Is Your Therapy Practice F.A.T. enough?

StockSnap_Y7OQI22I2PInvest In Your Practice and make it F.A.T

 

Episode One: Podcast: Making Your Therapy Practice F.A.T.

The elephant is my favorite animal for many reasons and I will give you two.

  1. Despite it’s large size that may not make the elephant the fastest animal, it is quite powerful.
  2. When the elephant is falls, he does not stay down long.  Not moving fast to recover from a setback of falling will make him lose his breath and die if he stays down for too long.

I remind myself of this in all areas of my life.  I am a wife, a mom, a daughter, a great friend,  and a social entrepreneur.  I have to remember that I am also an elephant.  Powerful and Quick on a setback.

But the obvious is the size of the elephant.  Large-Enormous-Big-Huge.

How can a business, your therapy practice, become F.A.T.

Being F.A.T. is essential for your therapy practice.

Focused.  We know why we are here and how we can help you.  We know why we are here and who are best employees and clients are.

Accountable. We are here to serve and have measures of internal accountability for your child’s progress and how well our staff serve our consumers.

Transparent. This is who we are, our fees are consistent. We are the same company and people when the doors are closed and the blinds are short from a fiscal and clinical integrity standpoint.

Now what does F.A.T. look like?  

Listen to more on the first episode of the my podcast:

Clinical Practice and The Business of Therapy

Until next time!  Continue to Thrive.

~Landria Seals Green,MA., CCC-SLP-BCBA

Chief Clinical Officer, Momentum Autism Therapy Services

Chief Knowledge Officer, SOAR Solutions for ABA, Autism, and Special Education

#MichiganABATherapy

#MomentumABATherapyMichigan

#SLPGURU

#TherapyBizCoach

FOCUS

bb9jwutmpuk-anthony-indrausLet your life get you IN FOCUS. Align YOU and REALIGN your business.

Sometimes I just get tired.  Not so much physically…but head filled with thoughts and things to do kind of tired.  Sometimes I just want to answer a question saying  “I’m tired.  I have two beautiful children: infant and toddler.  I own more than one business and have the nerve to want to write a book.”   I deal with saying no to things I’d love to do because the thought of arranging my family life and schedule makes me want to run.  Sometimes I just want to sit in a corner and eat.  But I don’t.  Because it is my life…my choice…my goals being manifested that require my head, my heart, and my hands to be fully engaged and in the game.

Life gets busy.  Business will experience growth (slow or fast). Family and friend demands don’t east.  Parents get sick.  Children get sick.  Presents need to be mailed.  Marketing requires thought, money, and follow through.  Staff need to be taken care of.  Waitlists need to move.  Emails need answering.

So how do you get through life and all of its wonderful demands and dreams?  You take it one step at a time.  You pick up the crying baby.  You pause.  You imagine the business you want and you put each item into action.

Here is the big lesson: There is no rush.  There is no race.  There is no competition.  There is no finite number of clients.  It is all there for you…for me…for us.  I have learned through some wonderful and some painful lessons, that LIFE requires my presence not my anxious unassured self wondering if my business(s) will work.  Of course they will!  Not from wishing and magic (been there)…it will happen from actionable plans knowing that all does not need to happen right away.

What should you do in focusing on your life and business?

  • Here Choose three things
  • Focus (this is the key)…this is where we lose heart and faint.  This is where we wonder if our business will work…you must FOCUS on these three things.
  • Get it done in a measurable time period (15 or 30 days)

This is all very doable and when you lose focus, forgive yourself and get back on course.  Create accountability with a coach or a colleague (choose carefully)…and always take care of YOU!

We are all in this together.  Let’s Thrive!

