Providing Speech Language Intervention Using Teletherapy · 8 Tips for Easy –Fast –Free Speech...

Providing Speech Language Intervention Using TeletherapyProviding Speech Language

Intervention Using Teletherapy

‐Technology is readily available

‐Controlled Environment

‐Support Personnel

‐By choice

‐Technology isn’t readily available

‐Home environment

‐Parents are not the service providers or the support personnel

‐Because Pandemic

‐Emotional stressors for clinicians and families

‐Economic stressors

‐Shifted Priorities

‐Requires knowledge of video platform (privacy and settings)

‐selecting clients who are appropriate for assessment and intervention services via telepractice

‐Requires understanding of interactive features for student engagement

‐understanding and applying appropriate models of technology used to deliver services;

‐selecting and using assessments and interventions that are appropriate to the technology being used and that take into consideration client and disorder variables

Teletherapy Teletherapy during a Pandemic

Things have changed. BUT…

There are industries that have successfully transitioned over to remote working.

We just need to learn how they are scheduling, organizing their sessions, using technology, and interacting as new professionals


There are SLPs, albeit, a small number, who have already been doing teletherapy for years.

We just need to get up to speed on how they are effectively evaluating, treating, and achieving balance between work and life.


Early Intervention Specialists have developed Routines‐Based Intervention and interact really well with families and in the home.

We just need to know how to flip the model from teacher‐centered to parent‐centered and form goals around home activities.


Some (not all!) of our tired‐and‐true therapy technigues are still successful when used remotely.

We just need to know which ones, how to share materials digitally, and how to track progress.

Providing Highly Effective Speech Language Teletherapy

Improve Your Technology Use6 Tips to Use Zoom/Hangouts /Powerpoint/ Google Slides Effectively

1. Light source and camera angle Put the light to the side and have your camera up higher.

2. What to check and uncheck

Check• “Recurring” for Weekly Sessions

• Meeting Password to avoid Zoom Bombing

• Join Before Host

Uncheck• Meeting Required• Waiting Room (Zoom)• Mute Participants Upon Arrival

3. Test Audio and Video• Don’t take it for granted anyone can

see or hear you.

3. Test Audio and Video• Zoom “Share computer sound”

4. Open 3 things: Presentation, Chat, & Participants

5. Build your materials in PowerPoint or Google Slides

6. Browse by Individual Window

So how did we do this?

For PowerPoint:

• Open Powerpoint• Click on SlideShow• Click Browse By Individual Kiosk

• Open the full Powerpoint view

• Shrink down this window

• In Zoom, share the Powerpoint, not your whole screen

Easier Scheduling and Increasing Show Rates

Schedule Reminders : Scheduling like a dentist

Use Email

Use Text

Remind at the end of the prior session

Email reminder the day of

Text reminder an hour before

Email Templates

Email Scheduling

Bulk write all your emails on Monday and schedule them.

Email Scheduling

Search: Install Gmail Boomerang or How to Delay Sending an Email Using Lotus Notes

Bulk schedule texts

Use Google Translate

How do we handle texting?

The Problem• We need our phone on to hear from parents but it is distracting during sessions.

• We normally don’t mark texts for “later” to be able to respond by email.

• In terms of the global pandemic, there is a lot more going on.

The Solution

• Set Notification Rules

• Pin Messages

Pin Messages

• We often feel an immediate need to respond to texting.

• If we don’t the message can get buried by everything else that comes in that day.

• This is unlike email where we can mark things for later.

• Pin messages so that that stay at the top.

• Batch respond to everyone at one time later in the day.

Set Notification Rules

• Mark certain people or groups to silent or inactive.

• A Case Study:• My family!• I have 6 sisters and 1 brother • They text like crazy at times.• During the global health crisis, one of my sisters is a nurse who contracted Covid. Our 80—year‐old aunt and uncle also got sick.

• So I want to stay tuned in, just not all day.

