you that opportunity to meet with your national reps and your state advocacy reps. You can attend sessions related to advocacy, connect with your state association and ASHA leaders. present and view posters and sessions, volunteer on commit on convention committees and of course, earn CEUs. Just in general, the conventions are a great chance to network with and more importantly, learn from others in our field who might be practicing in different workplaces, settings, or even states. There is so much that we can learn from one another. And it's [00:49:00]  surprisingly easy to serve on committees at both the state and national level. Asha actually has approximately 45 committees, boards, and councils that provide numerous volunteer opportunities for members. The link in the slide that we're showing and that will also be included in the show notes, if you click on that link, it will take you to an Transcribed by https: otter. ai Extensive list of all the committees, boards and councils that ASHA provides. There are groups for a variety of issues in any in our field, anywhere from infant hearing to multicultural issues. The contact information from members on the committees. is available on the ASHA website. If you're interested in participating in ASHA advocacy, there is surely a committee for you. If you prefer to advocate for SLPs at the state level, you should contact your state association to learn more about committee opportunities. I'm [00:50:00]  sure that they would be happy to have new state association members ready to lend a hand and volunteer. We have discussed naTional and state committee participation, but volunteering directly in your community Is one of the best ways to advocate, advocate for the people who matter most, our clients that we're serving. Personally, one of the most rewarding ways for me to connect with our community and find out what our true advocacy needs are. Is my participation in the Adaptive Football Camp that we have each year in Elizabethton, Tennessee. I have had the opportunity to connect with our local zoo to provide a presentation about how best to accommodate autistic individuals and adults that come to day camps at the zoo. Jennifer helped me with that and we had a great time there. So these volunteer opportunities have allowed me to connect with the community and hear from the individuals directly impacted by the bills and laws that we are advocating for. [00:51:00]  Shakiria is going to take over now and we'll answer some important advocacy related questions. Shequria Williams:  All right, guys. So just in case you're wondering, does my voice really make a difference? Yes. Yes. Your voice absolutely does make a difference. And I am going to share with you all about how your voice makes a difference. So, of course, your voice matters. There's, of course, power in numbers, which is why we are encouraging you today. So if you feel it right now, just take another pause. And go ahead and join your state, uh, organization. Um, I will share with you a bit about what TaskLift has advocated for and some things we have accomplished due to our advocacy efforts. So let's dig a little deep in here guys. So in Tennessee, um, SLPs used to pay 400 annually for what we call a professional privilege tax to the state. I am [00:52:00]  pretty sure that every SLP in the state of Tennessee dreaded the month of June because that is when we had to pay this tax. And so our, you know, task force members and SLPs advocated to remove this and we made it happen guys. This passed in 2020 and we couldn't be more thrilled not to have to pay this annual tax every year. Telepractice approved for reimbursement past COVID emergency. This passed in 2021 and it became a permanent stay in 2022. Tennessee joined the interstate compact and that passed in 2022. SLP licensure timelines, uh, that bill passed to keep processing times at 60 days or less, and that passed in 2023. SLP workloads, we're still working on that, it's a work in progress, um, and guys we can't stress you enough, your membership dues into the state organizations are definitely used to support our lobbyists, and so we are still working on that in the state of Tennessee. Um, we've [00:53:00]  also had a Medicaid rate increase that, um, well, we've not had one, but that's a work in progress. Our STAR representative, who is so fabulous, Casey, she's definitely working on that guy. So again, be patient because she is working hard to advocate for those Medicaid rates.  Kacey Hammonds:  Check your emails, , we've got a survey coming that how the way that Tencare is set up, we, we need your help on it. Shequria Williams:  Yes, definitely. Definitely. So again, your voice matters. Let's hear from you as well. Um, so let's talk about what some other states are doing. So for example, in Kansas, they have actually accomplished a lot of major things as well. So in 2016, the bill for the language assessment program for death. and hard of hearing children was passed. In 2018, they passed the teletherapy bill. In 2021, um, they opposed cuts to Medicare reimbursement. And in 2021, they passed the air state compact. So lots of things, [00:54:00]  lots of amazing things are happening, um, in states across the U. S. Right, and you can learn more about advocacy efforts across the country, uh, simply by visiting ASHA's advocacy website to stay up to date with advocacy efforts impacting schools and healthcare. Um, you can also learn more about professional practice and workforce issues. patient, client, and student issues, and diversity, equity, and inclusion issues. You can find ASHA's public policy agenda that Jessica spoke about earlier by visiting the 2024 advocacy priorities for audiologists and speech language pathologists on ASHA. org. In the area of workforce priorities, ASHA is enhancing efforts to help address the shortage of practitioners that often contributes to high workloads, burnout, and dissatisfaction across the work setting. In the areas of payment and coverage priorities, ASHA's advocacy efforts address policies that limit client patient [00:55:00]  access to care due to unsustainably low Payment rates for services provided by audiologists and SLPs and inadequate coverage for their evaluation and treatment services. And in the areas of service delivery and access priorities, ASHA is working to address barriers that impede the ability of audiologists and SLPs to provide robust and inclusive access to care. So all of the actions that ASHA is taking to work towards meeting their 2024 goals are outlined on the website and instructions for how you can become involved are also located there as well. So now we're going to pass it on over to Jessica to share with you some of our resources.  Jessica Lenden-Holt:  I know we've shared so much with you today. It might seem a little bit daunting at first, but even if you just take a couple of those key action items, I promise you it does make a difference. Like Shakira mentioned, your voice matters. State associations can't do it alone. Your star rep, your stamp rep, your seal rep, we can't do [00:56:00]  it alone. Um, ASHA alone without you. Pushing and encouraging and answering those surveys. No one is doing this alone. It takes all of us, right? So, really want to encourage you all. Take the one thing that you think you can do, and do it today. Take that first step. I promise it gets so much easier. Um, and once you write that first letter, for example, it doesn't take but a few more minutes to go over and write. That second, third, fourth, fifth letter, right, Jennifer? I think Jennifer was like, Oh, this is all you have to do. And then she wrote like five. So, I mean,  Jennifer Henderson:  it took me five minutes, maybe to write five. I mean, not even five minutes, you know.  Jessica Lenden-Holt:  It seems so daunting at first and then you get there and you don't you're like, Oh, this is all this is I can do this or a survey, like Casey mentions, we send out surveys all the time and, you know, sometimes it's a little disappointing that we don't get a lot of responses back. So we know people have concerns, they have issues that need to be addressed, but we need to hear your voice so we can't carry the torch alone, we [00:57:00]  need all of us. So just want to really encourage you to. Use some of these resources. We've added different citations and research links and articles as well as all of the great, um, resources we've mentioned today. You will all have access to these and we're also always available to help answer questions. So you're welcome to reach out to any of us at any time. My Personal email is jlh at mypsychictherapy. com. We've given you lots of resources and ways to reach out to your individual state representatives as well. Um, and your state seal star stamp, VP of legislative affairs. So we just hope that you take some key things away. That you get involved with advocacy today and that you feel more equipped and have some tools to advocate for our profession, yourself and your clients after today. Um, that's really just the goal of our presentation. So really hoping that you all take something from this and, and try it out.  Kate Grandbois:  Thank you [00:58:00]  so much for sharing all of this wonderful information. I think for me, one of the biggest takeaways from listening to you all speak is related to dues being applied to something that is action oriented. Um, I know there has been a lot of conversation, particularly online and in social media about. How many dues we have to pay, licensing fees, ASHA dues. And there's a lot of frustration around financial transparency or transparency with which, you know, what is our money actually doing? What are we getting out of it? And, um, I think on the tail of that, this, you know, there is a difference between what a state association is capable of doing and what, uh, what ASHA is capable of doing, right? So I, I really appreciate. Just highlighting the impact that dues at a state organization can have in terms of [00:59:00]  action oriented outcomes. I hope I, I hope that makes sense. And I hope you agree. And I didn't get something completely wrong.  Jessica Lenden-Holt:  We are all volunteers. Board members are not paid. They're not paid positions on our state board. Uh, we don't have, um, a big fancy building. We don't have, you know, we, we're really operating on a very, very tight budget here. And so the dues are so important because like I mentioned earlier, lobbyists are not cheap, thousands and thousands and thousands of dollars a month. And that adds up across the year. And so it is, um, it is really key to have a large membership. Tool in order to pay for a high quality lobbyist. So definitely need our lobbyists to continue to help us advocate throughout the year. And that is really the bulk of what our dues go to.  Jennifer Henderson:  Yeah, and I just really encourage you, if you want to know what your dues are going to, like, go to your state association websites, go to the ASHA Advocacy Action site, like, those sites will tell [01:00:00]  you exactly what, um, ASHA and your state, um, Organizations are working on. So I just encourage you again to just go to those websites to find out Amy Wonkka:  for all of you who have been involved in this level of advocacy for so long. What are some of the benefits that you've experienced through being part of this process that might be something that would help somebody who's sort of on the fence and a little bit intimidated. I  Jessica Lenden-Holt:  love I love that you said so long. So I would love to point out everyone on this call, we have been in our role three years or less. So we are all newbies, which is why we thought we were the perfect people to come out here and like, tell you, like, you don't have to know it all. Just give it a shot. Just try it. Connect with that. You sound like you know it all. You sound, you sound like you're lying.  Kate Grandbois:  I think you're all lying. I think you know everything. We most definitely  Jessica Lenden-Holt:  do not. Um, but we can [01:01:00]  network and we can ask questions and we can research. And so I think that's actually my biggest takeaway. Like you don't have to have been in the field 25 plus years. You don't have to have been involved in advocacy for five plus years. You don't even have to have been a member of your state association for 15 plus years. Like Where you're at today is  Announcer:  a great place to get started. I'm not going to  Jennifer Henderson:  jump in and agree with what Jessica said as well. Like, just don't be afraid to get involved in advocacy. We definitely don't know it all. Like I need all the people that I surround myself with to like, encourage me, or I needed them to encourage me and let me know that I can do this because I didn't realize how easy advocating really could be just like those simple, just answering those surveys, like Casey. Mentioned that come through the email or going to the, um, ASHA action site to writing those letter campaigns. And again, I, Shakira mentioned just surrounding yourself with people who have similar goals and sharing your [01:02:00]  stories and, um, just encouraging each other because we all need each other because again, we don't know everything. We, we ask all the questions so that we can learn together.  Shequria Williams:  And I'd also have to add in that. It's also very rewarding. Um, when you are working hard to advocate for this thing and you see it come into fruition, that's very rewarding. When you get an email from an SLP that wants to know more about how to advocate for themselves and their students, and you give them advice, and they actually take the advice and use it, and they email you to say, hey, this actually worked. I was able to advocate for myself because of all the tools that you gave me to feel confident enough to do so. It is extremely rewarding. Kate Grandbois:  You all have shared so much. I feel very inspired. I've been sitting here looking at the Massachusetts State Organization website on the side browser. Thinking about all of the ways I feel a little bit of shame that I'm sitting here hosting you all with Amy, and [01:03:00]  I'm not a member of my organization. Don't be ashamed. Sorry. Sorry, Masha. I'm getting on it. I swear. I swear. Don't be  Jennifer Henderson:  ashamed. Don't be ashamed. That's what we're here for. There's no shame and blame.  Kate Grandbois:  There's no shame and blame. Um, you've just shared so much, and I feel very inspired to at least, Join my state organization and contribute funds that are going to go to helping with workload and, you know, licensure and things that genuinely impact our jobs. I think that's very powerful. In our last few minutes, do you have any, any additional last words of advice for anyone listening? Announcer:  You can do it. We all believe  Jessica Lenden-Holt:  in you. You can do this. You've got this. Just go out and do that one thing. Just go out and do that one letter. Just go out and research, um, your state association website. Do that one thing.  Jennifer Henderson:  One thing. I'm just going to jump on what Jessica just said, just because I already kind of gave my little tip [01:04:00]  earlier, but that one thing, remember your voice really does matter. It does make a difference. We need everyone.  Shequria Williams:  I agree. Today is the day. Take action, guys. We're looking forward to seeing all of the wonderful things that you are going to do in your venture in advocacy.  Kacey Hammonds:  I'll jump into to say when you do take that one step and reach out, please don't be afraid. We like the advocates at the state level are just normal people. All the stars in the ashes stars meeting are just regular SLPs. Who knew when I first started in those, I was like, Oh, these must be, I don't know, experts in the field, which they all are, but they're great. They're so sweet. They're so nice. They've helped me so much. So take the first step and don't be afraid to reach out and ask any question that you need. Kate Grandbois:  I love this. Thank you all so much for being here. This was really wonderful. We so appreciate your time, your expertise, your enthusiasm. This was so great. Thank you again so [01:05:00]  much.  Jennifer Henderson:  Thanks so much for having us. Thank you so much. Thank you. Awesome.  Amy Wonkka:  Thank you so much. This was great. I'm going to go do the one thing. Jennifer Henderson:  Yay.  Kate Grandbois:  Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study. Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com thank you so much for joining us and we hope to welcome you back here again soon. .

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 . [00:00:00]   Intro Kate Grandbois:  Welcome to SLP nerd cast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy  Amy Wonkka:  Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each  Kate Grandbois:  episode of this podcast is a course offered for ashes EU. Our podcast audio courses are here to help you level up your knowledge and earn those professional development hours that you need. This course. Plus the corresponding short post test is equal to one certificate of attendance to earn CEUs today and take the post test. After this session, follow the link provided in the show notes or head to SLP ncast.com . Amy Wonkka:  Before we get started one quick, disclaimer, our courses are not meant to replace clinical. We do not endorse products, procedures, or other services mentioned by our guests, unless otherwise  Kate Grandbois:  specified. We hope you enjoy  Announcer:  the course. Are you an SLP related [00:01:00]  professional? The SLP nerd cast unlimited subscription gives members access to over 100 courses, offered for ashes, EU, and certificates of attendance. With SLP nerd cast membership, you can earn unlimited EU all year at any time. SLP nerd cast courses are unique evidence based with a focus on information that is useful. When you join SLP nerd cast as a member, you'll have access to the best online platform for continuing education and speech and language pathology. Join as a member today and save 10% using code nerd caster 10. A link for membership is in the show notes Kate Grandbois:  Welcome to SLP Nerdcast. We are here today with one of our favorite repeat nerds. We are here to talk about stuttering and the neurodiversity movement with one of our favorite guests, Nina Reeves. Welcome, Nina.  Nina Reeves:  Hi, [00:02:00]  I'm, I'm so glad to be back with y'all because we're spreading the nerd love.  Amy Wonkka:  I love it. I love it. It's so nice to have you in the nerd room once again. Um, and you are here to talk to us about neurodiversity and stuttering, but before we get started, can you please tell us a little bit about yourself?  Nina Reeves:  Oh, uh, sure. Um, for those of you that are unfamiliar with me, uh, I am a school based speech language pathologist for all of my career, uh, except for last year, which is kind of interesting. My whole identity shifted, but it's okay. Um, we grow, we change. And I am a stuttering specialist. I have been for, uh, since the initial cadre of stuttering specialists way back in the day. And I work with Scott Yarris as my co author to, uh, produce lots of information and resources for clinicians working with stuttering. Kids who stutter.  Kate Grandbois:  We've [00:03:00]  learned so much from you over the last few years. You've come, I think this is maybe your fourth or fifth episode with us and I have learned so much from you. Your perspectives on stuttering, you, you've taught me everything I know. Your perspectives on stuttering are refreshing and, um, so needed in our field and we're really excited to have you back to talk about all of these things.  Um, You mentioned Scott Yaris, you all co own stuttering therapy resources. So for any listeners out there who are not familiar with stuttering therapy resources, a tremendous wealth of information. And again, something that we've learned so much about stuttering from you all, so thank you again for being here. I do need to read our learning objectives and disclosures before we get started, so I'm going to go ahead and do that quickly. Learning objective number one, describe how the neurodiversity movement is impacting our work with people who stutter. Learning Objective Number Two lists two ways to create a paradigm shift that is meaningful for people who [00:04:00]  stutter. And Learning Objective Number Three lists two ways SLP roles have changed to meet the needs of students who stutter. Disclosures. Nina's financial disclosures. Nina is part owner of Stuttering Therapy Resources Incorporated with ownership, interest, royalties, and intellectual property. Nina's non financial disclosures. Nina has no non financial relationships to disclose. Kate, that's me. My financial disclosures, I'm the owner and founder of Grand Bois Therapy and Consulting LLC and co founder of SLP Nerdcast. My non financial disclosures, 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.  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 Nerdcast, and my non financial disclosures are that I'm a member of ASHA, Special Interest Group 12, and I participate in the AEC Advisory Group for Massachusetts Advocates for Children. All [00:05:00]  right, all that stuff is done. On to the good stuff. Nina, why don't you start us off by just telling us a little bit about that first learning objective? So how Is the neurodiversity movement and how has the neurodiversity movement affected our work with people who stutter and maybe how has this changed over the past few years? Nina Reeves:  Oh, that's a, that's a wonderful question. And it's one that, um, those of us in the stuttering community have talked about, uh, ad nauseum for, for the past three or four years, especially it's kind of interesting. Um, it's changed a lot and it hasn't changed. A lot. So let me let me clarify that. Um, those of us who have been in this for decades. Think about the fact that we've been talking about neurodiversity. Um, concepts for a long time. It's okay to stutter was the is is and was the motto of the National Stuttering Association for decades. [00:06:00]  And what was happening is we were all talking about that. It's really okay to stutter. And I think the world was like, it's okay to stutter, you know, somewhat. There was kind of a limit on it in society. And we were like, no, it really is okay to stutter. So we were, you know, stutter affirming before stutter affirming was cool. However, now we have the language and we have the groundswell of understanding, um, came with the autistic population and the, the voices that came up and said, you know, we are who we are. This isn't, this isn't, you know, an articulation lisp. This is us. And who we are neuro wise and so trying to have people who stutter act like they're not people who stutter decreases their identity and doesn't allow them [00:07:00]  to show up authentically as who they are in society. or in any speaking situation. So the neurodiversity movement has really, you know, been that sort of open call that, uh, that now the profession is really, you know, moving into an understanding. And I think that that's an amazing part of the last three, four, five years is that understanding that trying to fix stuttering, which every clinician knew they weren't doing. Or couldn't do, but they went ahead and tried to do it because they thought that was expected of them, or that's how they were trained, or that's what the parents wanted. This is, that's what the kids wanted, right? They wanted us to make it go away. And instead of sort of sitting back and saying, wait a second, this is not really our [00:08:00]  role because scientifically we're not rewiring anyone's brain. And so let's try to help and align, let's align with the stuttering community, the voices that are saying, I'm, I'm me, uh, let me be in that way, but also support me in my journey, because this isn't something that everyone can just do on their own, is to learn how to navigate stuttering in a world that doesn't get it. Kate Grandbois:  I love that you use the word groundswell. Uh, I think it makes me think of, you know, this, this cresting wave, which implies this momentum, this forward momentum. Um, and I have to assume that with that momentum that was presumably started by the autistic community, there was this, there was [00:09:00]  this cresting wave of, of forward movement for the stuttering community as well. And I, I have to imagine in just thinking about. That groundswell, that forward thinking and all of the small changes that we've seen. So therapists now using words like neurodiversity, affirming therapy, neurodiversity, affirming goals, bringing in the voices of mark from marginalized groups, listening and centering those voices, which has always been a part of our EBP triangle. We've always have patient centered value, you know, patient perspectives and values as part of our EBP triangle. But. Really should making that shift to put that at the center of what we do. I have to assume that this is not just for preschoolers who have a diagnosis of autism. This is this is everywhere. So what are you seeing? How are you seeing this trickle into the detail of working with individuals who stutter?  Nina Reeves:  Great thought. It's I love [00:10:00]  the momentum that you mentioned. And the idea that this is helping to switch. All of those SLPs who never thought that they were supposed to be trying to fix kids who stutter, they're taking a big, deep sigh of relief. Okay. Like, wow, thank you for giving me permission to stop writing fluency goals when I never felt good about them anyway. Um, and to look at stuttering the way, uh, it, in my heart of hearts, I knew these kids did not need me to fix them. However, Now, if you're going to sort of empty that cup of, you know, let me work on tools, let me work on tools, this is what I do, then we have to be ready to fill up the cup with what am I doing instead. And there lies the [00:11:00]  shift that is still happening. It's, you know, and I'm sure I know, I feel that it's not happening fast enough, but what we have to realize is that this is like turning a, a, a cruise boat, like the culture surrounding not only the stuttering community, but also the profession of speech language pathology is the idea of. Slow, but sure, we've been trying to turn the cruise ship for a long time, but now we're having some momentum, but it's still not going to be overnight because we have a couple of generations of SLPs working in the field right now, who that's all they know is how to do tools and how to, and in fact, if we can get down to the nitty gritty, how to do fluency tools. People call their kids [00:12:00]  fluency kids. They call their therapy fluency therapy. We've been yelling about that for a long time. It's stuttering therapy. Call it what it is. And now people are getting it, even people in the upper echelons, say, of our profession, um, who are finally understanding that the fluency focus was always in the direction of Increasing negative impact for people who stutter. Um, instead of decreasing it, because we know from from literature now that those people who have the idea that they have to stop stuttering have more negative impact on their lives. And those who realize that coming to terms with stuttering. Even though that's not just, you know, easy coming to terms with stuttering and [00:13:00]  accepting that part of their identity have had a, an easier road of it. So it's important to realize that that's, that's the shift.  Amy Wonkka:  Right. And from a, from a clinical skills standpoint, there must also be, I know we've had you on before and we've talked to you a lot about counseling and how important counseling is. Um, and I think that that's something that is. pervasive across the field. I know every time I leave a conversation with you, I'm like, Oh my gosh, this is so applicable to everybody. Um, but I wonder if you could talk to us just a little bit more about that shift away from an emphasis on tools to an emphasis on those counseling skills that are so important for the speech language pathologist to have. Nina Reeves:  Yes. Uh, I, I love this topic because, um, I have learned that Those of us who are, you know, supposed leaders. I don't like to call myself a leader, but you know that we're up here talking about this, [00:14:00]  that we have to be okay with having the unpopular opinion. Okay. And we have to say the things that need to be said, even though most people don't want to hear it. And so the, every time when I'm presenting and teaching other SLPs about all of this, I use the word counseling and there's an immediate like reaction, you know, well I'm not a counselor and nobody trained me on this and, and I, and I understand that I really do. I also understand that it is part of our, our, you know, our principles of practice we're supposed to be at least understanding of counseling skills for communication differences. Not that we're supposed to have a counseling, you know, degree. We're not supposed to handle counseling about, you know, a child's issues that are beyond the scope of our practice. But we do, [00:15:00]  we are supposed to be aligned with the idea that people come to us as people and not disorders. They come to us as trying to navigate something that is challenging. Think about stuttering as we're talking about today. Stuttering can be challenging in, especially in society that doesn't get it and wants a quick fix and everybody wants it to just go away because it takes patient listening and understanding, which are not highly valued. or utilized in our society. So counseling skills become a huge part of what we do in stuttering therapy. And that's the bucket I was talking about that we have to continually fill up. And we've been working to do that with professional development and a few university programs around the [00:16:00]  country have been really trying to focus in on that. I believe that that has to be a huge change from the top down in Um, how university programs are designed going forward so that SLPs can at least come out. They don't have to know everything because, you know, university programs can't prepare us for everything, but have those basic clinical counseling skills that will allow us to sit across from a kiddo who stutters, who is crying about being bullied on the playground. And we're not going to give them easy starts. We're going to have to learn how to sit in that moment and discover what, how that is impacting this child and how we can be of support.  Kate Grandbois:  You just said something that was completely parallel to a question that was percolating in my mind as you were [00:17:00]  speaking about the clinical experience, you know, living in our society that doesn't necessarily value. Patience or empathy or, you know, acceptance, you know, our, our society is very ableist and I don't think that anybody who is listening would be surprised to hear me say that. Um, but when you're working clinically with a family or a student or a client individual who comes to your office and says, I don't want to stutter anymore. It's my value to get rid of this. Uh, this is causing me a lot of. Discomfort or pain, um, I would imagine this also come, would come out of the mouths of parents like he's stuttering, she's stuttering and you have to, you have to fix it. So then you're, I have to assume that you're sort of faced with an even larger counseling task. How, how would you recommend that we, you know, resolve some of that tension for families? What do we do in that situation? Well, that brings up, you know, the million  Nina Reeves:  dollar question [00:18:00]  is how, how can we be stutter affirming and not drive an agenda? Eeky beekies. You know, this isn't what, I'm not going to give therapy what I want you to do. Okay, and that's tough because I've seen down the line what You know, that fluency focus has done to people who stutter over the years. Okay. Um, but I also have to let everyone have their process. Okay. So we can't flip from, I need you to be fluent. I will, I'm writing fluency goals for you or at you to, I need you to just accept your stutter. That's not going to fly again. We're turning the culture persistently and patiently. Okay. a little at a time. We can't just flip a switch and now go, it's okay to stutter. So go out there and do your best. There has to be some sort of support and [00:19:00]  middle road that, that addresses those needs and desires of the client. Now we meet people where they are. Yes, but we also have to bring in the evidence base, which does mean we can't cure stuttering. So how do we, how do we balance that? And how do we talk about it with the people surrounding the child and the child? That's where counseling has to come in. We have to be able to perceive what's in front of us, ask deeper questions, and then align ourselves with appropriate expectations. But I'm going to, I'm going to wheel back to something you said that has been on my mind, uh, so, so, um, it's pervasive on my mind all the time. The idea that, of course, people who stutter come and say, I don't want to do this anymore. [00:20:00]  Of course, caregivers, teachers, parents, siblings, everybody wants it to be gone. Because it's a challenge. And it's. uncomfortable, both internally for the person and can be uncomfortable externally until people learn how to desensitize and accept that there are differences in communication. But those initial stages, I just look at people that say, I want fluency and I'm thinking, boy, are you normal? I validate that. Then we have to think about what is the fluency going to get you? Let's think of two things. Number one, has anybody ever given you a different choice? Has anyone ever said out loud that it's okay to stutter and meant it? Not, it's okay to stutter, but make that one smooth, [00:21:00]  right? So, has there been another perspective that has been in the mix of what we might want for kids who stutter? As parents, as teachers, as teachers. as ourselves, as children who stutter. So number one, has there been another perspective even raised? And number two, okay, so if the fluency is what you want, I want fluency because, so what is the value? This would be acceptance and commitment therapy coming through. What are the communication values? What do you want that you don't think you can get? If you stutter and then that list age appropriate as it is becomes what we work towards is working towards the values and I'm going to tell you every single time those things can I want to tell a joke. I want to be able to raise my hand in class and not feel so icky. that I [00:22:00]  might stutter. That doesn't come with fluency. It comes with acceptance and understanding that you are a perfectly great human being and stutter.  Kate Grandbois:  That was so well said, it was so well said. And I also want to mention for people listening who are not familiar with ACT, ACT stands for Acceptance Commitment Therapy. It is a, I don't believe it's considered cognitive behavioral therapy. I think that it's kind of straddles Applied Behavior Analysis and Cognitive Behavioral Therapy. Um, there is a book called The Happiness Trap that was a New York Times bestseller that describes acceptance commitment therapy. Highly recommend. We're all clinicians working with anyone in, in the world. It's, it's a really wonderful strategy. And I'm so glad that you brought that into this conversation to refocus the work we're doing to support someone in their goals and in their [00:23:00]  values and how those values can be uncoupled from the experience of stuttering. It's, it's brilliant, brilliant.  Nina Reeves:  Well, and and listen, there are people that have been writing about this in the stuttering speech pathology community for a long time. Um, the, the idea of there's a book called more than fluency. Which we'll put in the show notes, the idea, uh, there are different chapters in there. Of course, there's a chapter on it, cognitive behavioral acceptance and commitment, avoidance, reduction therapy. There are many ways that speech language pathologists can learn about these aspects of the counseling world that are then brought in and applicable to our work. And I'll, I'll go even farther. I think the happiness trap. And how to talk so kids will listen and listen so kids will talk should be a prerequisite reading, not only for speech pathologists, [00:24:00]  but for educators of all kinds and human beings. I just think it's, it's a helpful way for us to understand the relational part of communication. Because, you know, is communication is the goal of communication to be fluent in any in any way, shape or form. Are we all supposed to be fluent communicators? Because it doesn't exist. Perfect fluency does not exist in the stuttering community or in the, we call them fluenter community. Okay, it's not, it's, it's about being able to get your needs met, to communicate and connect with people. That's what communication is for. And so if we refocus just that shift of the mindset that I'm working on communication therapy with kids who stutter instead of fluency [00:25:00]  therapy, then it brings open everything. And when we talk about it in that way to parents and teachers, it starts to open up the idea that we are not technicians who just focus on the motor behavior. When, when our scope of practice and the ICF model, the International Classification of Functioning model from the World Health Organization, which I'll put some references to, they tell us that it's not just about the impairment. We're not just functioning on our focusing on the functional impairment, we have to be looking at the larger scope of how this communication difference this verbal diversity, as we like to call it, um, how this impacts this. this person who is sitting in front of you. Amy Wonkka:  I wonder if you can give us some examples. [00:26:00]  If you take us back to that child who's sitting in your therapy room with you and they're upset and they just want this to go away and you're talking to them through those components of like, okay, let's get a little bit more information about. The why, um, how, what are some of the next steps? What might that look like in your next few sessions with that student? Who's, you know, who's really upset. You're trying to help them navigate kind of the, the underlying pieces of connection that they're looking for. Um, what other things might you do? Just so SLPs who maybe are still really working on fluency, in their sessions. Like how does, how does that shift look?  Nina Reeves:  Um, wow. I think the, the most major shift would be learning how to listen. Okay. Letting the child tell you the story, learning how to ask probing questions [00:27:00]  that aren't driving an agenda, but are getting curious. We're getting about what that means for you. Um, so listening and validating. Are two things that we can do in those moments where it becomes imperative for us to say, I hear you. I'm sensing that you're upset and, and that how to talk. So kids will listen and listen. So kids will talk book taught me how to say, you know, I'm sensing that, or I, I'm hearing that there might be some upset feelings and if kids aren't feeling upset, they'll let you know. No, I'm not upset. I'm sad or I'm mad or whatever it is. They'll help you out with whatever feeling word. Of course, we want to continually help kids. The underlying message in that is we have to give them some, you know, emotional vocabulary and talking about what they're really feeling. But [00:28:00]  whatever comes out, it's like we validate that. Yeah, that sounds, that sounds like it's okay to be upset by that. And now we're not going to fix it. We don't have to take the next two sections to fix their which is what, in essence, we thought we were trained to do. Right? Let's, you know, I don't want him to cry in my therapy room. It's like, well, then, you know, don't work with people who stutter. I don't know what to tell you because there's gonna be some emotion in this and emotions are okay. It's not that positive emotions are better than negative emotions, right? It's that all emotions are validated. They just are. There's not good or bad emotions. Now. Let's take that further and think about, okay, we're feeling upset. We're feeling like, you know, we have to get this thing to stop. Okay. So let, then we can [00:29:00]  dig deeper about, like you said, the wise. Okay. I need it to stop because. Okay, and then you start hearing of all the impact that's happening, all the things that are happening that because my grandma tells me to slow down and it makes me mad because the kids laugh on the playground. Okay. Now, can I work on environment in the home, can I work on learning how to handle negative listener reactions. Yes. Can I change those people. Okay. No, but I can help them learn to respond in a way that is helpful to the person who stutters instead of trying to help by fixing. Everyone seems to be trying to help by fixing and that is the culture shift. It's the, what do you praise? Do you praise fluency? Well, what if the kid didn't [00:30:00]  say what they wanted to say? They only said two words instead of the 13 words, and we just praised them for that. We just taught them that it's more valuable to appear, let's get that lexicon going, appear fluent. I was writing some of these down. The idea that they're seemingly fluent, apparently fluent, appear to be fluent, which is different than being fluent, than experiencing fluency in their talking. So did, did we, just by praising that fluency. In indirectly and unknowingly praise them for masking themselves in the world. I was just going to bring up the word masking. Kate Grandbois:  I was just going to bring up the word masking asking if that was an applicable description here because I've heard it used in the autistic community as part of this. You know, you mentioned earlier the neuro, um, the, the vocabulary, we have all this [00:31:00]  vocabulary for it now as part of that groundswell groundswell, as part of that wave, as part of that momentum and masking is a huge piece of that. I'm so glad that you use  Nina Reeves:  that word. Well, of course it's applicable in the stuttering community because, um, for all of the decades where people have been trying to help people be fluent, they in turn have had to struggle To use, um, like who wants to sound like a turtle, who wants, I mean, these are just like ways of being fluent that then mask the child's ability to just communicate freely and authentically and spontaneously, you know, if it's okay to stutter, all of them, big, chunky ones, big, you know, um, big ones that, that You know, come out [00:32:00]  and letting them out is an appropriate goal, which it is, by the way, then it becomes a freedom for people who stutter and an allowance for them to say, this is how I talk sometimes. This is, you know, my kindergartners are like, that's how I talk sometimes. And, you know, we just learn to help them say out loud that they are who they are and that you can accept me or not accept me. It's up to you. It's not up to me, but I'm not going to change myself to make you feel more comfortable. Which is what's been happening.  Kate Grandbois:  I have another question that I hope is not a bad question. I know you're never going to yell at me for having, for asking a bad question. I'm, you mentioned, you know, the, that it's perfectly okay to have a goal [00:33:00]  for letting it out. And it made me think about, Being a clinician and listening to you talk, listening to this new paradigm shift, this new lens, this different way of thinking, and thinking about my kid on my caseload who, or my student on my caseload who stutters, and then sitting down to write the goals. And what that, what that process, that overwhelming, how overwhelming that must be. I'm wondering if you can tell us if you have any tips or tricks where, I was going to say where the rubber meets the road, but I'm going to say where the pen meets the paper because we're writing goals in terms of, you know, if we don't have a ton of counseling training, how, how do you write goals that reflect. what you're doing in your therapy session, which is maybe 70, 80 percent counseling focused or defining values or working on self acceptance or self advocacy or You know, being more comfortable unmasking, what, what does that feel like to write goals like [00:34:00]  this, particularly when we, most of us, I'm speaking for myself, but I think it's safe to say most of us don't have that training explicitly. Nina Reeves:  Um, again, we are building the plane while we're flying in it, so let's talk about the shift. But I'm, I do have some pro tips. Number one, you, you asked that question and immediately I'm like, Oh, here comes the gold question. And, but it's valid, right? I'm sorry. Did I give you a lot of anxiety? No, it brings anxiety because here's what happens. Teach me how to write the goals. What does that even mean? If you don't know how to do the therapy, I can, I can give you a goal of amazing stutter, affirming neurodiversity, affirming goals. But if you don't know how to do the therapy, I don't even care if you know how to write the goal. Now, [00:35:00]  unpopular opinion. But I have to write the goal, so teach me how to write the goal. So, you'll, Scott and I have talked about this for decades. You're not going to get a goal bank from us. Everybody says you've got to give a goal bank. There's goal banks on, you know, platforms out there. You know, and of course they make us cringe, right? Because they're not stutter affirming. And the fact is, is that knowing how to write a goal does not help. move us past sitting in front of the child and being able to manifest that goal in a therapy process. So I'm always, you know, one of the, one of the Instagram and Facebook posts I want to do is, um, look beyond the paperwork now on popular opinion. So here are a couple of pro tips. Every goal that you write, If you know the International Classification of Functioning [00:36:00]  Disability and Health, if you know the ICF model, Function, Reactions, Environment, Impact, then you do your, uh, assessment, to find out what's happening in those areas in the child's life, and then you find out the strengths that you can use to address the challenges, um, That they still have in each one of those areas. So let's just say for years and years, function. Okay, we're working on the speech motor, and that was it. We're assessing the speech motor, and that was it. And so we were missing 90 percent of what we were, um, we were supposed to be working on as professional speech language pathologists. So, if you look at the ICF model, it'll help you frame your assessment. which will help you frame [00:37:00]  your therapy planning, which will help you frame your goals and your documentation of those goals. It's like the framework from heaven. I don't know. I don't know how else to put it. It's how I do everything and how I check in with myself to say, have I been, you know, addressing one area more than the other? Cause they all, the beauty of the ICF model, especially the one that is out there for stuttering. Tichenor, Herring, and Yarris, and also Tichenor and Yarris as references. That one is something that you can check in with yourself on. And it just gives you that overwhelming understanding of what you're supposed to be doing. So how do I write the goals? dismisses, did I do an appropriate comprehensive assessment and dismisses, do I know how to do [00:38:00]  the therapy and then how to document it? So we do give sample goals in our books, in our writings. We talk about, you know, everybody knows you have to have that criterion and the setting and, but you don't always have to have percentages, which is another pro tip because everybody likes to count stutters because it's, You know, it's dichotomous. It's like there or not. There's your stutter or not your stutter problem is and you'll hear us, you know, continually talk about this. That's the listeners experience of the speakers stuttering and has nothing to do with how much there was stuttering on the inside that you didn't even see. So read, uh, a point of view about fluency, read the idea that the literature is telling us that the most, uh, utilized definition from people who stutter is the feeling of [00:39:00]  stuckness, which listeners can't always observe. So counting stutters and writing fluency goals is actually. Insane. Oh, she said it. It's like a definition of insanity. You're chasing a grease pig because stuttering is variable always. And so it's never going to be a certain percentage. And then if you, if you write a percentage and the child makes it, you have to understand why did he use a strategy? Did they, um, avoid the word or was it lucky, you know, sort of people who stutter have fluency. So was it just regular fluency? at that moment. It has nothing to do with what you did in therapy. I know paradigm shifting and makes everybody's heads spin off their shoulders. However, most clinicians, when they hear [00:40:00]  that go, Oh my gosh, that's so totally correct. And so when we talk about it in that way, it also helps society see it that way.  