~Landria Seals Green, MA., CCC-SLP, BCBA

#TherapyBizGuru #SLPGURU

1 -2 and then TALK. Entering a Social Group

The Collaboration Between SLPs and ABA Professionals are needed HERE.

stocksnap_rsp6nagl6bI dropped my son off at school and it was confirmed for me.  When entering a group, the social sequence is

  1. Physically Enter the Group
  2. Motor actions similar to those in the group and regulated physical movement.
  3. Talk Behavior

For as long as I can remember and even now, there is still the sit down at the table to teach conversation skills.  While there is a place for the seated conversation, there exists a whole world of running, playing, jumping, walking, standing, exercising and conversation at the same time especially for children.

Children with autism have challenges with motor imitation, complex movements, and nonverbal gestures.  With this information, we know treatment from ABA or Speech Therapy can often result in verbal behavior with static gestures, but lacking conversation fluency, increased pauses in response time, and more.  Is it possible to actually teach conversation fluency, fluidity of nonverbal gestures,  use of sarcasm/jokes, tone of voice, and verbal and nonverbal comprehension.  Absolutely!!  Here are three things that therapist’s in the field of ABA and Speech Pathology can do improve the social client.

  1. Breakdown the goals in the following categories: Social Skills, Social Behavior, Social Cognition, Conversation Fluency, and Social Motor Movement-Integration.
  2. Observe typical developers that are your clients’ neurotypical age range of your client. Write down the various skills that fit into each area mentioned above.
  3. Outline the deficits based upon #1 and #2 as a YES (they possess this skill) or NO (this is something we should work on).
  4. Design your treatment plan based upon the YES and the NO’s that are related to one another  by creating by writing down the how the YES will be achieved.
  5. Take Data and Monitor

It’s important to note that each area can benefit from and should seek the advice of the other professional.  For example, if there are more NO’s in social behavior as it relates to functions of behavior…seek the collaborative ABA professional.  In another example, if we looking at conversation fluency, sarcasm, nonliteral language comprehension…seek the collaborative SLP.

And no this is not quicky and easy…but well worth it!

~The SLP GURU

Landria Seals Green, M.A., CCC-SLP, BCBA

OPEN FOR BUSINESS: Paperless in ABA Therapy

IHUEIA0Y8TThe Paper-Scheduling Chase and HOW IT DOESN’T WORK

 You open your ABA, Speech, or OT Therapy Practice.  

You are happy.  

Your family is proud.

 You get a few clients.  

You are proud and happy.  

You start billing.

You get paid.  

You are very happy.  

You get more clients.  

You hire employees.  

You feel like a business owner.  

Then you get more clients…which means more paper.  More authorizations. More signatures.  You add services like ABA or Speech Therapy or OT.  You now want social groups.  Your staff is happy for the job security.  Your client’s are signing up.  And you have more paper.  You can’t keep up.  You are using program books and Excel to track ABA programs and it’s not keeping up and not very efficient.  

You chase employees down for signatures.  Employees break HIPAA even after training with leaving paper out and in their cars.  You don’t get the signatures you need at the timeline for billing and paying your expenses.  You are stressed.  Paperwork and Codes change.  You send out a memo.  Employees use old codes. You spend your weekends in the clinic fixing your employees coding errors and auditing paperwork for signatures.  Billing is late.  Payments are late.

 Employees are happy.  

YOU ARE STRESSED.  YOU ARE TIRED.  YOUR WEEKENDS AND NIGHTS BELONG TO THE CLINIC. 

The scheduler is putting people without authorizations on the treatment schedule.  You will never get paid for those services rendered.  You are losing money.  Your services are great but going down if you don’t get your hands in treatment…after all, you started to make a difference not enter a conundrum of billing, signatures, reports, and paperwork.  

Your processes suck and they are killing your quality of life as a business owner and hindering your business growth.  Finally….You add electronic system. You add a scheduling system.  You add a billing system.  You add a data collection system.  They work for a while…but don’t talk to each other.  Those systems don’t even meet the insurance requirements of getting signatures, note taking, and the scheduler is still scheduling visits for which you do not get paid.  You find yourself having the same conversations every time and are afraid to fire the scheduler and front desk staff because…they have all the information in their head and no one taught you about unemployment and those atrocities in SBA class and in graduate school.  