Sharing Materials and Giving Instructions

2 huge hurdles to transitioning over to

teletherapy:

Giving InstructionsSharing Materials

Make Your Own Website

• Websites are a great – single location – for you to share all of your stuff.

• There are several places you can go to build your own site quickly.

• This article has all you need to pick a site and get up and running quickly:

• https://www.websitetooltester.com/en/blog/best‐free‐website‐builders/

How do we share instructions?

Parents need a way to remember what to do or how to intervene between sessions.

Teachers would benefit from seeing examples or knowing how to improve communication in the classroom.

The fastest and most impactful way to share instructions is with videos.

The Speech Therapy Blog:

Easily Make SLP Videos

8Tips for Easy – Fast –Free Speech Pathology Video Creation

1. Use the Free Software your computer has:PC = Windows Movie MakerMac = / Quick Time / iMovie / Photo booth

8 Tips for Easy – Fast – Free Speech Pathology Video Creation2. Clap Your Hands After You Mess UpClapping your hands causes the audio to spike so that you can see where your mistake was. It makes it really easy to edit those parts out.

8 Tips for Easy – Fast – Free Speech Pathology Video Creation3. Don’t Turn Your Camera OffIf you make mistakes, keep rolling! Turning your camera off and on takes up a lot of time and can make you more‐and‐more nervous. Just roll with it and cut out the bad stuff later.

4. Add a Title Slide or Beginning StatementLet’s face it, we really don’t want to invest our time into a video if we don’t know what it is about. While it breaks our story‐telling hearts, we need to begin by saying EXACTLY what the video is about.

“This is a two‐minute video that will show you how X, Y, & Z.”

8 Tips for Easy – Fast – Free Speech Pathology Video Creation5. Smile for a Few Seconds Before You Start TalkingIf you smile and hold your smile for two seconds before you begin to talk, it is easier to find a frame you like to begin with.

8 Tips for Easy – Fast – Free Speech Pathology Video Creation6. Use Transition Slides to Cover‐Up Bad TransitionsIf you cut out a section you don’t want. You can spend hours trying to make the pieces fit together or make your face not look weird. Throw a transition action life Fading or a screen with a title between the breaks: “Next, How to Teach Following Directions”

7. Keep them short!Research from Vimeo, Youtube, and Facebook indicates that there is a big drop‐off in watching after three minutes. This is permission for us to keep it short!

8 Tips for Easy – Fast – Free Speech Pathology Video Creation8. Shrink your videos using HandbrakeHandbrake is a free program that you can download to your computer to reduce the size of the video.

https://handbrake.fr/

Telepractice Work‐Life “Balance” :Unblurring the Lines in the Age of Overlap

11 Tips for Working

Remotely and Maintaining a

Sense of Harmony

Gathered from Industries Who Have Made the Transition to Remote Working

Be careful how you define yourself"We tend to form our identity around what we do as a job. Part of the point of work‐life balance is recognizing that there's more to you than being a therapist. Work‐life balance helps practitioners to avoid over‐identifying with one role."

Roberta L. Nutt, PhD, chair of the APA Board of Professional Affairs' Advisory Committee on Colleague Assistance (ACCA)

Start with making some small changes

You don’t need dramatic upheaval, you just need to set your priorities and build up some small wins.

Have a clear endpoint to your work day

Have a set time when you’re done for the day, and allow yourself to recharge and engage in non‐work activities after that point.

Be unavailable

Unplug your devices and step away from the outside world.

Have a strong non‐work, non‐household social support network

Research shows a correlation between social support and lower levels of work‐family conflict

(Quick & Tetrick, 2002, p. 151).

Have fun after work during the weekDon’t save all of your fun activities for the weekend. What are you doing during the weeknight after work?

Know your limitations"Nowadays with the information age it feels as if there is always more to do than one can truly accomplish in

one day.

Accept that you're not going to be able to do everything that you want

to do.”

Learn how to say “no”Learn how to say “later”

Jonathan Huppert, PhD, assistant professor of clinical psychology in psychiatry at the University of Pennsylvania

Deliberately and intentionally take time off

Don’t forget about your vacation days!