Kate Grandbois:  Every time I, every time you come onto this podcast and you talk about something that I don't even do in my clinical life, I have A million light bulbs that go off because I think what you're saying is so, is, is saying that it's liberating, aggressive? I don't know. It's, it's inspiring. It's, it's a different way of thinking about things. And I agree. I think as a, as a working clinician, when you engage this paradigm shift, it is, it feels a little more It feels refocused on the things that matter, which alleviates some of the pressure to do all the extra little things. And I know we have to write goals, and I know we have IEPs, and we have paperwork, and there is things that we're never gonna get rid of. But what matters is the person in front of [00:41:00]  you. What matters is, is how you show up in that therapy room, and, and how you're making space for all that really important, important. Refocused, paradigm shifted counseling work. I, I, it, it's, it's, I'm gonna use the word liberating. I'm gonna double down on it. Nina Reeves:  You know, It's, uh, when I talk with you both, we, we have a lot of fun and there's back backstories and all sorts of fun things. And sometimes I leave a podcast thinking, wow, I just babbled. I have no idea if I said anything appropriate or if I, cause I do, I just did it, I do a thing where I get excited and then I don't finish a sentence. I'll insert an example before I finish the sentence, so I'm hopeful that it, that it, thank you for saying that something's coming through because this is such a passion, um, in my life that [00:42:00]  it, there's so many things in my brain that want to just be spilled out, and I'm hopeful that it comes out in ways that people can grab a hold of and hold on to as they make this shift, because I've been doing a lot of writing and you'll see it in our blogs and in, you know, in social media and in our new books that what we're really shifting. And I wasn't going to talk about this, but I will, because we do this, um, mindset ours. And by the way, others are message. The message is. easier communication, functional communication, free, spontaneous, lovely communication. So that's the message. Then our model changes because our, what, what we model in therapy is not stop and try that one again and make it fluent, right? [00:43:00]   So that changes. Then of course, the meaningfulness, which is what you just said, which sparked my attention to this, the meaningfulness of our therapy changes. It becomes what matters to the student, which is really their value of communication. What do they want to do when they talk with other people? And the values, which are bigger, you know, sort of the overarching understanding. Pretty much when I do values work with kids, I don't think I've ever had a child write down fluency as a value. So I'm thinking that mindset model. message and meaningfulness. Yes, I love alliteration are what we can help ourselves. No, those are the shifts and [00:44:00]  one follows the other. They're very synergistic with each other. So it's not like here are the 3000 things you have to do to do this better or to do this in this way. There are begin with your mindset. If your mindset shift is I always thought that kids who stutter should be allowed to stutter. What I want to help them with is to decrease their struggle. Well why do they struggle? Because internally it's not comfortable and externally they get messages that say this isn't okay. So then they struggle harder, and we've known for decades that the more you try not to stutter, the bigger the stutters become, okay? Not just the motor, but all the stuff that you do around it, the moment becomes longer and bigger because you're [00:45:00]  trying not to stutter. And that is internal. and externalized stigma. We're, we're stigma busters. If you want to really get to it, we're stigma busters. And that is part of our role, um, to align with the stuttering community, their voices elevated and honored to help de stigmatize this verbal diversity. And that, that term came, um, from me. When I was thinking about the neurodiversity and the whole diversity movement that was happening back in 19 and 20, that it, it became apparent to me that if we look at stuttering as verbal diversity, it's just another way of talking, which we've been saying for generations, but nobody got. And now people are looking at it going, Oh my gosh, that's exactly what this is. [00:46:00]  There's a famous line from someone who did from Bill Wade, who did a keynote, he told us about the time that it became apparent that his stuttering was his accent. And it's like, you know, your head just explodes and it's like, wow, but does society accept. You know, stuttering the way they accept accents, probably not. So we have a lot of work to do to turn the tide and there's more responsibility to the listener in the social relational model. It's not all what the stutterer has to do to fit in, which is the masking part, right? Which we've learned it's about. working together to understand that this is a valid and acceptable form of communication. [00:47:00]   Amy Wonkka:  I'm looking at this, um, ASHA landing page about the assessment of fluency disorders in the context of the WHO ICF framework, and there's just So many nice components in here that are so much more broad than this hyper focused lens on fluency. I wonder, because part of, part of what they're talking about in here is just activity and participation restrictions, the importance of the environment for those. People who are working in a school environment, what are some, what are some strategies and things that school based SLPs in particular can do to kind of help shift some of those environmental barriers that don't need to be there?  Nina Reeves:  Yeah. Um, oh, I'm going to be a broken record. Um, teach other people about the ICF and its concepts. Do I take the ICF model related to stuttering [00:48:00]  to my IEPs and my parent meetings? You bet I do. And this is the broad base. This is what we understand about the experience of stuttering, not the moment of stuttering, which we've been hyper focused on, as you said. So this is about the experience of stuttering. I'm looking at your child as a whole child. What parent is going to go, Oh, don't do that. I just want you to fix their stutter. Like, okay. Let's, let's get to the fact that we do have aligned, um, expectations and understandings of this. It's, it's, let's see this child as a bigger picture when, when parents, teachers and others are afraid, they hyper focus because fear makes us do things that when we have a presence of mind, we wouldn't do. So we try to open up the perspective to the experience of stuttering and the communication goals. And that [00:49:00]  does help to begin the process of alleviating the environmental impact. Now, um, another thing that I think, and I'll reference, um, an article that I co wrote with, uh, two guys who stutter. Um, one's a speech language pathologist in the public schools, and one is, you know, like, works for SpaceX. I'm not even sure what he does. It's probably secret. So he's, you know, these brilliant people and I got together in that forum from language, speech and hearing services in the schools, January 2023. The entire issue was focused on ableism. and school based therapy for stuttering and autism. Bam. Boom. Because they're, you know, you can just change the word, you know, back and forth, autism, stuttering, and it probably is applicable in terms [00:50:00]  of ableism and what society expects and how society has to change. Um, so those Institutional roadblocks are discussed in, in that whole issue, but also in, in our, um, our article in specific, we addressed all of that idea. We outlined neurodiversity and understanding, and then we went into case studies. Of what was being done and how the neurodiversity affirming therapist changed it. So I think it's almost like a mini tutorial doesn't give you everything you need to know, but it starts the process of. looking at the institutional structure of school based therapy, um, and saying, okay, these are the barriers and roadblocks, and this is how I'm going to go around them. I'm going to get creative and I'm going to find ways. And [00:51:00]  I'm just going to go, oh no, you can't do that in the public schools. I'm not going to do that. I'm going to say, how do I do it in the public schools? How do I do it better? Because any step along the process of increasing or like raising the bar. is better than no steps at all.  Kate Grandbois:  Earlier, you talked about how you were afraid that you just, you know, went on and on, and it wasn't helpful, and I'm just here to tell you that that was nonsense, and everything you're saying is extremely helpful. Um, And I, I think one of the things as, as a working SLP, you know, thinking about the intersection of, of this paradigm shift in conjunction with our everyday responsibilities, the stress we carry, the caseloads we carry, the lunches that we don't take, et cetera, et cetera. But thinking about realistic changes that we can make and action steps that we can embrace that will make a difference. And I think you've hit a, You've hit a bunch of them just to summarize a [00:52:00]  few and reflect this back to you is talking about things differently thinking about things differently and just talking about them differently. I is a is a very doable action step. So, uh, talking to teachers, talking to parents, bringing these these models to meetings, reviewing them. I know we don't have a lot of spare time, but, you know, reviewing these ICF models. Um, Not thinking about the goals as the end all and be all really focusing on the quality of the therapy and the important and meaningful things that we're doing all of these things are doable. All of these things are action steps that we can bring into our workplaces tomorrow. I'm wondering about any, I know you're full of pro tips and I don't want to, I don't want you to empty your well of pro tips, but how else our roles have changed. How else are. Action steps might change in a realistic, doable way to help shift these paradigms because I have [00:53:00]  to assume that this paradigm shift isn't just about how we think about things internally, but it's also working to shift these paradigms in our workplaces, right? I mean, it's, it's really kind of Embracing a whole new lens everywhere, which is a big task, but it starts somewhere with very realistic doable things. So tell us more.  Nina Reeves:  Okay, Renee Brown, I'll tell you more. Um, say more words. I'm gonna say that. Can I just do the, uh, the ideas around verbal diversity and what it doesn't mean? Because people get very confused. Okay, but this is if it's okay to stutter. This is one of the blogs I'm working on. If it's okay to stutter, then what do I do in therapy? How am I going to tell the parent that it's no longer fluency? How do I explain this? So these are things that we're working through and getting out there to support clinicians. Um, but one of the things that got very confusing right away. Was the idea that oh, then we don't have to [00:54:00]  work if it's if stuttering is verbal diversity. We don't have to work with kids who stutter like yeah, that was cute. That was an adorable idea. Nope, no such luck there person who's really afraid of stuttering therapy and wants to get the kid off your caseload. Um, which of course nobody ever does, but they might think it in their head. Uh, so it does not mean that there's an eligible eligibility change. IDEA reauthorization of 2004 still applies. Does the child have adverse impact in academic, non academic, or extracurricular areas? Which means academic, social, and functional communication. It's all of it. So, If we do a correct assessment of all of the areas of how communication, uh, impact happens for kids who stutter, then they're, they're aligned and they have eligibility. So, they are eligible most, most, most. Kids who [00:55:00]  stutter are eligible for therapy in the public schools. Um, we, we do not shift away and give this to counselors or psychologists. SLPs are still the people to work and help align with neurodiversity affirming principles. This is, you know, if, if a child has An identified anxiety disorder, generalized anxiety, that's for the other person. If the child is anxious because they stutter, that's us, alright? Um, unfortunately, there's not, um, verbal diversity doesn't give you a script of what to say, like it doesn't give you a goal bank of what to write. If you change the mindset, how you say what you say, if you say it, and when you say it becomes very apparent. And I, I start my, [00:56:00]  my presentations now with the idea, give yourself grace, because if you say something or do something that you think, Oh my gosh, what was that? That was from the old thinking. There's the lovely idea of repair. You can repair communication, which I'm going to talk about to give you that pro tip in a second. Okay, so it changes the idea that fluency percentages are gone, but support still happens, and it's documentable support participation goals, um, you know, are they raising their hand? Are they doing what they need to do to access the curriculum? I'm using a lot of IDEA language, by the way. Okay, and that we continually verbal diversity means we as professionals get aligned with the voices of people who stutter and don't just stay out here on our little island of, you know, we know everything about how to help people who stutter. They don't need [00:57:00]  saviors. They need allies. The idea of how can we change the environment as well in the schools, in the home, in society, because that's part of our role in allyship to be a part of that process to raise self advocacy with our kids who stutter and also be advocates. Um, aligning with that. So the idea of how to help other people understand it is not just the ICF model. But that entire refocusing of us, when we refocus our mindset, then we can talk with other people about how that mindset has shifted and how it has been told over decades to be the appropriate mindset and the workable mindset of supporting people who stutter [00:58:00]  instead of trying to fix them. It's It's so obvious when we start to do it, but the people around this child are not in this process with us, right? We're talking about it in professional ways and in, in, you know, this academic way, but we have to be able to say it out loud in functional ways for the parent, the teachers, you know, what do, what do they think fluency will get their child or their, or their student? What are, same thing we started with. In this podcast, what is it about fluency that they think is going to fix whatever they think is broken? What do they think is broken? And what are they worried about? What are they concerned about? Many times it's about their own ability to handle this. They just don't know it. It's all focused on the child. But, um, denial is a crisis of confidence. [00:59:00]  David Luterman, I know you guys are Luterman fans, right? Denial is a crisis of confidence. Denial that the idea that it's okay to stutter is a crisis of confidence of being able to walk with that child over their lifespan and handle the things that are going to come at the teacher and the parents about you aren't doing enough. You aren't enough. You are not fixing this. Did you try this? Did you try that? That that does not just happen to people who stutter. It happens to the people around them, especially the caregivers. So we have to help them with their process as well. But we do it in the same ways that we help our process, help the students process. We can use those same ideas and concepts to help society. Kate Grandbois:  You're a brilliant genius. I've  Nina Reeves:  just [01:00:00]  been doing this a  Kate Grandbois:  really long time. It's, it's just, it's wonderful to hear you, to hear you, I don't know, say all of this in such an organized, passionate way. We do love David Luterman. Um, I love the concept of it being a crisis of confidence. I mean, again, I'm not, I don't work in stuttering clinically, but I'm thinking about this and applying it to my own, to my own caseload. Um, in our last few minutes, do you have any Any last, not last words, that sounds very doom and gloom, but any, any parting thoughts, any, any final words of wisdom for our audience?  Nina Reeves:  You know, the top of mind that always comes when people say, you know, sum this up is the idea to give ourselves grace, but don't give yourself too much grace. Sorry, that just came out. Um, give [01:01:00]  yourself grace that this, if this is new for you, then it's okay to have your own process. Like I said before, we can't flip a switch. Okay. Well, it's okay to stutter. So what the heck am I doing in therapy? We've got to be, you've got to be able to tell yourself, I'm going to take small steps along a hierarchy of difficulty. See how stuttering therapy is life lessons. Like we use hierarchies in all kinds of our therapy. articulation language. We use hierarchies every day. How about we give ourselves a hierarchy of extra learning, finding appropriate places to get this information that is based in evidence, right? And also based in client values, which includes not just the person in front of you, but their entire family and the stuttering [01:02:00]  community. Like there are values out there that we can learn from them. If you've met one person who stutter, you've met one person who stutter. Okay, that's a zeitgeist like in the National Stuttering Association. We talk about that all the time because these are individuals. So just because you did therapy like this with one kid who stutters doesn't mean that's the kind of therapy you'll do with all kids. And that's why we are going to write How to Be a Savvy Consumer of What You See on the Internet. Because, you know, everybody's, you know, looking for that quick fix because we don't have time. So first pro tip, give yourself grace. How to When I said, don't give yourself too much grace. That means you've got to develop a hierarchy of how you're going to go about getting this information and learning to apply it a little at a time. Do no harm because sometimes a little information is deadly. So make sure that you're putting it in context with the entire [01:03:00]  experience and not just one activity on one day. And then just make certain that your work feels, feels like it resonates with you. Because I think we've been for decades, we've been doing work that never resonated with most of us. Yes, there are people that believe behavior is behavior and you just fix the behavior and you'll never, you'll never be worried about it, except that doesn't work because people who stutter have a neurologically based difference in communication. So make certain that it aligns with what you understand and that then can help you align the people around you patiently and persistently. Kate Grandbois:  There's nothing that can be said to follow that up. So I, I [01:04:00]  think the only choice is to just thank you for coming.  Nina Reeves:  Oh, you guys are so fun. Oh, you're so welcome. And, um, you know, Well, I'll try to summarize. I'm not sure what I said anymore. You know, my notes were gone like 40 minutes ago. We took our I'll make show notes and give those citations and make certain that people can get more information that's based. in, um, stutter affirming and evidence based. You're the best. You are the best.  Kate Grandbois:  We will put all of this in the show notes. We've been taking notes the whole time as well. Uh, we will also put a link to everything that stuttering therapy resources has to offer. You guys have lots and lots of free help, so much free helpful content on your website. So we will definitely link that as well. Thank you again so much for being here. You are the [01:05:00]  best. One of our, one of our most Our most prized guests.  Nina Reeves:  So yeah, you know, we were together back in the day, right in those early way that we're developing all of this. It was, it's been fun to watch you guys succeed and you do good work and I'm happy to be a part of it.  Kate Grandbois:  Thank you so much.  Nina Reeves:  All right.  Kate Grandbois:  Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study. Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com thank you so much for joining us and we hope to welcome you back here again [01:06:00]  soon.

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 . [00:00:00]   Intro Kate Grandbois:  Welcome to SLP nerdcast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy  Amy Wonkka:  Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each  Kate Grandbois:  episode of this podcast is a course offered for ashes EU. Our podcast audio courses are here to help you level up your knowledge and earn those professional development hours that you need. This course. Plus the corresponding short post test is equal to one certificate of attendance to earn CEUs today and take the post test. After this session, follow the link provided in the show notes or head to SLP ncast.com . Amy Wonkka:  Before we get started one quick, disclaimer, our courses are not meant to replace clinical. We do not endorse products, procedures, or other services mentioned by our guests, unless otherwise  Kate Grandbois:  specified. We hope you enjoy  Announcer:  the course. Are you an SLP related [00:01:00]  professional? The SLP nerd cast unlimited subscription gives members access to over 100 courses, offered for ashes, EU, and certificates of attendance. With SLP nerd cast membership, you can earn unlimited EU all year at any time. SLP nerd cast courses are unique evidence based with a focus on information that is useful. When you join SLP nerd cast as a member, you'll have access to the best online platform for continuing education and speech and language pathology. Join as a member today and save 10% using code nerd caster 10. A link for membership is in the show notes Episode Kate Grandbois:  Hello, everyone. Welcome to SLP Nerdcast. We are here with two guests today who are in a different time zone, which is always really exciting for us. Welcome, Jacqueline Morton and Ronan Miller. Hello. [00:02:00]  Hello. Thank you for having us. Thank you for being here. You're here today to discuss empowering caregivers in everyday lives of children who stutter. Amy Wonkka:  But before we get started, can you please tell us and our listeners just a little bit about yourselves? Shall I start? Go for it. Um, okay. I'm Jacqueline and I am a speech and language therapist and a mum of two boys. Um, I worked in the NHS. in the northeast of England for a long time. Um, and then when I had my second child, I came out of the NHS and got quite interested in conscious parenting, mindful parenting, respectful parenting, that kind of world, thinking, my goodness, I don't know how to parent. Jaclyn Morton:  What am I going to do here? Um, and so, yeah, so I got into that world a little bit. And [00:03:00]  the reason why that's kind of important, I think, is I really, really care about parents. I really think that we've got a difficult job and being conscious about parenting, I think can be really helpful to ourselves and to our little people. So then I came back into the speech and language therapy world. Um, and I work independently now with families and children who stutter. And I also do workshops for parents around the idea of minding less. So, um, that's, that's kind of me in a nutshell, really. And Ronan, before you tell us about you, for all of our American counterparts and listeners, what is the NHS? Oh yes, the National Health Service. So, um, where people don't have to pay and they come and see us. What is really tricky, that sounds wonderful, doesn't it? But what's very, very tricky about the NHS is we have [00:04:00]  mega long waiting lists. Um, so that kind of timely approach that, you know, All of us therapists would love to give is sometimes not available as, as well as many other positives. But yeah, that's definitely a factor. Interesting. Well, we could have a whole episode on the cultural intersections of, of medicine and therapy, but that's not what we're here to talk about. Um, Ronan, why don't you tell us a little bit about yourself? Yes. So I'm Ronan. I'm a person in stammers and I guess a researcher in some regard. Ronan Miller:  I completed my PhD looking at the experiences of people who stammer, uh, in foreign language learning. Um, and that was in some ways based around my own kind of interest in languages and, uh, experiences teaching English, uh, learning Spanish. [00:05:00]  and finding myself in the stammering community and trying to link all of that up in a, in a way that could potentially be helpful for people. Um, and I'm also a volunteer with Stammer Children, which is another UK organization. And yeah, I've been working with for a bit over a year on some ways. That we can potentially bring help to more parents, more carers of children who stammer. Um, we're aware that that's a challenge that is out there, a challenge not just for speech therapists, but also for the families as well. So we've been trying to do something there. Well, we're very excited for this conversation. Um, just second, before we get into the content, I do have to read our learning objectives and disclosures. I also just want to second, um, what Jacqueline said [00:06:00]  about the, how hard it is to be a parent and how, you know, it, it took me personally becoming a parent to realize all of the horrible things I had said to parents as a therapist, because living it is a really, it's a really unique experience. Kate Grandbois:  So I'm very excited. to center the experiences of parents and have, you know, hold space for that, um, in this conversation. But before we get there, I will read our learning objectives and disclosures. Learning objective number one, describe the importance of caregiver involvement in the therapy process for children who stutter and how this can impact the effectiveness of therapy. Learning objective number two. Describe how technological advancements can facilitate support for families within speech language pathology. And learning objective number three. Describe the collaboration between healthcare professionals and technology developers in creating applications like Penguin Stammering Support.  Disclosures course disclosure. This course focuses on an app called PEnguin Stammering Support. As this app is unique, the course, focuses on [00:07:00]  and only covers information that pertains to this technology. Kate Grandbois:  Jacqueline's Financial Disclosures. Jacqueline is an employee of Benet Talk, the company that builds the penguin and Super Penguin apps. Jacqueline owns an independent practice working with children who stutter and their families. Jacqueline's non financial disclosures. Jacqueline volunteers for the British Stammering Association, also referred to as STAMA, a charity organization. She also runs workshops for parents and SLPs called Minding Less About Stammering. Ronan's financial disclosures, Ronan is an employee of Benitoch, Ronan's non financial disclosures, Ronan volunteers for the British Stammering Association, also referred to as STAMA, a charity organization. Ronan also volunteers for a non profit called Action for Stammering Children. Kate, that's me, my financial disclosures. I am the owner and founder of Grand Blanc Therapy and Consulting and co founder of SLP Nerdcast. My non financial disclosures, 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 [00:08:00]  Behavior Analysis and Therapy.  Amy Wonkka:  Amy's financial disclosures. That's me. I am an employee of a public school system and co founder of SLP Nerdcast. And my non financial disclosures are that I'm a member of the American Speech Language Hearing Association Special Interest Group 12, which is AAC. Um, and I participate in the AAC Advisory Group for Massachusetts Advocates for Children. All right, we've made it through the disclosures and the learning objectives. Now onto the good stuff. Jacqueline and Ronan, why don't you So I'm going to start us off just by telling us a little bit about the first learning objective. Why is it important to have caregivers be involved in therapy for children who stutter?  Jaclyn Morton:  Okay, I'll, I'll open this one, Ronan, if that's all right.  Ronan Miller:  Go ahead.  Jaclyn Morton:  Um, oh my goodness. So if we think about stammering. You know, against, say, I don't know, speech sound disorders [00:09:00]  or whatever. We can sort of get little people in, work on their speech, and then they can go. With stammering, we don't know whether that child is going to stop stammering, or if they're going to go on to stammer into adulthood. Lots of children stop, but then we've got a percentage of children who will go and stammer into adulthood. It's very much part of that human, you know, it's a neurological thing, that's the way the brain is wired. Some people are born with stammery brains. And this sense of us as therapists being kind of in charge of therapy, in my mind, just sits really uncomfortably. It's actually not about us. It's about us. If we can take the time with parents. And when I say take the time, sometimes that can be really [00:10:00]  difficult in itself because we have children coming in to the clinic. Sometimes we might have, again, I'm talking about sort of an NHS framework, but sometimes we might just have six sessions. We've got parents coming in with, Potentially expectations of how can you fix my child? And that is because, you know, we look on the internet. We're kind of in this sort of scrambling as a parent of, Oh my goodness, my child just started stammering. What on earth do I do? We come across things like, okay, this is how we overcome stammering. This is how we stop stammering. This is how we cure stammering. It's all there. And it's all very, very attractive to parents. So parents can come in with that, those sort of expectations very, very naturally. And as parents, we don't want to see our little people struggle. If then we kind of turn it on its head and think, okay, parents are actually the most important person for us to be taking the time with at this point. [00:11:00]   Often the little person doesn't have a problem with stammering. That's a generalization. But so often it's the parents who have all of that anxiety. That anxiety, that Those kind of thought processes of how can I make this stop? How can I fix this? They can immediately feed in to the little person inadvertently, you know, we do it with love We say things like slow down or take your time or because we think I can't I don't want to see this struggle so That, the parent is actually the first step on the chain and it is, is the parent who's going to be the supporter of that little person all through their life if they continue to stammer, you know, that advocacy and I'm going to say the word acceptance loosely because We don't necessarily need parents to be, like, flying the Stammering Pride flag. They don't need to [00:12:00]  love it. However, that sense of, okay, this is my stuff as a parent that's going on. I don't like this, or I'm struggling with this. And then separating that from, but actually I think this is the best way for my child to be a confident communicator. So work around that, I think, is, is one of our most important roles. Kate Grandbois:  You just said so many things that made me want to high five you through our zoom screen here  Ronan Miller:  completely  Kate Grandbois:  I that was just so well said and I I wanted to scream, you know here here again multiple times I I think One of the things that struck me most about what you just said was this idea of separating a parent's need, a parent's anxiety, because it's true, I mean, you know, you worry about your kids at night when they're, you know, sick, or when, you know, we, it's our main jobs is to keep children, I always say to my kids, my number one job is [00:13:00]  to keep you safe, and my second job is to keep you happy, right? But when there's something wrong with our kids, It can be a major source of anxiety, and I love the idea of coaching families to identify their anxiety versus their child's experience, right? Because those are two different things, but when your kid is really little, there can be such a blend there. Oh,  Jaclyn Morton:  absolutely. Can I share with you one of my favorite quotes? Always. This is, um, by Alfie Cohn, who wrote the book Unconditional Parenting. I will just double check that, but this is the quote. So, it, he says in his book, Is it possible that what I just did or said to my child had more to do with my needs, my fears, my upbringing, than what's really in their best interest? And that sticks on [00:14:00]  my fridge, like obviously you can't see it, but I have that on my fridge as just a daily reminder because this stuff is difficult and it's not about perfection. It is not, but it's about being conscious and just checking in every day and stuff like that really helps me. Kate Grandbois:  This podcast is not about me, but I feel seen. That's all I want. That's all I want to say. I really, I love this. I love it. And another word that you use in your. Um, in your, the talking points that you sent over was the word stigmatize. And I, I feel like that, that concept, that ableist kind of, you know, cultural concept that we have, it's, is a part of that. Can you talk about that a little bit? Ronan Miller:  Is this for me to pick upon, Jacqueline, you think?  Jaclyn Morton:  This is yours.  Ronan Miller:  Well, it's a big, big topic, and I think there's probably people more qualified to talk on it than me, but [00:15:00]  I think in relation to our objective to try and support parents, um, as Jacqueline said, advocacy is kind of a part of that. So if you're accompanying your child through different stages in their life, you know, moving into school, for example, and then various stages of school, I think being able to understand stammering as what it is rather than maybe how it has been perceived and stigmatized, um, I'm not sure if I've expressed that in the right way, but how it has been perceived and the ways in which it has been stigmatized, um, is helpful for parents to then be able to advocate for their child as they move through these different social spaces. [00:16:00]  Um, and then you can tell me Jacqueline, but I think one of the hopes in therapy is that by equipping parents with that kind of insight and knowledge and understanding and, and powering them in that way, we also setting the stage for the child to kind of take on some of that and be able to build from that place as well. Um, because we're aware, you know, research shows that having a stammer can, uh, impact your life in a variety of ways, whether that's as you move through education or professional opportunities or in social situations. So, I think for parents to be kind of on, on the train, on the boat, not sure the right analogy, in [00:17:00]  the gang, um, and then use some of that knowledge and that insight, uh, in how they bring up their child who stammers could potentially improve the, the situation for that child as they grow up. And not just for them but obviously we're, we're thinking about. broader changes that we can perhaps try and facilitate as well. I hope that makes sense.  Jaclyn Morton:  It really does, and I think what's interesting is, you know, there's a huge movement within the Stammering, Stuttering community around acceptance. When a parent comes into a clinic, they don't want to hear that. They don't want to hear you've just got to accept it. Because this will impact on their child's life. It's not all kind of unicorns and roses. There will be bumps across the road. And I think this is why it's important to speak to parents [00:18:00]  about what their role is as well. You know, we've got a separate role. And as parents, they don't need to fix this, their job in a way is to be able to, as Ronan said, kind of advocate or be the ally or be able to validate those feelings like, yeah, this is just really hard at the minute, but also not for us to necessarily come in with our parenting cape, which again is, mine's always on, and I actually have to take it off sometimes. Well, now my 11 year old tells me, take it off, mom. I don't need it, but, um, you know, it's that this, this is going to be a struggle, but I trust you. And so this is what the kind of app sort of does, tries to set up as well. It's like, we trust you parents for you to trust your child. We can model slowing down [00:19:00]  and making space for stammering for you to model that to your child. And so again, in that chain, that first person is the parent, because then if we miss out the parent and go straight to the child, who's got their back in everyday life, you know, who, who's there. And. Being able to really, really be clear about that role of. You might not like this. It's going to be hard to see a child struggle. I'll just give a quick example. Um, a parent of mine had said, because I talk about being okay with being uncomfortable. It's all right for us to be uncomfortable in this space as a parent of a person who, who stammers. It's okay, actually, just to be comfortable. Therapists to be really uncomfortable in that situation as well, like, that's a whole other thing, but I really like that sense of being uncomfortable. I don't like it at all, but being able to stay in it I think is really important. So this mum, do you have ice cream vans in America? [00:20:00]  We do. Like, yeah. They  Kate Grandbois:  even play a song. Yeah. Well, I won't sing it for you, but there's, there's, there are singing ice cream trucks here.  Jaclyn Morton:  Yeah. Brilliant. So that, that, so the mum was in this massive, massive, massive queue with the child. He had quite a significant stammer, quite a lot of tension going on. There was lots of kind of blocking. This child isn't really that bothered about his stammer. The mum is really, really bothered about the stammer. So we've done quite a bit of work with, with mum. She knew that people were, it was a really hot day and people were getting a bit edgy and everyone was just wanting the ice cream and they were tired. And she's thinking, oh my goodness, he's going to go up there, he's not going to be able to get his words out and people will be even more irate. So all of this kind of reel of information and thoughts were going through her head and she just had, she was incredible and she stuck with it. With that child, the child [00:21:00]  went and asked for a strawberry ice cream, stammered all the way through it. The ice cream man just made space and, um, he got his ice cream, his strawberry ice cream. Not even a flicker. She, the mum was in a mess inside, inside. She'd kept it in, but she was thinking, if I'd gone in and said, I'll just say it for you. This, like, I'm really uncomfortable about all of this queue of people here. I'll just say it for you. We talked about if that had been the situation, which would have been fine. We looked at that other side of the coin of That message would have been, I kind of don't trust you to do this, or you're gonna stammer and it's not okay to stammer in front of lots of people. And so, she had that distinction, which, you know, I think is just a great gift, really. If we can be able to give that, and they can give that to the little people, then I think that's wonderful. [00:22:00]  Have I gone off on?  Kate Grandbois:  That was a wonderful story, and I think a wonderful illustration of an adult being with themselves and making space for their own anxieties and sitting with discomfort, which is, you know, something that culture, at least here in the States, is not easy to do. It's not something that we're taught to do. Um, you know, we've shoved down the feelings and don't ever speak of it again. So having that story really just illustrated the importance of slowing down and self awareness and accepting our own discomfort.  Ronan Miller:  I wanted to check and I wanted to, um, Just come back to something that you mentioned. And I understand that for some parents coming into therapy, um, the ideas around acceptance and things like that are a challenge. Um, and I myself, [00:23:00]  as opposed to stammerers, have found that journey from kind of wanting to stammering and hide as much as possible to slowly kind of becoming more and more, um, accepting of it and meeting all the people who stammer and all of the amazing things that community can bring and being exposed to new ways of thinking about stammering, which I think is the important thing that even if the parents aren't receptive to it in that moment or open or that's not the way they want to go with things. Just being aware that there are other options about how we think about it, you know, because I think, at least for me, and I think people, um, of my age, we were really brought up with only one way of thinking of it, which was, this isn't good, let's try and get rid of it, you know, um, and [00:24:00]  you, I know I did, I needed other. reference points to be, I wasn't able to create a new, uh, theory about stammering from my own experiences, you know, so I needed those external, um, people to kind of bring that in to view for me, and I think it's the same for parents as well, that, you know, we can encourage them to move away from the idea of trying to fix things, but we can also show them that there's, a world in which stammering isn't a problem. It's not something bad. Maybe there's even benefits to it. I know that people I know in the stammering community, myself included, would be able to, uh, identify some. So I think that's an important aspect of it as  Jaclyn Morton:  well. And I think as well, you know, we have lots of parents, I'm saying parents, but you know, I haven't said this, caregivers, anyone [00:25:00]  important in the little person's life, um, who are actually pretty chilled with the stammer. Like I think, I do think society is, you know, there was actually a poll by Stammer from the British Stammering Association and I won't give the number but there was something, some really quite large percentage of children who were actually kind of quite accepting of their stammering from quite a young age. So I do think there is a really positive societal shift and I get a lot of parents who come in and. It is just to get, like, well, I'm, if this is it, I'm fine with it. If it means they're going to stammer, I'm fine with it, but I just need to know that I'm doing my best. And that again is, is a similar concern. So it may not be, Oh, I just want rid of it. I, you know, it's not all like that, you know, parents need to know really [00:26:00]  quite immediately. This is why we've kind of created this app so parents can get the information right from that moment. And then those parents like, ah, okay, right. All I need to do is just continue to see my whole child, have my focus on that kind of. You know, not just on the stammer, but all of the wonderful other things that they're doing. And so, ah, I can rest easy now. That's just as important as those parents who are like, Get rid of it. I just don't want it. I can't handle it. You know, because I think actually that's less and less from all my times of working. So I do think we've got a really positive societal shift, which makes me very, very happy.  Kate Grandbois:  I want to hear more about the app, but before we get there, I want to circle back to one of the things you mentioned, which I think is a really important point, um, in terms of the role of the parents and caregivers, is that we as therapists are transient, and I think this kind of, you know, [00:27:00]  touches on our role and our healthcare systems, which is, you know, different where you are versus where we are, but an SLP is going to be in the life of a child for one school year before they move on, maybe a few, um, if it's through a private care setting, it sounds like you all have long wait lists and short visit limits, but you know, insurance has visit limits. We're transient. We're not a permanent part fixture of a child's life. by design, right? And I think by not centering, I just, I really love the way you're by refocusing on the parent, you're creating an ally for life, you're creating a support person for life, which is so important.  Jaclyn Morton:  Yeah, because without that, we've got a little person who's growing up that could be feeling potentially lonely. And also if mom or dad is saying, you did really well today, you didn't stammer. Oh, that's [00:28:00]  fantastic. But again, with love, again, with real appreciation of when you do this, you don't stammer. And then all of a sudden that little person who wants to please their mum and dad is thinking, mum doesn't like it actually when I stammer. So I'm going to find ways not to stammer. I know ways where I can be fluent. And I know if I don't say that word, or if I don't put my hand up in that class, then you did it. And so it goes on. So a week. To me, it's kind of, well, it's huge. It's huge. And also to empower parents, because parents will be doing some really good stuff already. But they might be thinking, oh, well, what do I need to do with the stammer? So often, they will be making space, but they don't know if that's actually Because actually making space and doing less Is what we're actually presenting to the parents. And so [00:29:00]  we often need to be doing something, you know, give me something to be, to be doing. Um, but actually if we can say to parents that what you are doing, there is a very active way of supporting your little person to be able to say what they want to say and they're like, oh, well I can do that. So if we can find ways that par things that parents are doing already, of which there will be loads, then again, it's. And it is about relate, this is what we talk about in the app as well, it is about relationship and it is about connection and it is about so much more than. You know, the stammer. The stammer is actually a little bit irrelevant, you know, when I speak to some parents and I'll say, they might come in and say, Oh, well, they stammer so much more when they're tired. Or, you know, they just, if we're not in routine and I, and again, I try and maybe take it a little bit away from that stammer talk. Ah, okay. So Katie loves to have routine and she loves to have structure. So it's about what things does Katie [00:30:00]  feel at her most comfortable with? kind of calm or what, what environment does Katie thrive in? Let's do more of that. And they know, we don't know. We don't know the answer to that. So, yeah, to be able to take us out of it, we can sometimes. Especially with these little ones. I think we have a different role with children who are coming in who are really, really struggling with their stammer. We, you know, we're not talking about that at this point. But I think for these kind of younger ones, we maybe need to kind of get down off our box. And put parents up  Kate Grandbois:  there instead. Pick off the expert hat, right? Because we're, we're there to facilitate and support, not be experts full of ego.  Jaclyn Morton:  Yeah. Which is hard again for us therapists sometimes. You know, it's, we need to just, all of this stuff that we're talking about in terms of giving parents, we need to do for ourselves. We need to check in with [00:31:00]  our thinking. And this is why I do a course for therapists. Also can I just say a massive disclaimer, I'm no expert at this. come from lots and lots and lots of mistakes, lots of reflection, lots of goofiness and just tripping up all over the place, you know, and it's not smooth. This is not an easy path. This is a harder path. Um, but I think if we can take the time as therapists to look at our own thinking, to look at our own role. And as I say, I do that workshop for therapists and, um, which talking to 160 therapists is really, really scary. It's the hardest bit of my year, but it's well received, so yeah, all these wonderful open hearted therapists who are willing to look at themselves. It's brilliant.  Kate Grandbois:  That's awesome. I wonder if you could tell us a little bit about the [00:32:00]  role of technology here. So now that we've kind of established the importance of the caregiver, the importance of our own professional humility, centering the needs of the family and the, and the parents, What what role does technology play? I mean, it's, you know, 2024. I don't, you know, I don't spend five minutes of my day without interacting with some piece of technology. So how is how is our current technological climate kind of impacting this work? Ronan Miller:  Go for it. What I should disclaim. I'm not a speech therapist. I have gone back to school to try and join you all in the on the box, but I'm not there yet. Um, hopefully one day soon.  Announcer:  One  Ronan Miller:  day. Okay. Yeah. On the ground. Um, so I can talk to you about this from my perspective, which is kind of from, uh, I put, I'm a person who stammers, which obviously has [00:33:00]  an influence, but also, um, yeah, from a research perspective, I'm just trying to kind of identify problems, I guess, and think of potential solutions. Um, so what we're doing isn't particularly groundbreaking. Um, you know, technology is used across healthcare in lots of ways which we won't go into, but there's, uh, many examples where apps are used to kind of bridge, bridge the gap a little bit between, um, in person sessions with a professional of some kind, and then the everyday life, which is the much more significant portion of time for most people. And I think in lots of areas, the idea of transfer or [00:34:00]  generalization is a challenge, both from a clinical perspective and for the person who's receiving help. So, Um, examples maybe, for example, in mental health support, there are in our context in the UK apps that are used in the NHS to support people who are receiving mental health support from professionals, but in maybe other moments of the day when they when they need support. something, there is an option there for them. So it's about bridging this gap in our, in our world of stammering and speech therapy, a significant challenge in the UK is providing access to support in a timely fashion. So unfortunately there's not [00:35:00]  enough, uh, speech therapy for speech therapy support for the demand. And that means that people can be waiting. anywhere really from six weeks to six months or more, uh, to receive support. So in that period of time, there's a lot of space there for the kind of things we've discussed, the challenges, the anxiety, um, to arise and for parents to be unsure about how, how to support. So technology offers kind of potential solution there. And as you say, we all, well, the vast majority of people now own a smartphone and use apps for various aspects of their everyday life. So having one there for something like this also kind of makes [00:36:00]  practical sense for lots of people. And there's a shift, it seems, with Some healthcare organizations, I'm not sure if it's this way in the U S towards encouraging kind of self management is, is the term people use. So providing people with, uh, resources that can potentially help them on the day to day and reduce their need to access, um, in person support. Obviously we, we want that support to be there. We're not trying to replace that. Um, But we're also aware that maybe with this extra support, we can kind of make space for other people who might be more in need. Um, so it's about finding the balance there. And yeah, just kind [00:37:00]  of does, I mean, I could talk about this for a long time. I'll try not to, but it's about immediacy of information for people. It's about, um, helping them make small changes potentially. every day that will contribute to something greater, and it's about improving access, ultimately. And for people who stammer and their families, there's not been many options for support. In some places, there are no options for support. So bringing another option to the table was, uh, something important, I think, for, for us in this, in our work. As I say, our work is a reflection of a broader. Uh, series of changes that I think are happening across [00:38:00]  healthcare as well. Jaclyn Morton:  We've had some really good feedback from therapists about how it can reduce their, their time, clinical sessions, but also that perhaps parents are already coming with a slightly different mindset through this, the apps kind of just 10 days at like five minute videos. So they're kind of often a bit more in the zone, which can help therapists, um, like, Oh, okay. Right. So you're thinking about that already, which, which is great. And also, I think it's having kind of parents a bit more kind of, I guess, primed or that's a silly word to use, but, um, but maybe even a bit more relaxed or a bit more confident. Like, that's really great for therapists, so I [00:39:00]  feel like this can really be a support for therapists, as well as a support for parents, um, and already we've, we've kind of introduced some certain topics or certain concepts,  Kate Grandbois:  so I, I love that you mention, um, you use the word primed and I could see how that would be a really good word because I'm, I'm thinking about myself. I'm thinking about my own experiences as a parent and how a lot of this is hard emotional work for me. the family for the mom for the dad for the caregiver. And when you're in therapy, as a parent, you know, you've got the therapist there, you've got the kid there, if you have a toddler, you're trying to maybe make sure the toddler isn't climbing on the couch or breaking a toy, I get out, it's it's a there's a lot going on. And I can imagine that by having access to access to technology with short digestible pieces of information, there's a little bit more room for self reflection, [00:40:00]  for quiet thinking, for kind of digesting that information at a pace that feels more personal, um, as opposed to, you know, I've taken my own children to therapy and I'm just thinking, thinking of like, you know, there's not a lot of self reflection when you're listening and digesting and parenting all at the same time. So this kind of gives that nice separation there.  