Podcast Transcript - Episode 11
SLP Toolkit Podcast, Episode 11, Transcript
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Well, hi Lisa.
How the heck are you today?
Great. I like that attitude for being here on a Saturday. You sound pretty chipper.
Well, you know, I always like to bring my A-game to the confessional.
As you should. And we've actually got a pretty exciting reason to be here on a Saturday. Do share.
Well, I would like to introduce the one, the only, the very, very, very sexiest of all sexy Kansas city transplant here in the confessional: Jennie Bjorem.
Thank you for having me.
Yeah. Now you are live. Sometimes we've had other guests, but they come in virtually. You are actually in the confessional.
I'm actually in the hot box.
It is hot. I'm so mean. I turned the air off because it sounded noisy.
We didn't want to sound like we were on an airplane.
That's exactly right. We, um, production quality is actually not one of our top priorities here in the confessional for this podcast. However, that being said, we do want it to sound, you know, somewhat nice and clear, and it was sounding a little noisy. So we're gonna be in here sweating just for your listening pleasure. But anyway, we're so excited to have you, Jennie, welcome.
Thank you. Thank you guys for flying me out here to the hotbox city.
It's as hot in here as it is outside.
It's about 108, right?
I feel like it's worse in here.
It might be! And I apologize, but I know Lisa and I were talking and we were like, we are so mean. If we were good friends, we would have brought you out in late December when it's beautiful.
But people need this content now.
We need it now.
Yeah. We couldn't wait.
Right. And your schedule is busy.
It's very busy. Yeah. But I get to see you guys at ASHA in Boston and it'll be cooler there. Yep. Yeah.
Yeah. So you're not, we didn't fly you just out for the confessional or else, Meredith Harold's gonna be super offended.
Don't offend Meredith!
Well, what are you doing here? Really? Why are you in the AZ?
I am in the AZ to help work on your content for apraxia for SLP Toolkit.
That's going to be so awesome.
I know, I—
Can we tell you how grateful we are that you were willing to come and do work on this project with us?
Yeah. Thank you. I'm excited. It's been tons of fun.
And so much learning because even the process of creating this content, I said this morning, I woke up and I felt like I got hit by a bus because it feels like we've been at an apraxia conference.
Yeah. Well, good. I'm glad you guys feel like you're learning some stuff.
Oh my gosh, yeah.
And we got some shenanigans mixed in.
Yeah, no, that's our MO.
Which makes it fun.
Yeah. We have said this many a times, but we live by the idea of work hard, play hard.
Jennie hypnotized me earlier today.
I did, with a crystal.
Now, are you snapped out of it or are you going to just say whatever she wants you to say?
I don't know.
(Whispering) I am very sexy.
Jennie is very, very sexy.
Okay, so still at work.
Jennie, I will give you all my money.
And that is a great example of prosody issues, sounding like a robot.
Right! Seriously, our heads are full of information. Well, I have learned more about apraxia in the last two days we've spent with you than I have learned in the last 12 years of my profession.
Oh, good. I love it.
And so this is one of those areas that, um, we talk again, we talked about this all the time, too, that in the schools, we have to be a Jack-of-all-trades and really kind of learn how to master them all too, because we do not get the benefit of referring out when we have students on our caseload with needs that we aren't experts in.
So, um, that being said, there's clearly a lot of roles and responsibilities of a school-based SLP, and we don't have the benefit of, um, taking these specialty courses, you know? Like these intensive bootcamp type courses so that we can gain more knowledge. Um, and so we are--hopefully with this collaboration with you--going to give SLPs the tools they need to feel more confident.
How many kids with apraxia did you have on your caseload throughout the years? Like how many kids did you personally work with, Sarah?
That's a good question. Here's the deal: I don't know.
That would be my answer. When I look back when I, uh, was in the schools? I don't know. I honestly don't know who had apraxia and who didn't. That's just me being flat out honest. I didn't diagnose my first kid with apraxia or treat my first kid with known apraxia until about 15 years ago. And, uh, yeah, I don't know.
I don't know. I think I might've had one or two that actually came in with a diagnosis. So they probably received that. Not probably, they did receive that outside of the schools. I think I've had maybe another two or three more that I was pretty convinced that's what it was, but not capable or competent to make that diagnosis.
Or even educated enough to know that we could make that diagnosis. That was one of my big takeaways from SLP Summit, because I think a lot of our diagnoses that float out in our field, we're not really sure what we can diagnose as SLPs? Obviously receptive and expressive language disorders or articulation disorders, we're like, alright, we've got that. But then apraxia because it's sort of more of a specialty sort of area?
It's just a speech term. It's just a speech term. Apraxia is just a speech term, like articulation disorder or phonological disorder or language disorder. It's just a speech term. It's not a medical diagnosis. And I think that's where people get hung up. And that was my aha moment. When Edith Strand said "apraxia is not a medical diagnosis", I was just like thrown back in my chair and my jaw was dropped open and I was shocked.
Cause you even thought—
I had thought!
It had to be diagnosed by a medical doctor.
And that was in the past year guys. I mean like I'm, I don't know at all. I'm still learning. You know, this is, you know, I know a lot, I think.
You do, because it may be, we are witnesses to your wealth of knowledge on the topic. But we talked about this a lot too, and I really loved, um, when you said, "I don't know everything about this, I'm still learning."
Where I have my imposter syndrome?
Let's talk about that.
Oh gosh. Well, and I think it's hard too, because in our field we get these clients and we work with these kids by ourselves and we're educated, you know, I'm in private practice. So I'm trying to educate families. I'm trying to educate their teachers. I'm trying to help support their speech therapists in the schools. So we try to work as one big team and here I'm looked at as the specialist and then I'm like, wow, do I really know what I'm talking about? Because I do know that I don't know what, I don't know. We talked about that earlier.
Knowing, you know, not knowing what you don't know, but maybe knowing that you don't know what you don't know?