Devote periods of time to personal interests outside of the workplace.

Develop outside interestsPsychology research indicates that having an outside interest improves mental health.

HobbiesVolunteeringRecreational activitiesExercise

Embrace flexibility

My daughter’s math teacher during the pandemic:

Hi all,All of my lessons are now up online. I set up my office and classroom hours so that I can also help get my three kids set up during their classes. I will have office hours from 9‐10 am and 5‐7 pm. And of course we will meet for class at 11am.

Adopt a long‐range perspective

"We all have different needs to balance during different stages of our careers…Keeping things in perspective and creating a long‐term balance is important. We may not be able to keep every day balanced, but we can work to keep the week or the month balanced. We all need to find the steps that work for us.“Roberta L. Nutt, PhD, chair of the APA Board of Professional Affairs' Advisory Committee on Colleague Assistance (ACCA)

Providing Speech Language Intervention Using Teletherapy

Region 6 ESC Online

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About Me

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Laura Finkel MS-SLP-CCC

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Major Transformations in my Practice

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YES and No……

• Agree or Disagree??

• Both….

BLEEP

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“The ability to shift quickly to virtual learning and learning-at-home models, with increased accountability for student engagement.”

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Reflecting on Practice: a Discussion on Equity in

Teletherapy

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Routine

• I work..I work…

• How do you feel?

• Song or Picture of the Day

• Story Grammar Review

• Intervention

• Wrap-Up Activity

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Acknowledge the Difference

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Google slides or Powerpoint

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I work!I work!

I work on…telling a story!my sounds!R, S, SH

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Welcome to Finkel Friday Speech

• I work..I work..I work on telling

stories.

• Check-In

• Song (or picture of the day)

• Story Grammar Rap

• Literacy-Based Intervention

• Game

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Welcome to Finkel Friday Speech


stories.

• Check-In

• Song



• Game

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stories.

• Check-In

• Picture of The Day



• Game

What’s Going On in This Picture? | May 18, 2020

Look closely at this image, stripped of its caption, and join the

moderated conversation about what you and other students

see.

May 21, 2020 By THE LEARNING NETWORK

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• https://www.archives.gov/education

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Speech

• I work..I work..I work on telling stories.

• Check-In

• Picture of The Day or Song



• Game

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Characters are the people in a story.Setting is when and where.Problem, hey what’s wrong?Solution, let’s solve it!

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What’s the Plan?


stories.

• Check-In




• Game/Show and Tell

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How important are narratives?

• We ask children to tell us about events, retell

stories, write about events in their journals, and

answer questions about stories.

• We analyze and judge the grammar and content

of their stories, the order of events, the semantic

complexity, and the narrative elements.

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Why Use storybooks in speech and language therapy?

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� Shared reading activities • Increase development in multiple areas (Doyle & Bramwell, 2006; Debaryshe, 1993; Burner, 1978)

• Promote language development in children with typical development (Teale & Sulzby, 1986; Westby, 1985) and with language impairments (Gillam & Ukrainetz, 2006)

• Promote a greater desire to read (Mason & Blanton, 1971)

• Exposes student to printed materials and positive reading models (Teal, 1984)

WHY USE STORYBOOKS?

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Language disabilities and reading disabilities:

• 40% of preschool children with language disorders develop significant literacy learning difficulties (Aram & Nation, 1980; Rescorla, 2003) even if their delays appear to have been resolved by age 5 (Scarborough, 1990; 2002)

• Approximately 90% of individuals with severe communication disorders experience significant literacy learning difficulties (Koppenhaver & Yoder, 1992).