Jaclyn Morton:  Well, that was something that I was a bit reluctant about, actually. I didn't know if it would work. Like, I'm used to working in a clinic setting, or I'm used to working in people's homes, and I ask a lot of questions and be guided by parents. I use a lot of solution focused therapy. I'm thinking, how on earth can we put this into an app? Do you remember, Ronan, right?  Announcer:  Mm hmm. Early  Jaclyn Morton:  stages, I don't know if we can make this happen. Like, how can we have empathy? How can we make it feel nurturing? How can we be able to have that reflective space within the app. And [00:41:00]  you're right, Kate, I feel like I've been very surprised by this, that It actually has allowed more space for that. You know, we're not saying anything so different from what you might see on a sheet, like a handout type thing. Oh, we are, we are actually going a bit deeper actually than what you get off a handout. Um, but I think by, one thing that was really, really important when we were writing this is, Can we make sure, because one size does not fit all, you know, how can we write an app, a generalized app, but really still get deep into that kind of nitty gritty stuff that I think is so important. Um, and I do think we've got it rolling actually. I do feel like we, we, we got that. That was the, one of our most important objectives to be able to have that. [00:42:00]  And in a clinic setting. Unless you've got a whole hour with just the parent, which I do love to do, but I think it can be luxury. I think there is something about the reflective questions and also saying it says things like these are some things that you could try what's best for your family. Like, again, it's that you're in charge here. We'll just suggest a few things. We'll facilitate. I didn't know if that was appable, if that's a word. Um, But I realise now that I think it is. And also, again, it's, it's, it's not about us. It's not us saying, right, again, I'm thinking UK. Your name's now at the top of the waiting list. You come into the clinic. Like, that's us, isn't it? That's us in our terms. Like, oh, we're ready to see you now. Whereas an app goes straight into that parent's, I need some help right now. So they're in charge then of, of, you know, their [00:43:00]  therapy or their situation. And I think technology can do that really, really wonderfully. Ronan Miller:  I agree. And I think just to add on to a couple of things there, one is the, I mean, I can look at this slightly from the outside, but I see Jacqueline's work and the impact that that has. And I think how amazing it is that parents anywhere really around the world could have Jacqueline in their pocket. giving them a bit of a talk and helping them through the day. She will cringe at me for saying that, but I know that's true.  Kate Grandbois:  For those of you who can't see, she is cringing. She's cringing right now.  Ronan Miller:  I know that that's a hugely valuable thing when you don't have. access to any immediate support, to have, you know, someone like Jacqueline who [00:44:00]  thinks about this stuff so, um, in such a way that it's, yeah, I think that's incredible that we can facilitate that to people. And then I like that Jacqueline's brought some examples in from her work. So just an example of a couple of things that we've, we've, we've learned from people who have used the app. One is that we've not designed the app at all for children. It's not, designed at all for children to use, only, uh, the adults who are supporting them. However, had a couple of stories where the app has, we've talked about bridging gaps, the app has bridged gaps between a child who stammers and the parent, um, who weren't able to talk about it. They had become kind of a, uh, abu, um, subject, which, [00:45:00]  can happen with Hammering, you know people who stand there sometimes don't want to talk about it People around them aren't quite sure how to get those conversations happening but we had a great, um piece of feedback a great story of a parent using it with their child and they would Go through The content and then talk about that stuff So that was kind of opening those conversations up and equally um, we've heard about parents kind of Using it as a team, I guess, in a way. So we're really kind of, uh, seeing how people adapt it and use it in ways that make sense for them, you know, and I think that's a really interesting, um, aspect of, of this way of providing help as well. Amy Wonkka:  So when you think about the collaboration between, you know, the healthcare side of things and the technology side of [00:46:00]  things, and kind of how that relationship has worked for you guys as being part of this app development, um, and then using it, Jacqueline, in your practice moving forward, what are some, what are some real press points for you? Pluses or maybe some barriers that you had through that process. I know one of the things you mentioned, Jacqueline was concerned about not being able to have that reflective relationship with your clients. Um, are there any other pieces just having gone through? Because I, I, I wouldn't have the first idea to sign an app as an SLP. So sort of what has that process been like? Yeah. Um, I'm going  Jaclyn Morton:  to say, thank goodness for Ronan. Who, yeah, who is, who is, was able to kind of allow my fluffy, verbose, kind of passionate, all of that stuff. And then we've got a wonderful, wonderful [00:47:00]  software team, wonderful software team. Ronan could just take all of that kind of stuff. Fluffy stuff. Um, and not, not let the passion go from it. And then the, the software team very, very wonderfully put it in. And, um, I think there is a sort of sense of, you know, we, I think there is a little bit of a, um, what's the word kind of, I think speech therapists can be a bit scared of. of technology, actually. Um, I know I was before I came into this. However, I did see it as a wonderful platform to be able to get information so quickly to parents. And that was the thing for me. But I think we can be a bit [00:48:00]  reserved around it and what's going to happen, you know, in the future and what's going to happen to us and what's going to happen to that relationship. And, but I think, as Ronan said, Another option is just wonderful that fits in with parents lives and being able to go on and have workshops and do it on an evening so you don't have, you know, toddlers climbing all over and have all of that come into your own space. I think I'm going to say especially for stammering, but I bet other therapists will be maybe thinking that this could work in their areas too, but for stammering, that sense of us coming to the families rather than the families coming to us, and I think technology is just a wonderful way of doing that. But I do think we still need to keep the heart in, in, in technology. Um, and that was one of my reservations really. [00:49:00]  Um, is there anything else Ronan that. In terms of that.  Ronan Miller:  Yeah, I think the challenge is as you say kind of maintaining that fuzziness and the human aspect of it that is  Jaclyn Morton:  Because if you just said that word that would have been that wouldn't have been okay, but  Ronan Miller:  So, yeah  Kate Grandbois:  It's good. Yeah, you know good it was perfect  Ronan Miller:  maintaining that is the challenge I think and Trying to kind of as you say, maintain empathy and the kind of, I guess, vibe that you might try and create in a therapy room or space. The challenge is trying to create something that approximates that. Because so  Jaclyn Morton:  much in therapy, I think, is about the relationship. Ronan Miller:  Yeah.  Jaclyn Morton:  And we're not trying to replicate that at all. And there are other, as we know, [00:50:00]  other bits of technology that. Don't think about that. And we're certainly not trying to be, although Ronan, you did say therapist in the pocket, but you know, it is just about being able to, to be an adjunct to that, to that therapy and fill those gaps. Um, but also if it means that parents can kind of go into this app and get that reassurance and don't need therapy, you know, winner, winner, chicken dinner. Like I love that expression. That  Kate Grandbois:  was so great.  Jaclyn Morton:  It's great. It's great. Everyone wins, you know, it's great for the service. It means someone who perhaps does need that support can be, it can take that time. So yeah, that's great too.  Ronan Miller:  No, I think thinking about our collaboration and our work, um, I think trust is [00:51:00]  important when you've got these kind of two, you know, potentially, not conflicting, but, you know, not quite sure how these things fit together. And I'd like to give a shout out to Kirsten Howes, who was a big part of this project in linking Jacqueline and I up. She kind of, identified things in both of us that she thought could work together and, um, did that. Hurston is a great, uh, speech therapist, also a person who stammers and is also deputy CEO of Stammer, which is the leading charity in the UK for stammering. Um, so I think that facilitated kind of the the, the trust that we, we built on, um, and [00:52:00]  as Jacqueline said, she wasn't quite sure. Um, I found it a challenge transferring all of those ideas into, as Jacqueline says, like an amplified way. I'm not a technology person, so I'm not, I wasn't responsible for any of the software analysis. Jacqueline said we have a great team around us who have, who have played a vital part in this, but I try to kind of translate the work that Jacqueline did and present it in a way that would in, in the most simple terms, fit on a screen, you know? Um, we're kind of restricted by the, uh, the technology as well as It provides us with opportunities, but it's also restrictive in a way. We have to kind of work within those, uh, spaces. And I [00:53:00]  think we can get a bit carried away with technology and think that's going to fix everything or sort of everything. Some people don't want to receive help in that way and that's completely fine. Some people don't have a phone, you know, Like, we also have to think about the fact that this isn't just, uh, the only way we should be trying to help people. Um, but if there's an opportunity there to provide another option for people, then I think it is, is kind of worth exploring. And I think something that is important as well is the way that you guys as therapists can kind of personalize the experience on the fly, in a way, um, in front of, of a person and adapt with your, um, [00:54:00]  insight and experience and knowledge. And that's very hard to replicate. Um, we, we're working on ways to do that now with kind of the next version. of the Penguin app, which reports to the Penguin now. Um, but yeah, that is a challenge that I think is key and we need to be aware that it's not a one size fits all. Some people benefit from different information at different points in their experience. So yeah, just kind of keeping all of those things in mind as well, I think is uh, an important part of the process. It's a challenge, but the challenges are what makes it rewarding in a way, I think. So that's kind of how we've, we've approached it to now.  Amy Wonkka:  Earlier in our conversation, we were talking about how important it is for caregivers to have the knowledge and with that [00:55:00]  knowledge, it's going to help them in building more positive relationships. I was wondering if you could just tell me and our listeners a little bit about what the Penguin app looks like. So what I'm picturing in my mind is sort of some digestible bits of caregiver information to help give people some of those basics that they might get in an initial few therapy sessions. But I wonder if you can just help us like visualize what it looks like a little bit.  Kate Grandbois:  Yeah. Before you tell us that I'm realizing that we have forgotten to mention something that's very important, which is that this is free. Is that correct?  Ronan Miller:  Yes. So people can find  Kate Grandbois:  free resource for people to download. And I am feeling like we should have mentioned that earlier, but you know, we love free stuff. Ronan Miller:  Yeah. So yeah, you can find it on Android, iOS, all of that stuff. Um, I'll tell you, I think, and then Jacqueline can tell you, and let's see if it matches or not. Um, so we designed it as kind of like a 10, it's a [00:56:00]  10 day thing. So we didn't want people to kind of rush through it. We wanted to kind of. model a bit of, you know, let's slow things down a little bit, get reflective. Um, so we encourage people to take it day by day if that works for them, obviously spread it out further if you'd like. Um, and we were very conscious of time. So we know time is limited. Parents, uh, are particularly under time pressures. Um, so we wanted to keep things kind of short and sweet, but without compromising on the information or the messages that we were giving to people. So another aspect of the challenge was to try and condense things and be quite succinct with how we were, uh, presenting it.  Jaclyn Morton:  Neither Ronan or I are [00:57:00]  succinct.  Ronan Miller:  Yeah,  Jaclyn Morton:  that was a challenge. How could as you  Ronan Miller:  may have as you may have learned from it on this recording, um  Jaclyn Morton:  Each other's work more words out more words out more words,  Ronan Miller:  but that's the trust, you know We're just we're there. So yeah providing that to people And we wanted it to be not overwhelming Want it to be supportive, not time consuming, but give enough, you know, so all of this kind of, um, balancing between these things so it's that's basically How people will experience the app if they if if they have a look I think Um, and we try to order is ordered This is, I guess, in a way I'm contradicting myself because we basically created an order of, in which the information comes, which, this is one of the limitations I think, potentially, with the app, but we were imagining, [00:58:00]  um, people who maybe hadn't had much support before, and were kind of more or less starting from a place of, you know, Not much insight. So we were very careful about the order in which we presented information to people and the things we were suggesting to them and asking them to reflect on as well. So there's, there was that aspect of it as well, which I recognize now might not be the best case for everybody. Um, And that's what we're, we're trying to work out how to kind of, uh, improve that moving forward. But yeah, so there was a flow of things which was also important to us in how we, we created the, the content that was there. Jacqueline, do you want to take over and stop me rambling?  Jaclyn Morton:  So we have this wonderful little character called Bene the penguin, and he's the main, or actually I don't know if it's a he,  Ronan Miller:  I don't know either. Jaclyn Morton:  Um, and [00:59:00]  he's very, very cute and just, it turns out everyone loves a penguin. But Ronan came up with the idea because if you, in the slammering world, we think about icebergs and what we see above the waterline, the bit that you can see is kind of what other people see, but then below the waterline, underneath the water, it can be so much more in terms of emotions and frustrations or excitement or all of these different types of emotions. So, and penguins are on. Icebergs. So, Bene is the star of the show, and then we have a little video, and it's, it is a bit cringe because it's mine and Ronan's voice, so I do day one and he does day two. Um, and it's, it, we've got this kind of lift music behind it, haven't we? It's like all very kind of calming, um, but people seem to like that, they kind of like that, but it's a bit cringey to listen back to. I think it's  Ronan Miller:  worth saying as well, we did this almost as an [01:00:00]  experiment, um.  Announcer:  Yeah,  Ronan Miller:  uh, we didn't really think about it too much. So there's definitely things we would change. Maybe the lift music would  Jaclyn Morton:  Well, you made up that music as well Yeah,  Ronan Miller:  yeah, and now I'm  Jaclyn Morton:  Questioning what I was up  Ronan Miller:  to At that time  Announcer:  I just want to  Ronan Miller:  jump in Jacqueline Because I don't think I can take credit for the penguin Um, our amazing illustrator of Ermine, who you can find on Instagram, her handle is at just ter. She's a person who's ERs as well, and. Just creates the most, most amazing, um, artwork around stuttering and the experience of it as well. Uh, and I was fortunate enough to meet her a few years ago and fortunate enough that she was up for being involved in this project as well. So I think the Penguin [01:01:00]  credit should go, go to her. Just wanted to add that.  Jaclyn Morton:  And so we have these five minute little videos that you can listen to or you can just, you can read. then an activity for parents to kind of reflect on and how it might fit into their lives, then we have like a little takeaway page. And because I'm such a big fan of quotes, we have a quote every day. But again, I think it's another way of parents thinking about things. So it's, it's full of these kind of little sort of mindful quotes, which, um, Yeah, I don't know how people have taken to the quotes, but it's part, part of it, isn't it? Um, and so some of the content includes things like how can you help, um, where is your focus? So we talk about focus being on the stammer or focus on the whole child. Um, a little bit about slowing down your life, if that's applicable to you, or slowing down your pace. [01:02:00]  Um, however you might interpret slowing down. Taking time in talking. Um, and we bring in about kind of the whole family situation and It's, it's not about creating this really artificial situation so the child can just take the whole kind of stage, but about how that can fit in with busy family life. A little bit about talking about stammering with your little person, supporting struggle and then next steps. So it is kind of the basics within that. Um, but I do think because it's a human voice, then it does give that bit of extra rather than say like a handout or something. So yeah, so. Uh, go on and have a look and, and see what you think and see if it's helpful to you, to you,  Ronan Miller:  or, sorry, Jacqueline, I didn't mean to interrupt you, that  Jaclyn Morton:  I, I was just waffling at that  Ronan Miller:  point. Okay. Um, and that, you know, I have to think about the research side of things as well. And [01:03:00]  we, within the app, we've included a self-report, just a really short, kind of five items, self report, uh. assessment. I guess you could call it evaluation, which we modeled on various validated measures, but we decided that we wanted to make something that was a bit more user friendly in that sense and not too overwhelming and not too kind of rough because some of the the way, uh, questions are phrased in, you know, the real Uh, style can be a bit intimidating, I think, which is what we were trying to move away from a little bit with the app. So we do ask parents to, um, reflect on a few things at the beginning, at the end and at the end of their journey with the app. And we've been pleasantly surprised by the outcomes of that. And it, it, [01:04:00]  really seems that I think I'm right in saying that, um, 70 percent of the people who've used the app, which is now, uh, in, in their thousands have seen significant kind of changes to, uh, things like concern about stammering or confidence in the support that they're able to provide for their child and things like this. So that's been, um, A rewarding thing to see as well. And another part of the app, sorry Jacqueline, just to say that, we haven't mentioned it, but another part of the app that we were very conscious about was including a stammering voice as well as a speech therapy voice as a way of kind of, yeah, just giving parents. as much of a big, I don't know if this is the right way to imagine it, but like the [01:05:00]  big picture view, you know, um, and it just so happens that it's us because no one else would do it, but, you know, it would have had the same, maybe not the same impact, but, uh, yeah, we're not voiceover artists by any means, but we tried our best to kind of, uh, present that as well to parents as a way of. showing them that stammering is okay, you know. And  Kate Grandbois:  well, I, I am so excited to share this with our audience. I will say that while you were speaking, I downloaded the app and I can attest that the background music that you used is very relaxing. It's very relaxing. There you are. So I want to say quickly that we will link the app in our show notes. It is free. [01:06:00]  This is a really, it seems like a really wonderful resource for a variety of reasons on only centering caregiver, parent, family perspectives and values, which is part of this speech language pathology evidence based practice model. But another reason it dawned on me while you were speaking is that there are very few instances where Um, parent and caregiver training or parent and caregiver counseling is billable. So we have this really difficult intersection with our infrastructure and our industry as well in terms of parents getting direct access to the care that they need. So, um, we will link all of this in the show notes as we, in our last final minutes. Do you have any, any last, any final thoughts that you would like to share with our audience? Jaclyn Morton:  I wish I could come up with something really wise at this point. You've said so many wise things already. I think you're off the hook.  Ronan Miller:  Winner, winner, chicken  Jaclyn Morton:  dinner. I [01:07:00]  do think as therapists, you know, we're talking about being reflective and we're talking about this kind of different way of working. I think if we can just be curious. And then that will show curiosity to our parents, like with us kind of modeling what we would like our parents to deliver to our little people. And I think that's what we do with the app as well. We, we're modeling within that. And actually, I think I was, again, a little bit worried about that. We wouldn't be able to do that, but I think we have. So I think as long as we are clear in our intentions and what we want to be able to deliver and then, and modeling that, I think. is so much, it's a harder path, but so much more in it than just telling. And I think that in parenting too, which is why parenting is really hard. Ronan Miller:  Um, that was quite wise. I think I am [01:08:00]  struggling to find wise words, but I think what I would like to say is to encourage the professionals that are listening, the speech pathologists who work with children who stammer to really look to the stammering community. And there's so many amazing organizations out there. Um, NSA in the US, Friends, Space, um, to name a few. And I strongly believe that for children who stammer, it's, uh, really important to let them know that there's other people like them out there, um, doing all kinds of things. the stammering, the stammering experience, the stammering experience as a child can be quite [01:09:00]  restrictive, um, if you don't have, you know, the right kind of support perhaps. So yeah, I think that's just, I guess, a personal plea to try and kind of bring, bring that into these children's world and yeah, see how they react to that.  Kate Grandbois:  That was lovely. Thank you both so much for taking the time to come on the show and share all of your knowledge and all of these resources. Everything that you've mentioned will be listed in the show notes as a resource. You've also sent over some literature that is, you know, behind a lot of the concepts and things that you've brought to the table today. So thank you again so much for being here. It was so wonderful having you.  Ronan Miller:  Thank you for having us. It's been a pleasure.  Kate Grandbois:  Thank you so much. Thank you so much for [01:10:00]  joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study. Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com thank you so much for joining us and we hope to welcome you back here again soon.

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 . [00:00:00]   Intro Kate Grandbois:  Welcome to SLP nerd cast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy  Amy Wonkka:  Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each  Kate Grandbois:  episode of this podcast is a course offered for ashes EU. Our podcast audio courses are here to help you level up your knowledge and earn those professional development hours that you need. This course. Plus the corresponding short post test is equal to one certificate of attendance to earn CEUs today and take the post test. After this session, follow the link provided in the show notes or head to SLP ncast.com . Amy Wonkka:  Before we get started one quick, disclaimer, our courses are not meant to replace clinical. We do not endorse products, procedures, or other services mentioned by our guests, unless otherwise  Kate Grandbois:  specified. We hope you enjoy  Announcer:  the course. Are you an SLP related [00:01:00]  professional? The SLP nerd cast unlimited subscription gives members access to over 100 courses, offered for ashes, EU, and certificates of attendance. With SLP nerd cast membership, you can earn unlimited EU all year at any time. SLP nerd cast courses are unique evidence based with a focus on information that is useful. When you join SLP nerd cast as a member, you'll have access to the best online platform for continuing education and speech and language pathology. Join as a member today and save 10% using code nerd caster 10. A link for membership is in the show notes Episode Kate Grandbois:  Hello everyone, welcome to SLP Nerdcast We are really excited to welcome Kelly Challen here today. Kelly is a local colleague that we have worked with in the past and we are thrilled to welcome her onto the show. [00:02:00]  Welcome Kelly. Thank you so much for inviting me to be here, Kate. I'm really excited to join you and Amy and your nerdcast today. Amy Wonkka:  We're so pumped to have you. Um, and this topic is a really exciting one for me. Um, you are here to discuss the transition from IEP to adulthood. Uh, before we get started, can you tell us a little bit about yourself? Yes. Um, I sometimes have a hard time. Talking about my succinct, myself succinctly, but I will try. So, uh, in terms of the experience that I'm bringing to the show today, I'm a transition specialist and I work as director of transition services at NESCA, which is a private practice here in New England. Um, I conduct and oversee something called transition assessment. And we're going to talk a lot about that today. Um, I also do consultation about a variety of different Transition related topics. Um, we offer planning and coaching services. We offer a lot of professional [00:03:00]  development cause this is a complicated topic. Um, and, um, my educational background is in psychology and school counseling originally, but I've worked in my current capacity as a private transition specialist for the past 11 years. Um, and I do a lot of in person work, but I also do remote work. So I actually have worked with families internationally, um, especially students from other countries transitioning to the United States for education or for post secondary education. Um, and I've worked with students in other regions of the country, um, but I certainly have the most experience and expertise locally. Kate Grandbois:  Well, I, um, I remember meeting you for the first time, I think it was 10 years ago, which is kind of horrifying. Uh, and the first time I heard you speak, it kind of blew my mind. Um, and I'm so excited to share this, as I was saying before we hit the record button, I feel like this topic of transition, transitional services is, is kind of a nebulous professional area where we all know it exists. We kind of have a [00:04:00]  general concept of, of, of what it is, what its purpose is, but. As you have kind of taught us previously, there is a lot more under the surface and it's really important for us to know because as clinicians and SLPs, we are supporting individuals who may benefit from these services or go through these services. So I'm really excited to share all this before we get into, um, the good stuff of today's episode. I do need to read aloud our learning objectives and disclosures. I will try to get through that as quickly as possible. Learning objective number one, list at least three post secondary goal areas required for IEP transition planning. Learning objective number two, identify two components of IDEA that impact transition planning. Learning objectivE number three, define transition assessment and transition services. And learning objective number four, list at least two components of a comprehensive transition assessment process. Disclosures. Kelly's financial [00:05:00]  disclosures. Kelly is an employee of a private clinic. Kelly's non financial disclosures. Kelly has no non financial relationships to disclose. Kate, that's me. My financial disclosures. I am the owner and founder of Grand Bois Therapy and Consulting LLC and co founder of SLP Nerdcast. My non financial disclosures. I'm a member of ASHA SIG 12 and I 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. Amy Wonkka:  Amy's financial disclosures are that I am an employee of a public school system and co founder of SLP Nerdcast. And my non financial disclosures are that I'm a member of ASHA, Special Interest Group 12, and I participate in the AAC Advisory Group for Massachusetts Advocates for Children. All right. On to the good stuff. Uh, Kelly, why don't you start us off by just telling us a little bit about the first learning objective? What is transition planning? So I think this is actually [00:06:00]  um, Yeah, I mean, it's the most important thing that we're talking about today, right? So transition planning, um, is something that can be done for any human being, right? Transition planning, if we sort of break it down, is thinking about a change in status from whatever's going on now to planning for the future. So for any individual, transition planning might include thinking Long term goals, breaking those down into short term goals, making a plan to be able to progress forward with that. Um, but the type of transition planning that I'm an expert in and that we're here to talk about today is really IEP transition planning. And that has to do with for any student who's on an IEP in the United States, thinking about what are the outcomes that we are all expecting for that student after they finish special education. And we talk about those outcomes sort of in three specific areas. We think about what is the integrated employment experience that student is going to have. After special [00:07:00]  education, and that in itself is really important because we're actually thinking about how is this person going to be included in employment in the real world when they finish education. We also think about what kinds of learning or training experiences. That individual is going to have, so maybe you've got a five year old on an IEP that we need to think about, like, what kinds of learning and training is that kid going to be ready for when they finish public education, and that might be something like college education, but that also might be something like hands on training or technical instruction, and there's different skill sets required for these different things, and then we also think about what is independent living going to look like for this individual, as well. And that is obviously going to be widely different for students who are on IEPs, but we want to be thinking about, you know, quality independent life for an individual. And sometimes within that independent living domain, we think about community engagement. And I shouldn't say sometimes, right? We should [00:08:00]  always be thinking about how is an individual who's on an IEP now going to be included in the greater community in their adult life. Um, so there are sort of these three Buckets of working, learning or training, learning and or training and living for adulthood. And so we look at those areas and then we look at what kinds of skills and strengths and preferences and interests that student has and we start to plan to make sure that we're going to be able to make progress towards those outcomes in adulthood. Um, so that's sort of what is transition planning in a nutshell. Um, but it's not something you just do one time, that's for sure.  Amy Wonkka:  Well, and you mentioned that five year old student who we might be thinking about their employment, and I wanted to ask you because I know at least in Massachusetts, uh, there's a structured transition planning form and transition planning process that takes part as part of the IEP. Um, but it sounds like you're talking about having this transition planning [00:09:00]  mindset much earlier than we start using the form. Can you talk? Absolutely.  Yeah. And so something that I am not sure if you and Kate are aware of is that we're actually getting a totally new IEP in Massachusetts this school year and we are getting rid of that transition planning form. And so transition planning is no longer going to be just a form that we use for students. Sometimes after the IEP was even completed, transition planning is going to be integrated into the IEP process. In Massachusetts, there's going to be a complete transition planning section as part of that process. But there will also be on the new IEP in Massachusetts, questions for kids ages 3 to 14, asking them about their vision for the next few years and some of the things that they're interested in. And so we won't get into formal transition planning for students who are under the age of 13 in Massachusetts, but we will get into this idea of what are [00:10:00]  you interested in? What are your goals? What are your concerns for your IEP process? And that's going to look different for every student. I don't expect that every kid three and up is going to be sitting in team meetings this next school year, but I'm hoping that what we are going to do is be shifting our mindset to number one, If you've got a child on an IEP, the IEP is about the child. And so if we're thinking about goals and objectives and what a kid's going to learn, we need to be thinking about what the kid cares about, right? What's motivating this student? What are they interested in? What do they like about school? What do they hate about school? You know, how do we make this a more kid centered process? How do we help empower kids to have a voice in this process? Which might mean finding other ways to get that voice into the team meeting when they're little. Um, but a five year old can make a PowerPoint, you know, with support, like a Google dot, right, can come up with pictures that were important to them from the year, things like that. Um, and then we also need to be thinking about Like, if we're putting things [00:11:00]  into an IEP for a student this school year, no matter what the school year is, first grade, second grade, third grade, are we helping this student in a functional way so that this student is going to be a more successful adult in the long term? And so where I think of this the most for younger students is certainly goals and objectives, right? Um, communication, um, SLPs who are listening to this, right? Speech language pathologists, you guys have such an important role in transition planning for students. Because one of the ways that students can be safest and most empowered in their adult life is if they have intelligible ways of communicating with other people. Right? So I think about that really early on. Right? For students who are non speaking or have fewer, you know, like, are we getting AAC in their classroom? Really early so that we can empower students to have their own voice like that is so critical as part of transition planning. Um, and then some of this like self advocacy and the social communication pieces, like all of [00:12:00]  that has such a huge impact on being a successful adult. Um, so those are some of the things I think about for students early on. And then just to caveat, cause I assume there will be a speech language pathologist listening to this throughout the like these IEP documents are different in each state. So if we look across states, there are going to be a number of states that have a transition planning section of the IEP. There will be other states that still have that separate transition planning document. Then there are going to be some states that just have it like embedded within and you can't really tell it's happening. Then there's some states that don't totally include it yet or we don't kind of know how that's included based on what's available. But the important thing is like the this mindset, right? This thinking about that. The reason we provide special education services for students is so that they can access education and it's so that they can access education and make progress towards meaningful adulthood, right? We are [00:13:00]  always thinking about students who are going to be workers and learners and active parts of their community. After they exit public education, and I do think about, you know, anytime you're talking about accommodations or support services for a student, are we putting an accommodation in because this kid really needs this accommodation. It's an accommodation. They need to learn how to use and it's an accommodation that they might get later in life. Are we putting an accommodation in because we're sort of avoiding teaching a skill that the student really needs and then the same with when we're at IEP goals to an IEP, you know, like, are we working on a math goal this year because this kid's really going to need this particular math skill in their adult life, or should we actually be going the technology route for that and working on other literacy stuff that's going to be more useful for that student. So it's tough because it is about prioritizing. I certainly don't want to cut any. Um, any potential routes out for a student early in life? But a lot of, I think, early [00:14:00]  IEP development is more around, like, what does this student need to be able to be an active driving force in their life, right? And a lot of times that is communication skills, literacy skills, numeracy skills, um, and certainly life skills for some students. Kate Grandbois:  Um, anyone who's listening to this can't see Amy and I aggressively bobbing our heads. Um, and enthusiastically, I want to, like, give you all the air high fives through, through Zoom. Um, What I love so much about this is the, I think as clinicians we've, Very often, and I'm very guilty of this, move along in our goal development process and our IEP development process kind of just following development. Well, this is what should come next, and so this is what we're going to do. And reframing this and constantly pinging back against what is, what is our long term goal? What is going to happen in the future? And making sure that all of those things are aligned is so critically important. And I just want to emphasize that and how much I. [00:15:00]  wholeheartedly and enthusiastically agree with everything that you're saying. But I also, it's at the same time making me think about the very real and difficult conversations that must end up coming out of those thoughts when you are a clinician working with a five year old who's in kindergarten or in first grade and Trying to find a way to bring this up to families or maybe reach out to the transition specialist because it might feel so premature or, you know, really feel like we're not ready to have that conversation yet. What can you tell us about how to navigate that, that difficulty?  So, I'm going to sidestep just a tiny bit and just point out one thing that's really important to know that's in the law about transition services, which is transition services are mandated to start for students at the age of 16 nationally in Massachusetts, we have stronger protections and they start at 14, but there is [00:16:00]  language in. Um, both federal and local laws wherever you are that also says or earlier if appropriate. And so if you are a speech language pathologist working with a student who is younger who is struggling in whatever domain they might be struggling in that they sort of are working with you to support there's always this question of do you think it's going to take a little bit longer for this student to develop. And if so, you know, how can you start that conversation with a parent? And I think a lot of times, at least if, you know, if a parent is accessing speech language services, They know there's something their kid needs that's outside of general, normative, you know, typical, right? Um, and so, I think sometimes that's your lead in, is like, you know how you knew to come to look for speech language services, or you put your kid through this evaluation? It was because X was taking a little bit longer to develop, or they just needed a specialized way of learning. [00:17:00]  Well, when we think about your child in the future, you know, becoming a successful middle schooler, becoming a successful high schooler, and then eventually becoming a successful adult. I'm thinking that it might take some additional specialized support for them to build those skills, right? I think anytime you can help a parent or family or a student buy into the fact that they've already made these decisions for their child and so it's likely that they're going to have to make some other more unique decisions in the future. Um, I think that's a really helpful approach as a clinician, and one of the things I tend to focus on, both on the professional but also on the parenting side, right, is just getting into the mindset of, like, noticing when you are helping, right? Like, noticing, when have I jumped in and provided a support, as opposed to, Giving the student as much time as possible to [00:18:00]  wiggle through or struggle through whatever the task is in the moment, right? Um, and if we can help parents to start thinking that way at early ages, that is an enormous piece of transition planning. An enormous piece of transition planning as professionals who are helpers, or as parents who love to help and support and prevent trauma. Risk and frustration is just finding opportunities to allow students to struggle to intentionally build skills, um, and trying to maximize those. And there are certainly times in the day, whether it's the school day, you know, the clinical session, the home life that we do have to just help because we got to get through something because we got to be somewhere. But then there are other times that we actually don't need to rush through things, right? And what we are struggling with is our own frustration tolerance or our own anxiety because a kiddo is struggling and trying to find those moments to just allow struggle, allow risk, you know, allow. [00:19:00]  That's when kids develop confidence and confidence and, you know, and coping skills, right? So I think some of it is, is reframing mindset to allow for more independence, more success, more skill building as early as possible. And if we can start building that mindset, um, We don't, I mean, that's just a piece of things. And then it's also when you head into team meetings thinking about that too, right? Like, where have we sort of like over set up the day for success for this kiddo? And where are there opportunities for challenge risk, you know, um, just additional skill building. And it can be, I mean, there's just so many skills that are part of this process. So it is a little bit of a mindset shift. And I think you can have that conversation without. Um, jumping into all of the scary things like you're going to need guardianship eventually, but we don't have to talk about that at five. Although it's interesting. [00:20:00]  I was recently actually over, you know, with a friend who had a child who will need guardianship. guardianship eventually, and they were starting to think about what are the most important pieces to plan. And there is something to be said for consulting with like special needs financial planners and special needs attorneys kind of early. And again, I think you can have that conversation of you've accessed some, some extra support for your child now. You may need to access some extra support for your child legally in the long term. Like, here, if you're somebody who's thinking about working with a financial planner, if you're somebody who's thinking about, you know, setting up, um, any sort of, like, guardianship in your absence as a parent, you may want to be seeking out people who have expertise in working with students with special needs, students with disabilities, as you're making those kinds of decisions. Right? I think just recognizing that you're part of the disability community, and that that means that you want to seek out professional supports from other people who [00:21:00]  understand the disability community is so important.  Kate Grandbois:  That's a great segue into my next question. My next question actually Uh, which is just related to infrastructure and supports. Um, so for anyone listening who might have some light bulbs going off and be thinking, Oh, these are conversations I should be thinking about, or I might want to reflect on the goals I've written a little bit differently and look through what I'm doing clinically. Look at what I'm doing clinically through a transition planning lens. I can imagine myself in those shoes wanting to reach out to someone like you or wanting to find a colleague or work with someone who has specific transitional supports in their skill set, but that would also imply that someone with that skill set is in my workplace and then we start talking about, What infrastructure is really required to execute this? Well, I wonder if you can just talk to us about some of those elements or some of those [00:22:00]  resources that an end infrastructure components that an SLP might seek out or look for to make sure that transition transition planning is supported.  