But if you ever feel like you don't feel like that, then you might want to reassess where you're at in your life. If you ever think, you know it all, then either you're Bethany from the real Housewives of New York or you just, you, I mean, really you should never, especially in the profession, we're in that we work, A.) with people. So there's always going to be somebody fresh that walks into your door that teaches you, that you don't know at all, or B.) that we are evolving in research?
And so we always are going to have to be continuing to educate ourselves and we'll never know it all right. Ever.
I will say it was really comforting to hear you say that, because again, we can witness, to your wealth of knowledge that you have just shared with us as we've been building out these tools. And so we know you are very, um, that bootcamp you went to and all of the years of experience, you've had make you very qualified to be working with these individuals. Um, and so it's comforting for me to still hear you say that you've got a lot to learn still.
I do. Yeah. I still question myself sometimes. And that's kind of where that imposter syndrome comes in is that you're like, "man, am I really an imposter? Do I, am I really an apraxia specialist? Do I really know what I'm doing?" And it was fun because when I went to bootcamp, I just went in acting like I knew — well, that's not true. Okay. I'm going to confess something. So when we went to bootcamp, they gave us a sheet and they wanted us to rate from 1 to 4. Maybe if I remember correctly, my brain was kind of fried at the end. But, um, you know, uh, how comfortable do you feel diagnosing apraxia? How comfortable do you feel treating apraxia? How do you feel in your overall knowledge of apraxia? So I think I was like three, four, four. So I was like, yeah, I'll just take off one little point. Cause I'm going to learn a little bit while I'm here. I raised my hand at the end. I was like, I need to go back and refill out the form I filled out the very first day. I needed to put like ones, or maybe like a two on the treatment. And then now I can put the three and the four and the four, because I was like, wow, I didn't know what I didn't know. And maybe I really didn't know what, I didn't know.
Your mind was just just blown.
And my mind was blown. And even with all my experience and all the training I've had, it still was this just really close knit and really dug into the deep, deep, deep depths of apraxia and yeah, it's, it's crazy.
But that's ignorance. Ignorance is you don't know what you don't know.
But that's part of our ethical responsibility. Is that being a lifelong learner, we have to kind of have this basis of knowledge, but always continually seek learning. There are so many opportunities now where we're at in this day and age to learn that we need to continually seek that. And you know, you're in a really cool, I think, perspective too, that you are working with kids with apraxia every single week. So you do have that foundation of, I mean, you're working it, you're living it, you're breathing it. And then you get to kind of like take that knowledge. And then as you're learning things, apply it on top of that. But it is harder, I think for a school based SLP that maybe two times in your career you've had that kid that you know about that has crossed your path.
And then what do you do about that? Yeah, I have all this knowledge about all these different subjects. I have, I have the ability to only take kids with apraxia under my caseload. So I see... I do 22 sessions of therapy a week and 95% of those kids have apraxia.
So let's talk about that.
That's very, very specific. And so you can focus on it. But before we go on, I did want to back up for just a second, because some people might not know what we're talking about with the bootcamp. Will you explain to us just real quick what that was?
Absolutely. So, uh, apraxiakids.org, uh, offers an apraxia bootcamp every other year. It's a four and a half, five day camp. Tis year it was held at Duquesne university in Pittsburgh and you have to apply and be accepted to the program. And then you go—
How many people were there?
There were twenty-four.
Twenty-four every other year.
And you know what, at school-based SLPs, I'm going to throw this out there at you. So I'd love to see some of you guys go to this camp. Every single person that was at the apraxia bootcamp this year was in private practice.
Okay. Yeah, and that's what I was saying is if I have one show up on my caseload and I'm like, crap, you know, I need to go learn all the things, right this second? I want go to this bootcamp, like, that's like, what are the chances?
Two years from now!
Two years from now. And I'm going to get picked as one of the twenty-four, but I need something right now. Yeah. So that's where Jennie comes in to this picture. You're going, I know you're kind of on a mission to help spread as much knowledge as you can, to people about this topic. Your summit presentation was highly regarded as, as one of the best we've had. You packed in so much in one hour. And I know everybody was like 1.) mind blown, but two 2.) really felt like, thank you for some practical solutions. And so that's just the beginning for you, right?
We're going to do this.
Yeah, because we all can't go to apraxia camp.
Although I want to.
I know it would be nice, but we just, it's not realistic. Obviously for everybody there's only 24 every two years, and time is an issue, and school-based SLPs specifically have a wide range of things they treat. You know, I don't treat fluency. I don't treat dyslexia. I don't treat a whole lot of school age language. I incorporate a little bit of it. But then I move my kids over to another private therapist that treats language because I really focus on the apraxia or I might have to bring—I know enough about AAC to be dangerous, but I'll bring in, uh, ACC specialists to consult on AAC.
Our responsibility is we don't have the luxury ever to pass a student on, you know, you get what you get. So you have whatever setting you're in—K-6, middle schools, high schools.
I don't know how you guys do--I don't know how you do it.
We don't either.
Well, the big thing though, is that it goes down to Sarah's favorite expression is to be a problem solver. If you just sit there and you stand still and you have either A.) false confidence or B.) you just try to wing it and you don't do any research or digging into things or seeing what's out there because there are so many resources out there. You can build your knowledge, I think. It's just a matter of looking for it.
Oh my gosh. In the day and age of technology, right?
This is not 20 years ago.
Well, and, and the case that you are going to be so much more successful as a therapist at treating a child with apraxia correctly than winging it and just treating them in a phonological group with other kids. And then they're not going to make the progress because you're working on phonological errors, which—they may present with phonological errors. But ultimately the goal is, uh, targeting movement and motor planning through movement. And so you're going to make so much faster progress if you see this child individually for maybe 15 minutes, three times a week or four times a week, rather than trying to throw them into a group with two or three other phonological kids. It's a totally different type of treatment.
You blew my mind when you said this, the goal is movement. Not sounds. That -- first time that I really ever thought about it that way. And of course, I know that—it's motor movement, a motor planning issue. I knew that!