• Children with oral language disorders are at great risk for reading disabilities (Schuele, 2004)

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IDEA

2004

•Free and Appropriate Public Education

IEP

•Access to the General Curriculum

SLP

Services

•Least Restrictive Environment

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Working Across All Levels

Serving a Range of Disorders

Ensuring Educational Relevance

Providing Unique Contributions to Curriculum

Highlighting Language/Literacy

Demonstrating Cultural Humility

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@theconsciouskid

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• • Follow and learn:

@theconsciouskid

@iamrachelricketts

@diversereads

@britthawthorne

@thetututeacher

@apron_education

@readlikearockstar

@blackandembodied

Elementary Level

A Kids Book about Racism by Jelani Memory

Last stop on Market Street by Matt de la Peňa

The New Small Person by Lauren Child

Look Up by Nathan Bryon and Dapo Adeola

Please Baby Please Spike Lee and Tonya Lewis Lee

Dancing in the Wings by Debbie Allen

Baby Dance by Ann Taylor

Peekaboo Morning by Rachel Isadora

I Can Do it Too by Karen Baicker

Lola at the Library by Anna Mcquinn

When Grandma Gives you a Lemon Tree by Jamie L.B.

Deenihan

I Got the Rhythm by Connie Schofield-Morrison

Jabari Jumps by Gaia Cornwall

Ron’s Big Mission by Rose Blue and Corinne Naden

Those Shoes by Maribeth Boelts

Martin’s Big Words by Doreen Rappaport

Henry’s Freedom Box by Ellen Levine

Snowy Day by Ezra Jack Keats Hair Love by Matthew A. Cherry

I am Enough by Grace Byers

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For Literacy-Based Teletherapy

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For Literacy-Based Teletherapy

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Immigrant Stories

• Islandborn By Junot Díaz

• My name is Yoon By Helen Recorvits

• Name Jar By Yangsook Choi

• One Green Apple by Eve Bunting

• Angel Child Dragon Child By Michele

Maria Surat

• Grandfather’s Journey By Allen Say

• The Memory Coat By Elvira Woodruff

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Read-Aloud Pre-recorded Example

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Problem: I cannot stand

the sound of chickens.

Characters: Claire Rose,

Ms. Phuong, chickens

Setting: At the speech

clinic

Solution: We close the

windows!

Telling: “Claire Rose and Ms. Phuong. We at speech, and we hear chickens.

And and we close the door and and work on on stories. “

Retelling (after Ms. Phuong’s) 1: “ We going in speech, and the windows are

window. And, I hear a chicken. Annoying! And, we close the door, and we end

speech.“

Retelling 2: Claire and Ms. Phuong in speech. I am not in school. I’m sitting

down at Ms. Phuong’s desk. I am angry about these chickens, and we are

working on stories and sounds. So, Ms. Phuong closed the windows! And,

Claire is sitting down in the chair.

X Characters?

X Setting?

X Problem?

X Solution?

X Feelings?

Dialogue?

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16-Part Narratives

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TheInformedSLP.com

TheInformedSLP.com

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Outside of the box pre and post-reading ideas

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4 Week Literacy-Based Intervention Plan

Building Background information and intro to Story-Tell by SLP

Round Robin Story Re-tell of “MATS”+ Song

Progress monitor by language sampling story re-tell for each

student

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Middle School Book Club

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This Photo by Unknown Author is licensed under CC BY-NC-ND

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Build Background Knowledge

• What are Fables?

• Watch a video

• Pre-teaching vocabulary

This Photo by Unknown Author is licensed under CC BY-ND

Language Sampling With Adolescents: Building a Normative Database With Fables, Marilyn A. Nippold , Laura M. Vigeland , Megan W. Frantz-Kaspar , and Jeannene M. Ward-Lonergan, Aug 2017

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Questions:

1. Do you agree with the moral of this story, “It

is better to bend than to break”?

2. Why or why not (do you agree or disagree)?

3. Can you think of a situation in real life

where that moral would apply?

4. Can you tell me anything more about the

moral or the situation?


The Oak and the Reed Adapted from Aesop’s Fables,

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Questions:

1. Do you agree with the moral of this story, “What is truly most valuable is often underrated”?


3. Can you think of a situation in real life where that moral would apply?

4. Can you tell me anything more about the moral or the situation?


The Stag at the Pool

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Questions:

1. Do you agree with the moral of this story, “Beware of flatterers”?


3. Can you think of a situation in real life where that moral would apply?

4. Can you tell me anything more about the moral or the situation?


The Fox and the Crow

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Questions:

1. Do you agree with the moral of this

story, “If you grasp at the shadow, you

will lose the substance?”