Your processes STILL SUCK and now you have technology that is not working for you.  Your Saturdays and late nights are still owned by the business…and you have convinced yourself that this is the cost of doing business and everyone goes through this.  Meanwhile…life is passing you by…your employees talk about their great weekends and you have been doing their work all weekend.  You write a memo. And the cycle continues…the happy service firestorm.

Can you relate?

I CAN.

This was me at different points and time.  

So when do things really get better?  It’s not a matter of when but HOW do things really get better.

Change systems.  Change culture. Change how we implement technology into our clinics and schools.  Our commitment at  TN Active Care is not just to get adoption of a system and add you to our numbers, but implementation of the system so that it works for your practice. And here is the real difference between TN Active Care and others aside from getting a “ME”:-)  (clinic director,entrepreneur, first hand understanding the leadership perspective).  Each client that works with us gets the environment created and custom to your clinic and school.  We ask questions..we listen to you and how you work, what you need especially and we custom our framework around you.  This is very much like what we do for our clients in ABA therapy and other treatments…what really works is not placing a program on a client and making it fit..but creating an program and client management system that actually works!

 This is about more than technology.  It’s about Efficiency, Productivity, Quality Assurance, and giving YOU your Saturdays and Evenings BACK (Quality of Life).

Let’s THRIVE!

~Landria Seals Green, SLP GURU

NEVER BEEN TO A BASEBALL GAME

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How Exposure, Opportunity, and Experience make a Difference in Teaching Concepts

I’m using this Saturday morning, taking a brief break from studying, and watching the movie “Hardball” with Keanu Reeves.  It’s a story of redemption for Keanu as he is tasked to coach an inner city youth baseball team.  True to life, he eventually learns that investment has a cost and the teaching-learning is reciprocal.  In a memorable statement, he asks the team if they’ve ever been to a baseball game.  The children reply “No”.  Keanu states “Until you see a baseball team, you’ll never learn to be one”.

Wow…

Isnt’ this what we know as therapist’s.  ABA, Speech, Occupational Therapist.  Especially those of us that work with children with autism.  Being is Seeing.

When we want our client’s to BE…we essentially want them to learn the concept and the proof of learning is in the data.  You know those pesky numbers that require us to show that what we are doing has social relevance, is working, and has generality.

But our client’s need to “see a baseball team”.  How do we deeply want our clients to identify fruits, vegetables, foods when the the opportunity to go to the grocery store doesn’t happen, the experience of eating a select food item happens often, and the exposure to only what he will eat continues to exist.  How then and what connection do our clients have with our learning tools and teaching stimuli? I was amazed in doing language therapy with a group of children last year that in discussing animals, none had ever visited a zoo; asking them about where to find books, few had visited the library.  How do we as therapist’s get up this mountain of language lack and get to acquisition, fluency, and generalization of new concepts?

  1. WE MUST WANT TO.

First things first.  The desire to get to know what our clients know has to be there. We must have the motivation to build our treatment around them, allowing the learning material and objects to be motivators.  The connection to the learning tools is because of interest and the need to know more.  Connect the small interest and expand on that.  After all, project based learning such as Reggio Emilia does this with typical brain developers. How awesome is this to take this concept of interest and expansion into the world of discrete trial teaching and ABA therapy.  For instance, if your client loves all things “red’.  Why not start with red things, apples, candy, veggies, chips, crayons and use them to teach categories and smaller categories (i.e. fruit, snacks, shapes, colors, crayons, clothing, etc.).

2. DON’T ASSUME. GET TO KNOW YOUR CLIENT.

Here is where it’s not tricky at all, but this is where therapist’s get in their own way.  This is the part we miss.  I recently read a post on FB from an SLP who gave reasons why she no longer does home visits…”section 8 families never home, too busy to answer the door because of drugs, sex, and alcohol”.  Because we live in a world of screen shots, I was flabbergasted.  I also thought…this therapist could not have any true friends-colleagues to remind her that arrogance has no place in the heart work of therapy and to take that #$@# down!  So the getting to know our clients is simply taking on each as an individual.  Not all families who speak a second language are dysfluent in English, they can be fluent in both and have a great language rich home.  A child of surgeons, can have poor opportunities and exposure because they may not fit the picture of what is imaged.  Never assume.  Get to know them, lay down your profiling and stereotypes,  and MAKE A DIFFERENCE!