And you have to have the sounds in order to work on the movement. So we assess repertoire. We need to know what's in the kid's phonemic inventory. We need to know what sounds they can do, what sounds they're stimulable for? Stimulable? How do you say that? Stimulable?
Watch me. Sti-mu-la-ble.
What if we do it simultaneously? Yeah, sti-mu—
There has been a lot of shenanigans over the last two days, as we said. Here's the best thing about working with Jennie, I'm just going to digress for a second is, um, she is very good at giving real life, examples and goals. And so then she makes us be like the client and do things with her. And so we've been working on our spontaneous invitation.
Our goal is spontaneous.
She really is an expert. Isn't she?
Yeah. So it's been so fun to have you model and you're really good. And this is one thing I always struggle with when I'm trying to give examples of things. I can never think off the top of my head. And you're really good at like, showing like, this is what is likely to have happened. You know, when I'm testing this word and here's what the kid's going to do. And you're, you've been like animated and showing us like these videos and real life examples. And that's why we've learned so much this week. Yeah. Good. I'm glad. Yeah. It's been awesome. So, let's go into this a little bit. You know, we don't have a two hour window for this show. Um, but I want to talk about some, some key points that you just made. The one about, we can not treat them like they're phonological.
We've got to treat the—the movement part of it.
Get the sound inventory so that you can build on that.
And so that's where I wanted you to start off right there, because this was a really powerful point you made to us. We need to know what sounds they have.
And what syllable shapes.
There we go.
Yeah. So the, we want to tax their motor system. So we want to find the spot at which it's difficult and that they're starting to break down, but yet we know that they can have success. So we're going to choose sounds that are in their repertoire. We're going to choose words that are meaningful to them. You know, some of my big words: I love. No. Now. Go away.
I love the example you used in Summit with that one little girl you were teaching her: "get out."
Get out. Um, yeah, for sure. Those are things I teach kids all the time. I have one little boy that was in my therapy sessions with his two older brothers and his brothers would kind of come into his play. And the very first thing he would do is whine. And I'd say, there is no whining in my room. Let's tell them no. And so he looked up and he's like, I can tell them no. And I'm like, yes, you can. I was like, tell them no. And he looked at them and he goes, no. And both brothers stopped to look at this and he got an immediate reaction. Now tell them "go away." And so we worked on using those correct sounds, but within the movement sequence. "Go away." And when he told them to go away, I told his brothers, they had to move to the other side of the room. And when he told them that and they moved to the other side of the room, he literally beamed, he lit up, he giggled. He was so proud. It gave him power. So, you know, I really encourage therapists when they're choosing target words to really choose those power words, and a lot of times it might be a brother's or a sister's name. You know, if the, the brother's name is Samuel and that kid doesn't have those sounds in his repertoire. Maybe we could, um, name that brother Bubba. Yeah. Let's call him Bubba. Or if Grandma, they can't say Grandma, well, can we call her Nana? Or can we call her, you know, something more simplified so that right now we're giving them function. So our big goals are function, success as quickly as possible because what of our kids with apraxia have? They have self-esteem issues. They shut down, they have anxiety issues because they have failed, failed, failed, failed, and failed. And nobody's really given them that opportunity to succeed because a lot of times things are not being worked on correctly. Right. So, and you know, that's no fault of anybody's except for, we just need to take a step up and educate ourselves and know that, you know what, it's really not that hard once you understand it. I just think it's just not an area of speech pathology that is understood. So it makes it more quirky or just kind of out there in a cloud. Like what do I I'm grasping at…
There's resources out there. I had some already I've taken courses on this, but I always felt like I was just pulling, pulling, pulling, or, or the materials really dense to go through, or there's not a sequential, like, um, you know, scope and sequence of instruction for me that made it real clear that I could get, and you are very good at getting to the meat of it and making those points that are really, really important.
But even before the therapy piece, I think it's important what she touched on too about for not just apraxia, but all students that we work with, our kids that we work with, you've got to know that, that assessment piece. Where are they in this moment in time? Because if you're just kind of winging that treatment plan and winging that information and throwing goals on there that aren't meaningful for the student, then that's a huge piece of getting that data that you need to find out where they are to then make those goals that are meaningful and then move into that treatment that connects into the goals. That's a huge piece that that's not just a proxy. I see that a lot with, you know, other areas of the field.
So that was one of the main reasons we brought Jennie out. We wanted to build a, um, informal screening tool, um, to be able to get the data you need to, to feel confident that this is in fact, a student with apraxia versus, like, a severe phonological processing delay because the treatment is so different. Um, and so we, we've got something really exciting that I think is going to give people a lot of great guidance. Not only did we, um, come up with the subtests, um, of things that are important to assess, um, but there's a lot of why statements, why these things are important and, and how that information is going to help guide your treatment decisions.
I'm excited about the why statements. I think that was a really good idea, girls, because, um, we don't want to do something and not know why we are doing it. We need to know why we're doing this. Why do I have to assess each word twice? Why is it important to, uh, do a non-speech oral motor exam? Why?
You know, and that's what makes that's what makes apraxia that— we should have a why for everything, but I think in general, people don't understand the why for apraxia and that's okay, but that's why we're here to help.
Exactly. Right. Yep. Tell me a little bit, um, so I know you've been working as a private clinician for, in your, you know, you own your own clinic and, and specializing in apraxia for about 15 years.
So I would not say specializing in apraxia for 15 years. I think it's evolved. I'd say apraxia has probably been the past six to seven years. Um, and prior to that, it was early intervention all together. So lots of experience with early intervention, birth to three, parent education, and autism, and like early language development, like teaching parents how to deal with behavior and getting through behavior to help start facilitate early language. So the kids that were delayed. So then it's kind of evolved from that in—.
Perfect. What a perfect evolution.