2. Why or why not (do you agree or

disagree)?

3. Can you think of a situation in real life

where that moral would apply?

4. Can you tell me anything more about

the moral or the situation?


The Dog and His Shadow

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The Hungry Caterpillar

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Toy Story 4

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Measuring Progress

•Macrostructure

•Story Grammar

•Rubrics

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Goals+Therapy=Outcomes

• Student will receive 22/35 points on the narrative scoring scheme by including character development (including character dialogue), setting, problem and solution given a graphic organizer and recasted language models.

• Student will score a 3 out of 5 on character development on the narrative scoring scheme by retelling a story with character dialogue and by including main and supporting characters given, “who question prompts” as needed.

Narrative Scoring Scheme

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Assessment of Fictional Narratives

www.Bilinguistics.com

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Articulation

• Student will produce

/target sounds/ with 80%

accuracy independently

at the word level.

• Student will produce

/target sounds/ with 80%

accuracy given models,

visual/verbal reminders,

recasted productions of

target words as needed

at the story re-tell level.

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Articulation In-Person

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Articulation Distance Learning

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Interactive Features for Articulation

Video Example

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Annotate

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The Cat who Climbed a tree (and got stuck)

By Santiago

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Articulation Create a story with target words and sounds

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Technology vs. Traditional Toys

This Photo by Unknown Author is licensed under CC BY-SA-NC This Photo by Unknown Author is licensed under CC BY-NC-ND

Auditory Bombardment, Discrimination, Phonemic Awareness Tasks

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Jesus, L. M. T., Martinez, J., Santos, J., Hall, A., & Joffe, V. (2019). Comparing Traditional and Tablet-Based Intervention for Children With Speech Sound Disorders: A Randomized Controlled Trial. Journal of Speech, Language, and Hearing Research. doi: 10.1044/2019_JSLHR-S-18-0301.

-The Informed SLP

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AAC and Core Vocabulary via Teletherapy Video Example

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Pre-recorded examples of Core Board

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Changing Virtual Background

Settings Virtual Background Choose new background

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Follow on YouTube

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Surprise Bags

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Social Skills

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stories.

• Check-In




• Game

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www.boomlearning.com/decklibrary

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Show and Tell

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SA Case Study 1st grade

• Selective-Communication Like Behavior

• Recently started communicating with me after 3 months of knowing him.

• Presents with phonological processes stopping and fronting

• Language Disorder

• Currently being evaluated for other dx besides SLI

• Difficulties with Reading, Writing, and Math.

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Scavenger Hunt

Expanding Expressions Tool

ExpandingExpression.com

Increasing Vocabulary Diversity

Bilinguistics.com

Hadley, E. B., Dickinson, D. K., Hirsch-Pasek, K., & Golinkoff, R. M. (2018). Building semantic networks: The impact of a vocabulary intervention on preschoolers’ depth of word knowledge.

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Informed SLP

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Parent Coaching

• “I wonder if…”

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The family’s perspective

• The therapist just plays with my child.

• They just sit and talk with me and do nothing with my child.

• This is all too overwhelming.

• I don’t have time in my day to do this.

• I forget what to do after the therapist leaves.

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The SLP’s perspective

Families don’t always follow through with suggestions.

I can’t get families to incorporate ideas into

daily routines.

Many times families don’t

make appointments.

I don’t have easily

accessible resources to share with families.

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Not on the same page

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Buy In

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Rationale

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Maslow’s Hierarchy

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Getting Families Involved

We know it’s important, how do we do it?

