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

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

 

The Value of Technology in Your Private Practice

And Tips for  Parents When Choosing Their Provider

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It’s 2016.  Everyday we use our smart phones for scheduling, googling, facetime, personal connections , banking, and business transactions.  Communication is at our fingertips.  This has become our norm.   We have now and expectation of automation and reduced duplicity.  And then, we put our kids in therapy and find ourselves back in the stone ages of paper, appointment reminder cards, and more importantly, little continuity of progress and clinical therapy programs because MOST of it is written down somewhere…or my favorite in the head of the therapist that knows your child like the back of her/his hand.

Imagine my being  in a meeting and politely inquiring what would happen with the child’s program and progress if the therapist did not wake up the next day or for some reason unable to return to work.  Would we be starting from scratch?  The gasps and silence at this meeting resulted in my being called morbid among other things…because a therapist would never do that.  My experience as a Director is that things happen, life happens to therapists and sometimes the best therapist cannot return to work.  Yes, goals are in place.  BUT, goals and objectives do not prevent the parents worse nightmare of starting from scratch.

Starting from scratch happens when goals and objectives are present without a running record of what the child has been taught and what they know.  This is prevalent across ABA, Speech, OT, Special Education and more.  The lack of the running record.  The teaching of the same categories because the goals are written to “Improve the ability to tact 9-11 nouns within the category of (food, animals, places, etc.”. The running record would tell us exactly what nouns were worked on, where the deficits are, and so on.

The lack of the running record is why many parents are afraid to transition between therapists, move to a better therapist, relocate, or even move to another grade level with a new teacher.  Not because parents are afraid of change.  Change is inevitable.  It is the unspoken angst of starting again because WE, therapists, don’t provide the record outside of ourselves…you know plan for the client to not have us/need us/ want us, etc.

Tips for Therapists:

  1.  GET and Create running records for all of your clients.   It is know longer to okay to say “Oh single word mands are on maintenance” without a list or running record of the actual words expressed.  When everyone knows all the words the client knows or is exposed to in direct or incidental teaching the expectations heighten outside of the four walls of treatment…or they should heighten.
  2. USE an EMR and Data system that reduces increases productivity, improves continuity within and across organizations (therapists) your client’s work with.  Increase Efficiency, Productivity, and Process.

Questions for Parents to ask their next therapist

  1. How do you collect data?  Paper/Pencil or Technology program.
  2. Who owns the data for my child’s program?  You as the parent (ultimate payor) should own the data.  Can I download this data on a weekly basis or login to view how well my child did this week?
  3. Does the data system track my child’s knowledge, language growth with specific lists of what they know?
  4. Do the progress reports maintain a running record that can be shared with all the therapists and teacher’s that work with my child?
  5. Is scheduling online?
  6. Is their a way to track how well my child does and the trend’s in learning based upon the therapist that works with them?  Does a supervisor train and work with the therapist for each change in program?

There is so much more to add for parents.  In a nutshell, since 2013…EMR should be used because that’s when we became more reliant upon technology to improve our lives.  The expectation for using the same when it comes to ABA Therapy, Autism programming, Speech Therapy should exist.  The push will come from you as a parent.  As a therapist, I will say that most organizations want to do this but hesitate with the change in their systems.  Well…it’s time.   2016 is here and we need better expectations, quality assurance, and ownership back to the parent.

Thriving is intentional work to move forward…letting go of the systems that once held us back.

Let’s THRIVE.

Landria , MA., CCC-SLP

~The SLP GURU

 

 

 

 

 

Teletherapy

The American Speech Language Hearing Association (ASHA) defines teletherapy as  “the application of telecommunications technology to delivery of professional services at a distance by linking clinician to client, or clinician to clinician, for assessment, intervention, and/or consultation.”

I started using teletherapy when I was the Executive Director of SLC Therapy.   With this medium, our clients didn’t have to leave their homes, but can tune into their therapists and receive intervention via the web.  We used teletherapy with a select few clients over the last year with a range of diagnosis (ASD, speech delay, and language impairment) to develop a protocol, get creative about our reinforcers, and compare the progress of the same child seen in the clinic vs. teletherapy.  Our biggest question was: Did progress stop when the client changed from center based to teletherapy.

HERE ARE MY RESULTS:

1. When teletherapy was initiated, two of the four clients were on the road to dismissal of services due to progress. Those two clients were able to be dismissed earlier as the home practic component became more intensified.

2. Parents were our parents in a more meaningful way.  We even made video samples of prompting, homework samples, etc. so that generalization could skillfully be applied by parents.

3. Social communication therapy can be very cool via web therapy.  Both from the therapist perspective and the client perspective.

4. Our families were less stressed about getting to therapy!  This was huge, especially during the winter months, client illness, etc.  Our clients were ready for therapy and rescheduling was very easy.  We found that this therapy fit into the family schedule a bit easier.

5. Private schools were open to this option as it allowed for better teacher and para collaboration.

6. Providing ABA Therapy via teletherapy can be done.  Creating the programs, implementing, and using the parent as our partner has been wonderful.  It’s great to see a child who could not wave and say hello with fluency do it quite readily with us on the web and generalize it to his home environment.

7. It placed parents in a better position of power and partnership.

8. Clients still made progress, 30 minute sessions 2x per week for mild- mildly moderate impairments.  Mild: 1x per week with home program component.

9. Most families already had a webcam and skype account.  Our skype account (business account) is secure, and we were able to provide this using with no additional cost to our clients.  And now this is not the medium I utilize for teletherapy as there are many other options.

To begin in teletherapy as any other therapy, an assessment, evaluation, or consultation is conducted.  Treatment plans are still created.  In addition, we complete a mock session in which a client eligibility form is completed to determine if they are ready for teletherapy.

As I watched weather reports and hear of clinics closing, client’s not being seen due to weather and travel concerns, I smile because I know many would benefit from losing the hustle and bustle of getting to therapy and would say “yes” to WebTherapy or Teletherapy.

For more information about Teletherapy, visit:

American Telemedicine Association:  http://www.americantelemed.org/i4a/pages/index.cfm?pageid=1

American Speech Language Hearing Association Position Statement:   http://www.asha.org/practice/telepractice/

http://www.asha.org/Publications/leader/2006/060815/060815f.htm

http://www.asha.org/Publications/leader/2002/020611/f020611_2/

http://www.hrsa.gov/telehealth/publications.htm

Enjoy and Be Empowered!  (Maybe I will see you via teletherapy).

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