It's a little complicated because obviously speech language pathologists might be working in a variety of different settings. And so the infrastructure that's available or the infrastructure to look for might be a little different. Um, I mean, I think. If folks are in more of like a clinic or a hospital based setting, there may be like social workers or there may actually be somebody in that setting who focuses on, um, like medical transition for students and then they might have access to other kinds of community based resources. If folks are in schools, uh, it's pretty widely discrepant who is in the setting who's going to have any sense of. IEP transition planning, transition services, um, [00:23:00]  how do we sort of seamlessly make the transition from special education to adulthood? Um, but certainly I think there are questions you can ask within a school district setting or questions you can ask families to ask to start to figure out, like, Is there anybody here? Is there anybody who's part of this infrastructure? I mean, I think about, um, something we haven't talked about yet, but part of special education, um, transition planning is that students have access to something called transition assessment eventually. And even if we don't dive into what that is, a question you can ask is like, who does transition assessment in our school district, right? Like you now know, because you're listening to this, that this is a requirement. Somewhere throughout, you know, the K to 12 or post 12th grade process to have transition assessment happen. So a good question to start to assess your infrastructure is like who does transition assessment in our school district who's involved in determining what transition services are part of the students IEP. [00:24:00]   Because the truth is, legally, that could be a lot of different people in different school districts. We are seeing, there are national transition specialist endorsements now. There are some states that have transition specialist endorsements now. Massachusetts is one of them that has a local endorsement. However, there are no rules that say that schools must employ transition specialists. And that's okay. Sometimes there are people with different career titles who might have expertise in this. It might be a special ed administrator. It might be be a special ed teacher. It might be an occupational therapist. We're seeing a lot of occupational therapists, um, in the transition specialist role in certain places. So, um, asking those questions of like, who does transition assessment and who's involved in implementation of transition services will give you a sense of like who in our system is doing this. And there are systems where they're going to turn around and say like, no one, we don't do that. We haven't heard of that. And then, um. Like [00:25:00]  outside of like who's doing this internally, it's a lot about like what's going on in the community, you know, every, every state to some degree is going to have some organization that's involved in advocacy for families, especially families on IEPs, there are usually parent information centers or parent information groups. And so you might also look for in the community, you know, where are. The groups that provide parent information around transition planning, like that's actually part of your, you know, your infrastructure or your ability to sort of bring in those groups for training, bring in those groups to to be able to help parents. I also think about things like if we're talking about employment. Um, states will have vocational rehabilitation agencies. I don't know how often as a speech language pathologist you interface with VR, but it's great to know, like, what does VR do? Because for students who are school aged, there's actually a requirement for voc rehab to provide pre employment transition [00:26:00]  services in every single state in this country, typically 14 and up. If the school doesn't know that, they may not refer the student to do that. Or if you at the hospital don't know that you might not know that, but this is something that's often available. So looking up what are the pre employment transition services in my state? How did, how could a kiddo access that? The truth is that vocational rehabilitation services are all about helping with disabilities, helping people with disabilities to access employment in adult life. They're pretty good at employment. That's, you know, that's what they do. So involving that agency at earlier ages can only be helpful for students. Um, and also in, in a lot of, um, States, there's going to be like a department of developmental services or, you know, somebody who is providing developmental services for students with intellectual disabilities, there are often family support services right before students have exited. So helping, uh, to make sure [00:27:00]  that families know. That there's going to be some agency that can provide them with family support. In some states, there are going to be agencies that can provide them with autism support. I mean, transition planning is all about figuring out like who the kid's going to be in adulthood, but also who their support community is going to be in adulthood. We all have support communities. It's not just for kids with disabilities. And so part of what you can do is if we don't have internal infrastructure, Um, and you're ambitious, right? Like, how do I at least start to figure out who the external resources are? Even if it's just, I mean, one list of like, I know who provides parents support. I know who provides employment support. It's going to be book rehab. I know who provides, um, a little bit more of the family support and case management, you know, it's like, and actually something I haven't mentioned, but it's another great resource in all 50 States are independent living centers. There are independent living centers or centers for independent living in every state and [00:28:00]  their entire purpose and existence is to support adults with disabilities to live in their communities and they will often service any individual with disability any age. And they can provide things like peer mentoring and skill development, but also advocacy and support. And so sometimes families just accessing that one resource or students just accessing that one resource, um, can be really helpful. And those can be accessed during school ages. So there there's kind of like a handful of things you can look for in almost any state that aren't, I mean, there's state infrastructure as opposed to within a school or within a clinic infrastructure, but. That's really what transition planning is, you know, it's not just about like what's in the building. It's about how do I connect this individual to life outside the building. Um, so I, I'm hoping that I'm given enough information to give like starting places for thinking about this.  Kate Grandbois:  Oh, totally. And everything you said also made me think about the intersection of all of this infrastructure or lack of infrastructure. [00:29:00]   And the culture of our workplaces, right? So depending on where we work, we may work in a place that really values EBP. We might work in a place that really values, um, parent, parent centered education. We also might work in a place that doesn't value those things. And I think transition planning sounds like it may fall into one of those categories where your workplace setting either values and centers or doesn't value. And, you know, values, obviously the things that, uh, you know, From a professional standpoint, what kind of resources are allocated? How easy is it to access those resources? And all of this is making me think about, you know, the clinician who's working in a place and then maybe thinking, Oh, I have a few barriers to overcome because my workplace doesn't necessarily center those things. But But if you're working in a school, they may be federally required to provide some of these things. So what can you tell us about IDEA? What the federal requirements are? Um, I'm just thinking, you [00:30:00]  know, an SLP out there who is maybe thinking about some of those barriers that might really help us out to know what those federal requirements are so we can very kindly educate our colleagues, um, about what we must be providing to students on IEPs. Thanks. I think,  I mean, I think that's so important. And I, I think what I am, um, somewhat constantly reminded of as a transition specialist, which is obviously a pretty small profession right now in the United States, who's been doing, you know, who's been working as a transition specialist in the same place, you know, like in a pretty prominent, um, city in Massachusetts for 11 years. I think like, oh, I've been doing this for 11 years here. Everybody must know that I exist and that transition services exist. And, you know, and sometimes I, I walk into team meetings in the same school district that I've been going into for 11 years and I see some, some really similar challenges and I do not at all. Place [00:31:00]  blame on anybody within a school district for this not happening seamlessly, right? Because we have limited budgets and we have increasing numbers of students with special education needs, and especially post pandemic. Now we're seeing students who are just more complex, right? So I'm not saying that it's easy to follow this federal mandate at all. Um, but, but it's, it is, it's sad and fascinating to me that like this has been part of the law for 20 years. And yet, there are so many, um, families, students, and professionals who support the IEP process who don't actually realize that this is such a critical piece of this process, right? So, um, you know, as, as spe as speech language pathologists, related providers, anybody listening to this, like, you're certainly, hopefully, familiar with IDEA, right? You know that this is a federal law that guarantees students with disabilities an equal opportunity to free and appropriate public education. Bye. You may or may not be aware that right within the [00:32:00]  purpose of special education, right, within the law when we talk about what's the purpose of special education, it actually specifically mandates that the purpose of special education and related services is to meet the unique needs of students with disabilities and to prepare them for further education, employment, and independent living. So those are those buckets that I mentioned before. So literally the reason we have special education is so that kids are better prepared for further education or training, employment, and independent living. So just knowing that, and that's one of our learning objectives, that's why I'm sort of hammering it home, but just knowing that and being able to talk about that in your school community, you're like, how are we as a district or as a community, um, using our IEPs to prepare students for these things is a key. Question, you know, so that's one component of idea. That's so important. And I think a lot of times, even in districts where we do transition planning. Well, we may not think about that until students are high school, or it may not be considered at all. Or it's like an [00:33:00]  afterthought. So then we tack on, but really thinking about that when you walk into meetings, right? If you're part of a team, like, did we at all think about. Preparing this kid for life after high school. You know, that's important. Um, and then there's sort of this, like, what's the primary mechanism through which we help to prepare students for life after special education? And that's this, this word we've been talking about, or this phrase we've been talking about, which is transition services. Um, and transition services are described and defined right in IDEA as well. So, uh, this is more within the definition of an IEP, like what has to be in an IEP. The law states that no later than age 16, Or earlier when required. And as I said, Massachusetts is one of these states that starts at 14. There is at least one state that starts at 12, although I don't know which one. And it's interesting, right, like the age ranges, some states offer special education all the way up till age 26 so like there's shorter and longer transition planning periods. [00:34:00]  Mandated by law, depending on what state you're in, but no later than age 16, a student's IEP must include appropriate measurable post secondary goals. So we have to list out exactly what those goals are for after special education and the IEP. Those goals have to be based on age appropriate transition assessment. So there has to be assessment that was done to help determine those goals, and that assessment needs to be documented in the IEP, and the assessments need to be related to training, education, employment, and where appropriate, independent living skills, and then it has to list out transition services. Including the course of study that is needed to assist this child in reaching those goals, right? So we actually have to be listing out. Is this student going to get a diploma? You know, are there certain classes this student needs to have? Is this student, um, going to be sitting for standardized testing if that's required in your state or things like that? Like, that all has to be in there. [00:35:00]  Um, And then I want to break down transition services a little bit more, but it's big, and that's why this is hard to do. So, you know, the transition services have to be part of an IEP, right? You gotta be able to see those in the document annually after the kid's 16, um, after the kid's 14 in Massachusetts. Um, but transition services are a coordinated set of activities. So they can't just be ad hoc. Like, there has to be a way that these things are happening in a coordinated manner. Um, they're designed to be within a results oriented process. So again, It's reasonably calculated that these services are going to help the kid make progress towards their goals, and then they need to be focused on improving the academic and the functional achievement of the child with a disability to facilitate the child's movement from school to post school activities that include, again, post secondary education. Vocational education, um, integrated employment, continuing adult education, adult services, [00:36:00]  independent living, or community participation, right? So the services are going to propel movement forward towards those different outcomes. They're based on the child's needs. That's not a surprise because in special education, we're always looking at the child's needs. But the other thing about transition services is they take into account the child's strengths. The child's preferences and the child's interests. So when I think about, um, transition IEPs or IEPs where you can tell that transition services are being delivered appropriately, it should, there should be documentation of like, what is this kid good at? What are they interested in? What do we know about their preferences that's going to impact their future employment or their future, um, learning or things like that, right? Thanks. And then, okay, so we talked a lot about like the qualifiers for the services, but what are the services? Well, they can be instruction, right? They can be general ed instruction, right? It could be taking a computer science class, if you're a kid who wants to be a computer programmer in the long term. So they can be instruction. They can also be specialized [00:37:00]  instruction. And that's what's interesting is a lot of times kids need very specialized instruction. To develop skills that maybe their peers didn't need very specialized instruction to develop, but their skills that we know are going to be important for employment or for accessing college or training or for living more independently. And so we first need to think about is there instruction or specialized instruction that this kid needs. They can be related services. Like speech language services, uh, like occupational therapy services, which we often don't see at the high school level in Massachusetts, but occupational therapy is critical when sensory, you know, when sensory integration is getting in the way, when there's a motor piece to what's going on, right? So there's, they can be speech language, they can be OT, they can be PT, physical therapy. They can be a lot of things we're used to for related services, but they can also be things like job coaching. If a student needs to be practicing vocational skills, either within a school environment or out in the community setting, um, they could be something like a [00:38:00]  transition specialist as a related service provider, if that exists. You know, they could be, uh, they could actually be voc rehab services. Like, it's interesting because those can be accessed, obviously, um, in a free way, but there can also be ways that those are integrated into the IEP process. Um, they can also be things like community experiences. Right. And if we're talking about students who have trouble with skill generalization, then providing IEP services in the same classroom throughout high school and never seeing if they can generalize those skills to another setting is kind of irrational. So these community experiences, like what are the community experiences a student needs to have this year that would help them to be progressing towards post secondary adult life? One of the things I think is so fascinating is we require the You know, kids to have assessments where they can set goals for life after high school, but half the times the kids don't know what the options are for setting those goals. So sometimes there are community experiences that need to happen [00:39:00]  so that students can better be part of this goal setting process. The other things that can be part of transition services is literally like the development of employment and other post school adult living objectives. So let's say I'm starting transition services. I've got a 13 year old 13 year old is going to turn 14 during this period. Therefore, we need to talk about transition. You know, we need to have transition assessment and talk about transition services at the IEP meeting, but that 13 year old. Doesn't know what they want to do for a job after high school. That's okay. Part of their transition services this year can be thinking about developmentally appropriate career education for that student, right? That could be a student, you know, putting together a PowerPoint over the year of like interviewing their parents and interviewing other people to figure out what they do for work and what their career paths were, right? Like you can think about, um, what are, what's appropriate for this kid this year so that they can have better employment objectives. Next year, right? Um, and then if [00:40:00]  appropriate, it says acquisition of daily living skills and functional vocational evaluation. Those are two very different things, but they're put in one bullet point. So daily living skills to me, um, there are lots of places in the federal law that says transition services. Might include daily living skills. I think historically the percentage of students who are on IEPs that needed help with like ADLs or IADLs, um, was a lot smaller. I think when we think about students who have special education needs now, there are many times they're going to need some level of specialized instruction or a service to be able to have age appropriate daily living skills. Um, What's interesting is, and I know we started this talking about speech language pathologists who might not have the infrastructure around transition services in their school system, one of the things to just note if you're sitting in a team meeting is, you know, is this student, um, is any part of this IEP supporting the student's acquisition of [00:41:00]  daily living skills? And if not, how was that determination to do that? Made, right? Like, did somebody just say, I don't think this kid needs ADLs, or was there some sort of informal or formal assessment tool that helped to define that? I think there are times that students can show up at school looking like they don't have daily living skills, uh, challenges, and it might have been like three hours at home with a parent to get the kid looking like that. And if we don't ask the question or use some sort of standardized measure to figure out if these are sort of age normative skills, um, the team doesn't really have a basis for determining that that's not appropriate for ADLs to be part of this IEP, right? So something to just think about is like, did transition assessment happen? And did we ever talk about whether it was important for this kid to develop daily living skills? If we didn't like, you could raise that question, like, um, you know, depending on, uh, sort of, What your team dynamics are. But just to say like, Oh, I know for transition planning, we're [00:42:00]  supposed to determine if it's appropriate to work on daily living skills, like, does anyone have data to be able to figure that out? Right. Um, there are a lot of kids that we know they're gonna need specialized instruction in that area. And so, um, just making sure that, uh, somebody's done an assessment to, to be able to quantify that and figure out who the best person is to work on that. And how are we integrating that into the IEP process is so important. And I, I don't know, um. Sort of like what percentage of speech language pathologists would be working on executive functioning skills in school. But certainly if a kid has executive dysfunction, that is going to impact their ability to carry out daily living skills. And so that's important. Um, and then the last piece of transition services. that I mentioned was that functional vocational evaluation, some students really need to go through more of a hands on evaluation process with a rehab specialist or an occupational therapist or transition specialist to be able to figure out more about what accommodations they might need for work, what technologies need to be in place to support [00:43:00]  them. And like, what kinds of jobs are going to be sort of reasonable or that they need to be trialing over time. So that is also something that can be a transition service, right? We did a career interest at, you know, inventory for this kid, but that's not really the best way to evaluate vocational skills for this student. So functional vocational evaluation is going to happen this school year. And It's going to be, you know, over X amount of time or it's going to be a couple of days or but that can be a transition service for a student. So it's a little odd because you're supposed to do assessment to be able to name the goals to then figure out the services. But sometimes what you figure out is that we actually need more assessment over the course of the next year to be able to do the transition planning better next year. And that's okay. If you have started this process on time or early enough for the student. It's a problem when it's 12th grade, you know. So. Um, that's the piece. So hopefully I just gave again enough information to  Kate Grandbois:  it's no, this is great. And I, I, you know, [00:44:00]  as you were talking, one of the things that stood out to me was if we don't ask the question, then we don't have the reason we don't have the space to. We don't have the information we need to move forward. I think is you said something. I'm paraphrasing and botching all of the brilliance that you just shared. But I think that is such an important point. And it's something that we talk about on this podcast a lot is that Uh, the importance of asking those questions, the importance of measurement, the importance of measurement, and then the relationship between how we measure things and how we move forward. So what kind of goals do we write? What kind of targets are we choosing? Um, I'm thinking about SLPs listening to this and absorbing it, understanding that it's, you know, related to what we're doing every single day, even though it may not be the central focus of what we're doing every single day. I'm thinking about SLPs who might be. starting to have these conversations with administrators or parents, um, and making referrals. So finding those resources, um, or, [00:45:00]  you know, asking for some of these assessments. Are there things that an SLP can look for in a transition assessment that would make it a good transition assessment? Are there things other, before we start talking about goals and the connection between assessment and goal writing and how we move forward, Are there things other than what you've already listed that would be really critically important to look for in a trans in a comprehensive transitional assessment? Yeah, I think what is complicated and actually I haven't defined transition assessment yet. So when I kind of step back. And provide a definition of it, but it's not going to be that helpful, but, but I want to make sure you know, as someone's listening to this and they're thinking about it, you need to know what it is to be able to share. It will be very helpful.  Kate Grandbois:  You're not giving it. So, so  the funny thing about transition assessment is it's absolutely in idea. It says we have to determine post secondary [00:46:00]  goals based on age appropriate transition assessment. Um, I think speech language, you know, assessment is defined in IDEA. Occupational therapy assessment is defined in IDEA. Transition assessment is not defined in the federal law. Uh, but, um, we do have a commonly accepted definition of transition assessment that has sort of been utilized, um, in various ways legally over the years. And that comes from the Division on Career Development and Transition, Which is called DCDT, which is out of the Council for Exceptional Children, um, CEC. So DCDT wrote a position paper that defines transition assessment. And the way that they define it is an ongoing process of collecting data on the individual's needs, preferences, and interests. As they relate to the demands of current and future working, educational, educational, living, and personal and social environments. So, it's a broad, vague definition, but the whole point is, [00:47:00]  the way you know if you've, if you have enough data, if you've seen a comprehensive transition assessment for a student, or if you've seen enough different evaluations that we are sort of coordinating in a comprehensive way for a student, is. Do we have information about what the student's goals are going to be after high school? And do we have information about what the student's needs and strengths and preferences are right now that can help us to define annual goals and objectives for this year and figure out what services are needed and figure out if we need to do more assessments. So it's a little bit of a reverse, you know, reverse thinking in terms of the way you know you had good transition assessment as you have the information you need to develop the IEP. Right. Um, and You know, then it's sort of like, do I also have information about what I suspect would be challenging for this kid when we think about the transition planning process? One of the questions that I like to ask as an evaluator, um, to professionals working [00:48:00]  with the student at school, to the parents, to the student themselves, is like, what are you most worried about when this kid exits public education and enters into adulthood? Right, if I ask everyone who knows this kid what they're most worried about, what could go wrong, what are the obstacles here, I'm gonna know if there's something I need to evaluate or dig into more. And if you're reading, um, if you are lucky enough to actually be looking at a transition assessment report, um, that was either done school based or done by a collaborative or an organization outside of the school, um, Then the question is like if you read that report, do you clearly see what the goals are for the student after special education? I see a lot of really thorough transition assessments that give a lot of information about these domains of transition planning, but never actually get to the point of saying here are the post secondary goals that should be in this kid's IEP and that we should be aiming for. And so if that's not in the report, [00:49:00]  Then, like, what are, how are we coming up with those for the team meeting? How are we then creating an IEP? So that's one thing to look for is, like, Did we, you know, sort of flesh out what the kids goals are, or if if the goals were vague, did we say here's the goals right now and a recommendation for this year is going to be sort of working with the student to participate in some activities that they're learning more about themselves so that these goals can be better defined next year when we meet as a team. Um, and then the other thing is just are there sort of clear recommendations around again in those different buckets of have we thought about employment for this student? Were there assessments and recommendations related to employment for this kid? Career planning, career development, vocational aptitude, vocational interests, you know, like, did we learn something about employment for this student through this evaluation process? And, um, you know, are there recommendations in that area? Certainly, um, Are there like assessments that are helping to formulate what that kid's going to do for learning and training [00:50:00]  after high school and whether they have the skills to be able to progress in that path. And I'm sort of smiling as I say this because I see so many times in Massachusetts in particular we are very college focused. And I think there are other states that are very much like that. And, um, so often it's like the kid's going to go to college, you know, but then when you look at IEP objectives that did not, the kid's not going to college, right? And so there's either a mismatch between we have a post secondary goal here that's unachievable for this student, or we haven't set up annual objectives to be, um, Ambitious enough for the student to actually be able to bridge that transition. And what's wonderful in the United States right now is like, there's a lot of different ways to go to college. There are a lot of different support services available to make that transition. But again, the IEP has to be setting the student up to access those, right? Um, if a student's going to need disability services or need an executive function coach or need, need a support, then they have to know they have a diagnosis and they have [00:51:00]  to have the skills to be able to disclose and use that resource. So. So sometimes it's, it's like self advocacy skills that are needed. Um, and then the other thing with the transition assessment, and this is so important is like, did anybody bother to check if life skills are needed for this student? Right. I think that's the one you're, you're going to look for the most of, like, if we don't have life skills data in this transition assessment, was it evaluated somewhere else in the student's career? And if not, we're really missing out on an important domain for a student. Um, And some of the other things that I look for, or that I strongly recommend looking for when you're thinking about was this comprehensive, are sort of, where did the data come from? You know, did we get data from a variety of sources? Number one, did we get data from the student themselves? Right? Uh, that is important. But if that's all the data we got, that's probably not super valid. Um, there are a couple students that might be valid for, but, but really it's not just, The student, but also did we get information from the parent or guardians [00:52:00]  or did we get information from school providers? If there's a really important related provider out there in the universe of the kids got a therapist, you know, if the kids got like, is there some data coming in from people who know this student really well, so that we are certainly. So we have the most appropriate post secondary goals for the student, and so that we have the most appropriate information in terms of what transition services are needed for this year. So I like to see data from multiple sources. I also like to see, as part of transition assessment, like one, I'm going to say transition planning inventory and it's funny because there is a tool that's called the transition planning inventory. It's the third edition now and it's like a 57 item checklist, but there are a number of other like transition activities transition inventories. There's even like Washington State has this life skills inventory. That's actually like pretty broad. It covers all the transition planning areas. I like to see one. Checklist that's across all the areas. Um, you know, [00:53:00]  almost as that like quick check to make sure that we haven't missed something. And if that's done, then it's like, I don't need like a big Vinelander at a bath if I did a transition planning checklist, and that has a couple of life skills questions on it. Like, you'll be able to flag areas that need to be part of transition planning just by doing that.  Amy Wonkka:  As you're speaking, I'm listening to you talking about it and I'm listening to, you know, sort of the piece about this transition as a process that's happening, if I'm an SLP, who's working with a middle school age student or a high school age student, uh, but I do keep coming back to, it can also sort of be a shift in mindset for those of us who are working with younger age students. You know, I think about in, in my career, I've mostly worked with I previously worked with early intervention up through high school age students, and my focus for my younger students on my caseload has been about access to school and not really broadening that vision to think that far into the full into the future. [00:54:00]   About what some of those skills are and I wonder if you can talk to us Like I think if you're working with the later age students You actually have the benefit of hopefully having somebody who has done the transition assessment So now, you know all of these areas that you should be more thoughtful about I wonder if you can talk to us a little bit about how we might see the transition planning reflected in a course In some IEP goals, both for those older age students, but also, you know, for those of us who are working with younger preschool, elementary school age students, how we might also sort of broaden our mindset, have those bigger conversations with families, you know, thinking back to the comment you made about, is this something that is a skill deficit versus an accommodation? Um, and just how we can be thoughtful across the entire. age spectrum of school aged, um, individuals who are going to receive some sort of IEP transition supports.  Yeah. I think for the younger students in particular, um, [00:55:00]  I mean, access to school is important, right? Like, an integration into the community is important. Like, those are skills that we want for students lifelong. We want them to be able to access learning and be part of their communities lifelong. So, that focus is quite important. I think these self advocacy and the self determination skills are really what I would just encourage Anybody working with a preschool student and elementary school student and middle school student to make sure that that is embedded in this IEP process and that we aren't circumventing those skills for students. And so, you know, when I just gave my sort of lengthy description of transition assessment and transition services, one of the things I talked about is that this process is based on the students needs, but it is also based on their strengths. And their interests and their preferences. And the most ideal way for that to be part of this process is because the student has [00:56:00]  learned what their strengths and their interests and their preferences are and how to communicate those to other people. And so I think, um, you know, like, Those self advocacy kinds of skills, the self awareness, um, the perspective taking in terms of how are my strengths different than somebody else's strengths or how are my needs different, you know, like the ownership of like the some things are hard for me, um, that is all critical and and Honestly, I mean, that's what often prevents teenage students from participating in this process is either, um, I am not willing or able to acknowledge that I have a disability, I am not willing or able to acknowledge that anything is hard for me. So like, if we could work on those skills earlier if we had that mindset of not just does this kid need a math goal or reading a writing goal. Um, a fluency goal, you know, an audiology, sort of like a listening, [00:57:00]  right? Like, like, if we're thinking about, like, does this kid need to be able to talk about themselves? Does this kid need to be able to compare different parts of their own sort of skill set, right? Like those kinds of things early on would empower students to be so much more successful as part of this transition planning process. And I think about, um, and I, I wrote like a blog post or not just like a LinkedIn post about this recently, but just having a conversation at, uh, my son was at the dinner table and like I was standing, my son eats for a very long time, so the dinner table and we were just talking about, um, memory, right? And. He made some comment and I was like, and, uh, he noticed that his dad had gotten a haircut and he made the comment of like, dad, did you cut your hair this morning? And my husband said, actually, I cut my hair last night and my son looks at me. He goes, mom, did you notice that dad got a haircut? I'm like, no, no, I did not notice that dad got a haircut. And I said, but that's one of the things I love about [00:58:00]  you. You have you pay very close attention to your environment. You look really closely at what's going on visually in your environment, and you have an amazing visual memory, so you will notice if something in your environment changed from yesterday to today. My brain's not like that. I'm not paying attention to the world around me. I walk into walls and doors frequently, right? Like literally I'm just, I'm in such a hurry. I don't, I don't, you know, position myself correctly, but I remember everything that is said in my environment, right? Like my, my listening memory is really strong. And then my son said, mine's not, you know, and, and just being able to say like, Hey, my visual memory is really great. My auditory memory. It's pretty terrible. Um, and being okay with that, just that it was a matter of fact discussion, like that's what we want for younger students, is that like, it is okay that different parts of my cognitive profile are different from one another. It is okay that I can learn [00:59:00]  math faster than I can learn reading and writing, right? Like just being able to engage in discussions about that meaningfully Like that is transition planning and that is what enables kids to be part of this process and set goals and then be willing to work hard on certain things and also like students getting acknowledgement for the hard things that they've learned to do and like this was harder for you to learn but like you were you worked really hard and you got that and you can do that because that is going to also be a big part of transition planning is being willing to work hard at the stuff that you're not so good at. Kate Grandbois:  I love this so much because what you've just described is a conversation with another human being, not because they have a disability, but because they are a human, right? That's, that is a, that is a condition of human existence is to have some things that are easier and some things that are more challenging. Not everyone is good at everything. And I love the example you've given of sharing something about yourself, making it very [01:00:00]  normalized, creating a space in your professional and, you know, your professional relationship with your client where they don't feel othered. Well, we're here to work on something because it's really hard for you. You know, that, that is not the environment that is, that is going to be therapeutic or helpful. Um, it was just a really great example. And I, I, I thank you for sharing that. That was awesome.  Yeah, I think that's just, um, I mean, again, it's this shift in mindset. Like, I'm lucky because I do this professionally. So, so in some ways, you know, like, I'm up in the middle of the night thinking about, like, planning for adulthood for my own family or for my students. But it really is. It's just thinking about like, when can we be working on goal setting? When can we be working on self awareness? You know, how do you embed that? And then I also think, and unfortunately I don't think this is something you guys struggle with professionally, but I think really thinking about communication for students early, um, not waiting on AAC, you [01:01:00]  know, it's so frustrating working with these like 17 or 18 year olds who are just not intelligible to anybody, but. their parent. And, um, like that's a wonderful thing. And I'm super happy for that parent that they have a communication method that's working for them. But that means that their kid can't access the world without their parent right next to them. And I do, I have a student who actually is like out shopping. And if the sort of clerk doesn't understand what he's saying, he knows enough to call mom, get mom on the phone. She interprets in the moment. But then if mom is busy, That's no longer a functional way for that student to be able to make a purchase, right? So I think you guys have such, um, an important role in making sure that students can self advocate, making sure that students can be safe because they can communicate with other people. And especially making sure that students are set up with the right. Low tech, high tech, whatever kind of tech support is going to work for them. Um, so that they, again, can be more independent in adulthood. So I think [01:02:00]  there's, there's no, I would never sell a student short on that being really important for them early in life. And I do think, you know, the other thing that, um, To give you more food for thought, which isn't always helpful, but I think is really important, special education is about education. And so I don't, I don't want the transition planning mindset to take over the fact that there are skills that kids need to learn through special education, through education, that there's no other opportunity for them to learn later in life. I have a number of families that get to my office because they're worried about planning for life. After special education, and I start to look through and I'm like, Oh my goodness, we need to be so much more focused on reading, writing and math, because the reality is what we know from research what we know, you know, no looking at like our economy and other things is that your sort of foundational literacy skills and numeracy skills like that is that is your earning power right like that has such an [01:03:00]  impact on being able to obtain Integrated employment, which is what we should be aiming for, for everybody. Um, and being able to make the most money in employment is like reading, writing, math, you know, and if, uh, if that needs to be done through accommodations, you're going to be able to use those accommodations extremely fluidly to be able to do that out in the real world. So I am not a proponent of like, we got to get this fifth grader out, you know, doing volunteer work. I mean, that would be great. Doing that with your family is great, but I'm not a fan. I've taken instructional time just to say we're doing community experiences if they're not age normative community experiences, and that student really needs two hours of reading every day, you know, if you have a kid who is Still motivated to be working on their reading skills, whether it's middle school or high school, and can continue to progress with those and is going to be able to get to a point where those reading skills will be either functional for daily life or [01:04:00]  functional for community college, or, you know, functional for them to read their medical paperwork. The time is better spent on. reading, you know, like that is absolutely what we should be getting out of special education. We have, you know, voc rehab services are great at supporting students with employment. So I don't just want a kid going out doing a volunteer job that isn't actually related to competitive employment, where they're maybe not being held to appropriate competitive work standards in lieu of education. So that we're saying we've got this great Transition services, you know, it's really helping that student to build skills, um, and have the experiences and activities that are going to be most functional for them so that they can be most successful when they transition eventually. And, um, so that's also something you can notice in team meetings. It's like, Whoa, did we go way too far towards functional for this kid? And there's still untapped learning here. Kate Grandbois:  I feel like you've mentioned a few things that are really important to focus on when we [01:05:00]  were thinking about that forward thinking. So you've talked a lot about self advocacy, obviously literacy and math. Are there any other, um, goal areas that a speech language pathologist could really focus on or consider when working with their clients or students in projecting forward, doing that forward thinking and considering transition planning? I mean, depending on what age you're working with the students, executive functioning is one of the areas that certainly has come up and we've talked about. And I think, uh, one of the things that is really hard with executive functioning. Is, you know, it develops through obviously direct instruction, but also opportunities to practice with and without support. And so sometimes it's almost thinking about like, where is this kid practicing some of these skills in more functional way? You know, like, is it executive functioning for recess or exactly? You're like this stuff that [01:06:00]  happens overnight in terms of like, uh, do they need goals around getting themselves ready for school in the morning, right? Like, like where, where can we be a little bit more functional? Functional and are thinking about that skill set. Um, but a lot of what we've already talked about. I mean, this, this self advocacy and self awareness and, and, and knowing what resources are available to me and being willing to ask for help. Like, that is huge. Right? Communication is huge. Um, some of these foundational academic skills are huge, but certainly like. Being able to implement those in real time, being able to generalize, having strategies and supports to keep myself organized, to be able to plan, to be able to set goals, to be able to break goals down into manageable steps. Um, those are a lot of the most important skills that are part of transition planning. Um, and then the other thing, uh, it would really be for people working later in life, but it's just a sort of check mark, and it might be something to talk with clients about if you're working with middle school or high school clients, is just thinking about like, When is this kid going to have their first [01:07:00]  paid community based work experience? And I know I'm like throwing in an extra, but that's one of the most important things is for students to actually have meaningful employment activities at some point before they've exited public education. And so I'm always talking with families about that. If you've got a family that's like over programming their student over the summer, or if a student's got IEP services during the summer, and then that's preventing them from like maybe doing a CIT position or getting a job. Um, and I think it's really important to think about, you know, when you're planning a job at market basket, uh, which is a local grocery store, you know, it, it's thinking about like, have we put enough time into this kid's schedule and enough support so that they can start their, their work experiences early? Because we do know that those paid integrated work experiences. Um, while in high school are enormous predictors of success post high school. So. That's not a goal area. It's not an objective, but it is sort of something you can have in your mind if you just, if you really want to have that transition planning mindset. And if you happen to have an older student. Um, and then, you know, [01:08:00]  the access to community resources, that being part of, um, our thinking, uh, a lot of times it's just, it's, um, who's in your network, right? Like, you know, if you have a family that you notice is a little bit more isolated, um, like, who's in their network? Can we introduce other people into this network? Life is absolutely all about networking. Transition planning is about having that supportive community and getting a job eventually is about, about who you know, like, just like it is for any of us. I think sometimes we think, like, sometimes we think work works differently when you have a disability, but there are so many pieces of this process that are exactly the same. Like, it's who you know, and it's being willing to, like, you know, make a lot of phone calls. It's being able to deal with rejection. You know, it's being able to sell yourself to other people, which is a hard skill that you Students should be practicing with you guys, right? Can I talk about myself comfortably, right? Can I, can I talk, you know, can I talk about something that I, is an area of challenge without giving way too much detail, [01:09:00]  right? So there's a lot to this that's just, um, similar stuff to when any of us, you know, started adulting.  Kate Grandbois:  We both appreciate this so much. And I wonder in our last couple of minutes, if there's anything you haven't shared that you want to share or anything that you'd really like to leave our listeners with. I think, um, what I like to share is like it's never too late or too early to start thinking about transition planning. You haven't missed the boat because you have like a 25 year old speech client who is still living at home, right? Like it's never too late to think about a young person setting goals for themselves, making a little bit of progress, taking a few steps. And it's also not too early to start thinking about how is this student going to be independent and integrated in their adult life. Thanks. And then the other thing I just want to say is I'm sure I've shared a lot of information. Like for me, this is obviously what I do day in, day out. So I just talk about it. Like it's common knowledge, you know, really easy. And I know it's not [01:10:00]  easy. And so like, don't try to process everything from this particular session and memorize it all and do it all. Like pick that up. One thing and do it a little differently in your clinical practice tomorrow, right? Like it's just or in your educational practice tomorrow. It's like, if you're just doing one thing that's going to support transition planning, like that's more than yesterday. And like, that's important. And then you can learn more knowledge over time. I, for families, um, uh, in Massachusetts, like there are certain. workshops or conferences that are all about transition planning. And I tell people like, go early because you're going to be overwhelmed, right? Like, go when your kid is 12, because it's all going to feel like, Jar, you know, like jargon and jumble and it's good. You're going to be so overwhelmed, but then you go again every year. And like you, you know, like your child is different every year. You learn something different every year. And I feel like professionally too. It's like transition planning is complicated. I feel super lucky that I get to specialize in this area. There are so many professionals working in transition where it's a small piece of what they do. And that is not [01:11:00]  easy to stay on top of this. If it's a small piece of what you do. So just take one thing away, listen to this again later, you know, like Do some other transition planning workshops, um. There are some great, you know, again, like local and national resources if you want to learn more about it, but don't try to do it all at once. I've been doing this intensively for 11 years, and there's still so much to learn. Kate Grandbois:  Well, we can tell that you've been doing this intensively for 11 years. You're brilliant, and you've just shared so much information with us in an hour. We're so grateful for your time. Thank you so much for being here. Thank you so much for having me. This was wonderful. Thank you so much.  so much.  Kate Grandbois:  Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study. Please check in with your governing bodies or you can go to our website, [01:12:00]   www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com thank you so much for joining us and we hope to welcome you back here again soon. .