• Provide specific instructions

• Provide a rationale

• Keep it simple and consistent

• Have it pertain to a family event or routine

• Set expectations

• Follow through

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The Informed SLP

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Shared-Reading

Switching mindset from “education” to gaining insight into the child’s thoughts

No such thing as right or wrong

Increasing use of wait time

Increasing conversational turns

Making phonemic awareness fun and silly (like making up nonsense words by taking words in the text and changing one phoneme)

Using open ended prompts: “I wish…” “I think…” “I wonder…” “What do you think?”

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Interacting with Teachers and Parents

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Creating a website

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How to use your website during therapy

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https://youtu.be/s-P_WdQWPc8

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BitmojiClassrooms

ToyaNicol3 on Teachers Pay Teachers and YouTube

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Technology as a Social Engagement

Tool

What if the students didn’t touch

the iPad even when you’re doing

in-person learning. It’s a barrier

activity that can be used in-

person and through distance

learning.

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Using Technology: Sentence Combining as Evidenced-Based Practice

This Photo by Unknown Author is licensed under CC BY-SA-NC

It CAN be FUN!

Lynne Telesca (2018).

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Sentence Combining

• Student will increase sentence

complexity from an average of 1

clause per utterance to 1.2

clauses per utterance during a

story retell, given a word bank of

subordinating conjunctions.

1. The boy ran quickly.

2. The bees were chasing him.

Subordinating Conjunction

Because

Lynne Telesca (2018). Supporting Adolescent Writing Manipulating Complex Syntax Across Disciplines. ASHA Connect Summer 2018.

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TinyBop Apps

• Creature Garden

• Weather

• Space

• The Robot Factory

• Plants

• The earth

• Coral Reef

• States of Matter

Target word:

Because

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Group vs Individual Teletherapy

This Photo by Unknown Author is licensed under CC BY-NC

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Considerations for Teletherapy

• There’s not a one-size fits all with families and speech-language pathologists.

• When you enjoy what you’re doing, you’ll be more effective.

• Technology vs traditional toys….it doesn’t matter. It’s the approach that matters.

• Find your groove within tele-therapy while keeping yourself rooted in evidenced-based practice.

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Follow on YouTube

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Resourceshttps://www.theconsciouskid.org/books

https://www.theinformedslp.com/

Hessling, A., & Schuele, C.M. (2020). Individualized narrative intervention for school-age children with specific language impairment.

Language, Speech, and Hearing Services in Schools. https://doi.org/10.1044/2019_LSHSS-19-00082 [available to ASHA members].

Curran, M., & Van Horne, A. O. (2019). Use of Recast Intervention to Teach Causal Adverbials to Young Children With Developmental

Language Disorder Within a Science Curriculum: A Single Case Design Study. American Journal of Speech-Language Pathology.

doi:10.1044/2018_AJSLP-17-0164

Language Sampling With Adolescents: Building a Normative Database With Fables, Marilyn A. Nippold , Laura M. Vigeland , Megan W.

Frantz-Kaspar , and Jeannene M. Ward-Lonergan, Aug 2017

Jesus, L. M. T., Martinez, J., Santos, J., Hall, A., & Joffe, V. (2019). Comparing Traditional and Tablet-Based Intervention for Children With

Speech Sound Disorders: A Randomized Controlled Trial. Journal of Speech, Language, and Hearing Research. doi:

10.1044/2019_JSLHR-S-18-0301.

Hadley, E. B., Dickinson, D. K., Hirsch-Pasek, K., & Golinkoff, R. M. (2018). Building semantic networks: The impact of a vocabulary

intervention on preschoolers’ depth of word knowledge.

Nelson, L. H., Stoddard, S. M., Fryer, S. L., & Muñoz, K. (2019). Increasing Engagement of Children Who Are DHH During Parent–Child

Storybook Reading. Communication Disorders Quarterly. doi:10.1177/1525740118819662

Lynne Telesca (2018). Supporting Adolescent Writing Manipulating Complex Syntax Across Disciplines. ASHA Connect Summer 2018.

Jissel B. Anaya , Elizabeth D. Peña , and Lisa M. Bedore. (2018). Conceptual Scoring and Classification Accuracy of Vocabulary Testing in Bilingual

Children.

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