Yeah, it's really, really good. You know, and the cool thing about apraxia is that you don't need to have a diagnosis in order to treat apraxia. Actually, I can say it about anything. We don't need to have, the diagnosis doesn't necessarily drive, um, how we treat children. So we treat an individual child. Now the diagnosis is, gives us more information about how we might change things, but, you know, if a kid comes to me and they look like they have a motor planning disorder, but they don't have a diagnosis of apraxia, well, I'm still gonna treat it as if it were a motor planning disorder, because especially in very young children, we know that a motor planning approach works for them, whether they have phonological or just delayed speech or apraxia. So I pretty much treat it as if it were using a motor planning approach anyway, for very young kids, two, three, four year olds, if I've got kiddos coming in and then once they evolve and, and I see that it's not apraxia, then I might treat it more like, um, more like a phonological, you know, because then I'm seeing that that's going to work in that situation with that child.
It's a huge point. Yeah.
And so I think, you know, just being familiar and knowing what it is, especially if let's say, even though I say you can diagnose a Praxia as a school-based SLP, but you aren't allowed to do that because your school district says you can't, um, you still need to be aware and know what the signs are and have these red flags and using SLP Toolkit's screening procedures, knowing what to look at, what to assess, what are the top 8, 10 things that we might see in children with apraxia and consistently across the board, then you can take a motorboat based planning approach,
Information at school setting, a proxy is not an eligibility category. Speech language impairment is in Arizona. And I think are those consistent eligibility categories?
I don't remember if that's state specific or if those are federal eligibility, but either way you will look at the eligibility categories in your state and it's based, always, an IEP is based on needs.
That's where you develop your treatment plan. So it doesn't matter what the eligibility category is. It's going to be the kids' needs.
Yeah. So it could be an eligibility category. And then you could say that, um, this child exhibits, um, signs consistent with apraxia. Yeah.
Well even I thought it was fascinating. Didn't you— A statistic you threw out before we started the podcast was, didn't you say 70%?
I think it's close to 70% of kids with autism have apraxia. I don't want to quote it wrong, but I think, I think that's correct.
So think of that. Like, if, if you have students currently within the eligibility of autism and that doesn't mean, you know.
You're very likely to have this.
You're way more likely to have apraxia than a child that doesn't have autism.
So you've got to know the signs so that you can use that information. So you can take a direct approach treatment approach.
Uh, let's talk about prognosis. I think this is something I'm sure. Families always want to know. You probably see the wide range of severity over these last several years of treating children with the Praxia. Um, obviously I know we would never tell a parent, Oh, this will take two years in six weeks. Right. But like, um, what is, what's the outlook?
So the good thing is, is that we know how to treat apraxia. That's what we do know, but you have to take many things into consideration. You have to take into consideration. If the child's getting the right treatment approach, you have to take into consideration how many times they're receiving therapy a week, how involved the family is, if there's comorbidity, what other type of, you know, uh, disorders or issues the child may have that are impacting their learning, whether it be autism or down syndrome or a cognitive disability, or, you know, whatever it may be, that's impacting the child's learning. Um, but you know, the nice thing is, is that kids can make progress. They really can make progress if they have the right treatment approach.
And early intervention, I'm assuming.
Early intervention is huge, and you know, when you've got a kiddo that comes to you and they're in sixth grade, they've gotten phonological therapy their whole life. And I diagnosed them with apraxia and they've never, ever worked on prosody ever. And the poor child is cognitively intact a hundred percent, but has a hard time making friends because he sounds like a robot and he can't vary his vocal range from, uh, to, uh, that's it.
Um, we can't go up and we can't go down. And then they sound like this all of the time, including speech chairs. It's really hard.
What about like, I know one of the characteristics is that intrusive schwa. What is Sarah’s prognosis with that, because she is an intrusive schwa.
That's her new nickname.
Yeah. Yes. I got named that a couple of days ago.
Sarah. She's an intrusive schwa.
It's not intrusive! It's supposed to be there.
We can do this. Sarah-ah. Lisa-ah. Je-ah-anie.
That's a better example of an intrusive schwa than my name, Lis-ah.
Intrusive schwa's interesting. It kind of comes and goes, and we've got little kids that will say no forever. And they'll come in and be like, mom's like, Oh gosh, they're saying No-ah. And I'm like, we're going to just going to stop that right now. No. And then I just do a visual stop. So you know, it, it's, it's awesome.
One thing you cannot see because we're on a podcast and I wish this was a video in some ways, or I should have just videoed Jennie for the last two days. Um, it's not just, um, uh, verbal modeling. Lot of tactile and visual cues in your face, in your face. Yes. And you've got signs for things and you've got your beautiful visual cards as speech sound cues. And, and there is a lot happening in your high energy. And I imagine you go home and pass out after a day of sessions.
My poor kids. I go home, they're like, "Will you play with me?" Nope.
That will be $85 an hour.
Yeah. It is hard. It's hard, but you know, it's so funny. Cause I had a dad in with his son, um, this past week and his son, uh, is in second grade and he's the same age as my daughter. And they've been getting a lot, a lot of therapy over the years, but I've never received true, correct apraxia treatment and he's making phenomenal progress, dad and dad. And I was like, I am so impressed with his progress. And dad's like, well, that's because he's with you. And I was like, well, that's a little much. But, um.
But thank you.
I said, you know what? One of the things is, is that, um, I've created a bond between this child and I, and he trusts me. He trusts that I'm going to help him. He trusts that, um, he does better when I'm there to support him. And he truly loves me. He actually licked my face.
That is love.
And, and dad goes, that means a lot. And so, you know, when the children are hanging on you, hugging you, and you're doing your, because guess what apraxia is a very hands-on physical, um, in their face type of therapy. And it's not sit at that table. Here's a worksheet.
Say this word five times, um, color the picture, or put a stamp on it and be done. It's really not. And, and I think that's hard for school-based SLPs because their time is limited and their resources are limited. And they've got all these kids, but it isn't on the floor. Physical. We're going to get as many repetitions that are functional as possible. So, you know, one of the things, um, that he and I were doing is I had Magna-Tiles and he was actually sitting at the table this time, but I had Magna-Tiles and I was giving the Magna-Tiles and he'd slide it off the table and he'd put it down on the floor. And one of our target words was down. And so every time he threw it on the floor and he would say down, or we'd say it together simultaneously. Should we try that?