3. CREATE COMMUNITY RELATIONSHIPS.

You want your client’s to have social opportunities. You want them to experience the vocabulary and actually engage with the concepts and words you teach.  Well this where the extra mile gets impactful.  Make calls to your local library, supermarkets,museums, and arrange discounts or make it more autism friendly so that the loudness, etc. of the place doesn’t get in the way of them experiencing the target goal.  And how about those supports coordinators for autism waivers and such…this is what they should really be doing to make the therapy work. So let’s help them be better at and more integral in coordinating and establishing those community relationships for you.  It takes a village. Yes.  And village creation is not magical.  It takes reaching out, reaching across, and communication.

4. BE IMPACTFUL. MOVE AWAY FROM WORKSHEETS.

I don’t like worksheets for most things especially therapy homework.  Circle the_____. Cross out the _____.  Versus write down your dinner,circle the vegetable, the dairy.  Look through this article on USA today or Time for Kids, make a video summary and tell me about what you read.  In a world of SnapChat, Instagram, Facebook Live and all things to come…I don’t want my client on these platforms engaging in ways that look as if therapy were never part of his world.  To be impactful in 2016 and beyond, today’s therapist will need to assign relevant homework with applicable outputs.  The therapist will have to assign experiences and discuss them rather than the solitary worksheet that may support acquisition but will not readily yield fluency and out of touch generalization.

Seeing is Being.  And on the flipside…how can a therapist assign a client to make an Instagram video and give a movie review (2 things you like and don’t like about a movie), if they themselves don’t use the tools.  Going to the baseball game is a two part.  The coach had already experienced this phenomena and studied it…he enjoyed it and saw the relevance and therefore exposed his apprentice.  As people in this world, we experience life…and don’t bring the “baseball” game to the therapy room and we lack relationship with our families…never getting to know them beyond the surface.  Time out for this!  Life is not only short, but our time spent together must be impactful.

Therefore, my clients have no room for my assumptions about their life…I need to bring them to the baseball game…to frame the words from the Statue of Landria, SLP GURU

Bring me your behaviors. Food Aversions. Sarcastic say anything selves.  Bring your spitting, bolting, and focused interests.  Bring your inflexibility, large vocabulary and small experiences.  Bring me your large experiences that you keep to yourself.  Bring me your hitting. Bring your slang, defensiveness…I am your Autism Therapist…it is my job to accept you, broaden your world, and make you better for having known me…not from any pseudoscience, but from evidenced based practice, real world application, and data collection.  Bring yourself. I bring myself. And let’s get to work!  ~Landria Seals Green

We WILL THRIVE!!

~Landria Seals Green, SLP GURU

THE WORLD IS YOURS

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My Decision to Move Forward and Enter A Brilliant Expanded -New Path

I can often be heard reciting a poem I heard at church in my childhood to my son.  I give him a modified version that gives the consistent ending “You can be anything you want to be. You can go anywhere you want to go. The WORLD is yours.”  Now, at the age of three, he chimes in with me and ends with the question “The world is mine?” I respond with a resounding Yes!  He then sticks his chest out and smiles.  This inside building of self-esteem is not new in my family.  My mother would sing the “If you Believe/ Believe in yourself” song from The Wizard of OZ and The Wiz to us and charged my sister and I to sing this song on every Youth Sunday.

Believing in myself.  As an adult, when #$#@ happens, you may forget to believe from the inside and move towards that outside validation and needing to be approved by others.  My mentors always taught and trained me to make sure that I had data and evidenced based research to support the belief or the next step for my clients.  This was important in clinical decision making or helping clinics and organizations make decisions in program development and application.  For personal decisions, I go inward, consult my inner circle, and go to the heart tug.