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 . [00:00:00]  Intro Kate Grandbois:  Welcome to SLP nerd cast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy  Amy Wonkka:  Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each  Kate Grandbois:  episode of this podcast is a course offered for ashes EU. Our podcast audio courses are here to help you level up your knowledge and earn those professional development hours that you need. This course. Plus the corresponding short post test is equal to one certificate of attendance to earn CEUs today and take the post test. After this session, follow the link provided in the show notes or head to SLP ncast.com . Amy Wonkka:  Before we get started one quick, disclaimer, our courses are not meant to replace clinical. We do not endorse products, procedures, or other services mentioned by our guests, unless otherwise  Kate Grandbois:  specified. We hope you enjoy  Announcer:  the course. Are you an SLP related [00:01:00] professional? The SLP nerd cast unlimited subscription gives members access to over 100 courses, offered for ashes, EU, and certificates of attendance. With SLP nerd cast membership, you can earn unlimited EU all year at any time. SLP nerd cast courses are unique evidence based with a focus on information that is useful. When you join SLP nerd cast as a member, you'll have access to the best online platform for continuing education and speech and language pathology. Join as a member today and save 10% using code nerd caster 10. A link for membership is in the show notes EpisodeSponsor 1 Kate Grandbois:  Hello, everyone. Welcome to SLP Nerdcast. I am very, very excited about this evening's, uh, or today's episode. I am here with the most people we have ever hosted on this podcast, ever in the history of this podcast, [00:02:00] which is really exciting. Today, we have the pleasure of welcoming the heads and members of the Multicultural Constituency Groups from ASHA, also known as the MCCGs. Does everyone want to say a collective hello? Hi! So great! Alright, so today we are going to discuss allyship and cultural humility. Which is something that we've mentioned on this podcast in the past here and there, but I'm very much looking forward to unpacking these concepts and going a little bit deeper with all of you. Um, especially how these concepts relate to our field, both speech language pathology and audiology. But before we get started, I was wondering if each of you would like to briefly introduce yourself so that our audience knows who is with us today. I can go first. Um, I am Gregory Robinson. My pronouns are they, them, and um, [00:03:00] I am the chair of LAGASP, the LGBTQ Caucus of ASHA. Hi, good evening. My name is Sophia Carias. Sofia Carias:  I'm a bilingual service provider, an SLP in the Los Angeles area, and I'm the, uh, past president of the Hispanic Caucus. Hi, my name is Xin Hui Xin Cho, and my pronouns is she and her. I'm a professor at Minnesota State University, Mankato, and I co lead the Asian Pacific Islander Speech Language Hearing Caucus with Archie, and this is my fifth year leading the caucus, and we're very excited. Archie Soelaeman:  Hello, my name is Archie Sulaiman, and I am the co president of the Asian Pacific Islander Speech Language Hearing Caucus with Xin, and if you hear cooing, that's the Hi,  Brittani Hightower:  everyone. I'm Brittany Hightower. I'm the chair of the National Black Association of Speech, Language, and Hearing, also known as NBASLA, and I'm an [00:04:00] SLP in Texas. Ranjini Mohan:  Hi, everyone. I'm Ranjani Mohan. My pronouns are she, her. I am an associate professor at Texas State University. And, um, the president of the South Asian Caucus of ASHA. Shine Burnette:  Good evening. My name is Aletha Shine Burnett. I'm half White Mountain Apache, half Navajo. I'm the president of the Native American Caucus. I'm a speech language pathologist in Arizona, and I work in the schools. Kate Grandbois:  And that is everyone. I've never felt more part of a group here. Usually it's just me, Amy, and one other individual, or maybe two, but this is very exciting and lots of fun. Um, and before we get into the content of the episode, I do need to read our learning objectives and our disclosures, which are lengthy because we have a panel of people here and I'm going to try and get through them as quickly as possible. Learning objective number one, define allyship and list [00:05:00] two reasons why allyship is not a selfless endeavor. Learning objective number two, describe the importance of allyship in speech language pathology. Learning objective number three, list at least two action steps that clinicians can take to show professional allyship. Disclosures. Sheen's financial disclosures. Sheen is a full time employee at Minnesota State University, Mankato. Sheen is receiving an honorarium for participating in this course. Sheen's non financial disclosures. Sheen has a professional affiliation with the Academy of Neurologic Communication Disorders and Sciences. Sheen Asian Pacific Islander Speech Language Hearing Caucus, the American Speech and Hearing Association, Mankato North Mankato Act on Alzheimer's Action Team, Minnesota Connect, Aphasia Now, Minnesota Speech Language Hearing Association, Sophia's Financial Disclosures, Sophia is receiving an honorarium for participating in this course. Of course, Sophia's non financial disclosures. Sophia has no non financial relationships to disclose. Shine's financial disclosures. Shine is self employed and [00:06:00] receiving an honorarium for participating in this course, Shine's non financial disclosures. Shine is the president of the Native American caucus. Gregory's financial disclosures. Gregory is receiving an honorarium for participating in this course and has a full time associate professor at the University of Arkansas for medical sciences, and is also a contract employee for prismatic speech services. Gregory's non financial disclosures. Gregory is the president of Legasp, the LGBTQ plus caucus of ASHA. Archie's financial disclosures. Archie is receiving an honorarium for participating in this course. Archie's non financial disclosures. Archie is the co president of the Asian Pacific Islander Speech Language Hearing Caucus, a member of ASHA SIG 12 and SIG 14. Brittany's financial disclosures. Brittany is an employee of a public school system. Brittany is also receiving an honorarium for participating in this course. Brittany's non financial disclosures. Brittany is the chair of the board of directors of the National Black Association for Speech, Language, and Hearing, also referred to as NBASLA. school system. Brittany is also receiving an honorarium for [00:07:00] participating in this course. Brittany's non financial disclosures. Brittany is the chair of the board of directors of the National Black Association for Speech, Language, and Hearing, also referred to as NBASLA. Kate, that's me. Most people who are listening likely know that I am Kate, that's me. Most people who are listening likely know that I am the regular co host here. My pronouns are she, her. I didn't even introduce myself. My financial disclosures. I am the owner and founder of Grand Blanc Therapy and Consulting LLC and co founder of SLP Nerdcast. My non financial disclosure is I'm a member of ASHIC 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. That was, I'm very impressed with, with, with myself for getting, if everybody's still here and with us, we've done it. Everybody's clapping. Hooray. Now, let's get into the fun stuff. I would really like to start this conversation by talking a little generally about allyship. [00:08:00] Um, I wonder if any of you can sort of kick this conversation off by telling us what an ally is. How would you define an ally?  H Sheen Chiou:  I can start, or Brittany, would you like to start? Sure. You can go ahead. I'll jump right in. Sure. Um, so an ally is a person who is not a member of an underrepresented individual or group, but wants to support and take action to help others. So that targeted individual or group is typically underrepresented, marginalized, or discriminated. Um, in general, an ally will build. A supportive relationship with the individual and group and works in solidarity in partnership with them so their voices can be heard.  Brittani Hightower:  I 100 percent agree with that definition of an ally. I think, um, just to add to it. Being an ally is, [00:09:00] is more of a, and I know we're going to touch on it probably as we keep going through the conversation, but it is, um, something that you do almost, I feel like it's more from the heart. It's not a, it's not something that you're doing to show just because, Hey, I can help out with this group and help out with that group, but you genuinely want to support those who are underrepresented and want to, uh, help with promoting their agendas or their, their missions and visions to make sure that their groups are, uh, represented in the larger majority. Kate Grandbois:  This definition is bringing to mind two other terms I have heard used adjacent to the concept of allyship, which are performative allyship and also virtue signaling. Can any of you walk us through what those concepts are and how they are related to allyship? Okay.  Gregory C. Robinson:  [00:10:00] I mean, I can talk a little bit about, um, about performative allyship, um, as this is something that's very common that we see, um, that we talk about in the, um, LGBTQ community, um, because it's, uh, you know, it's sort of like, Um, there are a lot of like, uh, I don't know, big companies or something like that that during Pride Month, you know, they're, they're out there and they've got their rainbows up and they've got their, uh, they've got their, um, their packaging and it's very clear in those situations that they're not in it. really for the community, but they're in it for them, for, for themselves. Like they're, they're in it because they think that that's going to sell more, um, more things. They're, they're, they're going to sell more if they, if they seem to show that they are Like an ally to the community during this pride month kind of a thing. And you know, that it's performative [00:11:00] because once that, uh, currency runs out and the climate changes, as we are seeing in here in Arkansas, where I am, um, you know, suddenly everybody starts to backtrack and they're just like, Oh, wait a minute. Like, um, now we don't actually. need to, um, support the LGBTQ community or now we need to be like suddenly quiet about it or we don't need to be loud and it's like, Oh, okay. So when it was benefiting you, um, then you were like all loud and proud, but then when suddenly the risk got high and, um, you started to feel like there was something at stake or you might. You might get in trouble for being an ally. Suddenly you backed off and that's, that's what we call performative allyship. Now, um, I think we have to be a little careful about that because I think a lot of people get called out for, for being performative. Um, but there is a [00:12:00] place for it. Like, okay, so, you know, if, if we, if we have some anti trans legislation that's going down across the country and we have like people that are being attacked, um. I'm like, please do not, if you are actually an ally, please don't care about being performative or seeming performative. I was like, you know, honey, the stage is out, the lights are up, the curtains are open, perform now. Okay. Now is the time we need you to perform. It's not like you don't need to be like, oh, I don't want to seem performative. Like. I think you missed the point and we need you out there on stage now because there are people that are being harmed and there are, uh, we need the voice. We need the voices of support during the times when it's critical. So I think that, um, I think that we have to be careful, like people don't need to be concerned or scared about like seeming performative. I don't know.  Brittani Hightower:  I think, I almost think if you are [00:13:00] in that mindset, Then you're, you're probably not being a performative ally. You're probably a true ally and just go ahead and. Be, be that, be an ally.  Sofia Carias:  That's right. People. Um, I think we're going to talk about that too, as we talk about this, uh, topic throughout this hour about, um, that kind of allyship, maybe they just don't know what to do to be a good ally. And so it comes off like you're giving a performance to somebody. Um, but they don't mean to, I think that's what Brittany and Gregory were touching. Um, they don't know what to do to be an ally. They're like, how can I help that kind of thing? And I think that's, that's important to talk about too. It's like what could they do and feel like they're genuinely being an ally and not putting on a performance  Ranjini Mohan:  and I think sometimes, um, with social media, there is a pressure to seem like you need to contribute to creating awareness, but I think that's where it stops there. performance or their virtual, virtual signaling is it stops with [00:14:00] sharing a hashtag or, um, you know, the, there was the, um, during the Black Lives Matter movement, um, there was the, um, what was that? The Blackout Tuesday Square? Um. Mm hmm. So people would share that, but then not actually take any action. They wouldn't, um, you know, uh, donate or sponsor. They wouldn't actually do anything more than that. And they'd think, well, I contributed to creating awareness. Well, we were all aware. I don't think that one action necessarily did anything. much to benefit the community. Um, and even if it did, it's a very small act. And then to think that you're an ally because you, um, shared something online is, it just means that, well, yes, that's like maybe valuable in some way, but that's not enough. And it's, it's, we can't assume that. Um, I mean, there is this idea that It's about, um, you know, a previous act of solidarity [00:15:00] does not guarantee a future act of solidarity. And so, um, I think sometimes it's just as Sophia said, it might also be, they don't know what else to do and they feel the pressure. Um, they want to be seen as someone who's supportive. And so there's that one little thing, but that's where it stops.  Gregory C. Robinson:  Yeah. And I think it comes with an awareness of the fact that being an ally is dangerous. Like, it should be dangerous, like there is a risk to being an ally, um, because there is a risk to being a part of the marginalized community as well. And so, um, by being an ally, you, you are, you are, you are taking a risk. And so to only Only do that work when it's not risky is, is, um, it's a little bit, I don't know, fake, I guess.  Brittani Hightower:  And then also I think allyship is, it's not a one time thing. And I think Rangini was touching on that, but it's, [00:16:00] it's truly like a, it's almost like in your daily life. Um, you may not do something every single day, but at some point in the course of your life, you, you be shown that you are an ally to a particular group. More than just that one share on Instagram, or, you know, and more than just in social media also like in your physical workplace in just the community at large, it trend, it transpires through all aspects of life. H Sheen Chiou:  And I, one thing I really love about, like, getting together with our multicultural constituency groups is, like, each group has their work  Announcer:  group,  H Sheen Chiou:  like, um, focusing on how, like, how to work together and make our voices heard. So, like, my example is, like, my, for the APA caucus, we have an anti [00:17:00] racism learning community, and It's kind of like we have different issues, different concerns that we like members bring up and then we host a plat. We have a platform for people to talk about it and to talk about it. Generate actions and on how to work on things that we would like to work on, like, uh, for asset modification and for a, uh, code of ethics. And, uh, recently we have, uh, to, like Archie and I, and a lot of our members work down like how to remove, uh, um, an articulation. book treatment material from the market just because they, uh, for some members, it's a racist, uh, image. So, like, I really appreciate having to be part of this group because, and with MCCGs, because [00:18:00] there's so much that we can do and there are so many allies that they are not, like, They are not Asians, they are not Pacific Islanders, they are not native Hawaiians, but they are here for us, um, and just, I, I just feel very blessed to be in my caucus and in this group. Kate Grandbois:  This conversation about allyship and and performative allyship is making me think of something that someone said to me once a long time ago, and I'm interested to hear your perspective on the statement. It was that allyship requires an exchange. So the person who is. actively trying to be an ally is giving some form of their privilege, time, money, activism. There is an active exchange happening. It's not a passive, Activity like an Instagram square. Would you say, does that resonate with any of you as, as a decent [00:19:00] description? Gregory C. Robinson:  I think it's, I think that's interesting. I've never, I've never thought about that. And I, I like that. It's a, um, it's a rule of thumb that I think is. Good.  Kate Grandbois:  And I know we're going to be talking a lot about action steps that clinicians can take later on in this hour as we move through this. So, um, I think we can maybe ping back to that later on as people who are listening are reflecting on things that they can do and how that exchange might play out. I had also been told at one point that a person in a position of privilege doesn't really, can't really call themselves an ally. And the term ally is something that is given to you by another individual. Is that true? What are your thoughts on that as a concept? Ranjini Mohan:  So I do, um, align with that idea, um, a little bit. And I think it comes [00:20:00] from a lot of the marginalized people being slighted. Um, uh, throughout history by trusting allies, people who claim to be allies, and then finding out that it was not genuine or that we can't count on them. Um, and because, uh, in the beginning, when, um, Brittany and Sheen were talking about the definition of allyship, they talked about action, right? So, allyship is, In the moment of the action, but unfortunately, a lot of people claim it to be their part of their personality like it's an identity. And the downfall with that is that when they are silent in a specific situation, or they act in misalignment with their proclaimed allyship. and they're called out on it, it hurts their ego because they say, well, I'm an ally. Someone questioned [00:21:00] their identity. And, um, that can have a negative effect on, um, on, on the group that the community that they intend to be. Um, I can give an example. So I have a, a colleague, a friend who, uh, is, uh, is her back. She's Indian and she worked at pediatric clinic and she loved her boss because her boss claimed he loved Indian food. organize, you know, cultural events, uh, like Diwali parties and always insisted that everybody, all their employees receive, um, diversity training. But it was that same boss who consistently made multiple recommendations to my colleague to, um, risk to seek accent modification services, which she consistently refused. And none of her colleagues or her clients had ever complained about it. And, um, when she called out her boss on it, he said, Well, but I, [00:22:00] you know, I'm just learning. I, I, I, you know, I need more information. You need to tell me when, when I'm doing something that's wrong. And then again, that comes to this idea of is it our response? Is it the, the marginalized person's responsibility to teach someone what, um, is acceptable and what is, uh, discriminatory or not. And, and that person clearly that boss's ego was hurt because he thought he was an ally. So it, when people use these like one off moments to claim or prove allyship, it becomes about them and not about the community that they are, uh, they aim to support. Because people don't realize that it's a lifelong process. And there's a lot of, you know, Um, time and, uh, energy and emotions in practicing lifelong allyship. Um, and so, um, I think, uh, by and also, I mean, the other idea is that by calling yourself an ally, it implies that your [00:23:00] journey is over, that you're already completed that process and you're an ally now. But as long as, uh, systematic oppression exists, the process can never be complete. And that goes for all of us, right? Where just because we are part of, um, someone is part of a marginalized community doesn't mean that there isn't room to learn and support other communities. And so it goes for all of us. We've all made mistakes, but it continues to be where you, it has to be about, Continuing to acknowledge those mistakes and learn and, um, and, and actually take action. So you're only an ally in that moment of action. Um, and not, and it's not necessarily, uh, something that is something that we can count on. Gregory C. Robinson:  Yeah, I would, I would agree with Ranjini a hundred percent. And, um, I think that. I think that, um, I think that people might benefit from being more descriptive with their language a little [00:24:00] bit, so rather than, you know, when people are referring, like, to the LGBTQ community, um, to, that they are an ally. So a lot of times what they're saying is that they are a safe space. So they're saying that you can feel safe with me. I am an accepting person. And that's very beneficial. Like I need to know where those safe spaces are and I need to know, um, uh, you know, that, that those exist, but, um, perhaps, you know, um, staying away from I'm an ally as if that is something that has been now achieved and now it's done and set and and everything like that. I think that that's different. I think that it's, it's interesting because like, um, We all have, we all have identities, right? We all have identities that we claim and we have ownership over those identities and what the name is we give ourselves. But there are some identities that are really more about relationships [00:25:00] than they are about your own personal identity. So like I have The sole authority to say that my gender is non binary, that is it. I am the only person who can say that. And, um, and that's it. I am the sole expert on that. However, to say that I'm an ally is actually a different kind of term because that's about my relationship With another group or another person and it's more akin to a word like friend so, um, you know, so I Can can you ever say that you're somebody else's best friend like that's a weird sort of thing Like why would you can I say that I am? Oh, I am her best friend. Well, no, I can say she's my best friend But, like, for me to be so presumptive to say that I am her best friend, it requires a little bit of a, wait, you don't have the authority to [00:26:00] say that. That's, that's their authority to say that. Um, and I don't know, maybe their relationship is such that, that she's okay with me saying that, you know, that, uh, I'm her best friend or, or something like that. But, um, nevertheless, it's a, it's a little bit of a different kind of, you know. Identity term ally is not like all of the other terms of identity that we have. It's different. Kate Grandbois:  I love that, um, description of making it akin to saying, Oh, well, I'm her best friend. I think that's a real that clicked. I think that was a really, um, clear parallel. And I really appreciate that. Um, in the conversation that we had, uh, I think the last time I spoke with all of you was about six months ago for anyone listening, and this is being recorded. So this is odd nebulous of time. You don't know when that was. We do have a previous recorded course with all of these lovely humans, um, specifically talking about the resources [00:27:00] that are available through the multicultural caucuses at ASHA. And I. You know, you all, your groups, the organizations that you're leading and that you're a part of, have so much to offer our field. You all have talked about continuing education opportunities, community outreach, and it's, we all know by now, That the field of speech pathology is incredibly homogenous. I don't have the exact statistic in front of me, but I can safely say it's around 92%, 92 point something percent of white women. And that leads me to make the assumption that a lot of people who are listening fit that demographic. And I'm wondering, For those of us who identify as white, cisgender, heterosexual might be listening to this conversation and thinking about the multicultural constituency groups and thinking this does not apply to me. I don't [00:28:00] belong in one of these groups because those are not my identity. Um, and. In our previous conversations, you all had talked about not only the resources that the groups offer, but that your doors are open. You are wanting people to be involved, and for anyone who is listening, who is in, who is not part of a marginalized group, why should a white cisgender woman join one of these groups? What are the Um, emotional barriers that they may need to overcome to feel comfortable approaching one of these groups and, and taking, taking action to join them. Sofia Carias:  Chances are that in our profession. You will be working with somebody in a marginalized group. Um, the chances are very high considering the um, educational disadvantages and the um, disparities in healthcare.  Shine Burnette:  Like,  Sofia Carias:  um, you will [00:29:00] most likely be working with somebody from a marginalized group. And I think you have to have um, information to do that. And that's why I think we exist. Part of the reason we exist is to give that information. You don't have to be, you know, Hispanic to be in the Hispanic Caucus, um, you just have to work with that population or be interested in working with that population. Um, yeah, I  Gregory C. Robinson:  mean, none of us exist in a silo, like everybody, everybody is connected, like we're all connected and I would ask anybody out there. Are you interested in making the world a better place? Like, are you interested in making it a more inclusive place for everybody? And like, that means you too, because by making the world a better place for, um, marginalized people, you're making it a better place for everybody. And I, I love this quote that, um, that I came across, uh, from Lilla Watson. Um, and it says, If you have come here to help me, you are wasting your [00:30:00] time. But if you have come because your liberation is bound up with mine, then let us work together. And I just love that because, um, You are, you enter into these relationships with groups because you realize that you are a part of helping to make the world a better place. And also it's an acknowledgement of the fact that the very oppression that people of color are facing is the result. Of white history. And so is it only up to the people of color to address the discrimination that is actually caused by, and it originates from, um, the, the people in power. And so it's, you know, it's, I think that it's an acknowledgement that, that we are all a part. Of this together and we are all here [00:31:00] little fishes swimming in a swimming in a in a fishbowl and we are, um, and, uh, we all need to work together to make sure that it's a pleasant place to be for everybody.  Brittani Hightower:  Right. I think also. Um, like, I think we mentioned before, like, yes, we have all these resources that would be beneficial to people who are not of our, uh, identify as a person of our groups. But, um, I think that research that we offer the resources that we offer. They just help to make you a better and more well rounded clinician. So if you're able to join our groups and one, like we've said before, you don't have to look like us or identify as how we identify to be a part of our groups. Um, we're in Basel. We always say if you align with our mission, our vision, and you want to support [00:32:00] our, our efforts, come on in, like our doors wide open. We do have members who are not black. I know a lot of people don't think that, but we do have members who are not black, um, and we welcome them and they are right in the fold, uh, on serving on committees, um, putting the initiatives into place. So. I think that you should not feel, uh, there should be no emotional barrier, uh, if you have a genuine want to support any of our groups. Come on in. We're here. We're welcome. We want you to join us. We're happy to share our knowledge with you and then whatever questions you may have. It's a, we are those safe spaces. Shine Burnette:  I also think that. You know, when, um, when they come in that they could get a feel for some of maybe our cultural, our cultural [00:33:00] identities, the things that we kind of value. And, you know, not just as each, you know, Each of our ethnic groups, but also as a person, you know, today I was asking my kids. Hey, what are you guys doing for Christmas and they all had different, you know, um, Things that they do with their families, which was all different. Whereas, you know, for us, they could get a little bit of of history of background of the reasons why we do certain things, you know, going back to the ally thing, you know, very, um, Um, difficult for some groups to really trust others to really believe that if they say they are allied do you really mean it or not, you know, but also we've gotten a lot of questions like hey, I work in this population. Is there anything that you that you can help us with or that I should know which is great because you know then we can kind of give an insight but [00:34:00] also it's so diverse just even for us to cover every You know, tribe, but I think for people to at least come and say, Hey, can I just hang out with you or come to your meeting so I can get a little bit of understanding of why certain things are the way they are. Gregory C. Robinson:  I think that's really important. I think that it's something to circle back to something that Kate, you said in the question was that you said, you know, how do you, um, how do you feel comfortable going to these groups? Maybe you don't feel comfortable. Maybe it's not about being comfortable. Maybe that's the big thing. Maybe you need to not be comfortable for a minute.  Ranjini Mohan:  And, you know, Asha talks about providing culturally responsible, um, services, and, uh, one of the first steps is to acknowledge your own privilege and then to learn about other, um, others [00:35:00] experiences. And one of the best ways to learn is to, um, hear from others about their lived experiences. And, um, what better place than a group that is, um, is, is working so hard to. Uh, support their community. And, um, so, and, you know, your question did ask about what can a white, cis gendered person do, but I would say that it doesn't matter what your um, race or ethnicity is, um, there is so much intersectionality even, um, across communities and I think learning from people who are learning more about it is very valuable. So for example, like when I was, you know, a few years ago, when I was learning about trans rights, um, I, it made me reflect on, you know, like body autonomy and, and my experiences as a cisgendered female. And, you know, when I was learning about Black Lives Matter, it showed [00:36:00] me like concrete examples of potentially how I could, um, Um, advocate as a South Asian. So not to say that I'm making it about myself and my identity, but it made me more invested in there, in these movements because I was able to relate to it. So it, it taught me about where I had privilege and where I didn't. And for the longest time, when I moved to the United States and I was South Asian, I thought, well, I'm part of the marginalized group. But I didn't recognize my own privileges also as someone who is highly educated, someone who is, um, female, cisgender. And so I think, um, it, it shouldn't matter what your, um, your race, ethnicity or specific identities are. It's important for us to learn about people who are different from us. People who don't share those same identities because we might find that it's actually mutually beneficial. We might learn things we about ourselves that we hadn't before. So I think it goes along with what Gregory was saying earlier about building a world that you build a better world. [00:37:00] But also, there are very specific things that you can take away from it that's beneficial for us also, as well as the community that. Archie Soelaeman:  And I just want to add to that a part of it is essentially just being vulnerable. Um, so join and be vulnerable. Um, learn from us. Um, and, you know, just like what everyone else has been saying.  Shine Burnette:  And, and who knows, we could learn from you as well, you know, so like how, you know, to approach. Different topics or different things, you know, sometimes we kind of think like, oh, this is how they need to know or learn, but then they may come back and say, hey, this, you know, for us. You know, could you kind of present it in a certain way just by different cultural things that we kind of present? You know, some people could be very straightforward and forceful with some things about the past history and of what has happened to our [00:38:00] people, but maybe that's not the way to approach some of these things Kate Grandbois:  for anyone who is listening and is. not only interested in joining, but would like to take some action in joining. I'm sure each of your groups has a different website and a different, you know, email signup process or whatever. So what we will do is link, um, we will put links in the show notes and on the website for each of the individual caucuses so that anyone listening has that information right at their fingertips and can, um, move through the process of joining. I do want to take a second to unpack a little further the concept of discomfort. Um, I have, I really appreciate that, you know, several of you have talked about your own experiences with learning about other cultures. You know, one of the, in the title of this course is, and we've talked about it a little bit, this concept of cultural humility. And. The, that what [00:39:00] goes along with that is something that you brought up, which is this concept of intersectionality. So there is no monolith. Everyone is their own individual person with different levels of, of privilege. Um, and I want to take a second just to talk a little bit about those uncomfortable feelings and what a person can do when they have those uncomfortable feelings. If it's fear of hurting someone's feelings or. You know, I don't want to say the wrong thing and offend anyone. So I'm not going to join because I just don't want to put my foot in my mouth. Um, or I feel so guilty about my privilege that I am just not going to join or I'm going to stay within my own group because I feel more comfortable. What are some of the, you, you've talked about this a little bit, um, but what are some of the action steps that a clinician could take if they want to show they have a [00:40:00] value to show some of this professional allyship or get involved in an MCCG, but there are still some emotional barriers or still some of those feelings of, um, guilt or shame or fear. Which are very powerful feelings that will definitely stop action from happening. And I think it's important to talk about it a little bit more. Gregory C. Robinson:  Um, I can start, I guess. Um, I think that it is important to, um, to remember that, uh, that this is not, this is not about you. It's not necessarily about you. Um, and so that's something that, um, I, it is, it is about you and it's not about you. So like, I always try to go, okay, wait, are these feelings I'm having from ego? Like, is it, is that, is that where these are originating? Um, because if that's the case, maybe I can do some internal work to try to like, okay, let's calm that. And let's focus a little bit more on the harm [00:41:00] that. Um, is happening over here. And let's see what we can do to mitigate that harm. Um, but, but also to, to recognize that, that it, it is a little bit about you as well. Um, and, and to acknowledge that your, your place in that mix. Um, And sometimes like people will, I, I, I encourage some people to, if you're having uncomfortable feelings, because like, Oh, you said the wrong thing. Or like you, you, you, you did something that might've hurt somebody's feelings. And then they told you about that. Like, um, I, um, I try and I'm not always successful, but I try to, to look at those moments as. Moments of celebration rather than moments of shame. And what I mean by that is like, I, it's a life work. We all have our biases. We all have our prejudices. We all have places where we [00:42:00] are potentially discriminatory. And it is a life's work to constantly, constantly be looking and self reflecting and trying to find those places that could be potentially harmful. So when you find one, it is not a time to be upset at yourself because you're not a good person. It is a time for you to be Very happy because you discovered another thing for you to work on. Like you made something that was secretive and possibly harmful, obvious, and something that you can definitely address. And like that flip In the switch is something that I think is really is sometimes very helpful. Um, and regarding being called out or called in, I saw a little acronym. Um, I shared this with the group and they thought, Oh yeah, you better share that because it was, um, I don't know where I found it and I tried to Google it and I couldn't find it anymore. So if anybody [00:43:00] out there knows where it is fine, you know, um, shoot us the, the, the citation or the credit, but, um, it was an acronym that was called claim. Claim responsibility. So C, the C stands for center yourself. So if I'm being called out or called in, I'm being told that I've done something that was potentially harmful. The first thing that you need to do is center yourself, like breathe, like, whoa, whoa, whoa, you're about to have some pretty intense emotions because that happens anytime anybody gets called out or called in. That's a natural thing. So center yourself. Let's breathe. Now, L stands for listen. Listen to what it is that is the problem. Listen to the person. Don't talk, listen. Then A is accept responsibility for what you did. And then I is inquire or investigate how [00:44:00] you can do better next time. And then M is move on. Don't over apologize. Don't make it about yourself. move on and commit to doing a little bit better next time. So C. L. A. I. M. And I just love that little acronym. And it's hard to remember in the moment, but, um, it's, it's great to, um, to kind of aspire to anyway. Kate Grandbois:  That was awesome. That's a great acronym. Another thing that I think can sometimes be helpful is practicing some self compassion and some self forgiveness, just like you said, because no one is perfect. And we all carry biases and, um, everyone makes mistakes. And just because you've made a mistake doesn't mean that you are a terrible person. Uh, it's an opportunity. It's an opportunity to, to learn and to do better next time. Uh, I want to. Maybe spend the rest of our, the rest of our episode talking a little bit about action [00:45:00] steps. So we've laid the groundwork for what true allyship is. Um, we've talked about how it's very action oriented that we've mentioned this component of exchange. Um, we've talked about the resources out there, all of these wonderful groups that you all lead and are a part of. within our field to show and hold up professional allyship or create opportunities for professional allyship. Aside from joining one of these groups or becoming active in one of these groups, what are some additional action steps that clinicians can take to, to become a professional ally or get on a journey to become a professional ally? Archie Soelaeman:  I would say one of the things is just kind of take different opportunities to learn, um, be in the moment and just, you know, if you're, if you mess up, that's fine. Use that as basically a learning opportunity. Um, and, [00:46:00] you know, there are all of these, uh, all of our groups where you can, um, come and join us. And then also. learn from the different constituencies and um, essentially like what Gregory said, just move forward, right? So learn, um, and use that as a learning opportunity. Ranjini Mohan:  I think another, um, thing that kind of goes with what you had, the real previous question is, you know, rather than coming with this, um, intention of, hey, I'm an ally, this is what I can do to help you. is ask a community. How can I help? So don't come with any idea. You can have ideas of different ways that you can use your privilege, but just asking, how can I help? How can I, what can I do to support your mission? What can I do to support your agenda is just as simple as that. And it could be something as simple as, [00:47:00] can you help me create a week? I mean, the response could be, Can you help me create this flyer? Here is the information I want you to put on that flyer. Or it could be as, as big as, uh, would you be able to join me in this protest? Um, or would you be able to sign off on this letter that we want to send to, uh, another organization to support our cause? So it just asking, and I think that, that sometimes the fear that people have is I don't know what to do. I you have good intentions. But I don't know what to do, and I don't want to overstep, um, my boundaries. So just ask, how can I help? And accept whatever help they, they request. And if you're able to do that, then do it.  Brittani Hightower:  I think that piece is important, uh, just so that you're, you're not unintentionally offending anybody, because I know, um, and even I might do it. Like, I might think, oh, this is a good idea. This might be helpful for this [00:48:00] particular group. But in reality, it's far from what they need help with at that time. That might be a great, like, a couple months down the line, but right now, the help is something that's smaller that, that is more actionable for them in that moment. So that ask, and I know we've mentioned having those feelings of uncomfortable, but, or uncomfortability, but I think if you can, Center yourself, find that, that inward, um, I don't know, motivation just to say, okay, let me put myself aside. I know that I want to help this particular group. Let me seek the person that may be able to help and also. Anybody in our marginalized groups, we're not the expert on our marginalized groups. So we know what we need, but there's, we're not the only ones who can, [00:49:00] um, I don't know if I'm wording this correctly, but y'all know what I'm trying to, trying to say, but just like, because I'm a black woman does not mean that I know what all black women need, um, or want or desire and need help with. So that's, I think that's something just to be aware of. We are not the experts on our particular group.  H Sheen Chiou:  Yeah, exactly. Brittany, there's no way that we know everything. And it's no way that we, I think it's important to acknowledge that it's okay that we don't know everything we don't know how people live their life, and how to what their lived experiences are. I think, uh, Ranjini touched on that earlier too, like, it's okay not to know everything and what do you do about it, uh, by joining us, uh, the Multicultural Constituency Group by, uh, uh, supporting our mission, our vision, [00:50:00] supporting our, Uh, what our tasks, uh, whatever we are doing at this at the time. Um, and, um, and usually an ally probably will be someone with power, right? Uh, just that they are supporting a marginalized group. Because, so an ally probably has more power than an ally. a marginalized individual, what can they do to support, um, a marginalized individual or group? I think that's very important to consider, um, and lots of, like, those unconscious biases that are hard to identify, to be identified until there's a specific scenario happened. And then you're like, Oh my God, that's my unconscious bias. And so it's okay to feel uncomfortable and to be able to kind of acknowledge, Oh, I didn't know this. And Oh, what did I say? That is very harmful to have that, um, [00:51:00] to feel comfortable being in a comfortable position. I think it's What's the term like to be comfortable with the, um, I think Brittany was trying to, uh, talk about that. Um, yeah, what's that phrase? Being comfortable being uncomfortable?  Sofia Carias:  Somebody Google it. Google it because I don't know. Um, I wanted to touch, uh, upon that, uh, I think I would suggest to people as a, an action step is to do some self reflection about the concept of like other, the otherness of other people. Um, if that makes sense. Um, I think that we think a lot about other, like, like we're, we call ourselves marginalized groups and we're other. And I think people doing some self reflection about how much we have in common, not so much our differences, but thinking about what we all have in common. Um, so it doesn't seem like so other, like when you talk to people that you've never known or you don't know anything about, like, they don't seem like aliens anymore, you know, like, we won't seem like other those [00:52:00] other people over there. Those over there. I think self reflection is an important part of that. I think that again, thinking about our commonalities and not so much of our differences. Gregory C. Robinson:  I'd like to add that, um, and so I'm about to make some pretty bold statements. So, um, so, um, so the, the, the disability community has, um, has a phrase, uh, nothing about us without us. Okay. And so that's, I think a super important thing to remember when we're dealing with, um, all of our marginalized communities and, um, we as a profession of speech language pathology have a long history of doing a lot of. Things that we think would benefit other groups, but then not actually including anybody from those other groups on the planning board or the, um, the thing, um, that is out there, um, to find out if that's actually what they actually need or actually want or, or anything like that, or if we're even doing the right thing. [00:53:00] Um, and so to, to include if, and this means, this is where I'm getting bold, like, We have a whole bunch of research, like, a lot of research that's going on in our profession. And the researchers are often not a part of the groups that are being researched. And I mean even the people with disabilities. So, like, actually, like, getting the input of the people with disabilities, or the, the communities, or the, the populations, and finding out what is it that you want to know. me as a researcher to, to, to research. Like what do your, what does your community need? Is there any way that I can use my power to empower you instead of always trying to get acclaim and acknowledgement for myself? So like, you know, if, um, And so I think that that's, I think that's just really, really super important is to remember that. And, and that also involves [00:54:00] like therapy, um, therapy endeavors that we are doing. I mean, if you're starting a new, um, I don't know, stroke support group in the nursing home, which is something I did when I first started my practice, I had a whole little stroke support group. Like bringing in the actual people in the group and co creating that together. Um, but, but the big thing about this and the big caveat with this is a little bit, um, about like what Brittany was talking about is that, um, you don't lean on One member of that group as the expert and you don't If you are relying on the expertise of somebody else in the community Then that person should be getting something for that like that should be Compensated it should be an authorship an authorship like a co author on the paper that you're writing Yeah, they may not be [00:55:00] a researcher and they may just be a trans woman and you are researching trans women and then you bring on this person to help you write your dang paper and give them authorship because then they can put that on their resume and possibly get something from that. Like that is important. Um, so it's just important to bring in the people from the community and make sure that we are actually doing. The work that we do, because like, it's really terrible allyship to just be assuming that you know best. What some other group needs and unfortunately that's what the history of our profession and the history of our country has been doing for a very long time. Um, to the great detriment of, um, lots of, um, indigenous people, lots of, um, black, uh, other people of color. Like it is, it is, that is what the, um, This whole, uh, issue, and believe me, I have a lot of [00:56:00] lawmakers down the street here who think they know exactly what trans children need, and they've never met a trans child in their life. And so, um, it's, it's very damaging, um, and I think that that's one of the biggest things that we as a profession really need to, to watch. And I think the disability rights movement with a nothing about us without us, if you can just plug that in repeat in your brain as you are going about your allyship work, like that will do a lot, I think. Shine Burnette:  And  Archie Soelaeman:  I also just want to add, um, as we mentioned very early in this conversation, um, the field of speech language pathology and audiology is very, um, white. So when you. When you're in all of these spaces and listening to different conversations, [00:57:00] if you hear something that doesn't sound quite right, get uncomfortable and speak up. That's how you can also help us is speaking out in those spaces where we are not there, because there's only 8 percent of us. Versus the 92% of everyone else. So if you hear something and you think that doesn't sound quite right, um, be the one that calls it out and get uncomfortable, I would to even add onto  Brittani Hightower:  that part, in those spaces where you don't see us, if there's a way to include us, reach out and get us in there because like, like we said before, ne, none of us are experts on our own. In our own group. However, that voice still needs to be heard. So if you're in those spaces where we're not represented yet you're talking about a [00:58:00] topic that directly affects that particular group. Ask why is that person or why somebody who represents that group is not there. And if there's a way to get someone in there, get them in there, let their voices be heard, get it straight from the source, if you will. Ranjini Mohan:  And going back to what Gregory was saying, which is really important, you know, having representation in leadership or in policymaking, but that there's the other side of it, which is sometimes there is this. Um, there is a token minority person that you always go to and you want, and that person then gets overburdened because they're in all these committees. And it's also important to know that that one person is, does not necessarily represent their entire group and has perspectives that may, um, not necessarily be the collective voice. And so those are also opportunities where I think they can reach out to the multicultural constituency groups, because we do.[00:59:00]  Aim to represent collective voices. Um, and we have experience hearing multiple perspectives within our communities. And so, um, we can offer, um, advice. We can be consultants. We can, um, uh, uh, refer you to other people who have better expertise potentially, if you just want to listen, if you just need some additional help. H Sheen Chiou:  Yeah, I agree. I think like everybody has something to offer. Um, like in our field, like we have most of. Our, uh, certified speech language pathologists are all monolingual, uh, English speaking, female, and do we know that there are 350 languages spoken in the U. S., and if we can only serve one, we have problems. So to be able to connect with multicultural constituency groups, you get resources, you [01:00:00] get support, you, even if we cannot figure it out, we can help connect you with someone who can help you. Um, again, like we don't know everything we are, like, if we are Um, if you let us show you the rope, we can support you, we can support our ally and our ally can support us. I think it goes both ways.  Ranjini Mohan:  Yeah. And, and, you know, some of, um, uh, the, these multicultural constituency groups, they, um, include languages or ethnicities and nationalities outside of the United States. And so we have relationships with, um, the speech language, um, and hearing associations from these other community, from these other countries, um, or states. And so, um, if, if like we were talking about, like what, what do we, um, what are some of the services we offer? What are some of the resources we have? Um, if you have a client [01:01:00] that, uh, speaks a specific language and you don't know what standardized tests are available in that language. Um, you can reach out to us and we can, uh, help you find those resources or connect you to people who can share those resources with you. Sofia Carias:  I think like the title of this presentation and the one we did before, it's stronger together. Like, it sounds like a kitsch phrase, but it's absolutely true. We are all stronger together. And that's why we've made it a point at these groups lately, the last couple of years to work together on things. We've made it a point to, you know, present and to disseminate information and to be seen You know, not just again, each other's like group over here and I'm over there and you're over there, like we've made it a point to be working together with each other so that we can do it because we have so many things in common. We have more in common than we do not. And I think if we can generalize that, like, can you tell I work at a school I need to generalize those skills. We need to generalize that to the greater population of our profession. [01:02:00] We need to do that. 'cause Yeah, Gregory C. Robinson:  I'm really having a hard time not singing the high school musical song. We're all in this together. .  Sofia Carias:  You can play us out. Kate, can you play us out with that song? I was gonna say, I put it over Wish  Announcer:  I wish someone had warned me. I'd cue it up and we would just play it. The exit music copy you should do in editing. Sofia Carias:  You should do it. Can you do it in  Announcer:  post? Can you put that in? Post  Kate Grandbois:  I, I'll, I'll do my best. I'll do my best. Um, this has been such a wonderful conversation and I'm incredibly grateful to all of you for spending your time and your energy walking us through these concepts, unpacking all of this for anyone listening. We encourage you to use the links in the show notes to learn more about the MCCGs, the multicultural constituency groups at ASHA. If you are sitting and listening to this or watching on YouTube and you're biking or walking or folding your laundry and you're having some [01:03:00] feelings that I have feelings too. We all do. That's okay. Um, and we will link all of the additional resources in the show notes for further learning. Thank you all of you for being here with us. I really, really appreciate it.  Brittani Hightower:  Thanks for having us. so  Ranjini Mohan:  much. This was a great opportunity.  Sofia Carias:  Thank you for the platform.  Kate Grandbois:  Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study. Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com thank you so much for [01:04:00] joining us and we hope to welcome you back here again soon.