Yeah, let's try that.
Jennie, Lisa, and Sarah (30:51):
Ready? With me. [All, simultaneously] Down.
Nice. That was very nice.
Good job, Sarah. We've been working hard, right.
Great therapy, Jennie.
Okay. And so, you know, he would, and then he would giggle and giggle, but you know, we were playing, I have another little girl. Oh, poor mom. She's like, I was like, I'm so sorry. I'm sending your daughter home doing this, but we were working on "go away". Tiny little girl. She's just two. And we were working on go a-way, and I'd give her an animal and I'd make the animal sound. And then I give it to her. And then I'd say, then I throw it across the therapy room, I'd say go away. And she would giggle and oh, she's throwing her toys now.
Schools, I think have their, their kind of norms. I think for teachers and students where there has to be a little bit of boundary, but no matter what, I mean, you can do that in one-on-one therapy. You can do it. Yeah. You can do that in a school setting. I think the biggest thing is what the biggest pushback that you might get from a listener right now is I have no time for one-on-one therapy. And here's the thing. You probably won't have many students in your lifetime that have truly need one-on-one therapy. But if you do, I think you might be able to find a few times in your schedule that, that you can find 10 minutes, 15 minutes to provide the student the therapy they need. They don't need a one-on-one hour, every day.
That's the job. That's an individualized…
And also it can be 15 minutes. And if you've got a wish list of 10 target words, and you can get through three of those target words and get 30 productions of each word in this silly repetition. Heck, I had let a kid bind me up with blue painter's tape last week, I was totally bound. And, you know, guess what? He's got the word tape down because you know, we worked on it over and over and over and over and over again. But he was having fun while he was doing it and it was meaningful and it was one-on-one.
And kids, what they will pick up from all of this, again, no matter if you're in a clinic or a school, or even like a home setting or whatever, they know rapport, they know if you're genuinely interested in them. They know when you care about them. I know, like even I had one family that I worked with in the home setting where one of the siblings drew me in a family picture because I was there every week. And she knew that I was an important part of their family. Like they know that. So it doesn't matter, right? They trust in that rapport and that, that is such an important piece. You can't, this is not a scientific field that is about, you know, people are people and people are all about rapport and you can use the science piece to be that detective, to find out the techniques and treatments and things that have the evidence behind them to do the best for these people. But it really is. It's about the people.
Nobody works with someone they don't like.
No, think about it as adults.
I don't want to work with people I don't like. Like an intrusive schwa.
Stop. I'm really sensitive. No, I'm not, I don't actually care. But go back to that where you were talking about the three words, 30, um, uh, productions of the word. This was a huge point I learned. A hundred percent accuracy. Yeah. You can't say with a student, with a child with apraxia, uh, we accept 80%, or…
Well, because what you practice is what you learn in apraxia. Because it's motor planning. So what you practice is what you learned. So you, my goal is to get a hundred percent accuracy. If a word is on that child's target list, then that has to be an obtain—obtainable goal. Whew. Obtainable goal. Uh, so if that word on there is "bye" that child should have the "buh" sound and the "i" sound in their repertoire, but they just can't motor plan them together. So we're going to work on putting those lips together and we're going to work on that movement of "i", the mouth open and then the smile back for that "i", the "i" sound right? Together. So all three of those sound together. So "bye" is kind of three sounds right? "Bye", right? And so we are going to work on that movement. So if you go back to kind of the DTTC model, you do it in that simultaneous production, you do it together, and the kid has it and you start varying your prosodies so that they can start hearing that you wanted to be different. Bye bye. Bye bye. Right. We're going to vary our prosody. And then we're going to back off a little bit because our goal is what? Not to have them say it simultaneously with us all the time. Our goal is to have them say it spontaneously by themselves. So we're going to back off. Bye bye. Bye. Bye.
Make a mistake. Bye.
Make a mistake.
Oh, I thought we were doing prosody. Are we not working on prosody?
But I want you to make a mistake in your movement. Bye.
Nice. We're going to go back and say it together. Do it with me.
[with Jennie] Bye.
Yeah, we say it together. So then it's this backtrack. So I'm going to go back and give you the most support. So the second I hear you make a mistake. I'm going to add more cueing to help support you. Get it a hundred percent and we're going to get it a hundred percent, a hundred percent, a hundred percent fake, fake fake. How far can we go? All right, great. Let's work on. We're going to start at that level next time. And if I need to add in more support, I will.
That was really powerful just now. So the point of that was I, if I had done that correctly, if I said it four times correctly, you're fading, fading, fading. I say it incorrect. You're supporting, supporting, supporting till they get it correct again, then fading, fading, fading.
I thought one of the interesting things—
Climb up and down a ladder.
I thought one of the interesting things we learned too, is that just because students have certain core words independently, like maybe they have "bye-bye", and maybe they have "go" , but they don't have the motor planning to put "go" and "bye-bye" together. So you have to teach the motor planning for that. So it's not language related technically. It's that the motor planning for that?
Yes. Those pivot words and phrases. So combining the, the words they have with the, um, pivot phrases they have, then we're going to start with combining them.
So like I have a little girl, her dog's name is Bo. And so we use bow as a pivot word. And so we like left that bow word there and we did "no, Bo". So she already has, no, she already has go. She has my, she, you know, so we're gonna leave Bo there and then we're going to vary our prosody, no Bo, my Bo go, Bo. And so then we just, "Bo, no". You know, so then we can, "Bo, go," you know, so then you can put Bo first, you can put Bo second and we're adding other words that she has, and we're combining those together to end because we're working on that motor movement planning or that sequencing of motor movement between those core words. And, so.
Mind blown emoji insert here.
It's so good. Seriously. We could talk about this forever. Um, you've got some speaking engagements coming up, you're out and about sharing your knowledge with the world.
Yeah, it's great. Everyone needs you.
You also have, and I know we kind of touched upon this a little bit, that you have some speech sound cues that you've developed.
So if people want to check out more about some of the resources you created, can you tell us a little bit about that?