So here I am on this new path, after restoring and filling up my own cup and having a baby girl (surprise!).  This path is so great and vast, I am often breathless in the best way possible, knowing there is still more to do.  When I began to delve deeply in the field of autism, there was such and still is a disconnect in among and between the professions of applied behavior analysis (ABA), speech pathology, education-special education, core standards, and occupational therapy.  I continue to be astounded at the the number of therapy centers that only serve early learners and insulted that middle and highschool programs teach laundry and cooking as skills when in reality I know plenty of adults who don’t do their own laundry and can’t stand cooking…yet manage (and no one judges them, they learn real things like money, competitive job training skills, and more).  I am baffled by ABA centers operating without the input from speech pathology yet posts questions on Facebook of what to to do?  I gawk at feeding programs run by OTs only knowing that this is well outside the scope of practice of this profession.  So as I sat back with my cup of tea working, building, and restoring myself…my call to serve never left.  In fact, it is louder and resonates deeper than ever.

So imagine my surprise, when asked to partner with TN Active Care.  I had already created the SOAR Autism Curriculum as a library for  TN Active Care .  The creation of this library was so intimidating and exhilarating at the same time.  How often does one create a platform of therapy programs and targets for learners with autism and related disorders that integrates verbal behavior, social communication, preference assessments, academic academic programs, core curriculum, and fine motor programs?  My dream of having quality assurance and integration of disciplines for the execution of programming for learners with autism would be realized and reach a global platform.

In a recent conversation with the CEO of TN Active Care, Ling Huang, I was asked to take on the role of Director of Operations and Sales for the U.S. territory and build a team.  My heart jumped and said “YES”.  My head said, you are a speech pathologist…not a sales person.  And then I had to remember, at the core  in talking about services, getting new clients, etc. ..you sell.  When you think about branding, you sell yourself.  So yes, I could more than assume this role.  I believe in the product.  I helped to develop the product.  This opportunity was an intersection of passion, intellect, belief, and community global need…it is serendipity.

At the core, I am a change-maker.  I want to change the clinical landscape in how we look at and treat autism for the better.  I want Dr. Temple Grandin and all of her accomplishments to be the norm, not the anomaly.  I want to utilize STEM (STEAM) programs and capitalize on the strengths of autism so there is independence for living with real career attainment.  I want more options and choices for learners with autism outside of learning daily living skills and preparation for jobs in laundry, store greeting, and stock shelving.

I imagine every parent being able to say to their learner with autism

“You can do anything you want. The World is yours.”

Let me introduce to you, TN Active Care, a application and web based platform that pulls the best from old school program books and new school technology.  This tool, created by an awesome technology team supported by clinical therapists across the globe, is smart.  It collects data for ABA programs.  The data for trial by trial, duration, latency, inter-response time, and more.  It takes data on each and every target.  It remembers maintenance programs.  It moves by prompt level.  It embeds scheduling and pairs it with cost (how much were we authorized for), it allows for video conferencing technology for supervision.  And there is more…you know how much therapists text each other about scheduling and programs…and violate HIPPA??  Well the TN Active Care pulls in instant messaging within its secure platform and parent’s can use it to communicate with their child’s therapy team on this secure platform.  It generates reports needed for parents and third party billing.  It is paired with the SOAR Autism Curriculum, that supports early learner through higher level language and academic work toward vocational and pre-college readiness.

I am not only thrilled to join this team, I am excited.  The field needs smart technology.  This is it.  Parents need more information..weekends can be long.  Now they can see treatment programs and do them (as assigned by the therapist).  Parents can video behaviors not seen in treatment and show them through recording or real time to the therapy team.  Scheduling beyond authorizations support the front desk and back end.  Billing …yes it includes that too.  Oh and it connects the schedule to the therapist work hours…so now we have payroll and productivity tied to the clinical schedule.  And guess what?!?  The technology team listens and makes it better and customizes things to fit the center’s they work with.  I can attest to this because I actually meet with the tech team and have a deeper and newfound respect for security and technology development.