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 . [00:00:00]  Intro Kate Grandbois:  Welcome to SLP nerd cast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy  Amy Wonkka:  Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each  Kate Grandbois:  episode of this podcast is a course offered for ashes EU. Our podcast audio courses are here to help you level up your knowledge and earn those professional development hours that you need. This course. Plus the corresponding short post test is equal to one certificate of attendance to earn CEUs today and take the post test. After this session, follow the link provided in the show notes or head to SLP ncast.com . Amy Wonkka:  Before we get started one quick, disclaimer, our courses are not meant to replace clinical. We do not endorse products, procedures, or other services mentioned by our guests, unless otherwise  Kate Grandbois:  specified. We hope you enjoy  Announcer:  the course. Are you an SLP related [00:01:00] professional? The SLP nerd cast unlimited subscription gives members access to over 100 courses, offered for ashes, EU, and certificates of attendance. With SLP nerd cast membership, you can earn unlimited EU all year at any time. SLP nerd cast courses are unique evidence based with a focus on information that is useful. When you join SLP nerd cast as a member, you'll have access to the best online platform for continuing education and speech and language pathology. Join as a member today and save 10% using code nerd caster 10. A link for membership is in the show notes Sponsor 1 Announcer:  This episode is brought to you in part by listeners like you and by our corporate sponsor Practice Perfect EMR. Billing, scheduling, documentation, patient communication, business metrics, and more. Practice Perfect EMR [00:02:00] specializes in speech therapy practices like yours, connecting everything. Check them out at www. practiceperfectemr. com.  Kate Grandbois:  Hello, everyone. Welcome to SLP Nerdcast. I am Kate Granbois, and usually I am joined by my co host, Amy Wonka. Uh, she is not here today, but I am not alone. I have the pleasure of welcoming a repeat guest, Martin Holland. Welcome, Martin. Hi, Kate, how are you? I am fine. I am very excited to have the second conversation with you today. You've been on our show once before talking about private practice, um, and today's episode is going to be a slight extension of that. Um, I have a cute little story I want to tell about how we met, but I will save that for a few minutes from now. Why don't you start by telling us a little bit about yourself? Where did you acquire the knowledge that you have and where are you coming from [00:03:00] today?  Martin Holland:  Well, I'm coming from Norman, Oklahoma. . I've been in private business for 49 years, uh, soon to be 50. I've started eight businesses from scratch or reorganized, reorganized one. Uh, two of them failed, sold four of them and still active involved, actively involved in one or two, one of which is my wife's pediatric SLP OT. Physical therapy and feeding therapy business, which she started in 2014, after teaching speech language pathology at the university level. So, uh, my experience comes from having lived it after I sold my last business in 2011, I decided I didn't want to do that again, because as your listeners might understand, business can be a strenuous exercise, thought I might be able to help other people. With my, uh, history and found out it took a couple of years [00:04:00] to find out how to be a business coach. But eventually, I kind of figured it out. And that's what I've been doing since 2011  Kate Grandbois:  and onto my cute little story. I guess it's I'm not sure. Cute is the right word, but you and I got connected. Sort of by happenstance. So you wrote a book. I know we're going to be referencing this book quite a bit today. Your book is called the profit problem. They say I make money. So why don't I have any? And as our listeners know, I'm a business owner. I've been in private practice for about 12 years. And there have been some fundamental components of business that have always eluded me. And my brother in law, who knows very little about speech therapy, he's in a completely different field, said to me, hey, I just read this book and I really think that you would like it. So he gave me a copy of his book and lo and behold, this is the way I describe your book that I hope you take as a compliment, is it's business, it's a business book meets beach read. So I was able to finally understand some of these very complex components of [00:05:00] accounting of business strategy. Um, I, and it was just such a great book. I have recommended it to probably 10. I'm like your best saleswoman. I 10 or 15 recommendations I've made for this book and I connected with you on LinkedIn. And lo and behold, you messaged me back and said, Hey, are you a speech therapist? And so the story goes, we got to chatting and now you're here on our podcast. And, um, just to sort of preface this conversation with you have a very good book that's out there. Our link to it will be in the show notes. Uh, and before we get onto today's topic, which is the four fundamentals of business, I do need to read our learning objectives and disclosures. So I will get that over with quickly and then we'll jump right in. Learning objective number one. Describe the four fundamentals of every business. Learning objective number two, list two strategies for getting started in business. Financial disclosures, Martin's financial disclosures. Martin is the author of a book titled The Profit Problem. They say I make money, so why don't I have any? Martin also runs a business [00:06:00] coaching firm called Aneal Business Coaching. Martin's non financial disclosures. Martin has no non financial relationships to disclose. Kate, that's me. I am the owner and founder of Grand Bois Therapy and Consulting LLC and co founder of SLP Nerdcast. My non financial disclosures, 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. Okay, we got that over with. Let's move on to the fun stuff. Can you start by telling us a little bit about the four fundamentals of business? Sure.  Martin Holland:  Uh, as I said, when I started coaching, it took me a while to learn how to, to be a coach. And what I came up with was a construct, a mental construct, um, that has borne up over time. I've worked with over 500 individual business owners since I began coaching, and I found this to be true. That there are four fundamentals of every business, [00:07:00] regardless of what it is. I've had contractors, I've had psychiatrists, publishers, retailers, SLPs. Manufacturing and these four fundamentals hold up the way I use them is that I'm always cycling through the four fundamentals of business and saying, where's the weak point? Where's the thing that if we started today, if we improve that, stop doing it, started doing it would make the most impact on our business. So it's a mental construct for me, but the four fundamentals of business are guiding the business, getting the business, doing the business. and administering the business. And I think I talked to you before we started recording that most people start business to do something they're good at and know how to deliver and are passionate about. But what most don't realize, and I say most based on my experience is that being in the business of [00:08:00] doing something is a completely different animal than doing it. Speaking to SLPs and perhaps other therapists, most of you will not. Go out of business or suffer terribly because you don't know how to apply your trade because you don't know how to be a good speech path. it will be something else. It will be something in one of those other three. So there's guiding the business, getting the business, doing the businesses, delivering whatever you sold, which being a speech path, delivering therapy or administration, it will be in one of those other three areas that it will get you. And if, if it's okay, maybe we dive into what are in there.  Kate Grandbois:  Yeah, I, I, absolutely. I just, I'm having a lot of personal reflection as we have this conversation as a business owner. who got into business to work. My particular patient population is [00:09:00] pediatrics. I wanted to work with, with a pediatric population. I wanted to provide therapy in the homes way back in the day when I first opened my practice. Um, I still don't know very much about marketing and it's my biggest, my biggest weak point. So I'm looking forward to sort of unpacking all these different areas outside of my clinical expertise.  Martin Holland:  Well, let's start with leadership, um, or guiding the business, which is leadership. And so what, what's that, you know, leadership word. If you Google it, you'll get 800 million hits. What's leadership. But leadership includes things like having a vision for your business. Matter of fact, that's number one. Number two in leadership is having a culture for your business. If you're a solo practitioner, culture, It's a little bit easy, but you're starting at it. People. It's how do you hold people accountable? How do you incentivize people? How do you organize yourself in your company? So it's all these matters of leadership that people have all heard about. But in my [00:10:00] experience, very few people have done anything. Um, but it begins with having a vision or am I going to be a solopreneur? Or do I intend to bring people in? Do I want to be at multiple locations? You, and why am I doing this? I'm very proud of, uh, the vision for my wife's company, which is two, two items. And one is to be the clinic of choice for moms. And the second one is to be the clinic of choice for the finest pediatric therapists. And that sounds like something you might want to put on your website, which I think she does, but it is who she is. It guides everything she does. And just as anecdotally, she hired an SLP that we needed last week. And she said, I don't want you to come here because you're running away from something. I want you to come here because it's your dream job. Take some time. And make sure that this is where you want to be. [00:11:00] And the young lady said, I already know this is where I want to be. I got goosebumps when you told me what your vision was. Okay. So what's the vision for that company, right? What's your culture again, you can culture a bad culture in a business. We'll blow up the business more quickly than running out of cash, and I just won't be a whole lesson on that. But we can talk about that at great length. So that's that's a little bit about what the leadership is. Where are we going? Which direction? What's my purpose? Why am I doing this? Um, that should be articulated not only for you, so you know what you're doing in the morning, but for anybody you bring on board, they need to buy in to your vision and your culture or there will be trouble. Okay. The next one that was guiding, getting the business is marketing and sales and marketing, of course, is generating leads. Sales is closing the deal. It's a little bit, um, [00:12:00] different in an SLP practice than it is for a contractor because you're not really selling people. But the most important question in marketing is to whom am I speaking? Okay. So what jumps out at me immediately. Is, um, in SLP, or at least in my environment here, I know they're different one, different types of environments is who is my target audience and a lot of times you can spend tens of thousands of dollars a month with like digital, uh, Marketing and being in magazines and maybe billboard. I don't know. I've seen any billboards, but what you're really after is the doctor, the referring doctor, at least in our case. So, 1 of the 1st questions is what do doctors want and more particularly, the doctor scheduling nurse. What do they want? They want to know you received the facts. They want to know the [00:13:00] status. There are some reports you can send back to them unsolicited that they can just look at and know that you haven't forgotten them. And that doesn't cost nearly as much as 5, 000 a month for AdWords, right? And besides that, if a mom fives you on AdWords, that's no guarantee that you're going. If you're insurance, that's no guarantee that you're going to get a referral. So when it comes to marketing and sales. Sales, uh, doing the evals quickly and things like that, but marketing, where you get enough clients, uh, referrals, your role in it. Isn't necessarily to be really good at social media. It has to be really good at understanding what your target market wants. That target market is the scheduling nurse, right? So guiding the business marketing and sales is getting the business, doing the business. I'll drop off a little bit, but I will say doing the business. Which is what you're already good at is [00:14:00] really having processes so that you repeat it. That's oftentimes guided by, by rules, uh, with insurance company is guided by software, uh, that if you have a practice management software, it kind of creates those for you. So that takes us to the fourth one, guiding, getting, doing, and administration administration. I tell people, Uh, who have started their own business. I describe administrative matters as all those things you had never even heard of when you started business. It's finance, it's bookkeeping, it's HR issues, it's IT issues. You know, your software management, it's legal issues, it's regulatory or I'll call it regulatory ASHA. You know, what do you have to do? Schedule, credentialing, insurance. It's just like, oh, my gosh, it's a never ending stream of things, uh, it's corporate governments. Do you have an [00:15:00] operating agreement in your, in your new LLC? And are you current? I don't know. Everywhere, but where we have a, it's not really a franchise tax, but you have to pay a fee every year. Nobody tells you to pay it, but if you don't pay it, you're out of standing. And if something happened, you're in trouble,  Kate Grandbois:  right? I recently learned that I was supposed to have a business, several very specific business permits in my town hall. I mean, here in Massachusetts, we do everything by individual town, not county. And I was registered with the county. I was registered with the state. And it came up that because I do work at home and I have a home office that I was, you know, nobody had ever told me, but I, and I came across this information accidentally and panicked. I had to write my 40 check. I had to go get this application notarized. It was like a whole 18 hours of, of panic around this one. This one piece of paper I hadn't filed with my town clerk. So there are so many loose ends like that in my personal experience that have come [00:16:00] up. And I, I really appreciate taking a minute to highlight all of these things because I feel so many of us and I'm only speaking for myself and my colleagues, I suppose, but we go into this business for the primary purpose of doing, doing the business, the category of doing the business, doing the clinical work. Working with families, doing the counseling. Um, and I think many of us, we go into private practice, we're solo preneurs, we get some of the basics ironed out, we have our malpractice insurance and some things that are obvious that we know about. And then as business grows, it becomes this snowball effect of, Oh, but there are all of these other things that I. That I forgot to do, or I think I need to hire someone. Is it an independent contractor or an employee? And how, how on earth do I do payroll? You know, it becomes this domino effect of questions. That's extremely overwhelming. One of the things I loved about your book, and one of the things I love about this, this explanation is that it is [00:17:00] compartmentalizing all of these loose ends into these very easily digestible buckets,  Martin Holland:  I'll call them. And that's, that's why I came up with it as much for me as my clients. But my, it resonates with my clients. They know what we're doing and you're always, I'm always cycling through all the, is we've got an issue. Is that a leadership issue? Is that a culture issue? Is that a sales issue? Is there a marketing issue? Is it, we ran out of cash. Is it, you know, you mentioned insurance, which you got all the ones you need. How do you remember? To renew them next, next year, right? Hopefully your agent calls you, but how do you, I mean, getting organized as a whole kind of a, it runs through all four areas, but how do you remember that? How do you remember to pay that little franchise fee and that town hall fee? And I'll just give you one story, uh, because if people need to be terrified. Kate Grandbois:  It's being a good terrified. It's healthy fear. [00:18:00]  Martin Holland:  It's a healthy, healthy fear. But I have a lady, she's not a speech path. She's in the home care business and she's the most wonderful, kind, Generous person you will ever meet. She is all give, but she decided on her own that she would do her workers compliment comp through her 10 99, have her 10 99, uh, workers, which really aren't IRS issue. She would have them get their own workers comp. Well, she called me one day and she'd received a letter from the Oklahoma, whatever Bureau of workers compensation. And it announced a fine of 1, 470, 000 because she was out of compliance. And this lady's sales were 500, 000 annually. We negotiated that down to 43, 000. Oh my God. My stomach just  Kate Grandbois:  dap, just  Martin Holland:  dipped out. Yeah. That's my point. That's my point. What you don't know about these [00:19:00] things can really get you. I am not trying to scare people off from going into business. I think we had a discussion before we got on that, talked to people I know, I said, had you known everything that you were going to have to do, would you have ever started your business? And the honest answer was no. Well, I certainly don't want that. I want people who are so inclined to do it. Business owners are the backbone of the country that everything originates with small business owners, in my opinion, but I want them to go in and not have the terror of receiving a letter that finds you for over a million dollars. And by the way, the last. Sentence of that letter was, please enclose your payment or please return your payment in the enclosing of low.  Kate Grandbois:  Oh, that's hilarious. And  Martin Holland:  absurd. Yeah, we got it worked  Kate Grandbois:  out. So any anybody who is listening or any speech pathologist who is [00:20:00] interested in opening a small business or is already operating in a small business. Listening to this episode. I think you mentioned this maybe before we hit the record button. You also say this in your book, no one is good at all four of these things out of the gate. So if you, you know, if you're listening and you have this pit in your stomach, I don't know these things. That's okay. I think that that's, you know, we go into these business to do the business, to work with the work with our clients and patients to, um, maybe have more flexibility, maybe to be self employed because we can operate our own schedules. There are a lot of wonderful things that come with being self employed. And one of the points that you make in the book that I really appreciate is when you identify an area that is a weak spot, there are things you can do to mitigate those, those, those weaknesses.  Martin Holland:  Absolutely. And almost universally, or at least the place to start is get help. And I'm not pitching business coaching here. I'm pitching, [00:21:00] if you're in business and you don't have a CPA, then you need to get one this afternoon. Right. And there are, I talk about different kinds of CPAs or CPAs who just do taxes and they're not of that much help. You do need to pay your taxes, but there are CPAs who will help you keep good books so that you know, if you made money last month, , I make a grand statement, but I'll stick by it. That 90 percent of the businesses in the United States do not know if they made money last month or last quarter, or even last year. Until they get their tax return. And if says some number that they don't understand because it has depreciation and cash basis and all these things, you must know, you must know. If you're making money and if you're not, you must know what to do about it. Specifically, is it in our area? My wife's [00:22:00] issue is not finding referrals. We have a huge backlog. It's finding the therapist, right? So there's always something, but you need to know what it is that's holding you back, fix that and then move on. And if you don't know how to fix it, get an advisor and the minimum, uh, you You should have a bookkeeper, which is not the same thing as a CPA, somebody who can help you with HR, like the lady with a million dollar fine. If she had had an HR person, she had known you can't do that, which she just decided to do. Uh, you need somebody who can deal with benefits, uh, somebody who can help you. With leadership and developing a culture and recognizing what those things are, but you are exactly right. Nobody is good at all of those things. And even if you're that 1 in a 1, 000, 000, who [00:23:00] is pretty good at him 1, it's not the best use of your time in 2, you can easily get somebody who's a lot better. If you can keep books, you can for 3, 400 a month. It's somebody who can do a much better job than you.  Kate Grandbois:  I think this is, you know, something that I want to expand on a little bit, I suppose selfishly from my own learning experience. Before I launch into my, my comment though, I want to say that our first episode that we did went deep into accounting and how to use your book. So if you are listening and you want to learn more about that. Please feel free to go earlier into the season. Um, in our episode with Martin, I believe it's called, you can't run your business from your cell phone. So go back in time and your podcast player and find it and to learn more about, um, accounting and using your books to make sure that you know, if you're making money. The second, the comment that I was going to make selfishly about my own learning experience is that delineated, that [00:24:00] deciding factor. So that moment where you're trying to decide whether or not to hire someone and go get help, right? Because help costs money. And as you're growing a very small business, at first, many of us are doing, we're wearing all the hats. So we'll wear the clinician or the business owner or the administrator or the marketer or the salesperson. We're the HR compliance officer. We're, you know, we're, we're making all of the decisions, particularly as solopreneurs. And at some point the hats need to start coming off because nobody can do all the things forever, a hundred percent of the time and trying to decide when to make yourself better at something or when to hire out or bring in a specialist and how to make that decision. Can you tell us a little bit about  Martin Holland:  that? Sure. Two, two things. One, you can hire somebody without having to hire them, right? In other words, you can get somebody to help you with marketing without making them an [00:25:00] employee, right? Or you can get a rental bookkeeper. I mean, I have a number that I've put together who work with a lot of my companies and they only cost them some fraction of what an employee would. Would cost, um, but you're kind of bringing me to the, uh, point we would like to talk about is how do you get started on this? Okay. And I described you before we got on, you just draw a line on a whiteboard and put 3, a horizontal line, put 3. Vertical lines in there, and you've written out 4 quarters for the year. Right 3 month quarters, and you can sit and say, you know what? After listening today, I haven't emphasized it enough, but if you're not there, you need to start with good books. Okay. So, uh, everybody should start with books. If you don't have good books, you need to have, well, for the first quarter of this year, the next three months, whatever, wherever we start, I am going to do something about [00:26:00] books. I'm going to call a CPA. I'm going to call a bookkeeper. I'm going to find something out and I haven't spent a penny yet. And what else could I do? I can buy books, meaning paper, audible books, such as mine. I can watch YouTube videos. I can go to webinars. And so what I do is commit a little bit of time each week for three months to learn about books so that your role in the world. As the owner is very seldom the one who does it, your role will be to recognize if you're being well served. Okay. Marketing is a key place for that applies. There are countless people. You probably get inundated I do every day. They're going to do your SEO, or they're going to do your social media, or they'll design a website. And there's no doubt they can do all those things. But do they generate leads? And I mean, I measure marketing. [00:27:00] You can measure marketing and bounce rate and hits rates and all this. I measure markets. Have they brought in for sure identifiably, have they brought in more money than they cost me? If not, I'm going, eh, well, it's brand awareness. I go, you know, the best brand awareness is a satisfied paying customer doing referrals, right? So you can take three months and say, I need to explore this idea of marketing. And I can recommend some books and read, read a book or two. And matter of fact, I just have to mention Donald Miller marketing made simple, so the best there is he is by that book and do what it says. Okay. And we'll put the link  Kate Grandbois:  in the show notes.  Martin Holland:  Yeah. Yeah. He's just, he's brilliant. Oh, I can learn some things about marketing and I can learn to recognize what Martin said. The most important thing is to whom am I speaking with my marketing? So why, you know, why [00:28:00] advertise to a mom's group, although they, they matter until you've advertised to that scheduler at the doctor's office. Again, presuming that you're, Need referrals for insurance, right? So you spend three months thinking about that stuff and take a step get an advisor Maybe you're maybe you are doing some of it yourself. Maybe you take doughnuts to the doctor's office those kinds of things But do that and concentrate on that for three months. Then the next thing might be whatever the next thing  Kate Grandbois:  is Again, not to keep using the analogy of a beach read, but I really love how compartmentalized this is, this approach is in terms of professional development, identifying something that you're, that you're not great at, giving yourself a goal. You know, giving yourself a finite period of time, breaking things up to feel slightly more manageable. So instead of, Oh my gosh, I'm so overwhelmed. And believe me, as an entrepreneur, as a business owner overwhelmed, sometimes just [00:29:00] becomes your baseline, just becomes like your status quo, because there are always so many things going on. But being able to compartmentalize things and break it down to more digestible, approachable goals is a really wonderful strategy and it makes things feel so much more  Martin Holland:  manageable. There's you can only, you know, there is no such thing as multitasking. I've read a lot of research on that. There's fast switching, but when you've got when you've got to, I mean, that's literally what they found. You cannot. Well, nevermind that's another subject you cannot do all these things. I just mentioned, you can write out all the topics I mentioned. You can download that. Advisor and mentor checklist mentors checklist from my website and have them there, but you pick one, you pick one and you get better at that one. And you still have to do your speech, your [00:30:00] therapy, and you still have to pay the bills. Yes, you do. You still have to do that. It's the chaos of transition. But pick one and get better. And then pick another one and get better. And if you use my quarterly thing, by the end of the year, you've done four major things. And you look back and you go, wow, I know, I am a different person. And I thought I than I was at the beginning of the year, there's a lot more. I can learn about marketing. There's a lot more. I can learn about books. There's a lot more. I can learn about time management, which I threw up under the leadership thing. There's a lot more. I can learn about how to maintain a healthy culture, but you are making progress. You're always looking for the short stave in the barrel that limits how full it can get. Once you've shorn one up, go look for the next one. Work on that one. But constantly making progress, one thing at a time. Kate Grandbois:  So one of the things that I have found to be really helpful in my own development as a [00:31:00] business owner, and I don't know if you have comments of, you know, something to say about this. When you're in that early development phase, learning something for the first time, trying to get better, better at marketing for the first time. That's just the example I'm going to use because I'm still terrible. I'm still terrible at it. I think there are a lot of very low cost things you can do to teach yourself. You've already mentioned YouTube videos, um, having some good books at your fingertips, something, some sort of self study. Um, there's some continuing education about these kinds of things in our fields. I personally have found looking outside of our field to be most helpful in terms of learning about business. But the other thing that I've found is you, Loosely mentioned coaching, coaching and consultation. So I, for example, earlier in my career, knew someone through a friend who was an accountant and I didn't necessarily have the capital to pay for a weekly bookkeeper, to [00:32:00] pay for a monthly bookkeeper, but this lovely accountant, I paid her for an hour of her time or two hours of her time. I can't remember, which was much lower cost, lower barrier of entry for me. And she sat down with me. with my books for an hour and taught me some there. It was a class of one on one. She taught me a couple of things about how to use QuickBooks. She taught me some basic fundamentals. I didn't quite understand all of it, but I got, I had some, some guardrails. I had some, for taxes, definitely don't XYZ. I would definitely do XYZ, some black and white rules I could follow just as guideposts until I got to a point in my business where I could hire a weekly bookkeeper or could hire a CPA. How do you feel like that's a reasonable  Martin Holland:  suggestion? 100%. The other thing that you have is a phone number and a relationship, right? So something happens, you go, whoa. You have somebody to call. That's a good point. They might charge a 75. They might charge you 100 now or something, but that's better than a million dollar [00:33:00] fine. HR is that way too. People make HR human resource decisions all the time. I'm going to hire him. I'm going to do this. I'm going to do that. And I'm going to do that. Well, you know what? There's just a whole lot of things you can't do right now. And it behooves you to know what they are. So maybe you get a stab at a, an HR manual, you know, something very bare bones, but you have a relationship. And if you've got an employee who is presenting issues, you have somebody to call rather than just say, well, I'm going to fire you. That doesn't always go that far, but you have somebody to call. So build those relationships. Another one is a banker. Maybe you don't need money or don't anticipate needing money or scared to borrow money, have a relationship with a banker who can tell you, yes, I can give you a line of credit if you need that because of cashflow issues. What's cashflow issues? [00:34:00] Well, we're going to call that bookkeeper back, right? Everybody knows what that is, but maybe they don't know how to track it and so on. But, uh, yeah, it's, it's. Establishing the relationship, picking somebody out. That's something you should do in every one of those quarters is who can help me with this. Can I take somebody to lunch? Can I buy an hour of time and say, can you tell me what things I need to work on? The unfortunate thing is the 1st person you pick all the time may not be the right  Kate Grandbois:  one. I am definitely around. Yep. I've had to shop around a lot. Um, I think another. Another thing I found, I don't know if you have. Anything to say about this, but working with someone who's local. So I know, for example, here in Massachusetts, we have a lot of regulation around a handful of things. We have very strict laws on what constitutes an employee versus an independent contractor. And it's very different in New Hampshire, which is, you know, you know, An hour and a half drive from [00:35:00] my house So I think there is also something to be said for reaching out to a local bookkeeper accountant attorney somebody who knows What regulatory body bodies you're beholden to? And I say that only because you know now in our digital age with electronic medical records and electronic payroll systems There are Many blanket companies that will give you a service for a low cost subscription and you get quote, you know, HR HR advice at the click of a button, but you're getting an HR specialist who could be in a completely different state who maybe isn't well versed in the nuances of the regulatory bodies in your in your local jurisdiction, for example. My, the, one of those companies would never had known, have known that I needed to go drop off that duly notarized, tiny piece of paper to my town clerk after being in business, you know, so I, I think there's something to be said for that too.  Martin Holland:  Yes, and I, uh, certainly do a lot. I mean, more [00:36:00] than half of my, Coaching sessions are around the country and on zoom and so on, but I like a personal relationship. I really do. You can call up and say, man, and you anyway, I, that's still me. I think a lot of people are still that way too. I'm not dealing with a computer screen and a website.  Kate Grandbois:  In our last couple of minutes, I wonder if you have any additional guiding principles or words of advice for anyone who's listening, who's maybe hearing about the importance of fundamentals of business for the first time. Martin Holland:  I'm going to quote it, quote a guy. Who's, who's book I read recently, uh, he's talking about contractors, but he said, these things that we've just touched on today, you must do, okay, you must do them. You don't have to do them in one day, but you have to make that quarterly progress. [00:37:00] You must do them if you are unwilling to do them. Don't be in business. Okay. That's a harsh message and I don't want to run anybody off. But by the way, if me saying that runs you off, you probably weren't going to make it through the there are 30 million businesses in the United States. So it can be done. It's tremendously worthwhile in my, but be aware of these things. So you don't get ambushed and then do them. Because otherwise, the way the guy described it, whose book I'm quoting, he said, everybody wanted to be out for football because you got the uniform. But if you weren't willing to do the work, you weren't playing. Right. And said, you're just better to not do it. So anyway, that, you know, everybody thinks it's freedom. And, you know, I get set my own hours. I set my own wages. And I take, I had somebody, uh, tell me, oh, you and Diane both own your own businesses. That's so great. You can take off 6 months a year if you want. And [00:38:00] we were at a football game in another state. And both of us had our computers out. Right. And I said, you know, No clue, but we love it. We love it. Um, most of the time, sometimes it's, it's terrible on the overall it's, we love it. So take the time to figure these things out. And educate yourself and do not expect to become an expert immediately, but educate. Do you've heard what you've heard about bookkeeping and break even? Maybe you'll start hearing those words. You'll hear people say, wow, and you'll, you just grow like a weed. So I don't know if that was helpful or not, but that's  Kate Grandbois:  my closing. It was very, very helpful. And I, every time I speak with you, I feel a wave of, of inspiration that, you know, we can continue to learn and grow. And for those of us who are business owners, this is professional development. It's outside of what we typically think of in speech therapy as professional development. We think so much about professional [00:39:00] development in a clinical sense. Learning a new therapy technique, reading about a new research article in some sort of assessment method. Um, but as business owners, this definitely is a different kind of professional development where we're constantly learning and growing and improving our skills. And I just really appreciate you. And I can't, I can't say enough about your book. I know I'm like a broken record at this point, but I appreciate it. Thank you. Anybody who is listening, all of the references and resources that we mentioned during today's episode will be in the show notes as well as on our website. Um, a link to Martin's book will be on our website. And as a matter of fact, you have a blog post, um, and free download about this exact topic available on your website as well. So if anybody would like to print it, save it. We will link, um, we'll send a link over to your website for that as well. Thank you again so much for being here. It's always a pleasure to [00:40:00] have you.  Sponsor 2 Announcer:  Thank you again to our corporate sponsor, Practice Perfect EMR. Billing, scheduling, documentation, patient communication, business metrics, and more. Practice Perfect EMR specializes in speech therapy practices like yours, connecting everything. Check them out at www. practiceperfectemr. com. Outro Kate Grandbois:  Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study. Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com thank you [00:41:00] so much for joining us and we hope to welcome you back here again soon. .