Sure. You guys can go to bjoremspeech.com. Um, you can purchase the cues from there. I also have a YouTube channel, which is called Bjorem Speech and I post videos on there. Um, various videos of different things, usually treatment strategies or ideas. And then I also have a newsletter. So if you go to bjoremspeech.com, you can sign up for the newsletter there. And I try to send a newsletter out every week. Um, with some Q-tips.
It's a fun one.
I'm obsessed with your newsletter, you kill it in the newsletter game. Cause here's the deal. I am bombarded by email. And so, um, most of the time it's like delete, delete, delete. I open yours every single time you send it because it's, um, always visually very cute. I love how you changed the theme of it. Um, but also really great practical tips very quickly. Um, you just, you do a very nice job with that.
And I love your Instagram.
Thank you. Yeah. I've got an Instagram too. And I try to be funny. I think I'm funny.
We wouldn't have brought you out here if you are. Yeah. We just really enjoy Jennie and we know her, but, and the reason we wanted to work on this project, with her in particular is because she is very, um, practical and real and gets to the point of things. And we didn't talk about theory for 17 hours before we got into the meat of it. You know, you, you give the why, but then you get right to it in a very practical way. We saw that in summit. And so we knew you were going to be the right person to be able to help bring this, um, into the hands of all of these SLPs that really, really need it.
Yeah. You're, you're, and you're a real treat and we've had fun with you here.
Are we getting questions now? I'm really excited.
I threw it out on Instagram in our story that you guys could ask questions for Jennie. And there are some real treats in here that are interspersed, but of course also some practical questions too. So here we go. Are we ready? Yeah. What kind of goals do you write with cue—with your cue cards? So the cue cards that you created, what would be the goals that you would write?
Well, the cue cards are, um, not necessarily a program. There are, they're, they're a cueing set, so.
It's a treatment strategy.
Strategy. It's not a goal. So, so, you know, I use them for all of my goals. So my, you know that if kids, if kids need visual cueing or even if kids need verbal cueing, my kids that already know all the cues. If I, if they already know mad cat is [blows air] I don't even have to show them the mad cat. I said, we're working on the word fun. You've got to start out with biting your lip. It's your mad cat sound. [Blows air] Fun. So I can, I can use my cues as visuals. I can put them together to show them the combinations. I can put them together and show them when they're segmenting. I can, um, take the visual cues away and just use a verbal cue because they already know all the visual cues. I can use the visual cues combined with letters to help them with sound to letter correspondence. I can use the cues out on the table and say, show me which one begins the word C and they have to pick the snake sound out of a field of four. So I'm using my cues for all kinds of things. I'm using them for sound to letter correspondence. I'm using them for phonemic awareness. I'm using them for cueing.
But it's a treatment strategy, not a goal.
So a goal would be maybe at the very early stages, something like, uh, improved motor movement of a CVC word.
Yes, that's the goal.
But then I'm going to use those strategy, the cue cards to treat that.
Yeah. And then our whole goal is like, what we said is to get down that ladder faded out. So we don't have to use any cues so that they're using that spontaneously.
If you haven't seen her cue cards, by the way, they're fricking adorable. Like the illustrations are great, but they're so practical. You gave a really concrete, memorable, um, uh, cue to each sound and, and the kids have fun with them. I use them with my biological process students. Um, they're, they're fantastic.
Okay. Here's the next question. This one's really good. This is about, um, it's broken up into a few different parts, so I'll just kind of summarize what he was asking, but, um, students with cognitive impairments that also have apraxia, what's the outlook for that? Like I'm, I imagine that they're still gonna make progress, but maybe.
We've kind of touched upon this a little bit earlier.
I touched upon it a little bit earlier, you know, it's, it's different for each individual student because how severe their cognitive impairment is, what is the comorbidity of the things that are going is, how motivated the child is, how many times a week you're seeing them, how, how, uh, involved the family is, um, you know, all those different things. Is there a lot of prosody going on? Is there a lot of segmenting going on? What's their sound repertoire? And there's so many questions to ask, but I go back to is the great thing is we do know how to treat apraxia speech. And if you're treating it the same, the treatment is different. So if we're treating, if we're treating the treatment's different from phonological.
That's what I mean.
We're working. Our main goal is movement. Our main goal is that motor planning movement sequencing plan.
And I will use this treatment with a student with autism, down syndrome. It's all the same. Absolutely.
Okay, fantastic. Um, this was one of my personal favorite questions. What has it been like? This is real you guys. I'm not making this question up by the way. This is real. I have evidence I'll show you proof if I need to, What has it been like hanging out with the Amy Poehler and Tina Fey at the SLP world.
Oh my God, that is FABULOUS.
I was like--!
Billing 67. You're my new favorite person.
Oh my goodness. That is the hugest compliment ever!
Isn't it so nice? I know!
Who am I?
We've been called Batman and Robin, this is way cooler. Amy Poehler and Tina Fey. Thank you.
I know, who am I? I can't wait to find out.
Who are you?
I don't know.
I don't know, but you're just in it, in this.
I feel like—
You're Will Ferrell. [Laughter] She ran naked through the quad last night.
I will say-- has this like lived up to your expectations? You had a list of things you wanted to accomplish when you were here.
Yeah. My list consisted of holding Penny, getting my picture taken in the hotbox.
Slash confessional. Um, uh, I want to hold the, the chair in the face sign, which I haven't done yet. And then finally, and last on my list, I wanted a picture with, uh, Lisa and Sarah.
Oh, and roller skating.
Roller skating was a bust, haven't done that.
Can you confirm for our audience that we actually do work?
Yeah. We've worked a lot, you guys. It's a really healthy mix of work and play.
And I believe that's how it needs to be. But you guys, it's so much fun. I'm had a great week. We've had a lot of time. Lots of great laughs. Lots of really good education and really awesome minds coming together to just kick ass.
Good. I'm so glad because a fun. You know, so we met at ASHA last year in LA.