While there is still more to come for me (stay tuned), I am excited to introduce you to this program and start to build partnerships within the U.S. and beyond of those using this SMART ABA program technology.

I grew up with the song lyrics  “If you believe within your heart, you’ll know that nothing can change the path you must go.  Believe what you feel and know your right because the time will come around when you’ll say, it’s yours.  Believe in yourself right from the start.  Believe in the magic that’s inside your heart.  Believe ALL these things..”

So in my waiting, my listening, reciting the childhood poem to my children…I went back to my core and what I believe the impact therapy should be on its clients’.

And now this program, TN Active Care, is  available to the world…clinics, parents, groups, schools that serve people with autism.

Visit TNAC’s facebook page.  

Visit my FB page @SLP Guru for updates on what I’m up to and publishing (hint hint).

Let’s Keep THRIVING!

Landria Seals Green, MA., CCC-SLP

Establishing Instructional Control via Teletherapy

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Using Technology During Your Sessions with Learners with Behavior Challenges

Instructional Control.  Not as bad as it sounds, I promise.  Truth is, in most cases we all want and need it.  When a speaker is standing in front of the room and the audience is quiet: control.  See…not as bad as it sounds.

But how about the therapist that needs it so that a skilled learning (acquisition or fluency) can take place and the therapist cannot use his or her hands?  By this, what if the behavior of noncompliance is present and the session is via teletherapy or over the web?  What is a well-meaning therapist to do?  You’d do the same, with some variation, as if the child is in front of you.  That is, if you take the perspective that instructional control is about presence or owning the room in such a way that yelling or holding become completely unnecessary because YOU, therapist, have the floor.

Today I worked with a student who is constantly told “NO” all day.  So by the time he has a another provider he is, at my husband would say, full of hearing the same admonishment. This particular student is classic in escape.  We’ve all met versions of him in size, color, gender, age….doesn’t want to do anything at anytime except what he’d like to do at the time.  So when he told me I was boring, I ignored him.  Recognizing that wasn’t enough for me to change. He then started doing other things with not so kind language and then plain moving away.  Could I have used a variety of reinforcers?  Of course, but for him the only effective reinforcer would be the escape.  And getting him back to task after a break would have prolonged his escape.  So here is what I did and it worked.

  1. Planned Ignoring of client’s off task language (including insults)
  2. Restatement of the Consequences when the behavior escalated to property damage (break something, your parents will pay for it).
  3. Reminder: Work First. Then Leave.  No work done.  We will sit until you are ready.  I have the next two hours free (too much language…but he needed to know I was in it for the long haul)

My voice: Firm

Client Responded to the Consequence and the Reminder.  He completed his work.  I congratulated him (even though he was still disgruntled).  I then had him survey the room and posed this question “Is the room in the same condition at the beginning of our session or messier?”.  His response: Messier.  My response: Clean up for two minutes then leave.

He complied.  I instructed the adults in the room, we were not looking for perfection but for compliance.

Here is the lesson:  Hearing NO or admonishment all day can ruin your mood BUT  it is no excuse to break, destroy, or not complete assigned tasks.  In teaching children resilience in learning and extending their ability to stay with it…we teach them communication (telling another you are annoyed or irritated) and we implement realistic situational consequences.

After cleaning for two minutes, I called him to the computer and reviewed: Come in the room. Sit Down. Get the work done. Leave.  He responded: Yes.  I then said “I’m proud of you for getting it down.  It’s over. Now go enjoy the rest of your day”.

My voice: Soft and pleasant

In the It’s Over part, we as providers teach them to understand how NOT to carry the feeling of anger.  The challenge for us is not to carry on in our case and school meetings about the student’s behavior.  (Don’t you know when you’ve been discussed and the discomfort you feel…now imagine being a child or teen).

Still looking for a well written behavior plan and some data collection…but hey, Rome was not built in a day and neither are adults.  Everybody’s learning 🙂

Let’s THRIVE!

~Landria, SLP Guru