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 . [00:00:00]  Intro Kate Grandbois:  Welcome to SLP nerd cast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy  Amy Wonkka:  Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each  Kate Grandbois:  episode of this podcast is a course offered for ashes EU. Our podcast audio courses are here to help you level up your knowledge and earn those professional development hours that you need. This course. Plus the corresponding short post test is equal to one certificate of attendance to earn CEUs today and take the post test. After this session, follow the link provided in the show notes or head to SLP ncast.com . Amy Wonkka:  Before we get started one quick, disclaimer, our courses are not meant to replace clinical. We do not endorse products, procedures, or other services mentioned by our guests, unless otherwise  Kate Grandbois:  specified. We hope you enjoy  Announcer:  the course. Are you an SLP related [00:01:00] professional? The SLP nerd cast unlimited subscription gives members access to over 100 courses, offered for ashes, EU, and certificates of attendance. With SLP nerd cast membership, you can earn unlimited EU all year at any time. SLP nerd cast courses are unique evidence based with a focus on information that is useful. When you join SLP nerd cast as a member, you'll have access to the best online platform for continuing education and speech and language pathology. Join as a member today and save 10% using code nerd caster 10. A link for membership is in the show notes Episode Kate Grandbois:  Hello, everyone. Welcome to SLP Nerdcast. We are here today to talk about a topic that we have mentioned many times on the show, but we have two expert guests here to walk us through a lot of the detail. Welcome Danica Pfeiffer and Helen Long. [00:02:00] Thanks so much for having us. We're excited to be here. Thank you, Danica and Helen. Amy Wonkka:  You are both here to discuss ways to access research beyond the paywall. I'm super pumped about this topic, um, but before we get started, can you please tell us a little bit about yourselves? Sure. So my name is Danica Pfeiffer. I am an SLP and an assistant professor at Old Dominion University. And my research is in enhancing children's early language and literacy skills by building collaborative school based partnerships. Danika Pfeiffer:  But I'm also a volunteer with CS Disseminate with Helen and that's a group dedicated to promoting research accessibility in our field and so really excited to be here today to talk more about that. Yeah, and I'm Helen Long. I'm a postdoctoral researcher at the University of Wisconsin Madison. Um, my primary line of research studies early vocal development in kids at risk for [00:03:00] cerebral palsy. Helen Long:  Uh, and I'm also a collaborator with CS Disseminate, um, and I'm happy to be here. We're so happy to have you. The research practice gap is a massive problem, uh, that we've addressed in a few other episodes, but we've never had the opportunity to talk specifically about the paywall problem and how difficult it is for clinicians to access research. Kate Grandbois:  So we're really excited to get into this before we do get into this conversation. I do need to read our learning objectives and disclosures. So I will get through that as quickly as I can. Learning objective number one, describe five free and legal strategies for accessing research articles. Learning objective number two, identify common myths about accessing research articles. And learning objective number three, explain the different versions of research articles that authors may share. Disclosures, Danica's financial disclosures. Danica receives a salary from Old Dominion University. Danica also received an honorarium for participating in this [00:04:00] course. Danica's non financial disclosures. She is that Danica is a collaborator with CS disseminate and open CSD groups of volunteer CSD scientists and clinicians passionate about bridging the gap between scientific research and clinical practice, Helen's financial disclosures, Helen receives a salary from university of Wisconsin, Madison. Helen also received an honorarium for participating in this course. Helen's non financial disclosures. Helen is a collaborator with CS Disseminate and OpenCST, groups of volunteer CSD scientists and clinicians passionate about bridging the gap between scientific research and clinical practice. Kate, that's me, my financial disclosures. I am the owner and founder of Grand Bois Therapy and Consulting LLC and co founder of SLP Nerdcast. My non financial disclosures, I am 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 Amy, that's me. Amy Wonkka:  My financial disclosures are that I'm an [00:05:00] employee of a public school system and co founder of SLP Nerdcast, and my non financial disclosures are that I am a member of ASHA Special Interest Group 12, and I participate in the AAC Advisory Group for Massachusetts Advocates for Children. All right, on to the good stuff. Uh, Danica and Helen, as, as somebody who has personally struggled to access articles that are behind a paywall, I'm really excited to learn about free and legal ways to access this information. Uh, before we get into that though, could you start us off with just a quick overview of some of the current problems and misconceptions related to accessing research? Danika Pfeiffer:  Sure. So I think one of the big problems that our group really works to try to help solve is that it takes on average 17 years for research evidence to be used in clinical practice. And this is So much time. Um, and it's really unfortunate because in the research we find that these interventions are working and [00:06:00] we can't, they don't get implemented for so many years. And so that's one of the biggest problems that our group is trying to help tackle, but we really need all of us clinicians and researchers to work together to tackle that one. We also know that there's a lot of misconceptions around publishing in general, and so, um, one of them is that Researchers are not allowed to share their work for free. Um, there's a misconception there that clinicians are not able to reach out to researchers to ask them for their articles when they can. We actually can, as researchers, share our work. If clinicians email us and ask us for a copy of our work, we can send it to them. Um, and so that's one of the things that we'll get into a little bit more today. Helen, do you want to share some other misconceptions? Helen Long:  Man, that was like a really great summary. Um, yeah, I think a huge misconception is [00:07:00] that, um, gosh, I think you actually covered it. I don't know. I think I'm, I'm definitely going to skip ahead because I'm, I'm thinking about emailing the corresponding author, but there, there seems to be just a misconception about, um, Like if if you can't access the article directly through the publisher, then it's just unavailable to you. And I think, like so many of our suggestions that we'll have for you today are that that's just not true. And I think one of the easiest ways to do it is emailing. Uh, the corresponding author, which you can usually view on the publisher website or the first page of the PDF, um, and don't be afraid to do it. Kate Grandbois:  I just want to second that because I, I mentioned this to you all before we hit the record button, but as part of this little nerdy project, we have to cold call and reach out to people way more frequently than I do in [00:08:00] my personal life. Um, and I am repeatedly. Surprised by the kindness and enthusiasm that comes with the reply that I receive. So. I'd say eight times out of 10, I get not only a reply, but, oh, and here's another article that you might like, or I've cc'd my colleague on this email who does adjacent research that you might be interested in. There is a tremendous amount of transparency and enthusiasm in my, in my experience and both Amy and ours experience about what kind of information you can get just when you reach out. Um, I think that there is. You know, this conception from the clinician's end that researchers are sort of, they're exclusive, they're elusive, they're, but they're people, they're, you know, people just like me, you know, it's like a celebrity kind of thing. I, and every single piece of contact that we've made with a researcher, the response has been warm and welcoming. So I [00:09:00] just want to second that, um, if you're listening and that is a conception that you have, give it a shot. It's, it's really worked out well for us. Yeah,  Helen Long:  yeah, I just I bring that one up first because I think there's just a misconception that if you email the author then they're like going to be offended in some way that you're wasting their time, but it's like, so the opposite of that. This is one of the biggest interests in their world and it's so exciting. Knowing that someone is interested in your work and they want to apply what you've written about into practice and like these are the emails that we want to be answering every day. So do it.  Amy Wonkka:  I think connected with that is also something that I didn't realize until I was, I was involved in some work in this area, which is. The authors aren't getting paid if you pay for the article, right? Like they're not getting paid. And when you see those articles that are open access [00:10:00] articles, the authors had to pay for that. I was  Kate Grandbois:  just, when I was just going to say this, yes,  Amy Wonkka:  this is another, like you're not skirting around the author getting paid by you buying the article. And emailing them, they're not getting paid at  Helen Long:  all. I  Kate Grandbois:  was just going to piggyback on, just to piggyback on what you said, and I'm sorry I interrupted you, but it was astonishing when Amy and I had the opportunity to do some of this work and collaborate with publishers and work on a piece together, a manuscript. The publishing process. Was very in order to publish something as open access was going to cost money out of the author's pockets and I have had people, you know, I have heard some of the misconceptions before that if a piece of work isn't published as open access, then the authors had some choice in that, right? Like they're going to profit, um, but it's the actual, it's completely the opposite. Can you talk to us a little bit more, like, just a peek behind the curtain, [00:11:00] what is that process like if an author wants to publish something as open access?  Danika Pfeiffer:  Yeah, so when we start a research project, one of the things that we do right away is choose what's the potential journal that this piece, this study could fit in, and so when we are deciding where do we want to submit this work and where do we want to write this up to go, We, one of the big things that we look at is, is there an open access fee, or there's different kinds of open access in some journals. One in our field is teaching and learning and communication sciences and disorders. They do not charge authors to publish their work open access. So it's completely free for researchers and it's completely free for clinicians. So you can go onto their website and find all of the articles there for free. So, When we're deciding where to publish, that's something that we definitely consider. Other places have those [00:12:00] article processing charges, is what they're called, APCs, and those can be thousands of dollars. So usually if you don't have a grant that's funding your work, then that's not really doable for many researchers. Some researchers are starting to put them in their startup packages when they first start at a new university to try to cover some of those costs. But otherwise, it's usually just grant funds that that money comes from. So especially for new researchers in the field like myself, we don't have thousands of dollars to be putting towards publishing our work. Kate Grandbois:  That makes a lot of sense. And, you know, there are, there are a lot of people. Well, maybe not. I'm actually not sure how many, but there are individuals that don't have any grant money who are publishing like Amy and myself. And in those instances, if the manuscript that you've Written and you're shopping around for journals does have a fee. When we had our conversation with our coauthors, we were discussing taking it out of our own pockets at one point, [00:13:00] because there really aren't, there is a whole web of industry around this. And if the journal doesn't have. A no fee or low fee open access entry point, then that money does need to come from somewhere or clinicians have the option to access it through other legal ways if it's not already open access. Can you tell us a little bit about other ways, other legal ways to access an article if it is behind a paywall? Danika Pfeiffer:  Yes, so we have compiled a few different ways that clinicians can access this research. One of them is going through the ASHA journals. So if you're an ASHA member, then you can access these articles for free, which is great. But sometimes when you go onto the website and you So if you are looking at an article that's been published in one of the ASHA journals, you'll see that it immediately says no access, and something that we just want to remind you is that you have to [00:14:00] log in. So make sure that you have put in all of your login information, because if you haven't, then it will tell you that you can't access the article. So it's really easy. All you have to do is log in, and then you have access to all of the articles in that five different ASHA journals, which is really great. Um, another. One that you can use is called Unpaywall, which is a browser plugin. So all you have to do is you go into the Unpaywall website, and it's an online database that has over 47 million open access journals. So they scour the internet, they find all of the free versions of articles that have been published. And when you go on the website, you just Click, um, to add this browser extension to your Chrome browser, and then when you're searching online for an article, it will show this little green icon that shows you if there's any free versions available of it online. It's really quick, really [00:15:00] easy, and on their website, they report that 52 percent of users of this unpaywall extension can access research papers for free, so they do a lot of digging themselves, which makes it much quicker for you to know if there is any of these free versions available, and it helps you find them really quickly. The next one that I'll share is something that I think many of us are pretty familiar with using Google or Google Scholar. So Google Scholar is a great place to find research. It's a free search engine similar to Google, but it can help you find those academic papers. And when you go on to Google Scholar, you can either type in the article title or the author's names, and that can help you to find the article. And once you've found the one that you're looking for, on the right hand side in the column next to the article's title, sometimes you'll see a link that says PDF. And that means that [00:16:00] there is a free PDF version that has been linked in Google Scholar for you. So you just click on that link PDF right there, and you can pull up that free version. If that doesn't work, you can try looking to see, when you look at the article title, it'll have the author's name linked to it. And if the author's names are underlined in blue, that means that they have a Google Scholar profile. And a Google Scholar profile is for academics, and it basically compiles all of their work in one place. So if you click on their name, and it will populate all of the work that they have done, all of their articles, all together on one webpage. And that's another place that you can look to see if, um, there's a free version of the article there on their Google Scholar profile. What you'll often see on Google Scholar, too, is that it might say underneath the article title that there's several versions. So it might say seven versions of the article [00:17:00] are available. So you also want to check there, because it might be that there's several paywall links, but then there might be a free version linked under that as well. So you want to definitely try all of those options, kind of click around and see if you can find a free version that way as well. That's awesome. Um, as far as the finding the different versions of the articles, I know before we hit record on here, you had all mentioned that there are actually all these different types of articles, which Was sort of new information to me. I don't know if you want to talk a little bit about that too. Amy Wonkka:  So part of what somebody might see on that Google Scholar is a few different types of articles. Helen Long:  Yeah, so one of the things, so kind of going back to our earlier conversation of when authors are deciding on what. journal to submit your paper to. So I'm going to talk just a little bit through the process of submitting your articles, [00:18:00] um, and then just the pipeline that it goes through because this relates to all these different kinds of articles that might be available to you as you are looking through these. You know, new and exciting ways that, um, will make research available to you. Um, so once authors submit their paper to journals, Um, more and more journals are allowing paper, are allowing authors to share their articles as submitted versions. These are also known as preprints. There's also some, like, a lot of other terms that you might see floating around. I think submitted version and preprint are the two most common terms. And preprints are becoming increasingly common. For authors to share their work before it's been peer reviewed because the peer reviewed process just takes so long. I mean, some, it usually doesn't take [00:19:00] less than two months, but sometimes it can take up to a year or more. I've had a paper that was under review for two years. because it's just sometimes takes a long time to find a qualified peer reviewer to, you know, have the time to peer review your work. And so one of the ways I think it was, um, it really started growing in, uh, the field of psychology. But people started sharing their, um, submitted versions of manuscripts before they were peer reviewed because of this peer reviewed problem. Um, and so there are a growing number of repositories online that people are able to share their pre prints. So again, these are the non peer reviewed versions of papers that are currently under peer review. Um, Just so that people can have access to these papers, at least in an initial draft. [00:20:00] Um, and of course, you know, this is not, I think there's a little bit of a misconception around preprints that, um, some people are worried that people are going to stop trying to get their work peer reviewed at all. And I don't think that's what's happening at all. And it definitely shouldn't be what's happening. Um, but the point is that you can at least view a first draft of the work. While it's in the process of being peer reviewed. Um, and then the goal, of course, is that once it is peer reviewed, uh, then once it's accepted for publication, that then becomes the postprint or the accepted version of the manuscript, and then you end up replacing your earlier preprint version with that accepted version. So now the version that's available of the manuscript. If you've shared it on one of these repositories, um, that is now the peer reviewed version, um, that's available and, and that one you can view with, um, a little bit more confidence than the pre print in terms [00:21:00] of, um, you know, this has been peer reviewed, it's been vetted by So, other experts in this area. Um, and so the accepted version is kind of a unique version where it's the exact same copy as the published PDF, except it's just not as pretty. Um, it's just another like double spaced Word document that's kind of boring, but it's the exact same words and it's the exact same manuscript as the published version. And it's the accepted version that, um, authors have a lot more freedom. For most publishers, I mean, of course, it really depends on what journal you go through. Some are a little more strict with what authors can do with accepted versions, but more and more, um, it's really only the, the publisher PDF that you can download straight from the website. That's the version that the publishers own the copyright for, and that's the version that they're able to pay wall. But for most publishers, [00:22:00] authors can share their accepted versions just like they can their submitted versions. I have a question about the preprints. So if, let's say, someone were to find a preprint in one of these websites or through Google Scholar or wherever they find it, To what degree of caution does someone need to approach a preprint. Kate Grandbois:  In other words, we know that the peer review process is a gold standard of science. We know that once something has gone through the peer review process, many eyeballs have gone through it, and it really is as good as it could be. To what degree does someone need to be very wary of a preprint? In other words, is there a chance there is a preprint out there that is someone's musings and ramblings? That is very far from, from something that would be accepted through peer review. Yeah, I do think clinicians and, and researchers too. I mean, I think anyone who's reading [00:23:00] a preprint who is knowingly reading a preprint should absolutely use an extremely critical eye. Um, but very much I think, uh, you know, the same critical eye that you would read, even just a regular peer reviewed article where you're judging the quality of the article is this something that I think I can legitimately apply to my Clinical practice. Helen Long:  Um, but, but I do. I absolutely think that pre prints should be judged even more critically because like you say, it could very much. It could very well be just a using and rambling and extremely biased piece of work that maybe all of those. Things will be weeded out by the time the peer review process is over. Um, you know, you know, it's just a reflection of the unfortunate problem with the peer review process right now is that it's all in the hands of. Volunteers and just reviewers who are, you know, yes, this is a piece of work that interests me and [00:24:00] that I have no relationship with these people. And I want to see this piece of work. out there, and I want to spend time reviewing this work. And, um, it, unfortunately, that's, um, really reliant on a lot of volunteers, just kind of, Giving their time to support the advancement of science, which is, of course, a necessary part of our job. But, um, yeah, I'm not sure if I answered your question. No, you did. Kate Grandbois:  You did. It makes me it brings me to another question about the self archive process. So I think which I think you mentioned briefly, um, I wonder if you could tell us about the self archive process and whether or not. Um, which is essentially for those who don't know when an author publishes on their own website, um, or makes it independently available from a publisher. And I know you'll walk us through those details and correct me if I'm wrong, but to what degree a self archived process needs to be approached with caution? [00:25:00] That's a great question. So self archiving is something that researchers can do in a few different ways. And it's just a way of sharing our work more openly, more effectively, more quickly with clinicians and others that want to read our work. Danika Pfeiffer:  So one way that we can do that is putting establishing for ourselves our own personal website. So we can create our own website, or sometimes if you work at a university, you should have a webpage that's established for you. Sometimes, if you would be surprised, we aren't able to access our own websites that are available through our university, and someone else actually manages them. So that's not a great tool for some researchers, which is why they might establish their own personal website. Um, or you could, at a lot of universities, have repositories, which is the central place for uploading your work. And that way, um, usually, [00:26:00] if it's within your university, then other researchers within your university can access your work very easily. Um, there are more central open, um, repositories as well, like the Open Science Framework. There's a ton out there of places where you can also share your work, so lots of different places. Sometimes it's just hard to find the information, but again, if you just plug in that information in Google, Google Scholar, usually they will link for you and you can easily get there. So when we want to self archive our work , there's really a lot of steps that we have to go through. So first is figuring out what the journal's policy is on self archiving. So each journal has a different policy. So as a researcher, when I wanna share my work on my personal website, I first have to go. to the journal's website to figure out what is their policy. And this will outline which version of the work I can share, as well as when I can share that work. [00:27:00] So some journals place what's called an embargo on sharing the work, which means there's this set period of time after the article has been published by the publisher that I cannot share my work. So they want to make sure that people are going on to their website and purchasing the article before I share it myself for free. So often that's six months. It could be for some journals I published in a year, maybe two years before I'm allowed to self archive and share that free version on my own website. So we have to check and make sure that we're following those policies for each journal that we publish in. And so that can be very time consuming, which is why a lot of researchers choose not to do this process because it's very time consuming. You almost need someone, maybe a research assistant who is just dedicated to self archiving and helping you guide, guide through that process. But once you figure it out, When you can share it, you also want to look at which version you can [00:28:00] share. Oftentimes, that will be like Helen talked about earlier, the accepted version. That's the unformatted but peer reviewed version of the manuscript. That's basically just a Word document. And then we put a license at the top, which is just really a disclaimer to say that this is the accepted version. It's just unformatted and we're following the journal's policies for sharing this work. And then we just upload that onto whichever website, our own website or our institution's website that's been created for us so that clinicians or anyone can easily access the work. So to sort of reflect on this process, it's less likely if something that is labeled as a self archived manuscript or article, less likely for a clinician to stumble on that and have it be like a blog or someone's, you know, ramblings and musings and biased work. Kate Grandbois:  Is that inaccurate? Is that an accurate description? Yes, and it will say [00:29:00] at the top which version it is. So it will say exactly where it is in the peer review process, so it'll be very clear. And if there's any questions, just reach out to, to the author and they'll be able to tell you. But it should say right at the top there, which version it is. I have to say, listening to all of this, I'm getting a lot of frustrated feelings about the publishing industry, who is really profiting off of a lot of free labor across this entire process, but that's probably a whole other episode. I'll just leave that there for everyone to, to think about. Um, what are some of the other. Processes through which someone might be able to access an article legally that's behind a paywall. Do you have any other suggestions? Yeah, um, we mentioned emailing the corresponding author earlier. I think that is probably the easiest way if you've stumbled across an article through the publisher that [00:30:00] is, um, you know, directly inaccessible through that publisher emailing is probably the easiest way. Helen Long:  But I think another one that we haven't yet mentioned is PubMed Central. I think this is one that I think a lot of clinicians. Are still really familiar with from, uh, like grad school. Um, I remember both in undergrad and grad school, the, you know, when you're trying to write your, your research papers in your different classes. And you raise your hand and you ask your professor I'm not able to access any of these articles. They always say we'll just go look on pub med. And it is true that PubMed is probably the next. Um, easiest option than if it's not directly open through the publisher that, um, if, if, if that paper has received any funding from the NIH, [00:31:00] um, the National Institutes of Health, which is a major funding organization in, um, in the US, um, the, The government I don't know what the best term. I guess it was actually the White House that started a policy and 2008 that recognized the problem that a lot of taxpayer money. Was funding research. Many, many researchers in the U. S. are funded through the NIH, um, but all of this subsequent research coming from this funding is being paywalled. And so the White House, I think in 2008, built PubMed Central, which is essentially a repository that houses, uh, openly accessible versions of any NIH funded papers. I believe that's correct. I'm not like a hundred percent sure that that's super accurate, but, [00:32:00] um,  Kate Grandbois:  we won't quote you. It's  Helen Long:  okay. Okay. Okay. Um, but it really is. It's, it's another, usually if you're looking for a paper online, uh, sometimes you come up with the PubMed version of that paper. And that is basically just another accepted version of the paper, and you'll even find a little user license on the top that says this is the accepted version of this paper, you'll find, you know, it was originally published in whatever journal that it was published in. And so, that is a really great option. Um, and I wish that that was kind of an end all be all to like, okay, great, the, the American government has solved all our problems, but unfortunately, they, they, they had written in their original, um, policy that, Publishers were allowed to place up to a 12 month embargo, which means that's [00:33:00] yet another, that's more time that papers are still not available through PubMed. And so if you're trying to do up to date evidence based practice you're basically if you're only relying on PubMed, you're really always going to be 12 months behind because you can't access it for 12 months through PubMed, which is a big reason why a lot of scientists are starting to self archive their own research on their websites so that It's more accessible, uh, sooner after publication. Amy Wonkka:  Yeah. I mean, all of that is so helpful. And I think as a clinician who's looking for these free articles online, one thing I'm taking away is that if I can find an accepted version, that makes me feel more confident, whether I'm finding it on PubMed, whether I'm finding it with my browser plugin, or I emailed the author, the corresponding author, they sent it to me. That makes me feel better about it, even if it might not be the [00:34:00] very prettiest version of the paper. The content is solid. Um, in our, in our last couple of minutes, I know one other piece that we had talked about before we hit record was just Twitter. Um, and Twitter is being a potential place to get some of this information. I didn't know if you guys wanted to talk a little bit about Twitter as a potential resource.  Helen Long:  Yeah, I've noticed more and more through Twitter that there are actually a lot more browser plugins than just on paywall. I'm just scanning Twitter you'll find different threads, discussing different. Plugins that allow you to access papers. I found one recently called Paper Panda. It's very similar to Unpaywall. Uh, you just install it. I think it, it might just be required in Chrome, but you just install it and it's just another plugin that you can select when you're trying to access a paper. Um, I also found another one recently called [00:35:00] 12 foot ladder that bypasses news outlet paywalls, which I didn't realize I needed until I installed it. Um, and so that I could access, uh, news articles.  Danika Pfeiffer:  Um. Yeah, and I'll even say as an author of research, um, I collaborated with some of our CS Disseminate collaborators on an article for an ideology journal, and once it was published, I wasn't even able to access it myself as an SLP, so these are things that clinicians are facing, these are things that researchers are also facing, and we don't have all the answers, but hopefully these will be a few quick solutions that will help you get by If not, you can also always go to your public library or a university library if there's one near you. Typically they will have subscriptions to these journals, so you can go in, find the PDF and print it out, take it home, email it to yourself. So that's just [00:36:00] one other way without having to pay for the article. All of this information has been incredibly helpful. I think a big takeaway for me is there should be no, no clinician should be experiencing any guilt around not being able to access the literature that you need to access. Kate Grandbois:  We had, um, one of our previous guests, Natalie Douglas, said this beautifully that she had no. She had no higher power whatsoever, but she absolved everyone from all of their guilt around not being to not being able to access the science that they needed to do their jobs. If there is any takeaway from all of these wonderful information that you've given us, it's that this industry is incredibly complex. It is not working in our favor, and these, these barriers are very legitimate. So if you are feeling frustrated, if you are feeling irritated by all of this. You should be. Those are very valid feelings and all of these strategies [00:37:00] are incredibly helpful to get us over those barriers so that we can access the research that we need to do our jobs successfully. Do you have any final words of advice for our audience?  Helen Long:  I just want to commend clinicians who are going through all of these, you know, you have to admit we've gone through like so many options to try to just do our jobs, you know, and I just have to commend clinicians out there for if you are using any of these strategies when you're just trying to, you know, do evidence based practice. Thank you for your work.  Danika Pfeiffer:  Yeah, absolutely. I agree. It is, it can be very frustrating, very difficult to find this information, but I hope that you'll take away that at least reaching out to the researcher, we are very open to sharing our work. And as I mentioned earlier, always excited to talk about our work and what we're doing. And so [00:38:00] please just reach out if you are hitting those paywalls. Um, and we're happy to share our work.  Kate Grandbois:  Thank you so much for everything. It was really wonderful having you here. We really appreciate it.  Danika Pfeiffer:  Yeah. Thanks so much for having me.  Kate Grandbois:  Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study. Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com thank you so much for joining us and we hope to welcome you back here again soon.

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 . [00:00:00] Kate Grandbois: Welcome to SLP nerd cast the number one professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy  [00:00:09] Amy Wonkka: Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each  [00:00:16] Kate Grandbois: episode of this podcast is a course offered for ashes EU. Our podcast audio courses are here to help you level up your knowledge and earn those professional development hours that you need. This course. Plus the corresponding short post test is equal to one certificate of attendance to earn CEUs today and take the post test. After this session, follow the link provided in the show notes or head to SLP ncast.com . [00:00:41] Amy Wonkka: Before we get started one quick, disclaimer, our courses are not meant to replace clinical. We do not endorse products, procedures, or other services mentioned by our guests, unless otherwise  [00:00:53] Kate Grandbois: specified. We hope you enjoy  [00:00:55] Announcer: the course. Are you an SLP related [00:01:00] professional? The SLP nerd cast unlimited subscription gives members access to over 100 courses, offered for ashes, EU, and certificates of attendance. With SLP nerd cast membership, you can earn unlimited EU all year at any time. SLP nerd cast courses are unique evidence based with a focus on information that is useful. When you join SLP nerd cast as a member, you'll have access to the best online platform for continuing education and speech and language pathology. Join as a member today and save 10% using code nerd caster 10. A link for membership is in the show notes. [00:01:43] Kate Grandbois: Welcome everyone. We're. So looking forward to today's conversation, this episode is about language skills in youth offenders. We came across this topic from a research article that we read and really enjoyed, titled a systematic review and meta-analysis [00:02:00] of the language skills of youth offenders by chow at all. And we are lucky enough to have one of the authors Dr. Reed center. Join us today for this discussion. Welcome Dr. Reed center.  [00:02:10] Reed Senter: Welcome Reed. Thank you so much. It's a pleasure to be here and it's an honor that you invited me.  [00:02:16] Amy Wonkka: We're, we're so grateful that you joined us. Um, and you are here today to discuss language disorders in youth offenders, which I think is a really important topic. Um, for speech language pathologists to hear about before we get started. Can you just tell us a little bit about.  [00:02:32] Reed Senter: Absolutely. Yes, I'm a speech language pathologist. I worked, uh, clinically for, I guess, five years. Um, mostly in school based settings, middle and high schools. Um, after five years I realized I enjoy this work. I like the kids that I'm working with. Um, but my interests and skills were, uh, more suited for, uh, research in academia. So I went back, uh, to pursue a PhD. Um, that's how I got involved in this article, working with my advisor, Dr. Jason cha. [00:03:00] Um, and then I, uh, got my PhD in may of 2022. I'm now working as an assistant professor at desal university in cider valley, Pennsylvania. And, um, I'm really enjoying, researching, uh, you know, developmental language disorder and, uh, finding ways for especially school based SLPs to, uh, really make the most of their services.  [00:03:24] Kate Grandbois: Well, congratulations on your recent graduation. First and foremost, that's a huge accomplishment. Uh, and we are really excited to learn from you today and take some, you know, unpack everything that we found in this article, um, that we will include a reference to in the show notes and encourage everyone to read even after this today's discussion. So before we get into all the fun stuff, um, I wanna make sure that we have read our learning objectives and our financial and non-financial disclosures. So go ahead and get those out of the way.  Learning Objectives [00:03:57] Kate Grandbois: Learning objective. Number one, describe the prevalence [00:04:00] of language disorders and youth offenders learning. Objective number two, describe the relationship between language ability and behavior problems that pave the way for delinquency and learning. Objective number three, describe at least two targeted linguistic and behavioral supports to reduce the risk of incarceration. , disclosures, read centers, financial disclosures read, received, and honorarium for participation in this course read centers. Non-financial disclosures read previously served as vice president of governmental and professional affairs for the speech language hearing association of Virginia Kate that's me financial disclosures. I am the owner and founder of grand wa therapy and consulting LLC, and co-founder of SLP nerd cast. My non-financial disclosures. I'm a member of Asha CIG 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 and the association for applied behavior analysis international and the corresponding speech pathology applied behavior analysis, special interest group. [00:04:59] Amy Wonkka: [00:05:00] Amy that's me. Uh, 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 are that I am a member of Asha, CIG 12, and I serve on the AAC advisory group for Massachusetts advocates, for children. All right. Made it through the disclosure portion of this, of this episode. So Reed, we found out about your work with Dr. Chow, um, looking at language disorders and youth offenders. Can you talk to us a little bit about why that's a research question your team was exploring? Is there a relationship between language disorders and youth offenders? Because if there is, that seems like something that SLP should be aware of. [00:05:44] Reed Senter: Absolutely. So, um, just to set the stage for a second, um, rewind back to 2019, um, at the time I was blissfully unaware of the speech language pathologist's role in, uh, um, you know, [00:06:00] Understanding and diverting the, the school to confinement pipeline. Um, I was unaware of the connection between language disorders and youth offenders. Um, but in 2019, I think it started to become a, uh, bit of a more mainstream, uh, hot topic within our field. I remember, um, Dr. Shamika Stanford, she, uh, published an article in the Asha leader. Um, and that was the first time that I had seen it. I imagine the same is true for, uh, you know, many of your listeners. Um, she appeared on a podcast, the Asha voices later that year. Um, and then there were, uh, you know, other researchers across the globe, including, uh, One prominent article from Dr. Uh, Pamela Snow. Um, she published that in 2019 as well. Turns out there has been a research about language ability in youth offenders, going back, as far as I think we found them going back as far as 1991. Um, but it was just very scattered. There was one in 1991, there was one in 1993, um, one in [00:07:00] 1997 and then no more until the two thousands, um, around 2011, things started to pick up. Um, but really we just wanted to take all of these isolated studies, um, you know, a study of. Say maybe 20 youth offenders here, um, maybe 34 youth offenders there. We wanted to take all of these isolated studies, uh, compile them into a single meta-analysis, um, where we can take all of their data and kind of synthesize it together and come up with, uh, the most comprehensive view yet of the language ability of youth offenders. And what we found, um, is essentially that language disorders are extremely prevalent in that population. [00:07:43] Kate Grandbois: And  [00:07:44] Amy Wonkka: we were rereading your article this morning before hopping on this zoom with you. And I think I, I wrote down it's like you found 63%.  [00:07:53] Reed Senter: Yeah. So, um,  [00:07:56] Amy Wonkka: really high percent relative. Yeah. To, to what we find in the [00:08:00] general population. Right, right. And that, that  [00:08:01] Kate Grandbois: was gonna leave me into our, my next question is, can you tell us a little bit about the prevalence of language disorders in youth offenders and how it compares. To the general population.  [00:08:14] Reed Senter: Yeah. So when we think of a developmental language disorder, DLD, um, those are children who have language disorders that aren't associated with secondary con uh, condition like autism or intellectual disability. Um, developmental language disorder is prevalent in about, you know, maybe six to 8% of children, um, about one in 13 kids. Um, so you're thinking, you know, your average classroom of 26 children, maybe two of them will have DLD. They might be diagnosed. They might be undiagnosed. Um, Within the specific subset population of youth offenders. Um, it's not one in 13 it's, uh, like you said, just about 60%. Um, when [00:09:00] we, uh, look at children with, uh, language deficits, um, you know, greater than one standard deviation, about half of them, uh, 50%, um, had, uh, you know, language deficits of more than one standard deviation and an additional 10% of, uh, children had language deficits greater than two standard deviations below the mean, um, so again, more than half of youth offenders presented with, uh, developmental language disorder. [00:09:31] Kate Grandbois: And to your point about, I'm going to use your words being blissfully unaware. This is something that. I think you're right has come slightly more to the forefront in terms of our responsibilities as professionals, but is nowhere near the actual forefront of what we are learning in graduate school. What we are, what our ethical code directs us towards. It just doesn't seem to be, I [00:10:00] mean, as, as, as prominent of an issue as it, maybe it should be based on the numbers that you are giving us and how, how much higher that prevalence  [00:10:11] Reed Senter: is. Yeah, absolutely. If, um, if children with language disorders are that drastically overrepresented within the population of youth offenders, um, then that's something that, you know, we're coming into contact with these children before they even enter that school, the confinement pipeline, um, that's something that we can help with. We can, uh, um, help divert that pipeline. Um, and you know, should, unfortunately they enter that pipeline. Um, that's something that we, we can help support those children even, um, you know, once and during their, uh, confinements, um, You know, a large part of that is tracking those children with behavior problems and a lot of SLPs, I think, um, kind of push back on behavior. I remember my first year in the school system, [00:11:00] um, I got a transfer student, uh, who's IEP. Um, they were, uh, eligible for services under the category of emotional and behavioral, uh, disability, E B D. Um, and I thought to myself, what are they doing? Assigning an SL P to a kid with E B D while it turns out 80 per or yeah, 81% of children with, uh, E B D have undiagnosed language disorders. Um, undiagnosed is many as, uh, 97% of kids with EBD have language disorders, but 81% of those are undiagnosed. So SLPs really need to be at the forefront of that conversation. They need to be there in the room. They need to be working with those children and they need to be, uh, You know, empowering them with the, the language and behavioral skills. They need to make sure they don't end up in confinement a couple years down the road. I mean,  [00:11:50] Amy Wonkka: that's just a staggering number 80, I mean, 81% is a, is a huge number. And so one thing it makes me think about, [00:12:00] and we talk a lot about on the show, it's just trying to connect to what can that clinician do with the information they learn in the podcast. And that makes me think one of the things you can do, particularly if you're a school based SLP is, is get involved in your. Referral teams at your school when kids are coming up and your school based team is talking about these behavioral concerns, be aware of that percentage and advocate for appropriate assessment for these students. You know, don't, I, I think you make a really great point where you just about, like, we get kind of uncomfortable with behavior and what is the overlap there? And that's not, you know, my role. Um, but obviously it is right for 81% of these undiagnosed students. That's  [00:12:47] Reed Senter: huge. Absolutely. And I'm probably not making any friends among the school based SLPs out there right now, who are, you know, saying, why are you piling this extra work on me? I can't handle anymore, uh, children on my caseload. Um, but [00:13:00] absolutely proper screening, proper assessment procedures, um, especially for children, um, with behavioral concerns, EBD diagnoses, um, it's essential.  [00:13:10] Kate Grandbois: So I can feel myself wanting to go down like four rabbit holes with more questions and comments, because my, what I'm hearing is that this is touching so many aspects of our job and it's all very, it's all critically important. Um, and before we get into some of those more detailed conversations about the role of the SLP, just to set the stage for our listeners, what else can you tell us about what your research found, um, what the meta analysis revealed?  [00:13:43] Reed Senter: Absolutely. So, um, just a little background on the meta analysis, um, you know, it's regarded typically is one of the highest levels of research evidence because it takes high quality, you know, randomized control trials, or, um, quasi experimental trials. It takes [00:14:00] all of those and kind. Puts it in a blender and spits out the best available information. Um, it synthesizes all of the, um, high quality research that we have available our particular meta-analysis. Um, we found 18 studies, uh, that included data from youth offenders, um, under the age of 18. Um, and it also included, you know, quantitative. Language data on those students, um, that we could compare in some way, whether the study compared them to, um, their typical peers or whether we could use norm reference assessments. Um, we were able to compare data from 18 studies of children, of youth offenders, to their typical peers, um, between those 18 studies. Um, I believe that represents 3,304 individuals. Um, so there's a lot of data in here. Um, so we included, uh, just the children incarcerated in, uh, juvenile justice settings, not community based settings. [00:15:00] Um, and of course that's another rabbit hole. Um, the United States course rates quite a few children in juvenile justice settings. Whereas, um, you know, some of the other countries, uh, represented in our review, um, Australia, for one example, um, they use a lot of community based rehabilitation, um, for their youth offenders. So there were fewer children incarcerated there. I  [00:15:22] Amy Wonkka: literally wrote down a. And texted it to Kate from your article this morning. And I do just wanna read it here, cuz it connects to the point you just made the United States has more youth in incarceration than any other country.  [00:15:39] Reed Senter: Oh, yeah, of course. Um, not just by population, but by, uh, per capita as well. Um, total the United States, I believe there are around 60,000 children, uh, that are currently incarcerated. Um, you know, the rate varies by state. Um, my home state of Pennsylvania, uh, we have 235 children [00:16:00] per 100,000, uh, incarcerated, um, different states range from, I believe Vermont has the lowest, um, 58 children per a hundred thousand are incarcerated. Um, all the way up to the highest, uh, South Dakota incarcerates, almost 500 children per 100,000. Um, now compare that again to Australia because I have their data readily available. Um, Australia incarcerates 27 children per 100,000. Um, so that's less than half of our lowest state. Um,  [00:16:33] Kate Grandbois: I, I have so many things to say, but I'm gonna stay focused. Mm-hmm so. What I really appreciated about reading this article was considering the cultural components that are involved in this problem, not only, and, and how that intersects with, with us as professionals. Um, but it brings me to a question that I was gonna ask later, but I'm gonna ask now because mm-hmm, , it's relevant to what you're saying [00:17:00] out of all of the, out of all of the data analysis that you conducted, did you, since we've already established that this is really important for SLP to be aware of because of the high prevalence of DLD, were there any components of language intervention as part of these settings of incarceration?  [00:17:21] Reed Senter: So we didn't focus necessarily on studies for intervention. Um, I'm sure that could be a whole nother, uh, systematic review. Um, but while we were doing our research and, you know, reading through these articles, we did come across, um, you know, several different models for rehabilitation. Um, within the United States, it seems inconsistent. You know, there will be some facilities where, um, you know, youth offenders have plenty of access to. You know, rehabilitative interventions, um, whether it's, uh, psychologists or social workers, um, speech, language pathologists [00:18:00] working in juvenile justice settings are less common, but they're not completely non-existent. Um, there are some places that contract through their local school, uh, systems. Um, there are some places that contract through, um, I guess, local governmental agencies. I dunno if that would be, uh, department of health or, um, department of corrections. Um, there are opportunities for, uh, SLPs to provide intervention directly to, uh, youth offenders. Um, and of course, you know, that's just within the incarceration framework. Um, you know, we see in some places, uh, you know, more community based rehabilitation, um, where, you know, children might go to, uh, you know, a, uh, residential facility either just during the daytime, um, in sort of, uh, You know, serve out their sentence, um, in that kind of facility or, uh, you know, it might be residential or it might just be, um, you know, almost like a [00:19:00] school for youth offenders. Um, these might include some community based, uh, service projects, um, as part of their sentence that might not, um, there are, there are plenty of different models and it varies by state, by, um, locality by country, for sure. Um, but it's, it's not universal.  [00:19:20] Kate Grandbois: I'm sorry that I derailed you from your original, your original communication of everything in your study. So please it feel, I would love to hear more about the  [00:19:30] Reed Senter: meta analysis. Oh, absolutely. Yes. Um, So, yeah. Uh, we, you know, of the studies we found, um, more than half of them, 11 of the 18 studies were conducted in the USA. Um, there were three each from the United Kingdom, three from Australia, one from New Zealand. Um, and again, we just threw all of those. Uh, we call them effect sizes into, um, you know, a statistical analysis software. That's much more complex than anything I understand. [00:20:00] Um, but that's how we identified, um, you know, first the prevalence of language disorders in youth offenders. Uh, like I mentioned, um, 50, 50 or so percent, uh, with mild to moderate disorders, um, and additional 10% with severe disorders. Um, and then we were able just to compare the population of youth offenders to, um, you know, like the community sample. Um, and we found that on average, the average youth offenders language ability is about one and a quarter standard deviations below the mean. There were, uh, differences between the countries. Um, what we found was, uh, you know, especially compared to the United States, uh, United Kingdom had a significantly larger discrepancy, um, between, uh, the youth offenders, um, and the typical population. Um, and, uh, I mean, I guess I attribute that to it requiring a, uh, it likely requires a [00:21:00] higher threshold of offending, um, to get yourself incarcerated as a youth kingdom. Whereas it, you know, it doesn't take as much to become incarcerated within the United States [00:21:12] Amy Wonkka: was wondering when I was reading through kind of like the background section of the, of the article, you guys talked a lot about. Kind of the language based demands that are placed on a youth offender, who's been incorporated into the judicial setting. Um, and, and these were things like the Miranda warning or the charter cautions in Canada. Um, just some of that justice system related vocabulary. I didn't know if you could just talk to our listeners a little bit about those pieces because people might not be aware of the unique linguistic demands of being involved as a youth in our judicial system and kind of what those pieces are. Cuz it was interesting even for youth who [00:22:00] had typical language development, there were some real challenges there in some of those places. [00:22:06] Reed Senter: Yeah. Really children with, uh, language disorders are at a major disadvantage, um, along every single step of the, the path. And um, you know, like you mentioned, your listeners can, uh, um, You know, read our article for more. Um, Dr. Pam snow also had a, uh, a great review back in 2019, um, called speech language pathology and the youth offender, epidemiological overview and roadmap. Um, and that provides, you know, again, just a really great roadmap of how at every single step of this journey, um, children are at a disadvantage. Um, so if we think of that school to confinement pipeline, um, we know that language influences a lot language, um, influences academic success like reading, um, rioting, math, um, it comes into play for all of those. So children with language disorders are [00:23:00] at an academic disadvantage, um, language also, uh, factors into behavior, um, because children with poor language will have a poor, uh, student to teacher interactions, um, will typically have poor social skills, poor engagement. Um, and when we see, uh, language influencing both academics and behavior in that way, um, when academics and behavior. Kind of, uh, interact. That's what sets the student on their entire lifelong path to success on their achievement, their social success, their life outcomes, um, their propensity for incarceration. So children with language and behavior disorders, um, you know, from the very beginning, they will have poor social interactions, poor academic outcomes, which leads to higher rates of disciplinary referrals, higher rates of suspensions. Um, maybe they don't do as well in their class. Um, and they're more likely to drop out, which is another risk factor for [00:24:00] delinquency. Um, so between all of these, um, you know, referral suspensions, um, dropout risks, um, that leads to a higher risk for delinquency. So language disorders. We can draw that link there. Um, once they're in that whole delinquency pipeline, um, like you said, um, you know, from the moment they interact with a law enforcement officer, um, you know, perhaps the law enforcement officer is reading them their Miranda rights and, uh, um, you know, there, uh, you know, constitutional rights during arrest. Um, there are studies out there that demonstrate that children with language disorders, um, typically cannot understand the Miranda, um, warning. Um, we see, I think there was a study of, uh, you know, high school offenders, um, that determined on average, they had maybe like a, a third grade, um, oral comprehension, um, Ability. And then they [00:25:00] compared that to the, the Miranda warnings. They, they took actual scripts, um, read by law enforcement officers. And those were at like a 12th grade level. Um, so which is wild,  [00:25:11] Amy Wonkka: like that's wild kind of broadly. That's sort of wild that, that, that, that's what a choice that we make in terms of something that's supposed to be informing people of their rights at, at that high of a level, because we all exist on a bell curve in terms of language skills. Like, but yeah, that's  [00:25:30] Reed Senter: wild. Don't even get me started my understanding of the Miranda rights, um, are, you know, There are the specific rights that we are supposed to be read. Um, but there's no legally mandated script. So, uh, that same study that evaluated those Miranda warnings, um, you know, they found that they arranged from like 50 words to, you know, some officers were, uh, spatting off like 500 words worth of warnings. Um, that's what, like two pages, double spaced. Um, [00:26:00] And we think of things like, uh, you know, we all saw the, the Daniel Shafer, uh, video where, uh, you know, he was killed by police officers. Um, the police officers were spouting off contradictory instructions. They were saying, don't move your hands. And they, then they were saying crawl towards me. Um, he didn't understand, he put his hands down to crawl towards the law enforcement officer. Um, and when we think of, I'm not saying, you know, Daniel shaver had a, a language disorder necessarily. Um, but if we think of somebody who does have language disorder and then they're hearing contradictory, uh, inconsistent instructions from law enforcement officers, um, they're gonna have a tough time with that  [00:26:41] Amy Wonkka: and you're in a heightened state of arousal. So like another thing we know about language skills are that for all of us, Ty typical language or not, when we're in that elevated heightened state, our ability to process and respond is, is gonna be decreased  [00:26:59] Reed Senter: [00:27:00] 100%. Absolutely. Even moving on past the, you know, that initial interaction with the law enforcement, the, you know, whether it's the Miranda warning or whether it's just following their instructions. Um, children with language disorders are going to have a more difficulty understanding trial procedures. Um, there was a study of, I think, 20 youth offenders. Um, and most of them couldn't tell the difference between a prosecutor or a defense attorney. Um, they didn't necessarily, uh, all understand the word testimony. Um, so they don't understand how they're supposed to defend themselves. Um, once they're in the testimony, a child with language disorder, um, is going to have a more difficult time articulating their. I'm telling a consistent story and, you know, the defense attorney or the, sorry, you know, the prosecutor is gonna jump all over them for any inconsistencies in their story. Um, I can see that leading to a, uh, more likely chance, uh, for [00:28:00] conviction. Um, I think that's part of how more children with language disorders end up in at a school to confinement pipeline. And then once they're in there, they have fewer, um, opportunities to rehabilitate because literacy is an important of rehabilitation. Restorative justice, uh, conferencing is, um, hopefully trending upwards. And that scenario where, uh, children's language disorders might struggle  [00:28:25] Kate Grandbois: for our listeners who maybe haven't read this article. Can you define or tell us more about restorative justice and what that.  [00:28:34] Reed Senter: So restorative justice conferencing is a, uh, growing movement. I think you see it in, uh, you know, some judicial settings and, uh, increasingly I think you're finding it in some schools as well, um, where, uh, the youth offender is, um, essentially encouraged to, uh, um, you know, just have a conversation with the, the victims, the people that they heard. Um, and of course, you know, [00:29:00] this is likely dependent of the, the victim's willingness to engage in the process as well. Um, but by, you know, having that open conversation and, uh, you know, discussing, you know, Hey, here's an apology. Here's what I did. Um, Here are steps that I'm going to take in the future to fix it. Um, and then just being able to listen to the, you know, the victim, tell their side of the story as well. Um, you know, there are plenty of studies out there that show that this is, um, when done correctly and I'm sure you all have stories of, uh, times and places where it's not done correctly. Um, but when done correctly, this can be a, uh, a healthy and restorative process that reduces the risk of recidivism. Um, but of course, again, it's moderated by language ability. You can't have that great conversation if you're, um, you know, both emotionally charged and, uh, you know, struggle with communication, struggle with language and, uh, you know, [00:30:00] expressing yourself, telling your story. Uh, that's just a door that's not as wide open for you as it might be for, uh, typical peers. [00:30:08] Kate Grandbois: One of the things that struck me. When I read your article was how many barriers there are for youth with language disorders through this entire process. And I, it was very overwhelming to think. I mean, I think globally, we think, okay, there's a higher prevalence. I can see how these, how that's related or how that unfolds. But then when you get into the statistics of vocabulary barriers, I mean, it was, it's just the pipeline as you call it is long and arduous. I mean, just so many steps in the process. Everything from Miranda rights, I mean, starting in the classroom with negative teacher interactions all the way through first officer contact all the way through vocabulary. Um, and self-advocacy [00:31:00] through a trial. I mean, it's a, it's a very, and, and I say this back, I say this as a reflective statement, because for those listeners who are. Here with us. And haven't read this article. It is a very complex, large problem, much when you get into the numbers, it is much bigger than most of us who are even vaguely aware of this issue. It's much larger than we actually think. Do you think that that's a fair statement?  [00:31:27] Reed Senter: I think so. Um, I might be biased by my own personal, you know, investment in this. Um, but to me it just seems really bleak. Um, we can see models from other countries, um, where there are alternatives. We don't have to lock up this many children. Um, it's not like, you know, Australia, which incarcerates far fewer children. It's not, we like we see, um, just waves of, uh, youth violence and, uh, criminality. Um, you know, there, it doesn't have to be this way. Um, but it is, and [00:32:00] not to, you know, remove the personal responsibility component from these youth offenders. But they're children. Um, they're children who, you know, more than half the time they have language disorders. Clearly they have some sort of, uh, behavioral problems if they ended up, uh, incarcerated to begin with. Um, and we, uh, you know, I speak as, uh, you know, an educator, we educators, um, we have evidence based practices for language. We have evidence based practices for behavior management. Um, so it seems to me that, um, somewhere along the line, whether it's, it's not just LPs, I, you know, I'm not gonna pin all of the responsibility on us, but we as educators and we, as a society are failing these children. I  [00:32:47] Kate Grandbois: wanna read. This seems like a, a good place for me to read this quote. This really stood out to me. Um, and it, maybe it's a nice transition into our second and third learning objective, uh, learn second and third learning objectives related [00:33:00] to supports that we can provide. Um, this is on page 1,168 of the article identifying and examining additional risk factors, such as language may allow researchers and practitioners, right? So us may allow researchers and practitioners to determine which specific types of evidence based interventions, maybe most effective at providing youth with the skills necessary to successfully navigate the justice system and re-entry into society. And then this next sentence really hit me. This short term focus can then lead to the more important goal of ultimately changing the life trajectories of these youth via evidence based interventions that promote engagement in pro-social peer and community networks. That is a very powerful sentence. Yeah. When you start saying things about changing life trajectories and I, I would love to hear [00:34:00] more about that.  [00:34:02] Reed Senter: Yeah. These are the stakes they're high stakes. Um, you know, clearly as speech language pathologists, we chose this profession, not for the money we chose this profession because we want to help people. Um, and part of that is we can help people by communicating, um, Swallowing too. I know they're swallowing peeps out there. Um, but you know, at its core, our field is helping people communicate. Um, that is a basic human right. It's essential. Um, and it ties into so much of what we consider, you know, not just short term success, you know, passing a vocabulary quiz or, um, you know, learning syntactic structures. Um, but it's a huge factor in lifelong achievement, social success, life outcomes. Um, and if a child gets, uh, incarcerated along the way that is going to derail they're, um, you know, [00:35:00] lifelong path. Um, so I mean, to me, this is, this is one of the highest callings because it's not just, um, you know, and I don't mean to minimize this, but it's not just helping them pass their vocabulary tests. Um, This, this is their lives. These are lives at stake. Um, you know, of the youth offenders in the, uh, juvenile justice system, uh, I think it's about half of them will go into be repeat offenders. Um, and once you get wrapped up in that, uh, you know, pipeline of repeat offending the game's over for you. So if we, as SLP have the capacity, um, you know, to put, um, you know, put the brakes on this pipeline, I believe that's our obligation. We need to make sure that we're, um, in the right spaces where we can divert this pipeline, um, in a major part, um, you know, one of those major spaces are the schools. There are plenty of SLPs in the [00:36:00] schools. Um, so we just need to make sure that we're well equipped to, uh, provide the supports we. So how  do  [00:36:08] Kate Grandbois: we do that? I know that's a very big question for a very big problem, but can we talk a little bit about, and I I'm specifically thinking about our third learning objective, the targeted linguistic and behavioral supports, um, you know, and in combination with this quote from the article that I just read in terms of identifying and examining additional risk factors related to this pipeline. [00:36:37] Reed Senter: Yeah. That's um, that's a great question. And it's an important question, um, because it really gets to the whole, what can we do about this, um, research doesn't exist in isolation? You know, we're doing this so that we can figure out, um, And I think it ties back to, um, you know, in a sense certain behavioral principles, I think as SLPs, you know, obviously we have language in our [00:37:00] name, um, but we need to take a two-pronged approach to intervention. We need to, um, be mindful of both language and behavior. And before I get started, cuz I can probably hear some of you groaning at home. Um, I'm not suggesting SLPs need to adopt behavior into our scope of practice. Um, nor am I suggesting that we can replace behavior therapists and specialists. Um, rather I think we get the most banging for our buck when we can, uh, um, you know, support behavior by reinforcing their expectations across settings. Um, we get the most bang for our buck in therapy when we can manage. Children's challenging behaviors. Um, and when we can use our knowledge to compliment other disciplines, um, so from a behavioral, uh, perspective, and I know, um, there's a lot of behavior knowledge here, um, on, on this podcast. So, uh, please pipe in, um, I think a lot of it comes down to knowing your ABCs, your antied, your behaviors and your consequences, um, [00:38:00] starting with your antied, um, you, you know, you might take a, a function based thinking approach for that. Um, what is setting this child's behavior off? Are they looking for something, are they seeking something? Are they trying to escape something or avoid something unpleasant? Um, are they just doing it for, you know, the pure stimulation? Like, uh, um, you know, if we think of maybe a, an autistic child rocking, you know, it's a behavior, but it's, you know, Purely stemming. Um, so if we can identify those antied dent behaviors and then the consequences, which aren't, you know, strictly punishment, there's reinforcement, there's punishment, there's positive and negative reinforcement and punishment. Um, and I think it's important that we understand the, the difference between those. Um, but by taking that behaviorist perspective, um, we can figure out where. Most appropriate point to jump [00:39:00] in would be, do we need to, um, set up an anec and intervention where we can, um, you know, cut the behavior off, um, before it happens. Um, do we need to set up, you know, a better system of consequences, you know, beating this child's fingers with a ruler isn't working. So, uh, maybe we set up some sort of a positive reinforcement, um, reward system and, you know, say what you want about reward systems, but positive reinforcement, uh, seems to me like it has strongest evidence behind it. Um, so just knowing where we can jump in with behavior, um, not just language, but definitely taking that two-pronged approach in the therapy that we do. [00:39:38] Kate Grandbois: And I just wanna jump in here of two things. So if you're listening and you're not familiar with these terms, antied behavior consequence. Um, we have an episode called I'm not gonna be able to remember the name off the top of my head, but I think it's behavior management, part one that lays out that exact three term contingency and sort of verbally walks people through what [00:40:00] that is. Um, and I think the second, the second point that I wanna make is. How important and I, and please correct me if you have, or, or, you know, if you have anything to add, but it seems to me that good collaborative relationships with your behaviorally oriented professional, um, is a critical piece here. And I say behaviorally oriented professional, because depending on your workplace setting, it might be a, B, C, B a, it might be the school psychologist. It might be, it could be any various, you know, various titles, um, of people who are responsible for positive behavioral support plans or whatever model your workplace setting embraces. Um, and I know personally, just from carrying both licensures, but also from my clinical. And, and my existence in this prof in both professions, that those collaborative relationships between speech pathologists and behaviorally oriented professionals can be very, very strained, [00:41:00] um, for a variety of reasons related to overlapping scopes of practice related to, you know, feelings of encroachment, the list goes on and on. And that's not what, that's not what we're here to talk about, but my point is, That, when you think of it through the lens of how important this is and to use your words, um, when there are lives on the line, when you have the opportunity, and again, I'm gonna quote your article here to, um, change the life trajectory of youth at risk. Then it is absolutely worth your time and effort to find a way to navigate that collaborative relationship, have an open conversation with them about how important this is, share this article, you know, try and find a way to move through whatever discomfort you're experiencing or whatever, as Amy. And I always say, whatever emotional food poisoning you have, or whatever, grumpy feelings you're bringing to the table about that behaviorally oriented professional, and really try and consider what [00:42:00] interventions could be better implemented with both brains at the table. And that's the end of my soapbox. I just wanted to sort of piggyback onto that a bit. How important I assume that collaborative relationship is.  [00:42:12] Reed Senter: No 100% and I will, uh, I will second that soapbox. I think that's very important. Um, shameless self-promotion here. Um, there are resources out there for SLPs that are looking to develop their, uh, you know, own behavioral management practices. Um, I co-authored and article with my advisor again, um, about, you know, some of those very, uh, low investment, um, you know, evidence based interventions for behavior, um, whether it's, uh, visual activity schedules or behavior specific praise, um, you can find that on my website, I'm sure it'll be linked somewhere. Um, so there are these evidence based interventions that SLTs can implement independently that will help them manage behavior in their settings. Um, but from all of my research, from all of my understanding, the best behavior [00:43:00] management system, Is the one that the student's already receiving. Um, if the, you know, if you're working with a student who has a behavior specialist, um, or a behavior plan, that's implemented by a special education teacher, um, make sure you take the time to learn that plan and, uh, you know, be there for those meetings because, you know, behavior overlaps with our, our scope of practice, you know, especially because of that whole, uh, language to behavior association. Um, but make sure you learn what everybody else is doing to, uh, support behavior. Um, in that way you can, you know, continue yeah. To manage that behavior plan, um, across all settings, not just the classroom, but in your speech therapy setting too. Um, and that will be more successful than anything the SLP tries to implement independently. [00:43:52] Amy Wonkka: And I think, I mean, just to think more about the interdisciplinary collaboration, it does keep [00:44:00] also bringing me back to educating other providers in your institution about this connection between behavior. And language. Um, and so, you know, if you're in a school, just being aware of what that referral process looks like, making some connections with whether it's behavior specialists or special educators or whomever is sort of driving the Boston terms of behavior management and behavioral supports for students in classrooms. Um, you know, maybe, maybe just reach out in a friendly way and, you know, let people know that you're a resource. And I think, you know, Reid, you made the point the last time I brought this up just about the reality that, you know, there aren't enough LPs and we're all like drowning under these scary caseloads. Um, you know, and that's sort of a separate soap box that I get on about advocating to make sure that your employer adequately staffs your position. Um, but yeah, just thinking about, you know, extending it obviously through the therapeutic piece and implementing the [00:45:00] behavior plans consistently, but also making sure that. These kids are even on your radar because mm-hmm, some of the figures we talked about earlier today indicate that there probably aren't awful large. There's probably an awfully large number of those students who, who we don't even  [00:45:16] Kate Grandbois: know about.  [00:45:17] Reed Senter: Yeah. And delinquency aside, um, we need to be mindful of that language and behavior association. Um, I think it's, if you, uh, you know, if you find a kid in kindergarten who has, uh, um, some sort of language delay or disorder, um, they are twice as likely as they're typically developing peers to develop, um, challenging behaviors, um, you know, within the next couple of years. Um, and we see that, uh, not just in, you know, those externalizing behaviors, um, those are the ones that we. You know, based on the name, we can see them externally when a kid's throwing a pencil. Um, you know, that's an externalizing behavior. We can see that when a [00:46:00] kid's, uh, bullying a kid or some, uh, calling somebody names, um, or, um, you know, just hopping out of their seat, those are externalizing behaviors. Um, you know, we see those manifest, um, but also internalizing behaviors. And I don't know, uh, you know, again, I was blissfully unaware of this, um, but I don't know how many SLPs are aware of, you know, the propensity for, uh, internalizing behaviors in children with language disorders. We think of that as anxiety, depression, um, you know, other clinical things like that. Phobias children with language disorders are, um, You know, again, twice as likely to experience, um, both externalizing and internalizing behaviors, uh, over the course of their lifetimes. Um, so these children that we're working with, you know, um, as a school based SLP, you know, language was a huge part of my caseload. These children are very, very likely to present with some sort of challenging behaviors, whether it's something we can see or something that we can [00:47:00] see. So it is vitally important that we, you know, we take advantage of the resources at our, uh, disposal, whether it's evidence based practices or whether it's, um, you know, Collaboration with our colleagues who might be better versed in, uh, um, you know, the practices than we are, or even just the colleagues that are better versed in the students that we are. Um, you know, I see, you know, say Johnny, I see him once, maybe twice a week for 30 minutes and his teachers, um, spend hours a day, maybe, um, with him, um, they know the student well, so they are a resource, um, for, you know, what's going on in their lives and how we might be able to manage it, to get the most out of our limited time with this child. I so  [00:47:45] Kate Grandbois: appreciate the, the point that our students with language disorders are also at risk for internalizing, uh, I think I was aware of that, but when you said it, it [00:48:00] really resonated with me a lot more. Um, and again, just considering the seriousness with which we need to approach our treatment and our evidence based treatments, that we're not just very rarely are we just treating language. There are so often so many more, um, related issues or experiences that go along with a language disorder. And if we just treat the language, we're not really treating the whole child, we're not treating the whole system. We're not really engaging in as much person-centered care as our code of ethics and evidence based practice models call us  [00:48:40] Reed Senter: to do absolutely. It's all about taking a holistic view. Um, you know, when I'm working with a, a student, um, You know, I'm not thinking, you know, oh gosh, I hope 10 years from now. Um, I really hope he's just mastered his prepositions. I'm thinking 10 years from [00:49:00] now. I'm really hoping that the student, you know, has the, the tools necessary for success, um, in language or speech or fluency or, um, what have you, you know, all of those are components of success. Um, but by taking a holistic view, we can just make sure that we keep the bigger picture in mind. And I'm not saying that we need to treat everything. I'm not saying we need to be a counselor and a behavior technician and a psychologist. And, uh, um, teacher, I'm not saying that we need to do everything ourselves, but we owe it to our students to be a part of that, um, collaborative network to make sure that, um, You know, we're providing them with the holistic services that they need, but then also that their providers in other settings, um, are also, um, you know, providing them with the services they need. Because if they're working, say with a, a psychologist or a counselor or somebody, um, who's trying to teach them, um, you know, say self-regulation, but they're using [00:50:00] vocabulary. That's way outside of this student with a language disorder's, um, capacity. Um, you know, they're not gonna have the, um, they're not gonna be set up for success either. So by being part of that collaborative network, um, we just really need to be ingrained in the whole entire, um, whole holistic process of maximizing the student success.  [00:50:22] Kate Grandbois: So we've got, I'm just thinking about our third learning objective related to linguistic and behavioral supports. We've gone over some of the behavioral supports, um, antecedent, behavioral consequence, collaborating with behavioral oriented, professional, maximizing a team approach. Um, I'm not sure if you have other behavioral support suggestions, but I also wanted to know about linguistic supports that you would, that the research shows that you would recommend.  [00:50:50] Reed Senter: Yeah. Um, and again, before we move on, if you want to, you know, hear more about those behavior, um, specific evidence based practices, there are some that are available on my [00:51:00] website. Sounds like, uh, you all have had great conversations on your podcast as well. So those resources are there. And please take a couple minutes to, uh, familiarize yourselves with those resources. Um, but in terms of linguistic supports, um, I think that's, that's where SLPs shine. And I don't know that there's a whole lot that I can, uh, you know, tell your listeners that they won't already, uh, you know, know in some sort of level, um, because I'm sure your listeners are at the very peak of, you know, practicing with evidence based practice. Um, but I do really want to, uh, you know, single out literacy as being a big deal. Um, and again, we haven't yet done a systematic review of, uh, juvenile justice interventions. Um, but some of the articles that, uh, you know, we've come across in our research, um, suggest that literacy is the number one predictor for reducing recidivism. Um, if a child gets a literacy intervention, perhaps [00:52:00] while they're, uh, incarcerated, um, That will be the one biggest factor in whether they become a repeat offender or not. Um, if they can get that literacy intervention before they offend for that very first time, um, that might help divert the pipeline. Um, so I know, you know, literacy is, uh, it's one of those things that I think more and more LPs are talking about it. Um, and there are, you know, an increasing number of resources out there for evidence based practices and literacy. Um, and I, I do want to, uh, you know, embrace the science of reading approach. Um, I'll just go ahead and align myself with that, um, pipeline. Um, But in terms of literacy, you know, some schools might have reading specialists, some schools, um, might say, you know, oh, literacy, you know, that's not necessarily the SLP, we'll just have this other person work on it. Um, but if you're in a school that lets you work on [00:53:00] literacy, um, I know we're already overworked as it is, but if we can work on literacy, that might be one of the biggest factors, um, in diverting the school to confinement pipeline. Um, so keep that in mind, especially when you've got a child who's, uh, you know, um, been placed at risk for behavioral concerns that you think, you know, oh, they're gonna end up as, uh, you know, juvenile delinquent or something like that. Um, make sure those kids are getting the literacy instruction that they need.  [00:53:29] Kate Grandbois: I have one quick que I'm sorry to interrupt you, Amy. I have one quick question about that. So what we've learned just through interviewing, you know, on our podcast interviewing other literacy specialists, is that depending on where you are in the country and depending on, on your workplace setting literacy might not be within the scope of practice or within the role of the S L P on the team. Because it, my impression is that literacy intervention can often be the [00:54:00] role of a reading specialist or a resource specialist, or, uh, you know, various titles, depending on, on where you work. And I'm wonder. If there are LPs listening who don't feel that literacy intervention is within their scope of competence, um, in terms of, you know, intervening within their therapy time, would you recommend having this direct, you know, bringing this issue to light when in a collaborative relationship or having that SLP reach out to the literacy, the person who is in charge of literacy instruction, I also have to assume that early screening and identifying is a huge piece of this. So maybe the SLPs role is more advocating in case they have a, a hunch that someone needs to be screened. Can you tell me a little bit more about what an SLP can do if they're not in charge of litera in charge of literacy, or if they don't have it in their scope of competence?  [00:54:55] Reed Senter: Yeah, I definitely think those are two very real, very major issues. [00:55:00] Um, for an unrelated research project, I was interviewing SLPs across the country. Um, uh, that was about, uh, executive function interventions. Um, and the one thing that I kept hearing, uh, across interviews, um, was that SLPs are getting pushback, um, saying, stay in your lane, um, in different schools. And that was true for executive function interventions. Um, but they also mentioned that, you know, oh, it's kind of like with literacy too, stay in your lane. Um, so yes, I'm sure there are highly qualified SLPs out there. Um, who could do wonders for literacy that are being told, stay in your lane? Um, if that's the issue, I highly encourage those SLPs. Um, you don't necessarily need. Teach literacy in your sessions, but work with the people that are working on literacy with these students, um, and make sure they know what they're doing, make sure they're embracing the signs of reading, make sure they're teaching, um, both decoding, um, comprehension, [00:56:00] um, all of that, um, stay away from that whole like, oh, what's the first letter. Can we guess? Can we look at these pictures and uh, um, you know, make a guess what this word is. We want to teach, you know, real skills, decoding and comprehension. Um, so. There are plenty of ways you can embed literacy in your therapy. Um, you can say, oh, I'm working such and such skill and we just happen to be doing it through a book. Um, and then again, it just comes back to that collaborative relationship. If you have a relationship with the reading specialists where you can, you know, support evidence based literacy practices and, um, you know, bring to their attention, you know, Hey, are you working with Johnny? He has, um, emotional and behavioral disorders. And I know these kids are at a, um, hugely heightened risk for literacy problems too. Um, you know, whatever it takes to make sure that the child is receiving the services they need. Um, so that's, I think the first issue you brought up, but then the second issue, um, SLP, [00:57:00] who don't necessarily feel like it's within their scope of competency. Um, and that's, that's a huge problem because. We are a profession where we're encouraged to be, you know, jacks of all trades, um, and arguably masters of none. But there are just so many trades that we can't even be jacks of all of them, much less masters. Um, so if literacy is without, um, or outside of our area of expertise, um, I mean the easiest solution would be, Hey, go educate yourselves. And I know that's so easy for me to say from the other side of things, like I literally have time in my day devoted to just reading, cutting edge research. Um, that's a luxury that school based SLPs don't have. I know that's, I mean, let's be real. That's a huge reason why I got back in academia. I was, uh, spending my lunch breaks in, uh, the Asha journals. Um,  [00:57:59] Kate Grandbois: You guys are the same. [00:58:00] I'm just saying you've met, you've met a match  [00:58:02] Reed Senter: in each other on top kindred spirits but, uh, um, whatever it is, the easy solution is, you know, well, let's shore up that weakness. Um, that might mean listening to, uh, some of your nerd cast episodes, that address literacy. Um, wouldn't that be cool. Um, but again, it's just, it's all about making sure that the students get the, the services they need. So if you don't know literacy, if you don't feel confident, if your idea of good reading instruction is well, let's take a look at these pictures and guess what's going on here. Um, and maybe that's what the words say. Um, I encourage you to refer to someone else. Um, we should not be practicing something that we do not feel professionally competent in. Um, so until we can address that area of competency, um, Please make sure the students are getting the services that they need. Cause again, these are the highest stakes imaginable. [00:59:00] This is incarceration here  [00:59:01] Amy Wonkka: and it's, and it's such a good point that first of all, we, we can't reasonably know all the things in our scope of practice, which is gigantic. Um, and a referral is not a bad thing. We don't have to know and do everything it's physically impossible for us to know and do everything. Um, but what we can do is identify this need and this knowledge, that literacy is such a pivotal skill. Um, for our students who, who either are, or may become youth offenders and engaged in the justice system, um, we can be aware that literacy is really important and we can make sure that these students are connected with the appropriate resources and make those appropriate referrals. Um, I also did wanna let our listeners know. We had in season three, episode 23, we had Tim DeLuca and Kate Radwell come in and talk to oh, great. Specifically about DLD and dyslexia. And what does it mean for [01:00:00] the SLP? So that might be, that's like a nice intersection, um, of those pieces that for those folks who maybe it's not in your scope of competence, but, or, or you just like to add to your knowledge base on that, that might be, um, was a fun podcast. Give it a listen.  [01:00:16] Kate Grandbois: We also had one on, uh, with Jeanette Washington related to dyslexia, um, evaluation and different state regulations. So that's another resource that we can, um, link in the show notes.  [01:00:29] Amy Wonkka: So one other thing that kind of stuck out to me as I was reading your article, um, was that, you know, the language disability is a huge piece, but it's definitely not the only variable that seems to make a difference in terms of who, what youth find themselves engaged in our criminal justice system. Um, so some of the pieces that really stuck out to me. These very stark differences, um, across racial and ethnic groups, um, as well as some [01:01:00] real differences across socioeconomic status, specifically the correlation with poverty and likelihood of a language disability, and then also likelihood of being involved in the criminal justice system. So I didn't know if you could talk to us just a little bit and inform our listeners who might not be aware of. Significant differences.  [01:01:22] Reed Senter: absolutely. And I'm glad you asked about this because it's just a very vitally important component of this whole puzzle. Um, I want to be clear and make no mistake about it. The school to confinement pipeline is a deeply racist institution. Um, it was conceived in racism. It perpetuates in racism. Um, it unfairly targets minorities. Racial and ethnic minorities. Um, and as such, it is just one of the grave injustices that plates our society. Um, [01:02:00] The, the school to confinement pipeline, uh, a major component of that is zero tolerance policies instituted in schools. Um, and you might think like, oh zero tolerance, you know, that's fair. That treats everybody the same way. Um, but we find is that it's not fair that it doesn't treat everybody the same way. Um, zero tolerance policies are most likely to be implemented in a, um, You know, minority school districts, urban school districts, um, you know, school districts where those kids are, the ones that, you know, get locked up. Um, part of that might be differences between, um, you know, the, the racial and ethnic and cultural backgrounds, um, between the teachers and the students. Um, we know. Black children are more likely to see in school, uh, in school, um, when they have black teachers. Um, I don't know how much of that is, uh, just being able to receive the culturally relevant [01:03:00] instruction that they need. I don't know how much of that is, um, because the teachers can recognize. Um, or better equipped to recognize, you know, actions and behaviors as, um, cultural rather than, uh, um, you know, problem behaviors. Um, I don't know how much of that is the fact that, um, perhaps white teachers, um, don't necessarily understand, um, you know, dialect the difference between dialect and disorder. Um, and really when it comes to our meta-analysis. Um, the whole dialect and disorder thing really is the elephant in the room. Um, because when we first started, that was one of the things that we were interested in. We wanted to see, um, how many of the participants in, you know, each study, um, spoke, say, you know, African American vernacular English, um, a, a V E um, as opposed to. You know, the standard American or general American English. Um, but the, [01:04:00] the studies didn't mention that the studies didn't mention dialect. Um, I'm personally curious because we know. Um, you know, people with different cultural and dialectal, um, differences are overrepresented in speech, language pathology, um, they're overdiagnosed with language disorders. Um, I was wondering, you know, what kinds of culturally relevant assessment practices, um, are these researchers using in their studies to, uh, ensure that, um, you know, they're correctly distinguishing between children in the pipeline who. You know, dialectal differences in disorders. Um, I couldn't really find anything. Um, you know, I, I didn't read every single one of the studies. We split them out, you know, between three different readers. Um, But none of the studies I reviewed made any mention of dialect or culturally relevant assessment practices. Um, so many of them relied strictly on [01:05:00] standardized scores, like, uh, um, you know, the self or, uh, the, you know, the whisk language measures, um, Peabody, picture, vocabulary tests. So many of these, you know, they're staples of our, uh, you know, SLP practice, but. Not necessarily equipped to, uh, discern between dialectical differences, cultural differences, um, and what actually is, um, a real disorder. So that's the elephant in the room. We, we know that black children and other minority children are overrepresented in juvenile justice, confinement settings. Um, we know that many of those children speak in. Um, you know, different dialects. Uh, we know that our profession, speech language pathology, uh, is over 90% white. Um, so we just, that's one of the mysteries. We, we don't know how much of this is accurate and how much of this is just manifestation of a deeply racist school [01:06:00] confinement pipeline. [01:06:03] Amy Wonkka: Thank you for sharing all of that. I think. You know, another really important piece is. Being aware of culturally responsive assessment practices in general, and moving away from this overreliance on norm reference assessments because we know, and we're learning more and more about how to be effective in our assessment process. Um, and hopefully in the future, that will be better represented. The literature to come, it would be great to see, you know, future studies looking at dynamic assessment and maybe incorporating some components of norm reference assessment. If it's appropriate, if it, if the normative sample even just re even reflects the. Population of students we're testing. Um, but I think that that's, that's hopefully a shift that we'll see more and more in our field, because it is a problem. We don't, we as a population, as we sit here through, you know, three white people talking [01:07:00] about this, but we don't as a field, represent the diversity of the clients who we're serving and we need that's, that's something we need to be very aware  [01:07:09] Reed Senter: of. Absolutely. [01:07:12] Kate Grandbois: And if anyone who is listening would like to learn more about the relationship of linguistic diversity, language, ideology, and racist infrastructures and white supremacy. We did interview a researcher at Chelsea PVE on that exact topic it's in our library and the Ashe CEU for that course, our process for free. Um, it was a really wonderful conversation and we encourage anyone who's not familiar with Chelsea Pervet and her work to, um, look it up. We will list it in the show notes as.  So before we wrap up, I'm wondering, are there any other linguistic supports that you would recommend an S L P be aware of in terms of, um, mitigating risk or identifying risk factors?  [01:07:56] Reed Senter: And again, SLPs should hopefully know, [01:08:00] um, you know, their preferred evidence based practices. Um, I don't think any of this specifically speaks necessarily to, um, you know, youth offenders or children place that risk for youth offense. Um, but for that population in particular, it's so vitally important to teach functional transferable skills. Um, so if you're working on say vocabulary, for instance, um, Teaching functional vocabulary. Um, but also teaching it through roots and a fixes, um, that can be transferred to, uh, you know, other contexts and other settings, um, you know, teach things that will matter, teach things that will be important to their lives. Um, I know we're running low on time, so I do want to give, um, a brief shout out. Um, let's see, in, uh, 2019 or no, 2020, um, Dr. Shamika Stanford, uh, published an [01:09:00] article in an Asha journal school based SLPs role in diverting the school to confinement pipeline for youth, um, with communication disorders. Um, and that article talks a lot about, you know, the overlapping risks between, uh, developmental language disorder and juvenile justice, like, uh, low verbal intelligence learning and reading disabilities, impulsivity, low theory of mind and empathy. Um, all of those, you know, Concurrent risks. Um, but then it goes on to talk about what SLPs can do. Um, you know, both through the identification, um, assessment goal setting, and then, uh, most importantly, culturally and linguistically relevant intervention. Um, so if any of your listeners are wanting additional information beyond just, you know, behavior language, it's important and that's, you know, what sets the S for delinquency, um, that might be a good article for them to check out as. [01:09:56] Kate Grandbois: And we will link every, all of the articles that you've mentioned and all [01:10:00] the resources that we've mentioned will be linked in the show notes. Um, they'll also be listed on the web, on our website for anybody, if you are commuting or jogging or folding laundry, and your hands are busy, all of those resources will be there for you to check out later at another time we have so enjoyed this conversation, and I'm so grateful that you were able to, to join us this morning. Do you have any last words, any parting words of wisdom that you would like to leave our audience with?  [01:10:31] Reed Senter: What we do is important. Um, whether the child is a youth offender or on the path or, um, you know, or not what we do is important. So we owe it to ourselves and more importantly, we owe it to the children that we serve, um, to do the best we can. This is important. Um, and it really can make a difference. So, uh, Another important piece of this puzzle is advocacy. And of course I'm a little bit biased because I served as a, [01:11:00] um, you know, the vice P uh, president for governmental affairs, um, for my state association, um, and a large part of that was just trying to drag people into advocacy. And I think there's this misconception in our field. That advocacy means. You know, showing up on advocacy day, carrying a sign, maybe talking and shaking hands with a couple legislators, which is just deeply and profoundly intimidating. Um, and then going home, um, that can be a part of advocacy, but it's so much more than that. Um, part of our role is to advocate for ourselves. If we don't feel like we have the knowledge in culturally. Um, relevant assessment and instruction. Um, we need to advocate for, um, ourselves to be able to, you know, pursue continuing education on that topic or, uh, you know, get an in-service or professional development. If we feel we don't have the resources to do so, we need to, um, advocate for that. If we feel like we need, uh, better instruction or, [01:12:00] um, materials for literacy assessment. Um, we need to advocate for ourselves for that. So advocate for yourselves, um, advocate for your students. Um, and we've talked about this throughout the podcast. Um, make sure you, uh, explain the impact of language, um, to all of the stakeholders. Um, make sure the students understand, you know, Why am I like this? Why am I getting speech therapy? My speech is fine. Oh, it's my language. Um, explain to them, uh, explain to their educators. Um, if your student is involved in a, um, you know, one of the, um, You know, meetings. Oh, shoot. What's it called? Student  [01:12:39] Amy Wonkka: referral, like student referral process, I guess. [01:12:42] Reed Senter: Yeah. If your student is involved in one of those, um, you know, make sure you explain to the other educators the impact. Um, if they're getting in trouble, if they're about to be expelled for a behavior, um, talk about how their language may have, uh, you know, influenced their behavior there. Um, so, you [01:13:00] know, advocate for your students advocate for yourselves, um, advocate for fair policies. Um, Policies that will hear out students rather than say a zero tolerance policy that doesn't give the student the opportunity to explain or defend themselves, um, advocate for, you know, a, uh, a fair process where you can hear them out in a way that even with a language disorder, they can make themselves heard, understand, um, and help them advocate for themselves. And then yes, finally, it's hard. Advocate for legislative policies that support schools and reduce incarceration, research, and vote for candidates that support these policies, um, call your legislators. You can write to them. Um, it's so easy. Um, you know, whenever Asha has one of their, uh, Asha advocacy things, um, you can just type in your name and your email address, and they'll practically auto fill it out themselves, but I really encourage you all to, um, You know, reach out to your legislators personally. [01:14:00] Um, it's intimidating. And if you don't wanna do it directly, maybe get involved with a state association. Um, it's also working with those state officials. Asha handles a lot of things at national levels and Asha supports, um, state associations, advocacy. Um, but a lot of times it is these state associations, um, that have the best chance to have things matter, um, at the level that it can actually be dealt with. So, um, Yeah, I know advocacy is scary, but please try your best to get involved. It's it's important and it matters. I also  [01:14:32] Kate Grandbois: think that based on what you, what I've heard you say, SLPs are in a unique position to be advocates based not only on our roles within school systems, but also because of our unique knowledge. Related to language disorders and how, and now that anybody who's listening has taken this course, . And how language disorders are related to school to, to this school, to confinement pipeline, particularly.[01:15:00]  And I'm going to quote again, your article, um, when it comes to ultimately changing quote, ultimately changing the life trajectory of youth via evidence based practice and intervention. So, um, we are in a really unique positions to support that advocacy.  [01:15:18] Reed Senter: I like what you're saying there, especially about us being in a unique position, um, because yeah, speech, language impairments are what the most common or the second most common, um, eligibility category in the United States. Um, so if you're building a personal connection, if you're talking to, um, You know, you're a state legislator, for instance, there's a decent chance that they may say like, oh yeah, I have a nephew who, uh, sees a speech therapist or something like that. And that's a connection that you can use. You can be like, oh yeah, tell me more about them, you know, learn about their issues. Oh yeah. You know, I work with students like that. I also work with these students who are at risks and that's, that's a segue that you can use to, uh, um, [01:16:00] you know, Build that personal connection, which is super important, um, for advocacy purposes, but then also segue it into, you know, whether it's, uh, you know, the youth to confinement pipeline or whatever you're advocating for. Um, just build that connection and leverage it. [01:16:15] Kate Grandbois: Thank you so much. Thank you so much. This was really, really wonderful, and we really appreciate your time.  [01:16:22] Reed Senter: Thank you for having me. It's been a pleasure.   [01:16:25] Kate Grandbois: Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study. Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com [01:17:00]  thank you so much for joining us and we hope to welcome you back here again soon.