And just, I mean briefly, like we didn't go hang out or anything. We just met and we chatted in the exhibit hall. And then you did Summit for us and we've corresponded on things before. Um, but this is like our first like time, really all hanging out and collaborating, but then, okay. It's been amazing. It met my expectations, I hope it met yours.
It was worth your money? Did you see how I used the word “it”? Was it worth it? Because I have been an it apparently. I was the it.
You were the it surprise, the special delivery, and it was absolutely worth it. I really do think this is game changing stuff, um, for, uh, any pediatric SLP.
And so I think this collaboration is going to be very important for us, um, with the assessment piece and progress monitoring and you with the treatment. Um, do you want to talk a little bit about the future project?
I don't know about the future project.
I mean, we won't spill it.
We've got a surprise future project coming. Um, but it's, it's a work in progress.
More info to come.
It's going to be good, guys. Follow Jennie so you can get updates on that and stay tuned, cause it's going to, it's going to be kind of, game-changing. Not kind of. It is. Okay. Next question. Um, this question is highly subject. Who does Jennie like better: Sarah or Lisa, question mark? Nevermind. It's clearly Lisa. I wonder who asked that question?
So, I mean, I think that's a fair question. I think we know the answer.
It's like asking your mom what kid you like better.
I mean, that's not fair to me, right?
It's not fair, Jennie. And you don't have to answer it. I already know.
It's clearly Lisa.
I have videoed you more and like hazed you a little bit more than Sarah.
We've swapped real stories on our ride to the hotel.
Because you have been, Lisa has been transportation.
She's my Uber.
She's been my counselor.
Okay. That's okay. That's okay. I'm happy for you, both, whatever. Okay. This is a real question. What are your, some of your favorite reinforcers or toys?
Oh gosh. Um, blue tape.
I was going to say.
Kids love blue tape.
You write on your tables a lot with markers.
I do. I write on my tables a lot, like all of the time. Uh, so I love letting kids write on the tables because they're breaking the rules.
I break rules all of the time. We throw shit.
And I love that you throw shit.
Not real shit. That would be distracting.
Oh, um, you know what? I almost always have animals and my therapy session, the little tubes animals, the miniature animals, because number one, kids love them. You can manipulate them. They're little. They, um, all make sounds. You can make them make sounds. We work on them peeing.
I love that. That was one of my favorite examples. When you were, um, working on blending the P, Pole.
Oh yeah. I was teaching one of my kids how to say people and he's older and we were working really hard on people and I'm like, I need a visual. So I drew on the table, a guy peeing, and then I drew a pole next to him. I'm like, It's P, like pee like when you go pee, pee, pee, and this is a big tall pole, he's going to climb. Pee, pole people. And he got it. Pee, pole.
Whatever it takes!
I have one kid. Um, mom videoed it and she shared it on her Facebook page. I don't remember what it was, but all I knew is I drew a toilet on my table and colored the water yellow.
Functional word. Functional. So functional. Poop.
Pee and poop. And you know what, if you can talk about pee, poop and farts with kindergartners and preschoolers, they will trust you and love you forever.
It's so true.
It's so true.
And I love it. Pretty much, the few examples you just gave this isn't, you don't have to go to Target. You don't have to spend a gazillion dollars to do whatever.
You don't have to do anything. I really don't use worksheets because I'm a very functional based SLP. So, you know, I love getting ideas from worksheets. And then I incorporate them into a play-based type therapy. I try to make apraxia therapy as functional as possible, because what are kids going to carry over? If we are working on mama, dada, baby, baba. If I were working on family names, what do I do? I get six giraffes. I get six bears. I get six goats. And what do we do? We name them, mama, baby, dada, nana, papa, baba. And then guess what we do: "no Baba, go Baba, my Baba, ni-ni mama." And so—
She puts the fun in functional.
Oh my gosh.
So Yeah, I mean you just, the kids and then they're going to, what are they going to do? They're going to home and do those play scenarios. They're going to go home and use those in their functional setting. And I'm lucky and blessed enough to have parents in every single one of my therapy sessions. So I'm modeling for parents how to play with their children.
And how to carry it over to everyday life, how to carry it over all of the time, how they can use this. How can, how a child can be empowered to tell his brothers go away? No?
Because he's the littlest kid and he can't communicate. And the other two brothers are on top of them all of the time in his space. And then what does he do? Whine? Well, let's use our words that we have in our core vocabulary.
It's so good. Okay. I think there was just a couple more questions. Um, oh, uh, this is a great question. SLP Talk Desiree, good question. Do you have any tips or tricks for collaborating between school and private therapists? So if you're working with the same child, this is huge. Do you know this is, do you know, this is an issue for school based SLPs, that relationship and working with private clinicians?
So, um, I love this question because it's one of my favorite things to do is to collaborate with school-based SLPs. I've had many school-based SLPs in Kansas City actually come to my clinic and my therapy sessions to observe how I do therapy with kiddos and for an SLP to have the, to be willing, to step out of that comfort zone and come into my private practice and see what we're doing is awesome.
That's putting the student or the child first. Putting egos inside.
It's not about SLP shaming. This is about learning and working.
No and you know what? I have been a school-based SLP. I did it for four years. So I understand where school-based SLPs are at. And I understand that they have to treat all these kids. And I am only treating apraxia. I don't treat fluency. I don't treat boys. I don't treat these other things. I don't do it. They know so much more than I do on a wide range. I may know a whole lot, a whole heck of a lot about apraxia itself, but I sure, I don't think I could step into the role of a school-based speech therapist.
And so you use that frame of mind.
I use that frame of mind.
And don't judge.
Absolutely. And you know, what if parents asked me to go to IEP meetings, the very first thing I make sure I do as a private practice, um, therapist is really praise the speech therapist for what they are doing and, and find out how I could help support them in, in what they're doing for my kids, with apraxia, or handing them over my list of target words and how we're working on them.
Can I tell you how important that step is from the side of... you are modeling for the parents that you're affirming that what the school SLP is doing is important because that is not how it goes all the time. Oftentimes what it is is there's no communication between a school SLP and a clinic SLP, and that's why there is no visiting of clinic and in school because there's no communication to start with. And then at those meetings it can be tense because you're getting, you know, even the buy-in where the family does get that time with the clinic SLP. So there is a relationship there versus no relationship with the school SLP. So anything of the clinic-based SLP says, whether it be like, not everybody's going to be a rockstar SLP, just because they work in a clinic, you know, like there are, there are rock stars and they're in any setting and they're going to be rock stars or not, but it needs to be this whole continuum of we're all working towards a goal, a goal of making this child having communication.
Open communications come from a place of wanting to share what you do know.
I don't know more. Or if I do know, like if there is a need to really.
We also, in the schools, need to be reaching out.
Clearly if I, if I am not an expert and I know you are an expert in apraxia, I can learn from you by all means, I want to do that.
I need to pick up the phone and call you. And, um, sometimes I, I make my own assumptions about the clinic SLP or what they think of me. And so I hesitate or help sometimes it just comes down to time like I need to prioritize that.
Time is a huge issue for school-based SLPs. Yeah. Huge issue.
So you do—you do want to be working with the school-based SLP.
It's is going to benefit the family and the child. Absolutely. I think it's, I think it's probably one of the most important things we can do. I don't ever want to step on toes and I don't ever want, you know, I had a family come to me two weeks ago and say, I am so mad. The school offered my child 15 minutes, four times a week of speech, but in a group with another child, I said, first of all, 15 minutes, four times a week, it's rock solid. Awesome. It's huge. So she's in a classroom setting and they're doing some rotating and, um, mom is not real excited about that. And I think the child would benefit better obviously for one-on-one for four, 15 minute sessions a week. And mom's asked me to write a letter about, you know, maybe research-based why it works better for children with apraxia. And I'm happy to do that. Um, and, but I just want to make sure that how I do that is received, um, positively. And not that I'm a person that's going against what they're doing and also being respectful of their time and their resources and their caseload size and their methods.
I had a director that once told me though, that if it shouldn't be about the school resources, so to speak that if, if, if a student truly needs 15 minutes, one-on-one because again, that is not a typical, like, most kids don't need one-on-one therapy. There will be kids that need that. And so if that's truly what the student needs, if that's what the data supports and shows and the research supports and shows, then it's up to the district to provide the resources. So if it's even like, if you have a, an SLP, that's like, Oh wait, I'm only at that school two days a week. I can't be there four days a week to provide 15 minute one-on-one therapy. That's not the SLPs problem. It's the district's problem. So there's some disconnect I think there too, where SLPs don't always have that, um, support from their district, that there does have to be a little bit of advocacy too of, there has to be that communication up to the higher ups of–
Hey, this is what the student needs to be successful. Here's how the data shows it.
I can do this. How is this going to be met? So you need to send somebody to, for the two other days, I can do this. And, but again, I–we've talked about this. This has been the theme of this trip too. That you don't just say, I can't, don't throw up those "I can't" flags. What can you do? What do you need to fill in and provide some part of the solution?
Yep. I can listen to problems all day long. Right. I don't want to.
If you've got a problem, bring me some solutions. Right. So what can we do? What can we do? What can we do? What can we do? I'm—I don't want to hear the problem. I want to hear the solution.
Absolutely agree with you.
I mean, yeah. And, and I think that we all have to come together and get off of our "I'm the school SLP, or I'm the private SLP, or I'm the scientist" and all come together and work together and support each other through research and through experience. And we're all here to help together, not one person better than the other, just because I've got more experience in one area. I don't, I, you know, I think that's one reason I don't edit my videos when I, when I present is that I don't, I, I choose videos. And then when I say things or do things that I would otherwise tell therapists not to do, I don't take them out of my presentations because I want them to see that just because I know what I know and I do what I do doesn't mean I always necessarily do it right. Because I'm human and I make mistakes.
I like to see that.
It's like the parents that sit in the chair in my therapy room and they cry. They're like, you're the best parent ever. I wish I was like you I'm like, Oh no. Oh no. I threatened to sell my son. And they're like, you did what? And I'm like, yeah, that's true, that happened.
I had a family once that they wanted to hire me as their son's nanny. And I told my parents that, and they started dying laughing because like, they see me as a parent.
And they were like, "Oh, that's cute."
And I'm like, yeah, I'm much better on like these one hour doses.
Cause they know her. It's a hard balance.
And that's, um, why, I think Lisa and I, um, really try to be relatable. We really—that's our goal. We want people to feel comfortable and we want to talk about things that are tough and hard. Um, and we like to throw ourselves under the bus because that's what people need.
That's real life.
You know, we sometimes can put ourselves up on this pedestal and somebody needs to kick it from underneath us.
Hard. Just a swift kick to it because that's not reality. And we are all learning and learning best we can. And that's all we can ask for.
I think one of my favorite things is that when I went to bootcamp, Sue Kasparian stood up in front of the group and she says, “I'm still learning.” And this is Sue Kasparian. I'm like, I, gosh, you're amazing. And you know, and she stood up there and said that, and I love that because we all are, no matter how much we know, no matter how much we don't know, we're all still learning and we have to support and learn from each other.
I honestly don't think we could end this on a better note. I think that was the perfect summary of this entire episode. Um, it has been an absolute pleasure to have you here. I really do think that this is, this is such a needed, um, conversation to be had. So thank you for being willing to come in here with us. You never know what you're gonna get.
My personal takeaway is Jennie likes me better.
That actually was never said.
My personal takeaway is that you like pickles.
And yeast rolls.
And, um, Sarah is....
An intrusive schwa.
She's very intrusive. She takes pictures of us when we don't know it and videos when we don't know it, and posts videos of me missing the golf ball.
Yeah, I do do that. Yeah. That's my role here at Toolkit. I am the documenter. And even with this podcast, like I, I'm not editing this shit, so it's going out the way it is. All right. There we go.
That’s the best.
Bye. Thanks for listening, four listeners.
Bye, you guys.